Fillable SubjectAccessApplication Subject Access Request Form

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SubjectAccessApplication Subject Access Request Form

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The Data Protection Act 2018 and GDPR provides Data Subjects (individuals to whom “personal data”
relates) with a right to access data held about them.
Please complete this form giving as much information as possible in order to assist us in identifying your
personal data. Once the required information has been submitted and the Council is satisfied with your
identity you will receive a response within one month.
Please provide copies (photocopies are valid) of TWO official documents listed in Section 2 of this application.
Between them they should clearly show your name and current address (one showing date of birth if
possible). Please also include any documentation that proves any change of name, such as a copy of a
marriage certificate.
Please return the completed form by email to: freedom@nsdc.info
Subject access request
Application form
The information requested below is to help the Council (a) satisfy itself as to your identity and (b) find
any data held about you.
Your name
Previous name
(if applicable)
Date of birth
Current address
Post code
Length of time Years: Months:
at this address
Email address
Telephone no.
If you have lived at the above address for less than two years please give details of your previous address:
Previous address
Post code
Dates of From: To:
occupancy
Please note that you will be required to provide two forms of identification before we can process your
request. These need to be emailed to us at freedom@nsdc.info or bringing in to our headquarters at Castle
House, Great North Road, Newark, Notts NG24 1BY. Examples of identification you will need to provide us
with are: Birth certificate, Driving licence, Passport or an official letter with your address on. Between them
they should clearly show your name and current address (one showing date of birth if possible). Please also
include any documentation that proves any change of name, such as a copy of a marriage certificate.
In order for the Council to identify what data you require access to, please state in your own words the
information you require, the department(s) or service(s) from which you require the information and quote
any reference numbers or account numbers you have been given. Please also provide any previous addresses
this information may relate to. The more accurate you can be the quicker we can send you the information
you require.
Please tick
Council Tax Collection
Benefits
Housing
(Any information about your housing tenancy need
to be directed to Newark and Sherwood Homes Ltd)
Planning
Complaints
Leisure
Rents and Recovery
Other – please specify
2. Proof of identification and entitlement
3. Details of the information you require
Please describe further the information you require including relevant dates and addresses:
In exercise of the right granted to me under the terms of the the Data Protection Act 2018 and GDPR, I
request that you provide me with a copy of the personal data about me which you process for the
purpose I have indicated above.
I confirm that the above is all of the personal data to which I am requesting access and which is held by
the Authority for its purpose.
I confirm that I am the Data Subject and not someone acting on his/her behalf.
Signature of Data Subject
Date
Please note that the information you provide on this form will be recorded for administrative
purposes and may be used for statistical analysis. We will not disclose or share your personal
information for any other purpose.
3. Details of the information you require
4. Data subject declaration
Please complete your personal details as requested. Please tell us if you have been previously known by any other name and if
you have lived at your present address for less than two years, your previous address. If you are requesting historical information
then provide as many details as possible; for example, previous addresses with dates. Use a separate sheet of paper if required.
Proof of name and address is required to ensure we only give information to the correct person. We require two pieces of
documentation, for example, a recent utility bill (less than 12 months old), bank statement, passport or photo ID driving licence.
Between them the ID documents should confirm your name and address. Please provide proof of change of name document(s), if
relevant (photocopies are acceptable).
Under the the Data Protection Act 2018 and GDPR, only the data subject has a right to ask to see their own records. We
normally expect the subject access request to be made by the data subject; all individuals aged 16 or over should make their
own subject access requests if they have the mental capacity to make their own decisions (mental capacity as defined in the
Mental Capacity Act 2005), unless they appoint someone else to make the subject access request on their behalf.
People making subject access requests on behalf of the data subject need to demonstrate that they have the right to do so.
For persons who lack the capacity to manage their affairs, the only person who can make a request for access on that person’s
behalf is an individual acting under an order of the Court of Protection or acting within the terms of a registered Enduring Power
of Attorney.
Persons who have capacity can appoint agents to act on their behalf. Agents should always be asked to provide written proof of
their authority (and possibly proof of their identity and relationship to the individual on whose behalf they are acting).
NB - The fact that another family member pays rent, council tax or hands in a benefit claim form on behalf of an elderly or
incapacitated person should not be taken as proof that the family member is empowered to act for the data subject in all other
matters.
You should give as much assistance as you can about particular areas to search so that we can give you what you require without
further correspondence. You should also give any relevant reference numbers that might be used for you. These details are
required to assist location of your information so you can be given a copy of everything held about you, as required by the
Regulations.
If you have any questions relating to identification requirements or any other aspect of a subject access request, you can email
the Information Governance Officer at freedom@nsdc.info or telephone us on 01636 650000.
Guidance notes
1. About you
2. Proof of identification…
…and entitlement
3. Details of the information you require
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SubjectAccessApplication Subject Access Request Form

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Completed 6 July 2020

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