Any person who knows or reasonably believes that a breach of the security of personal identifiable information has occurred should report their concern to the University. Any University employee or student with responsibility for data must report known or suspected breaches of security of personal identifiable information. These reports will enable the University to investigate and address the concern and to make determinations about appropriate notification to the subjects of the personal identifiable information.

This form is for staff and students to report a breach of security. Should you require any assistance with the form, please contact Ryno Boshoff on 27 41 504 1065.

POPIA information:

The Protection of Personal Information Act, 2013 (POPI Act) has been promulgated and implemented on 1 July 2020. All personal identifiable information provided by you shall be treated in accordance with this statute and only used for academic and academic administration purposes, as indicated in the University Privacy Policy. By providing your information, you are giving consent for the use of all your personal identifiable information, provided to the University, for the aforesaid purposes.

Name:

Contact Number:

Email:

Approximate Month of Breach:

January February March April May June July August September October November December

Year of Breach:

2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010

If exact date of Breach is known, please supply:

Date and timeNow

Date of Discovery of Breach:

Date and timeNow

Breach Type:

Unintended disclosure Hacking or Malware Payment Card Fraud Insider Physical Loss Portable Device Stationary Device Other

Was notification delayed because of a law enforcement investigation?:

Yes No N/A

Estimated number of affected individuals:

Brief description of the Security Breach:

Type of Personal Information Involved in the Breach:

Information relating to the race, gender, sex, pregnancy, marital status, national, ethnic or social origin, colour, sexual orientation, age, physical or mental health, well-being, disability, religion, conscience, belief, culture, language and birth of the person(s)
Information relating to the education or the medical, financial, criminal or employment history of the person(s)
Identifying number, symbol, e-mail address, physical address, telephone number, location information, online identifier or other particular assignment to the person(s)
Biometric information of the person(s)
Personal opinions, views or preferences of the person(s)
Correspondence sent by the person(s) that is implicitly or explicitly of a private or confidential nature or further correspondence that would reveal the contents of the original correspondence
Views or opinions of another individual about the person(s)
Name of the person(s) if it appears with other personal information relating to the person(s) or if the disclosure of the name itself would reveal information about the person(s)

Location of Breached Personal Information:

Paper Breach Laptop Desktop Computer Server Email Other Portable Electronic Device

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