Fillable Data Subject Request Form This form is for (Northern Ireland Housing Executive)

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Data Subject Request Form This form is for (Northern Ireland Housing Executive)

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Data Subject Request Form
This form is for any person who wishes to make a request relating to personal
information held by the Housing Executive. Please read the Guidance Notes below
before completing the form.
NOTE: This form is designed to assist the process of making a request; but it is not
mandatory, requests made in other valid formats will also be processed.
You are entitled to receive this information under the Data Protection Act (DPA)
2018 and the UK General Data Protection Regulation (UK GDPR). We will also
provide you with information about any processing of your personal information that
is being carried out, the retention periods which apply to your personal information,
and any rights to rectification, erasure, or restriction of processing that may exist.
Guidance Notes – Please read before filling in the form
What information does the Housing Executive hold?
The Housing Executive holds information relevant to the conduct of our functions
which will include, but not restricted to, personal information held on housing
applications made and any other action undertaken. However, some information may
have been reviewed and destroyed where appropriate in accordance with our
retention policies.
How long will it take to get your personal information?
We will endeavour to respond promptly to your request and in any event within one
month once we are satisfied that you meet the criteria under the DPA 2018 and the
UK GDPR.
Records may be held in several different locations in paper and electronic formats. If
you only require specific information and you clearly state what that is, for example a
specific document, then you are likely to get a quicker disclosure.
General Notes
1. There is no fee for requests (unless unfounded or excessive).
2. The documents you receive may have information redacted (blacked out) as
our records may also include third party information that we cannot release to
you.
3. We will not disclose information by fax or telephone. Disclosures will be sent
by first class post or emailed to the address provided.
Please send your completed form and proof of identity to:
Data Protection Officer
Information Governance
Northern Ireland Housing Executive
2 Adelaide Street
Belfast
BT2 8PB
Tel: 03448 920 900
Email: dataprotection@nihe.gov.uk
Data Subject Request
Section 1: Details of the person requesting information
Full name:
Other name(s) known by:
Date of birth (optional)*
(dd/mm/yyyy):
Current address:
Contact telephone number
(optional)**:
Email address:
Staff number (Housing
Executive staff only):
*We will use this information to identify you if we receive a request from another
person with the same name/address. Please note it is optional that you provide this
information.
**We will use this information to contact you if we need to clarify anything to speed
up your request. Please note it is optional that you provide this information.
Section 2: Are you the data subject?
Please tick the appropriate box and read the instructions which follow it.
Yes, I am the data subject. I enclose proof of my identity (see Appendix 1:
Acceptable forms of identification).
Please go to section 4
No, I am acting on behalf of the data subject. I have enclosed the data
subject’s written authority and proof of the data subject’s identity and my own
identity (see Appendix 1: Acceptable forms of identification).
Please go to section 3
In order to prove your identity, we need to see copies of one piece of identification
from list A or two from list B detailed in Appendix 1: Acceptable forms of
identification. If we are not satisfied you are who you claim to be, we reserve the
right to refuse to grant your request.
Section 3: – Details of the data subject (if different from section 1)
Full name:
Other name(s) known by:
Date of birth (optional)*
(dd/mm/yyyy):
Current address:
Contact telephone number
(optional)**:
Email address:
Staff number (Housing
Executive staff only):
*We will use this information to identify you if we receive a request from another
person with the same name/address. Please note it is optional that you provide this
information.
**We will use this information to contact you if we need to clarify anything to speed
up your request. Please note it is optional that you provide this information.
Section 4: What information are you seeking?
Please tick the appropriate box:
Make a Subject Access Request (SAR)
Rectify your personal information if you believe it is inaccurate or incomplete
Erase your personal information
Restrict the processing of your personal information
Move, copy or transfer your personal information
Object to processing of your personal information or direct marketing
Review automated decision making/profiling
These rights may only apply in certain circumstances.
Please use this space to give us any details about your request, for example by
stating specific documents you require (use extra sheets if necessary):
Please note that if the information you request reveals details directly or indirectly
about another person we will have to seek the consent of that person before we can
let you see that information. In certain circumstances, where disclosure would
adversely affect the rights and freedoms of others, we may not be able to disclose
the information to you, in which case you will be informed promptly and given full
reasons for that decision.
Section 5: Declaration
The information which I have supplied in this application is correct and I am the
person to whom it relates or a representative acting on his/her behalf. I understand
that the Housing Executive may need to obtain further information from me/my
representative in order to comply with this request.
Section 6: Authority to release information to a representative
A representative needs to obtain authority from the applicant before personal data
can be released. The representative should obtain the applicant’s signature below,
or provide a separate note of authority.
This must be an original signature, not an electronic signature or a photocopy.
I hereby give my authority for the representative named in Section 1 of this form to make
a request on my behalf under the DPA 2018 and the UK GDPR.
Signature of Applicant:
Date:
Signature of Representative:
Date:
Staff number:
Date:
Signature of Applicant:
Date:
Appendix 1: Acceptable forms of identification
List A - Primary proofs (one required)
Please DO NOT send an original passport, driving licence or identity card.
A current passport
A current NI/GB/ROI driving licence
A national identity card from a European Union member state
An electoral identity card
A Translink over 60 or Senior Smartpass
A Translink Y-Link travel card
A Construction Skills identity card
A Works Pass issued by a Government Department, Agency or Local Authority
If none of the above is available, TWO different documents from the list below should
be provided as evidence of identity.
List B - Secondary Proofs (two required)
Birth Certificate
Credit/debit card
Divorce/annulment papers
Home Office Standard Acknowledgement letter (SAL 1 or 2)
Life assurance or insurance policies
Marriage Certificate
Medical card
National Insurance Number Card
Utility Bill (for the last quarter)
Wage slip from current employer
UK residence permit
Bank statements (not older than 4 weeks)
Letter from solicitor/social worker/probation officer/Inland Revenue/PSNI
Please note any original documents you send to us will be returned by first class
post.
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Completed 17 May 2021

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