Restricted when completed Subject Access Request form

Under the Data Protection Act 1998, you have the right to enquire of any organisation whether they hold information about you and to see a copy of that information. Individuals are called ‘Data Subjects’ in the Act.

DECLARATION. To be completed by all applicants. Please note that any attempt to mislead may result in prosecution.

I certify that the information given on this application form to Derbyshire Record Office is true. I understand that it is necessary for Derbyshire Record Office to confirm my/the data subject’s identity and that it may be necessary to obtain more detailed information in order to locate the correct personal data.  Signed: ______Signed: ______Person Requesting the information Data Subject if not above Date ______

Note. We will deal with your request promptly and within 40 days of receipt of your proof of identity, excluding any time we may need to request any further information.

DRO Form 03 - Sep 2016

If there is any part of this form that you do not understand, or if you need any further guidance, please contact us Tel: 01629 538180 Email: [email protected] Please note that it may be necessary to seek further information or proof of identity (of Address: data subject or requester) before the request can be processed. If this is the case, then the statutory 40 day limit will start from the date all necessary information and proof is received. Every effort will be made to provide you with your information as soon as possible after receipt of your application. Telephone Post code: no:

Please return the completed form to: Email address: Derbyshire Record Office, c/o County Hall, Matlock, Derbyshire DE4 3AG

Please provide evidence of name and current address (if you are the data subject)

I am the Data Subject (The person the information is about): Also, please supply evidence of any change of name since the time in question I am acting on behalf of the Data Subject: (e.g. marriage certificate, statutory declaration). Copies or originals of the following documents are accepted: If you are seeking information on behalf of someone else, they must also sign the application form. We cannot disclose information about someone else without the data subject's written consent.

Details of person requesting the information

Date of Name: Birth:

Address:

Telephone Post code: no:

Email address:

Details of the Data Subject (if you are acting on behalf of Data Subject)

Name: For UK Residents: For Residents from outside the Please describe the information you seek together with any other relevant details. This will allow us to search for your personal information quickly and thoroughly. Current valid Passport UK: Your information will only be used to process your request and find data that relates Current Driving Licence Photo Card (Any Current Driving Licence Photo Card (Any Country) (Full or provisional) to you. It will be kept on file to respond to any subsequent correspondence, and Country) (Full or provisional) provide statistics relating to our response. Current Driving Licence - Old style paper version Current Driving Licence - Old style paper (Any Country) (Full or provisional) version (Any Country) (Full or provisional) National Insurance Number – found on: a payslip, Government entitlement document P60/P45 or National Insurance Certificate (UK/Channel Islands)* National Entitlement Card Cards carrying the PASS accreditation logo (UK/Channel Islands) Biometric Residence Permit (UK) EU National ID Card Adoption Certificate Mortgage Statement** HM Forces ID Card (UK) Bank/Building Society Statement* Fire Arms Licence (UK and Channel Islands) Credit Card Statement* Mortgage Statement** Council Tax Statement** Bank/Building Society Statement* Financial Statement** - e.g. pension, Bank/Building Society Account Opening endowment, ISA Confirmation Letter* Sponsorship Letter from future employer Credit Card Statement* Financial Statement** - e.g. pension, endowment, ISA (UK) Council Tax Statement** Work Permit/Visa (UK) (UK Residence Permit)** Utility Bill* Benefit Statement* - e.g. Child Allowance, Pension