Fillable Subject Access Request Form (Leicestershire Fire and Rescue Services)

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Subject Access Request Form (Leicestershire Fire and Rescue Services)

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1 PMB/June2018/V1.0
DATA PROTECTION ACT 2018
Subject Access Request Form
Please return the completed form to:
Service Information Team, Leicestershire Fire and Rescue Service Headquarters, 12 Geoff
Monk Way, Birstall, Leicester, LE4 3BU. Email: dataprotection@lfrs.org
1. Details of person requesting the information
Title (Mr, Mrs etc.):
Date of Birth:
Surname/Family Name:
Forename(s):
Address:
Post Code:
Telephone number:
Mobile number:
Email address:
3. Details of Data Subject (if different to Section 1)
Title (Mr, Mrs etc.):
Date of Birth:
Surname/Family Name:
Forename(s):
Address:
Post Code:
Telephone number:
Mobile number:
Email address:
2. Are you the Data Subject? (the person to whom the requested data relates)
Yes
If you are the Data Subject please supply 2 forms of evidence of your identity i.e.
Driving License, Passport, Birth Certificate (or photocopy). Please go to Section 5.
No
Are you acting on behalf of the Data Subject with their written authority? If so, that
authority must be enclosed. Please complete Sections 3 and 4.
2 PMB/June2018/V1.0
4. Relationship to the Data Subject
Please describe your relationship with the Data Subject that leads you to make this request
for information on their behalf.
5. Your Information Request
Please be as specific as possible in making your request, providing as much detail as you can
to help us locate the information. For example, it may be helpful if you can refer to the dates
and locations of events or meetings, the names of people you have spoken to or have
communicated with, the location of the information if known, the type and subject of any
documents or emails, the names or authors of any messages or documents, and any relevant
time periods. If requesting CCTV video footage including vehicle ‘Dashcam’ and ‘Body Worn
Video’ then give details of date/time, location and circumstance etc.
3 PMB/June2018/V1.0
I certify that the information given on this request form to Leicestershire Fire and Rescue
Service is true. I understand that it is necessary for Leicestershire Fire and Rescue Service to
confirm my/the Data Subjects identity and it may be necessary to obtain more detailed
information in order to locate the correct information.
Date:
Response
Leicestershire Fire and Rescue Service will provide you with a response within one month of the
date of your request. In some circumstances, the response period may be extended by up to a
further two months for complex requests.
Fees
The information will in most cases be provided to you free of charge however, where the
request is manifestly unfounded or excessive then Leicestershire Fire and Rescue Service may
charge a “reasonable fee” for the administrative costs of complying with the request.
Leicestershire Fire and Rescue Service may also also charge a reasonable fee if you request
further copies of your information following a request. In this case the fee will be based on the
administrative costs of providing further copies.
If Leicestershire Fire and Rescue Service intends to make a charge then you will be notified in
advance what the cost is and why it has been made. It may be possible to reduce or remove the
charge by reducing the amount of information requested, providing the information in
alternative formats or collecting etc.
Privacy statement:
The information collected on this form will be held in a secure location on Leicestershire Fire
and Rescue Service internal servers and only accessed by authorised people required to process
your request. The information will be retained by us and will be used for the purposes of:
Processing your request for information (note date of birth is required as special
consideration will be made to persons under the age of 16 years of age)
Helping us to make decisions about how we handle your request for information fairly
and lawfully
Informing the public from time to time of the types of requests we have received and
how we responded. In the case of (C), we will not publicise any personal data it will be
anonymised
All personal information will be processed in accordance with the requirements of the Data
Protection Act 2018.
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Subject Access Request Form (Leicestershire Fire and Rescue Services)

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Completed 21 December 2020

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