CCTV Surveillance System
Data Protection Act, 2018
LL sections of the form must be completed.
Failure to do so may delay your application
If you have
any queries regarding this form, or your application, please call 01304 872168
About Yourself
Title Mr Mrs Miss Ms Other
mily name
First names
Maiden name / former names
Sex Male
Date of Birth
Your Curren
t Home Address
(to which we will reply)
If you have l
ived at the above address for less than 1 year, please provide:
Previous Address(es)
Dates of Occupancy
From To
Supply of Information
You have a right, subject to certain exceptions, to receive a copy of the information in a
permanent form.
I wish to:
View the information and receive a permanent copy
Only view the information
Help us Find the Information
If the information you have reques
ted refers to a specific offence or incident, please
complete this Section.
Please complete a separate box in respect of different categories / incidents / involvement.
Continue on a separate sheet, in the same way, if necessary.
If the information you require relates to a vehicle or property, please give the vehicle
registration number and/or address, please complete the relevant section below.
If you are a victim of a criminal offence you MUST report this to the police who will make this request
on your behalf. We will not be able to provide you with footage in criminal matters.
Date(s) and time(s) of incident
Place incident happened
Brief details of incident
The information that I have supplied in this application is correct and I am the person to
whom it relates.
I have c
ompleted ALL sections of this form
I enclose TWO identification documents *
Further Information
These notes are only a guide. The law is set out in the Data Protection Act 2018,
obtainable from The Stationery Office. Further information and advice may be
obtained from:
Information Commissioner, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.
Tel: 01625
Please note that this application for access to information must be made direct to
Dover District Council and NOT to the Information Commissioner.
Official Use Only
Please complete ALL of this Section (refer to ‘CHECK’ box above).
Application checked and legible Date Application Received
Identification Documents checked Fee paid
Method of payment
Receipt No.
Details of 2 Documents
Documents Returned
Member of staff completing this section
Request agreed
Name Date information given
Signature Date
* identific
tion documents incl
ude birth/adoption certificate, driving licence, medical card,
passport or other official document that shows your name and address.
Please post your completed form and documents to:
CCTV, Dover Distric
t Council, Council Offices, White Cliffs Business Park Dover CT16 3PJ
Dover District Council is a data controller under GDPR. Our Privac
y Notice explains how we
use and share personal information and protect your privacy and rights.
Further Information
Data Protec