|
Incident Reference/Numru tar-Referenza*:
|
*
*
|
|
ID Card/Karta tal-Identità*:
|
*
*
|
|
Name/Isem*:
|
*
|
|
Surname/Kunjom*:
|
*
|
|
Name of Public Authority to which request is being made:
L-isem tal-Awtorità Pubblika ta’ fejn saret it-Talba:
|
|
|
|
|
|
|
|
|
|
|
*Required fields / Informazzjoni Obbligatorja