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Freedom of Information Request Form

This form should be completed if you wish to access records under the Freedom of Information Act, 2014.

The personal data given below will be processed in accordance with the Data Protection Acts, 1988 and 2003 (the “Acts”). By submitting this form, you agree to NMBI processing your personal data in accordance with the Acts and our Privacy Statement.

All fields marked * are mandatory

Freedom of Information Form

1. Details of applicant

a) Surname*

b) Maiden name (if applicable)

c) First name*

d) Date of birth

Today

f) Email address*

e) Postal address*

g) Telephone (daytime)*

2. Personal information

Before being given access to personal information, you will be asked to provide proof of identity i.e. copy of birth certificate, driver’s licence or passport. Do you consent to this?*

Yes
No

If you are requesting personal information in respect of another person, the written consent of that person must be submitted.

3. Preferred form of access

My preferred form of access is*

To receive copies of the record by post
To inspect the original record
Other

If other, please specify

4. Details of request

In accordance with Section 12 of the Freedom of Information Act 2014, I request access to records which are:*

Personal
Non-personal

5. Nature of records

In the space provided, please describe the records as fully as you can. If you are requesting personal information, state precisely in whose name the records are held.*

6. Payment (for personal records only)

Fees apply to personal records and should be paid online.

Please indicate the appropriate fee:*

Application fee of €15
Application fee for medical card holders (- € 5.00)

Total price: € 15.00

Pay Online Now

What we do

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Freedom of Information Request Form

What we do

Call to action section

Freedom of Information Request Form

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