Subject Access Application Form
If you would like to have access to your personal information (other than CCTV images), or
to exercise your other rights in respect of your personal information, please complete and
return this form to us. Please take time to read the following information before
completing the form.
Under the General Data Protection Regulation (GDPR) and the Data Protection Act 2018,
you are entitled to access, change, restrict or delete personal information held by the PCC
within one month of us receiving your completed application, unless there are certain
exemptions. This is known as your right of “subject access”.
We require proof of your identity before we can disclose, change, restrict or delete
personal data. Please provide a copy of recent correspondence giving your name and
address eg recent utility bill, a driving licence or passport. If you are not the data subject
but an agent appointed on their behalf you will need to provide written evidence of your
authority to act on their behalf.
Your details
Title
Surname
First names
Former/maiden name
Address (including postcode)
Previous address (if relevant to request)
Daytime telephone number
Email address:
.
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Details of your personal data which the Police and Crime Commissioner may hold:
Please provide as much information as possible about the personal data that may held by
the Police and Crime Commissioner e.g. type of information (ie emails, letters, reports),
and the timeframes for this information (ie to/from dates). Please continue on a separate
sheet if necessary.
Action to be taken:
Please state what action you would like the PCC to take with your personal information
(based on your rights under GDPR). This can include but not limited to disclosure of your
information to you, correction of inaccurate or incomplete data, the deletion of your
personal data, or a restriction on the way your personal data is used.
Third parties:
The information requested could include information on third parties, this may be removed
if we do not receive their consent to disclose it.
Would you like us to contact third parties to obtain their consent?
Please note: If you do not tick a box, we will not contact third parties for their consent.
Yes No
If you tick yes, are there certain third parties that you do not want us to contact?
Yes No
If you tick yes, please provide details:…………………………………………………………….
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Declaration
This form must be signed by you (the data subject) or your agent (if applicable).
I confirm that the information I have supplied is correct and that I am the person to whom it
relates.
Data Subject Signature Date
Please ensure you enclose with your signed form:
Evidence of your identity
I confirm that I am authorised to act on behalf of the data subject and that their personal
information will be disclosed to them through me.
Agent’s name and signature Date
Please ensure you enclose with the signed form:
Evidence of the identity of the data subject
Evidence of your authority to act on their behalf
Please return this form (together with evidence of identity and if applicable agent’s
authority to act) to our Data Protection Officer, Office of the Police and Crime
Commissioner, St George's Chambers, St George's Street, Winchester, Hampshire, SO23
8AJ. Telephone number: 01962 871595. Email:
opcc.dataprotection@hampshire.pnn.police.uk
Additional notes:
If you require more than one copy of the data, we may charge a reasonable fee for
further copies.
If your request involves additional costs we may charge a reasonable fee.
If your request is excessive we may charge a reasonable fee or refuse to provide
you with a copy of the data.
Please note there is a separate application form for CCTV images.
Privacy Notice
The Police and Crime Commissioner collects the above information about you in order to
carry out your request for access to any of your personal information that we may hold.
This is so that we can comply with our legal obligation to meet your data subject rights
under the GDPR and the DPA 2018.
For more information on your data subject rights please see our General Privacy Notice:
https://www.hampshire-pcc.gov.uk/privacy-policy
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