now - Worcestershire County Council

Data Protection Act 1998 – Subject Access Request Form
The Data Protection Act 1998 provides you, the data subject, with a right to receive a copy of the
data/information we hold about you or to authorise someone to act on your behalf. Please
complete this form if you wish to see your data. You will also need to provide proof of your
identity and a fee. Your request will be processed within 40 calendar days upon receipt of a fully
completed form, proof of identity and fee.
Proof of identity:
We require proof of your identity before we can disclose personal data. Proof of your identity
should include a copy of two documents such as your birth certificate, passport, driving licence,
official letter addressed to you at your address e.g. bank statement, recent utilities bill or council
tax bill. The documents should include your name, date of birth and current address. If you have
changed your name, please supply relevant documents evidencing the change.
Administration fee:
There is a fee of £10.00 for subject access requests and cheques or postal orders should be made
payable to Worcestershire County Council. If you are making a request for educational records
there is a sliding scale of fees depending on the number of pages of records disclosed to you.
Please contact the Information Access Team for further information.
Section1
Please fill in your details (the data subject). If you are not the data subject and you are applying on
behalf of someone else, please fill in the details of the data subject below and not your own.
Title:
Mr
Mrs
Ms
Miss
Other –
Surname/ Family Name:
First Name(s)/Forenames:
Date of Birth:
Address:
Post Code:
Previous Addresses:
Page 1
Post Code:
Day Time Telephone Number (s)
Information Access Team, Corporate Information Management Unit, Worcestershire County
Council, County Hall, Spetchley Road, Worcester, WR5 2NP. Tel: 01905 845571
March 2016 V2.0
I am enclosing the following copies as proof of identity:
Birth certificate
Driving Licence
Passport
An official letter to my address
If none of these are available please contact the Information Access Team for advice.
Personal Information
If you only want to know what information is held in specific records please tick the relevant box:
Children’s Social Care Records
Education Records*
Adult Social Care Records
If you think it will help us find your information using the box below, state in your own words why
you believe Worcestershire County Council is holding your personal data/information (using a
separate piece of paper if necessary).
Please tell us if you know in which Directorate, Unit or Team the information is being held, together
with any names or dates you may have. If you do not know the current name of the Directorate,
Unit or Team just tell us what you do know. If you do not know exact dates, please give the year(s)
that you think may be relevant.
* Please note that if you wish to access school records you need to apply to the school directly.
Details:
Personnel/employment records
Page 2
If you are now, or have been employed by Worcestershire County Council and are seeking
personal information in relation to your employment please provide details of your personnel
number/Directorate/Unit/Team/Dates of employment.
Information Access Team, Corporate Information Management Unit, Worcestershire County
Council, County Hall, Spetchley Road, Worcester, WR5 2NP. Tel: 01905 845571
March 2016 V2.0
Section 2
Please complete this section of the form with your details if you are acting on behalf of someone
else (i.e. the data subject).
If you are making a request on behalf of a child, please note that we would normally expect a child
of 12 years or over to make or authorise their own request (if they are deemed to have sufficient
maturity to understand their subject access right). If the child is under 12 years of age we will
consider a request from a parent with parental responsibility.
If you are NOT the data subject, but an agent appointed on their behalf, you will need to provide
evidence of your identity as well as that of the data subject and proof of your right to act on their
behalf. If you are a parent, foster parent or carer, acting on behalf of a child under 12 years of age,
you will need to provide proof of parental responsibility.
Title:
Mr
Mrs
Ms
Miss
Other –
Surname/ Family Name:
First Name(s)/Forenames:
Date of Birth:
Address:
Post Code:
Day Time Telephone Number (s)
Please provide proof of identity and the administration fee as detailed on page 1.
I am enclosing the following copies as proof of identity:
Birth certificate
Driving Licence
Passport
An official letter to my address
If none of these are available please contact the Information Access Team for advice.
Page 3
What is your relationship to the data subject? (e.g. parent, carer, legal representative)
Information Access Team, Corporate Information Management Unit, Worcestershire County
Council, County Hall, Spetchley Road, Worcester, WR5 2NP. Tel: 01905 845571
March 2016 V2.0
I am enclosing the following copy as proof of legal authorisation to act on behalf of the data
subject:
Letter of authority
Lasting or Enduring Power of Attorney
Evidence of parental responsibility
Other (give details):
Data Subject Declaration:
I certify that the information provided on this form is correct to the best of my knowledge and that I
am the person to whom it relates. I understand that Worcestershire County Council is obliged to
confirm proof of identity/authority and it may be necessary to obtain further information in order to
comply with this subject access request.
Name:
Signature:
Date:
OR
Authorised person – Declaration (if applicable):
I confirm that I am legally authorised to act on behalf of the data subject. I understand that
Worcestershire County Council is obliged to confirm proof of identity/authority and it may be
necessary to obtain further information in order to comply with this subject access request.
Name:
Signature:
Date:
Warning: a person who unlawfully obtains or attempts to obtain data is guilty of a criminal offence
and is liable to prosecution.
I wish to:
Receive the information by post*
View a copy of the information only
Collect the information in person
Go through the information with a member of staff
*Please
Please send your completed form, proof of identity, and fee by post to:
Information Access Team, Corporate Information Management Unit, Worcestershire County
Council, County Hall, Spetchley Road, Worcester, WR5 2NP. Tel: 01905 845571
March 2016 V2.0
Page 4
be aware that if you wish us to post the information to you, we will take every care to ensure that it is addressed
correctly. However, we cannot be held liable if the information is lost in the post or incorrectly delivered or opened by someone
else in your household. Loss or incorrect delivery may cause you embarrassment or harm if the information is 'sensitive'.