Subject Access Request Form - Hertfordshire County Council printable pdf download

Subject Access Request Form - Hertfordshire County Council

HCC/SAR/ _ _ _ _ _ _ _ _ _ _

NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

HERTFORDSHIRE COUNTY COUNCIL

SUBJECT ACCESS REQUEST FORM

Please fill in this form if you wish to apply to Hertfordshire County Council to have access to personal

information under the Data Protection Act 1998.

This form is in four parts:

Parts A & D must be completed by all subjects.

Part B must be completed if the request is on behalf of another adult.

Part C must be completed if the request is on behalf of a child by a person who has parental responsibility.

A. Please give details of the person who the information is about (the data subject).

Full Name :

Any other names or aliases e.g. : middle names, birth names, maiden names, step-family names:

(Please give as much detail as possible as this will speed up our process in finding your files.)

Date of Birth :________________

Contact Telephone Number :

Current Address :

Contact Email Address :

________________

Information and dates of information that you are applying to see:

(Please give as much information as possible to enable us to identify and locate all information.)

B. Fill in this if you are applying on behalf of another adult. This part authorises the below named to act on

the Data Subject’s behalf.

Full Name :

___________

Contact Telephone Number :

Address :

Email Address:

________________

Relationship to the person in Part A:

Family Member

Solicitor

Advocate

Other (please specify below) :

* Signature:

* Date:

We may require additional Signed Form of Authority from the Data Subject to validate this request.

Subject Access Request Form - Hertfordshire County Council