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Freedom of Information (FOI) Request Form

1. The document is a Freedom of Information request form submitted by Denmark P. Cabaddu from Camalanuigan, Cagayan, Philippines. 2. The request is for a list of micro and small enterprises operating in Camalanuigan, Cagayan from January 1, 2020 to November 30, 2021. 3. The purpose of the request is for a research study on the impact of COVID-19 on micro and small enterprises, to help determine sampling and potential respondents.

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Denmark Cabaddu
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© © All Rights Reserved
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55 views

Freedom of Information (FOI) Request Form

1. The document is a Freedom of Information request form submitted by Denmark P. Cabaddu from Camalanuigan, Cagayan, Philippines. 2. The request is for a list of micro and small enterprises operating in Camalanuigan, Cagayan from January 1, 2020 to November 30, 2021. 3. The purpose of the request is for a research study on the impact of COVID-19 on micro and small enterprises, to help determine sampling and potential respondents.

Uploaded by

Denmark Cabaddu
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Freedom of Information (FOI) Request Form

REQUESTING PARTY

Complete Name of the Requestor:


Title/Prefix First Name Middle Name Last Name Suffix
06 MARQUEZ DE ESTRELLA CENTRO SUR
House/Building No./Building Name Street Name Barangay
Address:
CAMALANIUGAN CAGAYAN II PHILIPPINES 3510
City/Municipality Province Region Country Zip Code
Contact Details: 09068803147 N/A [email protected]
Telephone No. Mobile No. Fax No. Email Address
Sex:  Male  Female Citizenship: FILIPINO
 Abled  Differently-abled  Indigenous Person
Social Classification:
 Senior Citizen  Youth  Out-of-school Youth
Proof of Valid Identification:  Passport  SSS/GSIS ID  Voter’s ID
(Please attach copy)  Driver’s License  Postal ID  Others (Please specify: TIN)
Preferred Mode of  Landline  Fax  Email:  Mobile:
Communication:
Preferred Mode of Receiving  Email  Registered Mail  Private courier
Requested Information:  Fax  Pick-up at DTI (If your request is successful, we will be sending the documents to you in this manner)

REPRESENTATIVE/GUARDIAN (if applicable)


Complete Name of ______________________________________________________________________________________________________
Representative/ Guardian: Title/Prefix First Name Middle Name Last Name Suffix

Proof of Valid Identification: ______________________________________ Valid Proof of Authority: _______________________________________


(please attach copy) (please attach copy)
REQUESTED INFORMATION
Title of Document Requested :  Photocopy  Softcopy
LIST OF MICRO AND SMALL ENTREPRISES OPERATING WITHIN CAMALANIUGAN, CAGAYAN
Note: Please provide as much detail as you can
Date/Period Covered 01/01/2020 - 30-11-2021
(DD/MM/YYYY – DD/MM/YYYY):
Specific Purpose (Please be as specific as possible): The documentary request shall be used purposely for our research study, entitled: The Impact of COVID-19 on Micro and Small
Enterprises: Challeneges and Opportunities. This request is useful in determining the sampling technique and potential respondents of our study.
Note: The following general averments of the purpose such as “for information,” “for research,” “for legal purposes” or other similarly worded purpose shall not be considered to have met the requirement of
specificity.
UNDERTAKING
Privacy Notice: All personal data collected herein shall be processed according to the provisions of the Data Privacy Act of 2012 (DPA), its Implementing Rules
and Regulations (IRR), and related issuances.
I declare and certify under oath that:
 The undersigned whose name and signature appears here and all the information provided in this form are complete and correct;
 I hereby agree and consent to the collection and processing of my personal data, as provided through this form, for the purpose of evaluating the
validity of my request for information;
 I understand that my personal information may be shared across DTI for the purpose of monitoring and evaluation; the use of which shall be
governed by the Data Privacy Act of 2012 and related laws and issuances;
 I assure the notification of DTI should there be any amendment in my personal information;
 The requested information shall only be used for the stated purpose and that I will not misuse any information obtained from this Office;
 I have read the privacy notice and understand that the DTI may collect, use , disclose and process personal information contained in this request;
 I have provided the necessary proof/s of identity (government ID), authority (if applicable) and at least one (1) contact detail; and
 I shall pay the necessary fees for reproduction, copying, certification and/or mailing if applicable under the circumstance.
I understand that any violation of this Undertaking will result in the denial of my request. I likewise understand and I am aware that the giving of false or
misleading information or using forged documents is a criminal offense that is punishable under the law.

DENMARK P. CABADDU December 1, 2021


Signature Over Printed Name Date Accomplished (DD/MM/YYYY) Please affix right thumbmark if unable to write
FOI RECEIVING OFFICER (For internal use only) Tracking Number: ___________________________________________
Received by: Date received:
(Last Name, First Name, Middle Name) (DD/MM/YYYY)

Action/s Taken:

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