Goole.com – SUBJECT ACCESS REQUEST

Goole.com Limited

REQUEST FOR PERSONAL INFORMATION – SUBJECT ACCESS REQUEST (SAR)

Return Address:

Mr. J Smith – Data Controller

Stone Cross Rigg,

Walton,

Brampton,

Cumbria

CA8 2BA.
Contact details:

 

Email: info@goole.com

Telephone: 01697741875

Section 1

Please provide the following details about yourself:

 

Full Name………………………………………………………………………………………………………………………………….

Any Previous Names……………………………..……………………………………………………………………………………..

Date of Birth………………………………………………………………………………………………………………………………… Address…………………………………..……………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………… Postcode…………………………………..………………………………………………………………………………………………….

Contact Number…………………………………………………………………………………………………………………………… Email……………………………………………………………………………………………………………………………………………

Please indicate whether you are happy to correspond about your request via the following methods:

Post                                Email

 

The following are required as part of a valid request

FEE- a fee of £10 is payable for each person you request information for. Please enclose a cheque or postal order made payable to “Goole & District Community Transport Group”If you are requesting information about yourself you will need to complete section 3.

If you are requesting information about someone else you will need to complete sections 2 and 3.

Proof of identity is required for you and the person you are requesting information about- for example a passport, driving licence or birth certificate- please supply as a photocopy. If you are requesting your child’s information you will need to supply evidence of parental responsibility e.g. your child’s birth certificate- please supply as a photocopy.

Proof of address is required for the person requesting the information- this needs to be a bank statement or bill dated within the last three months- please supply as a photocopy.

 

Section 2

 

Details of person you are requesting personal information about (if different from section 1):

 

Full Name………………………………………………………………………………………………………………………………..

Any Previous Names………………………………………………………………………………………………………………..

Date of Birth………………………………………………………………………………………………………………………….

Address………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………….

 

Postcode………………………………………………………………………………………………………………………………….

Please explain briefly why you are requesting the information on their behalf:

…………………………………………………………………………………………………………………………………………………

 

…………………………………………………………………………………………………………………………………………………

 

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Consent

Consent for children under the age of 12 is not required- you must however have evidence of parental responsibility as outlined above.

 

I give consent for the person named in Section 1 to request and receive my personal information as outlined on this form. I understand that the information and identification supplied will be used to locate the information requested and confirm my identity.

 

Signed…………………………………………………………………………………………………………………………………………………..

Date………………………………………………………………………………………………………………………………………………………

Print Name…………………………………………………………………………………………………………………………………………….

 

 

Section 3

 

Please describe the information you require (be specific as possible) together with any other relevant information that will help us in finding the requested information:

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Section 4 – ALL APPLICANTS TO COMPLETE

 

I have included the following with this form:

Fee for £10 (postal order, or cheque payable to “Goole.com Limited”.

Photocopy of proof of identity for me and for the person I am requesting information on (if applicable)

Photocopy of proof of address

I confirm that the information given on this form is correct and I understand that the Goole.com Limited may need more information from me to comply with this request. I understand that the information and identification supplied will be used to locate the information requested and confirm my identity.

 

Signed…………………………………………………………………………………………………………………………………………………..

Date………………………………………………………………………………………………………………………………………………………

Print Name…………………………………………………………………………………………………………………………………………….