Personal Data Request Form

PERSONAL DATA REQUEST FORM

You can use this form if you wish to make a request under the Data Protection Act 1998 to receive a copy of personal data that the Company holds about you.  Once completed, this form should be forwarded to Lee Williams, who is the Company’s Data Protection Officer.

Name of applicant:

(Please also provide any other names under which you have been employed, for example a maiden name)

Are you an employee, ex-employee, client or job applicant:

Employee/ ex-employee/ client/ job applicant*

(*delete as appropriate)

Company location and employing department (if applicable):

Relevant employment dates (as applicable):

  1. Commencement date
  2. Termination date
  3. Date of job application
  4. Date of job interview

Please specify precisely the personal data that you are requesting and give as much information as possible to enable the personal data to be located, including:

  1. The specific documents or files you wish to see.
  2. The names of any individuals or departments whom you believe may hold the personal data you have requested.
  3. Any other information which will assist us in searching for the personal data you have requested.

Address to which you would like the personal data to be sent:

Contact telephone number:

The items of copy documentation you have supplied with this request form as evidence of your identity and address (for example, a driving licence, passport or identity card as evidence of identity and a recent bill from a utility company or bank or credit card statement as evidence of address):

By completing this form, I accept that I am making a request under the Data Protection Act 1998 to receive a copy of specified personal data that the Company holds about me.  By signing below, I confirm that I am the data subject named above and that you can contact me if necessary if you wish to obtain further identifying information before agreeing to my request.

I acknowledge that you may also need to contact me to obtain any further information that you require to enable you to comply with my request.

I enclose a cheque in the sum of £10.00 made payable to the Company.  I understand that it may take up to 40 days from receipt of this form, or from receipt of any further information you request from me which is required to enable you to comply with my request, before a reply to my request is provided to me.

I also acknowledge that the Company is only obliged to disclose personal data that is held about me either on computer or as part of a relevant filing system.

Signed by applicant:

………………………….…..

Date: ……………………….