| Ref. No: |  | 
    
        | Name of Public Authority: |  | 
    
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                Original Description of Document /Information / Decision or Recommendations: 
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        | Type of Complaint: |  | 
    
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                Reasons for disagreement*: 
                
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                Data Protection Statement 
                Personal data collected in this form is for the purpose to process the request
                    regulated by the Freedom of Information Act (Cap. 496). All personal data will be
                    processed in accordance to the Data Protection Act (Cap. 440). | 
    *Please indicate why you disagree with the Public Authority’s decision not to provide
    the document/information you requested (This field is not mandatory)