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Info Request Form

This document is a personal information request form for the Government of Canada. It provides instructions for individuals to request access to personal information about themselves that is held by a Canadian federal government institution under the Privacy Act. The form guides applicants through selecting the relevant institution, describing the information sought, and selecting options for receiving or examining the information. It also notes the applicant's rights under the Privacy Act.

Uploaded by

Alexsei Aye-Vape
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
90 views

Info Request Form

This document is a personal information request form for the Government of Canada. It provides instructions for individuals to request access to personal information about themselves that is held by a Canadian federal government institution under the Privacy Act. The form guides applicants through selecting the relevant institution, describing the information sought, and selecting options for receiving or examining the information. It also notes the applicant's rights under the Privacy Act.

Uploaded by

Alexsei Aye-Vape
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Government Gouvernement

of Canada du Canada

Personal
TBC 350-58 (Rev. 1997/11)
Protected when completed

Information For official use only

Request
Form
Privacy Act
Step 1 Step 2 Step 3 Step 4
Determine which federal government institution is To apply for personal information Forward the personal When you receive an answer
most likely to hold personal information about you. about you under the Privacy Act, information request to your request, review the
Decide whether you wish to submit an informal complete this form. Describe the form to the Privacy information to determine
request for the information or a formal request information being sought and Coordinator of the whether you wish to make a
under the Privacy Act. If you wish to make an provide any relevant details institution holding the further request under the Act.
informal request, contact the appropriate necessary to help the institution information. The You also have the right to
institution. The address can likely be found in Info find it. If you require assistance, address is listed in the complain to the Privacy
Source publications which are available across refer to Info Source (Sources of “Introduction” to Info Commissioner should you
Canada, generally in major public and academic Federal Government Source. believe that you have been
libraries, constituency offices of federal Members Information) for a description of denied any of your rights under
of Parliament and most federal government public personal information banks held the Act.
enquiry and service offices. by the institution or contact its
Privacy Coordinator.

Federal Government Institution

I wish to examine the information


As it is All in English All in French
Provide details regarding the information being sought

Method of access preferred Receive copies Examine originals in


of originals government offices
Name of applicant

Street, address, apartment City or town

Province Postal Code Telephone number

I request access to personal information about myself under the Privacy Act as I am a Canadian citizen,
permanent resident or another individual, including an inmate, present in Canada

Signature Date

The personal information provided on this form is protected under the provisions of the Access to Information Act and the Privacy Act.

TBC 350-58 (Rev. 2000/06/19)

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