PROTECTED B (When completed)
Personal Information Request Form
Privacy Act
Step 1: Complete this form to apply for personal information about yourself under the Privacy Act. Describe the information being sought
and provide any relevant details necessary to help the Department find it.
Step 2: Forward the Personal Information Request Form to Director Access to Information and Privacy (DAIP), National Defence
Headquarters, MGen George R. Pearkes Building, 101 Colonel By Drive, Ottawa, Canada, K1A 0K2
Step 3: Review the information you receive in response to your request to determine whether you wish to make a further request, or whether
you wish to avail yourself of the complaint, notification or record correction rights provided by the Privacy Act.
Note: DAOD 1002-2 permits you to request informal access to most your personal records through your base, unit, or appropriate Information Holding
Custodian. This administrative process may provide you with quicker access to your records. Making an informal request under DAOD 1002-2 does
not affect your legal right to make requests for personal information under the Privacy Act
Name of Applicant (Previous name if applicable)
Address / Street Apt #
City or Town
Province Postal code
Telephone (Home) Telephone (Work)
For Military / Ex-Military Personnel
Currently serving:
Yes No
If No, indicate release date
Regular Reserve
Name / Location of unit
SN / SIN Rank DOB Enrolment date
For Civilian Personnel
PRI / SIN
Dates of employment with DND
From To
Please provide details below of documents or files you are seeking, ie. (Medical, Personnel, Dental, etc) :
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
DND 2797-E (02-2012)
PROTECTED B (When completed)
Current / Former place of employment
Design: Forms Management 613-957-6899 / 613-957-6906
