Your Name Last Name First Name Middle Name Title Title - None -MrMrsMsMissOther Enter other… Your Address Street, Apt.#, PO Box, RR No. City/Town Prov./Terr. Postal Code YOUR CONTACT INFORMATION Day Phone No. Alternate Phone No. Email Address DETAILS OF REQUESTED INFORMATION Ref or File # Please specify any Ref or File #, if known Information RequestedPlease describe the records you are requesting. Be as specific as possible, as this will assist the Request process. Attach a separate sheet if the space below is not sufficient. Are you requesting access to another person‘s personal information? YES NO Upload document If you are requesting access to another person's personal information, please attach, as appropriate:a) That person's signed consent for disclosure, orb) Proof of authority to act on that person's behalfOne file only.32 MB limit.Allowed types: jpg jpeg png pdf doc docx. Preferred method of access to records Examine Original Receive Copy Information collected on this form is done so under the general authority of the Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA. Questions about the collection of your personal information may be referred to the Legislative Services Department via email at foi@rdn.bc.ca.SignatureChecking the checkbox below certifies as a signature. Signature CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
