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LONDON BOROUGH OF BRENT
SUBJECT ACCESS REQUEST FORM
Under the Data Protection Act individuals have a statutory right to be told what the Council is doing with any personal information that it holds about them. Subject to certain exemptions you have a right
to be told by the Council whether it or someone else on its behalf is processing your personal data and, if so,
to be given an intelligible description of the personal data, the purposes for which it is being processed and the likely recipients and sources of that personal data;
• to receive a copy of the personal data.
You should complete this form if you want to make a Subject Access Request. If you are making the request on behalf of another individual, you will also need to complete section (2) of the form.
You must also provide sufficient proof of your identity, this can be done at the time of making the request This should be personal documentation of some sort e.g. Passport or Driving license and a recent utility bill at the address we have on record and to which we will send your personal data.
Details Required
Details of the person who is the subject of the Access Request
Name (full)
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Current address |
Daytime telephone number
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Date of Birth
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Please describe your connection or relationship to the Council (e.g. resident, supplier of goods, recipient of particular services). You do not have to do this but it will help us to identify the data more efficiently.
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Complete this section only if you are making the request on behalf of the person described in section (1) above.
Name (full)
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Current address |
Daytime telephone number
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Other telephone number |
Please describe your relationship to the person who is the subject of the Access request
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Why are you making a request on their behalf?
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If you are making the request on behalf of another person you must enclose with the request a signed authority from them to do so. If you are making the application because the data subject lacks capacity to make the application in their own right please describe in what way they lack capacity and your authority to make the application in their stead. You should enclose a copy of any evidence that you may have of that authority. The Council will contact you if further evidence is required.
Details Sought
If you would like to see only specific document(s), for example a specific departmental file or form etc, please describe these below. Please note that if insufficient detail is provided, we may have to come back to you to clarify.
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If you have not indicated that you only want us to search for particular document(s) we will conduct a more general search but you will need to tell us more about which records you are interested in. You will need to tell us about which departments or services may have dealt with you and the dates so that we know where to look. If insufficient information is given we will come back to you for further information.
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Declaration
I certify that the information given on this form is true.
Signed Date
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The Data Protection Officer
The London Borough of Brent
(IT Dept.)
5th Floor Brent House
349-357 High Road
Wembley
HA9 6BZ