[your email / postal address] [relevant Tusla office address] [date of request] Dear Child and Family Agency, I wish to apply for any information being held by you about my relative under the Freedom of Information Act 2014. 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 documents of 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 given to 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]