Data Protection Access Request

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An Garda Síochána
Data Protection Access Request
Within the terms of Section 4 of the Data Protection Act(s), 1988/2003, I wish to apply for access to a copy of
my personal data that may be in existence within An Garda Síochána, specifically in respect of the following:
Please Specify: ____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Full Name: _______________________________________________________________________
Previous or other name(s) (if applicable): _____________________________________________
_________________________________________________________________________________
Date of Birth: ____________________________________________________________________
Address(es): ______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Contact Phone Number: ____________________________________________________________
I attach the following:
1.
Photocopy of Passport, Birth Certificate or Driving License.
2.
Debit Card / Credit Card Information,
or
Non Domiciled Payments - International Euro Bank Draft or Euro Giro for €6.35,
or
Domiciled Payments - Personal Cheque, Bank Draft, Postal Order for €6.35, made payable to “The
Accountant, Department of Justice”.
Signed: ______________________________________________
Date: ___________________________
Return Address: ___________________________________________________________________________
Please Note:
1.
Request in writing should be made and signed by the applicant. Scan or photocopied application
forms will not be accepted.
2.
Cash/Sterling/Dollars cannot be accepted as payment.
3.
A disclosure of personal data under the Data Protection Act 1988/2003 should not be construed as
Garda Vetting, a Police Certificate, Garda Reference or Security Clearance.
4.
Within the terms of the Data Protection Act 1988/2003, An Garda Síochána will respond to your
request for personal data within 40 days.
5.
Requests should be submitted to: Data Protection Processing Unit, National Vetting Bureau,
Government Buildings, Vinegar Hill Lane, Templeshannon, Enniscorthy, Co Wexford.
Credit Card / Debit Card type: Visa
MasterCard
Visa Debit
American Express
Credit Card Number
______ - ______-______-______
Expiry Date (DD/MM)
______/______
Card Identification Number (CVV)
____________
Authorisation amount
____________
*incomplete authorisations will not be processed.
AGS927 Version 5.0 October 2016

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