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1. I am an adult male businessman with my principal place of business being Office, Street, City,
Full names and address of
complainant Country.
Statement by the complainant 2. The information contained in this statement is, to my knowledge, both true and correct.
that the information in the take-
down notification is to his or her
knowledge true and correct
3. I am filing this notice in good faith.
Statement that the
complainant is acting in good 4. I am the proprietor of a website located at http://www.mywebsite.co.za which has been
faith registered in my name since 2000 (proof of registration is enclosed). I am the author of content
I have posted to my website.
5. I reserve all rights to my content and do not permit other websites to publish my content.
8. I require that either my content be removed from the offending website or the offending website
The remedial action required
to be taken by the service itself be taking offline and removed from public view.
provider in respect of the
complaint My further contact details are below:
Telephonic and electronic
contact details, if any, of the Phone: +27 11 123 4567
complainant Fax: +27 11 123 4568
Email: me@mywebsite.co.za
______________________________
Joe Smith
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