[your email / postal address] Freedom of Information Officer, Department of Children, Equality, Disability, Integration and Youth, Block 1, Miesian Plaza, 50 – 58 Lower Baggot Street, D02 XW14. [date of request] Dear Department of Children, Equality, Disability, Integration and Youth, Under the Freedom of Information Act 2014 I am seeking any information being held by you about my relative [insert relative’s name]. This request is made in relation to my relative who was [born / gave birth] in [name of Mother and Baby Home / County Home / Hospital / Nursing Home]. Please provide any information on the circumstances of their entry into, detention within and exit from [name of Mother and Baby Home / County Home / Hospital / Nursing Home]. The documents requested may include but are not limited to the following: + All data processed by the Commission of Investigation into Mother and Baby Homes and certain related matters (MBHCOI) [use for either] + Registration of birth, including original name, natural parents names and ages. [use for adoptees] + Administration details, including correspondences about my relative, together with correspondences associated with the administrative process surrounding their detention. [use for either] + Adoption records, including correspondences about my relative, together with correspondences associated with the administrative process surrounding their adoption. [use for adoptees] + The names of individuals responsible for their care during their time in the institution named above. [use for either] + Medical records, including x-rays, tests, vaccine trials as well as natural family medical history. [use for either] + Social records including details of their parents and siblings as well as details on the father of the child. [use for mothers] + [add / delete as appropriate with reference to section 3 of the Guide] The details of my relative are as follows: + Date of Birth [if known]: + Date of Death [if relevant]: + Place of Birth [if known]: + Place of Death [if relevant]: + Name of Mother and Baby Home / County Home / Hospital / Nursing Home: + Location of Home: + Relevant dates and time spent in Mother and Baby Home / County Home / Hospital / Nursing Home [date of entry / date of exit, if known]: Yours sincerely, [insert your name]