SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998

Transcription

1 SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 To be completed by those requesting information held by the Council about them, or completed by their representative. INSTRUCTIONS The Data Protection Act provides a person with a right to data, or personal information, held about them and that person is called a Data Subject. To enable this authority to deal promptly with a request for access and to satisfy the legal requirements placed upon it, (to ensure the identity of Data Subjects and that access is given to the data required) the following information is required. Please ensure that you complete the relevant sections appropriate to your circumstances. If you are the Data Subject, Go to PART A. Children from the age of 12 are entitled to exercise their own rights as a Data Subject if they understand the nature and reasons for the request, and should complete a Subject Access Request (Part A) under their own name. If you are an Agent for the Data Subject, you must provide written authorisation to act for them. Go to PART B. If you are a Parent or Guardian of the Data Subject who is aged over 12 years and are acting as their Agent, and the Data Subject understands the nature and reasons for the request, then you must provide written authorisation to act for them. Go to PART B. If you are a Parent or Guardian of the Data Subject acting as their Agent, and the Data Subject does not understand the nature and reasons for the request, then you must provide sufficient information to enable us to confirm that you are acting in the best interests of the Data Subject. Parents or Guardians should only make an application in the interests of the child, not in their own interest. Go to PART B. All applicants must describe what you want to receive in the text box on page 5. PLEASE RETURN THIS FORM TO Information Access Officer Customer Relations Team Finance Department Plymouth City Council Ballard House West Hoe Road Plymouth PL1 3BJ Version 4, May 2016 RESTRICTED

2 PART A FOR USE BY DATA SUBJECTS ONLY - PLEASE USE CAPITALS Section A.1 Data subject (the person who wants information about themselves) Please provide your name, date of birth, and address in the space provided. Surname Forenames Title Mr Mrs Miss Ms Other (please state) Date of birth (DOB) Address Postcode Telephone number Section A.2 Same name? Are you the only person with the above initials and surname at the address given? Yes No If no, please state the full name(s) and date(s) of birth of the other person(s) with the same initials and surname. Section A.3 Areas of Interest previous addresses Please state the area(s) from which you require information by completing PART C - List of Registrations and Areas of Interest. Section A.4 Declaration I understand that it may be necessary for the Authority to obtain more detailed information in order to be satisfied as to my identity, and that the period in which the Authority must, under law, respond will not commence until they are satisfied. I confirm that the reply to my application may be sent by POST to the name and address given in Section A.1 above. I enclose the fee of 10 per registration which I understand is the fee payable to Plymouth City Council for instigating my request(s). I understand that upon any request being actioned and the search for data begun, this fee will not be refundable. Signed Date SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 Page 2 of 6

3 PART B FOR USE BY AGENTS OF THE DATA SUBJECT ONLY - PLEASE USE CAPITALS Section B.1 Data subject Please provide the data subject s name, date of birth and address in the space provided. Surname Forenames Title Mr Mrs Miss Ms Other (please state) Date of birth (DOB) Address Postcode Telephone number Section B.2 Same name? Is the data subject the only person with the above initials and surname at the address given? Yes No If no, please state the full name(s) and date(s) of birth of the other person(s) with the same initials and surname. Section B.3 Agent, parent or guardian details Please provide the name and address of the agent, parent or guardian in the space provided: Surname Forenames Title Mr Mrs Miss Ms Other (please state) Date of birth (DOB) Address Postcode Telephone number Relationship to data subject You must provide written confirmation of your entitlement to act on behalf of the data subject. I confirm documents have been enclosed SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 Page 3 of 6

4 Section B.4 Areas of interest Please state the area(s) from which you require information by completing Part C of this form. Section B.5 Declaration I understand that it may be necessary for the Authority to obtain more detailed information in order to be satisfied as to the subject s identity, and that the period in which the Authority must, by law, respond will not commence until they are satisfied. I confirm that the reply to my application may be sent by POST to the name and address given in Section B.1 or B.3 (please tick). I enclose the fee of 10 per registration, which I understand is the fee payable to Plymouth City Council for instigating my request(s). I understand that upon any request being actioned and the search for data begun, this fee will not be refundable. Signed Date SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 Page 4 of 6

5 PART C - LIST OF REGISTRATIONS AND AREAS OF INTEREST Please tick the box(s) and identify your particular area(s) of interest, to enable us to target and process your enquiry efficiently. It may be necessary for us to contact you to clarify where the Council holds your information. Registration no: G Electoral Registration Registration no: X Plymouth City Council Customer Services Collection of business rates or council tax Education and School Services Community Services for Adults Environmental Regulation Services Children s Care and Youth Services Housing Services Libraries or Museums Planning and Development Control Legal Services Personnel/Employee Administration Background Information to assist us in finding your information Please describe why you think that the Council holds information about you and whether you are interested in a particular time span or want recordings about a particular event. Please supply previous addresses that may assist us to locate records. SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 Page 5 of 6

6 PART D PAYMENT This is the fee payable to Plymouth City Council for instigating my request/s. I understand that upon any request being actioned and the search for data begun, this fee will not be refundable. A fee is not required if the application is for a child (the Data Subject) who is or was in care to the Council. There is a standard national fee of 10 for each application and for each registration i.e. if you just want a copy of what either Electoral Services or any other Council departments hold about you then the cost is 10. If you want a copy of what both Electoral Services and other Council departments hold about you, then the cost is 20. PLEASE COMPLETE: Name of applicant Representative (if applicable) Number of registrations at 10 each = Please enclose a cheque or postal order made payable to Plymouth City Council PRIVACY NOTICE The information that is requested will be used to process an application for information held by the Council about the person specified on this form. The personal information that you provide will be held securely and will only be shared for planning the provision of services, providing a service to you, informing you about Council services, seeking your views and to enable auditing of Council activities. If you wish to withdraw from a contact list then please let us know. Anonymous statistical information may also be passed to other organisations to assist in the planning and monitoring of services. In addition Plymouth City Council must cooperate with the prevention and detection of crime which may result in information about you being passed to others. If this form is completed by a representative, then you must make sure that you have informed an adult or a child that can understand, what you have told the Council. The Data Controller for Plymouth City Council is the Information Lead Officer, who can be contacted about the use of your personal information. info@plymouth.gov.uk FOR STAFF USE ONLY Date SAR received Fee amount Fee date Finance code Date sent to transaction centre Forms of identity included SUBJECT ACCESS REQUEST DATA PROTECTION ACT 1998 Page 6 of 6