Data Protection Act 1998 – Subject Access Request

This form is to be used when an individual (The Data Subject) wishes to access personal data held by Lincolnshire County Council. There is currently no fee payable for this service. Please send the completed form and appropriate identification to the address at the end of the form.

Please use BLOCK CAPITALS when completing this form.

Applicant check list – before returning your form please check you have
Provided enough details in section 2, 3 and 4 to allow us to locate the information you have requested
Signed and dated the declaration in section 4
Enclosed photocopies of your proof of identity and address as detailed in section 5
Completed and signed the declaration in section 7, if you wish us to send this information to a third party e.g. a representative acting on your behalf

Section 1: Applicant (to be completed in all cases)

Please select one of the following:

I am the Data Subject. I am requesting access to my personal information

I am not the Data Subject. I am requesting information on behalf of the data subject

Section 2: The Data Subject (to be completed in all cases)

Surname/ Family Name
First name (s)
Maiden / other names
Title / Date of Birth
Residential Address
Post Code:
Contact Telephone No
Contact e-mail address
Previous Addresses (Continue on separate sheet if necessary)

Section 3: Representative’s information (to be completed if you are applying as the data subject’s representative)

Relationship to the Data Subject
Surname/ Family Name
First name (s)
Maiden / other names
Title / Date of Birth
Residential Address
Post Code:
Contact Telephone No
Contact e-mail address
Please explain your entitlement to receive the Data Subject’s personal data -E.G: Data Subject’s signed authority, Lasting Power of Attorney or Parental Responsibility
What authorisation have you enclosed? E.g: •Marriage Certificate •Birth Certificate •Lasting Power of Attorney Court Order stamped •Signed consent.

Section 4Information Required

To help us find any information that may be held about you, and provide this to you as quickly as possible, we would ask that you please supply the additional details:

Were or are you or the subject…(please put a cross (x) in the relevant boxes)
An elected member
An employee of the Council
A service user
Services/areasdata subject would like records from.
Please put a cross (x) in the relevant boxes:
Education / Schools / Planning
Transport / Public Health
Library Services / Social Services Adults
Blue Badge / Social Services Children
Highways / Trading Standards
Other please state:
*Please note for records held locally by schools you must contact them directly.
*Please note for Adoption records you would have to apply to: Adoption Support Team, Lincolnshire Children's Services, Orchard House, Orchard Street, Lincoln LN1 1BA
Who did you have involvement with?(Any named LCC employee i.e. Social Worker, Key Worker, Officer etc.)
Please specify exactly what information you require?
Where did you have involvement with LCC? (Area/Head Office etc.)
What period are you interested in?(please supply approximate dates if you cannot be certain)
Please give any relevant reference numbers

Section 5: Identification

You must provide two forms of identification to confirm the identity of the Data Subject, one which confirms their identity and one which confirms their current address. Please send one document from each list below. Please do not send original documents, good quality photocopies are acceptable.

Note:If you are a representative applying on behalf of the Data Subject, you must also provide two forms of identification which confirm your identity and current address.

List A (Identity) / List B (address)
  • Birth/ adoption certificate
  • Driving license
  • Medical card or
  • Passport
/
  • Bank/Building Society statement
  • Utility bill (electric, gas, telephone or water)
  • Letter from Solicitor / Social Worker / Probation Officer / HM Revenues and Customs / Inland Revenue / Benefits Agency or Employer

Section 6:Format (to be completed in all cases)

Your file(s) will be sent to you on password protected compact disc(s) unless you tell us otherwise.

If you do not have access to a computer or would prefer to receive a paper copy

Please tick this box

Please select a password which you will remember.
(This will be used to verify your identity if you ever have to telephone us)

Please provide an answer to the following questions (these will be used if you forget your password).

What is your mother’s maiden name?
Which primary school did you attend?
What is your favourite colour?

Section 7a:Data Subjects Declaration

Section 7b:Representatives Declaration

Please send the completed form and appropriate identification and authorisation (if applicable) to the address below:

Subject Access Request Team

Lincolnshire County Council

Witham Park House

Waterside South, Lincoln,

LN5 7JN

If you have any queries regarding this form please contact the Subject AccessRequest Team on 01522 554011.

If you change your address please let us know so we can update our records.

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Lincolnshire County Council