Please note: If information to be disclosed includes incidental disclosure of third party (for example family member, referee, care worker) it cannot be disclosed without the consent of that party. Part 4 Person (agent) acting on behalf of the data subject – Title Mr Mrs Miss Ms Other: □ □ □ □ Surname Forename(s) Address Postcode Telephone What is your relationship to the data subject? (for example parent, carer, legal representative) Do you have legal authority to request the data subject’s personal information? Yes No □ □ If the data subject is under 16, do you have parental responsibility for them? Yes No □ □ Please provide proof that you are legally authorised to act on the data subject’s behalf in the form of: Evidence of parental responsibility Letter of authority □ □ Lasting Power of Attorney □ Other (give details) □ Please provide proof that you are the person authorised to act on behalf of the data subject by enclose a copy of one of the following: Birth certificate Driving licence Passport □ □ □ If none of these is available please contact the Data Protection Officer for advice on other acceptable forms of identification. Part 5 What is the nature of the request you are making? – Please help us deal with your request quickly and efficiently by giving as much detail as possible about the information you want. If possible restrict your request to a particular council service or department, period of time or incident. If necessary continue this section on a separate page. Request under your rights please tick the appropriate box – a. Request for access □ b. Request for rectification of incorrect personal data □
Please note: If information to be disclosed includes incidental disclosure of third party (for example family member, referee, care worker) it cannot be disclosed without the consent of that party. Part 4 – Person (agent) acting on behalf of the data subject Title Mr □ Mrs □ Miss □ Ms □ Other: Surname Forename(s) Address Postcode Telephone What is your relationship to the data subject? (for example parent, carer, legal representative) Do you have legal authority to request the data subject’s personal information? Yes □ No □ If the data subject is under 16, do you have parental responsibility for them? Yes □ No □ Please provide proof that you are legally authorised to act on the data subject’s behalf in the form of: Evidence of parental responsibility □ Letter of authority □ Lasting Power of Attorney □ Other (give details) □ Please provide proof that you are the person authorised to act on behalf of the data subject by enclose a copy of one of the following: Birth certificate □ Driving licence □ Passport □ If none of these is available please contact the Data Protection Officer for advice on other acceptable forms of identification. Part 5 – What is the nature of the request you are making? Please help us deal with your request quickly and efficiently by giving as much detail as possible about the information you want. If possible restrict your request to a particular council service or department, period of time or incident. If necessary continue this section on a separate page. Request under your rights – please tick the appropriate box a. Request for access □ b. Request for rectification of incorrect personal data □