Subject Access Request Form Data Protection Act 1998

Transcription

1 Subject Access Request Form Data Protection Act 1998 Please refer to the explanatory notes before completing this form. If you are only requesting CCTV images please use the separate CCTV subject access request form. If you are requesting your own personal data please complete sections 1 4 only. If you are giving permission for someone else to access your personal data on your behalf, please complete all sections except section 4. Please write clearly using pen. If you are unable to complete this form for any reason, please the Data Protection and Freedom of Information Officer for assistance. Section 1 Your details Surname: First names: Previously known as (if applicable): Address: Post Code: Date of birth: If you have lived at this address for less than two years please provide previous address below: - 1 -

2 Section 2 Personal data requested Please provide as much detail as you can about the personal data you are requesting to help us locate it quickly (continuing on a separate sheet if necessary): Section 3 - Additional information required You must provide: two different documents as evidence of your name and current address (we only accept copies of these through the post which will be securely destroyed once we have verified your identity; however we reserve the right to ask to see original documents); and a cheque or postal order for 10 made payable to Stockport Metropolitan Borough Council (Please note we do not accept cash payments) Section 4 - Declaration of data subject I confirm that I am the data subject named in Section 1 and I am requesting access to my own personal data. I understand that the information I have supplied will be used to confirm my identity and help locate the information I have requested. I also understand that it may be used for statistical and monitoring purposes. Signed: Section 5 - Declaration of data subject for agent to act on their behalf I confirm that I am the data subject named in Section 1. I give permission for the person or organisation named below to act on my behalf in relation to my subject access request. I have enclosed the evidence of my identity referred to in Section 3 and confirm that I want my personal data to be sent to my representative at the address below. I understand that the information I have supplied will be used to confirm my identity and help locate the information I have requested. I also understand that it may be used for statistical and monitoring purposes. Signed (data subject): - 2 -

3 Name of agent: Relationship to data subject: Address: Post Code: Returning your completed form Please send your completed form and the additional information requested in section 3 to: Data Protection and Freedom of Information Officer, Stockport Metropolitan Borough Council, Town Hall, Edward Street, Stockport, Cheshire, SK1 3XE. For Stockport Council use only: Form received by: Department: Date received: Original evidence of ID checked and returned to requester: Type of ID seen/supplied: Date returned: If received by post, copy ID documents attached: If yes, ID verified and documents shredded by: If no, date evidence of ID requested: Fee attached: If no, date fee requested: Date fee received: 40 calendar days expire on: Request referred to (Officer s name): Response completed and sent on: - 3 -

4 Subject Access Request Form - Explanatory Notes Completing the form: Section 1 Please provide your current contact details. If you have been known by another name (such as your maiden name) or lived at another address while you have been in contact with Stockport Council please provide these to us. This information will help us make sure we find and provide you with all the personal data you are requesting. You only need to provide your date of birth if this will help us locate your personal data. Date of birth is likely to be helpful if, for example, you have a common name or you have the same first name and surname as another member of your household. Section 2 So we can provide you with your personal data as quickly as possible it is important that you provide us with as much detail as you can about the information you are requesting. Please state the reason you were in contact with Stockport Council or the service area you dealt with if you know it. Please also provide the names of any Stockport Council employees you dealt with and any reference numbers you were given. This will help us locate the personal data you requested quickly and avoid the need for us to contact you for more information. Stockport Council uses individuals personal data to provide services and to carry out statutory functions and responsibilities. The Data Protection Act 1998 (DPA) requires us to notify the Information Commissioner s Office (ICO) of the purposes for which we process personal data (the Information Commissioner is an independent regulator who enforces and advises upon the Act). The purposes for which Stockport Council processes personal data fall into the following broad categories: Staff Administration; Advertising, Marketing & Public Relations; Accounts & Records; Property Management (including Council Housing); Leisure & Cultural Services; Education; Assessment and Collection of Taxes and Other Revenue; Benefits, Grants and Loans Administration; Planning, Licensing, Registration & Regulation; Social Services; Crime Prevention & Prosecution of Offenders; Corporate Functions; Other Non-commercial Activities; Other Commercial Services; and Advertising, Marketing and Public Relations for Others. This list should help you to decide which personal data you are requesting as your contact with Stockport Council should fall into one of these categories. You can find further details about our notification entry in the Public Register of Data Controllers which is available on the ICO s website. Our registration number is Z Section 3-1 -

5 Stockport Council is committed to keeping your personal data secure. We need to see evidence of your identity (including name and address) to make sure your personal data are only sent to you at your address unless you give us written permission to send them elsewhere. You can provide copies of documents as evidence if you post your form but we reserve the right to ask to see the original documents if we think it is necessary. If you post copies of your documents to us the copies will be destroyed securely once we have verified your identity. If you hand-deliver your form, the Council Officer you speak to can verify your identity by checking your documents there and then so you can take the originals away with you. The Data Protection (Subject Access)(Fees and Miscellaneous Provisions) Regulations 2000 entitle Stockport Council to charge a fee of 10 to cover the cost of dealing with your request. We will not begin to search for your personal data until you provide us with this fee. Section 4 You should complete this section if you are requesting your own personal data. If you have given someone else permission to act on your behalf and would like us to correspond with them, including sending your personal data to them, please do not complete this section. Go straight to section 5. Section 5 Only complete this section if you are the data subject named in section 1 and you want to give us permission to deal with someone else who is acting on your behalf. If you complete this section we will correspond with the person acting as your representative instead of you. This may include discussing your personal data with them. It also means we will send copies of your personal data to your representative instead of sending them to you. Once you have completed your form please send the form, the fee and evidence of your identity to Data Protection and Freedom of Information Officer, Stockport Metropolitan Borough Council, Town Hall, Edward Street, Stockport, Cheshire, SK1 3XE. Once we have received the fee and all the information we reasonably require to locate your personal data we have 40 calendar days to respond