Fillable Subject-Access-Request-Web-Form-August-2019 SUBJECT ACCESS REQUEST FORM

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Subject-Access-Request-Web-Form-August-2019 SUBJECT ACCESS REQUEST FORM

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SUBJECT ACCESS REQUEST FORM
Please read our Subject Access Procedural Guidelines before completing this form
1. DETAILS OF PERSON MAKING THE REQUEST
Full name:
Address:
Postcode:
Email:
2. A
RE YOU THE DATA SUBJECT?
YES - I am requesting personal information about myself (please complete sections 4 and 6)
NO - I am acting on behalf of the data subject (please complete sections 3, 4,5 & 6)
3. CONFIRMATION OF DATA SUBJECT’S IDENTITY (if different to 1.above)
Full name:
Address:
Postcode:
Email:
4. PROOF OF DATA SUBJECT’S IDENTITY [Please provide two forms of the following identification
– one from list A and one from list B]
List A (tick as appropriate):
• Copy current passport
• Copy birth certificate
• Copy current photo card driving licence (full or provisional)
List B (tick as appropriate):
• Copy utility bill dated within the last three months
• Copy council tax bill for current year
• Copy bank statement dated within the last three months
• Copy benefits agency/state pension correspondence (on letterhead)
dated within the last three months
GDPR Subject Access Request web form August 2019
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5. AUTHORITY TO RELEASE INFORMATION TO A THIRD PARTY [Note: If you are making the
request on behalf of the data subject, it is your responsibility to provide evidence of this entitlement to
act. You must provide one of the following in addition to the data subject’s proof of identity/address]
Acceptable proof of entitlement to act (tick as appropriate)
• Copy Power of Attorney
• Copy Court of Protection Order
• Solicitor’s letter confirming authority to act
• Copy of your written instructions to a third party (other than a solicitor)
to act on your behalf with confirmation of their identity and relationship
to you
6. SCOPE OF REQUEST - To help you comply with my request, you should know that it is likely that
the information is held in respect of the following matters:
i. Specific records relating to [insert details]
Ii Specific dates [insert details]
Iii Further information requested [insert details]
7. HOW TO SUBMIT YOUR REQUEST
If you are submitting the completed form by email, please scan the proof of identity/address and if
applicable, entitlement to act and attach these to your email: dataprotection@dartford.gov.uk
or, post to: Data Protection Officer, Dartford Borough Council, Civic Centre, Home Gardens, Dartford
Kent DA1 1DR.
FURTHER INFORMATION
It may be necessary for us to confirm proof of identity and/or ask for more detailed information to locate
the information requested.
Additional information we will provide - Once we have identified the personal information within the
scope of your request, we will provide a copy of the information and to the extent that the following are
not contained or referred to in the copy of the information, we will:
• provide a description of the information and the categories of personal information concerned;
• explain the purposes for which the information is processed;
• where possible, identify the source or sources of the information;
GDPR Subject Access Request web form August 2019
• set out to whom the information has been disclosed or may be disclosed, in particular where
possible, recipients in third countries or international organisations;
• set out, where possible, the envisaged period for which the information will be stored, or, if not
possible, the criteria used to determine that period;
• state whether there has been any automated decision-making using the information, including
profiling, and if so, any meaningful information about how it was based, as well as the significance
and the envisaged consequences for me/data subject of such processing.
Is a fee payable? – No - we will provide a copy of the information free of charge. However, we can
charge a ‘reasonable fee’ when a request is manifestly unfounded or excessive, particularly if it is
repetitive and can also charge a ‘reasonable fee’ to comply with requests for further copies of the same
information. Our fee will be based on the administrative cost of providing the information.
Time limit for responding – we will comply with a subject access request ‘without undue delay’ and in
any event within one calendar month of the date on which the request is received or (if later), the day on
which we receive:
(a) the fee (if any);
(b) any requested location information;
(c) any information requested to confirm the data subject’s identity.
We will be able to extend the period of compliance by a further two months where requests are
complex or numerous. If this is the case, within one month of the date of receipt of the request, we
will explain why the extension is necessary.
GDPR Subject Access Request web form August 2019
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Completed 14 November 2019

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