Data Protection Act 1998

Northumbria Police Authority processes personal data about members of the public only in very limited circumstances, for example when they take part in our public consultations, make a complaint or sign a petition presented to the Authority.

Most of the personal data that we process relates to members and officers of the Authority and to officers and support staff of Northumbria Police Force.

Please note - Police operations are the responsibility of the Chief Constable and information about individuals including victims of crime, witnesses, offenders and suspects is more likely to be held by Northumbria Police Force than the Authority.

Personal Details

We need your personal details to find any personal data that we hold about you.

We will keep this form on file up to two years after we reply to your request. We may transfer some of the information you give on this form to a computerised database to help us monitor and improve our performance. After two years we will destroy this form and delete identifying details from our database.

Name		Mr/Mrs/Ms/Miss
Present Address

	Postcode
Telephone	Date of Birth
If you have lived at this address for less than two years
Previous Address

	Postcode

Please tick the box beside the reason that we process your personal data or tick `other' and write it in.

Current / Past Member of the Authority		Current / Past Support Staff
Current / Past Police Officer		Other

Additional Information

Please provide any additional information that you think we may need to find your personal data like payroll number, other reference numbers, previous surname and approximate dates.

0x08 graphic

Data Subject Declaration

I wish to access personal data that Northumbria Police Authority holds about me. I have ticked the box overleaf beside all the reasons that I think the Authority may process my personal data.

I understand the Authority may need to contact me to confirm my identity. I understand the Authority may need more information from me to find the personal data that I have requested. The 40 day reply period will begin once I provide all the information the Authority needs to find my personal data.

I confirm that I am the Data Subject and not someone acting on his or her behalf.

Please send me the information I am entitled to under section 7(1) of the Data Protection Act 1998.

Signed

Date

Agent's Declaration

If you are not the data subject but have authority to act on his or her behalf you must complete this declaration.

I confirm that I act on behalf of the Data Subject named overleaf and I have shown Northumbria Police Authority proof of my authority to do so.

Please send the data subject / me (delete as appropriate) the information he or she is entitled to under section 7(1) of the Data Protection Act 1998.

Signed

Date

0x08 graphic

Please contact:

Information Rights Officer Northumbria Police Authority Civic Centre Regent Street Gateshead NE8 1HH	Or by e-mail to [email address]

			Or by fax on 0191 478 2755.

If you would like help completing this form please contact the Authority's Information Rights Officer on 0191 433 2170 or call in to the Civic Centre, Regent Street, Gateshead, NE8 1HH *If your request is for Police Clearance Confirmation please return your form to: CIB, Subject Access Office, Cramlington Police Station, Forum Way, Cramlington. Telephone 01661 861 888
For official use only
Date received		Request number	NPA 2009/
Date acknowledged		Date responded

LCS/IR/D/026 Page 2 of 2 05/03 Rev 01

	Data Protection Act 1998
Data Subject Access Application Form

LCS/IR/D/026 Page 1 of 2 05/03 Rev 01