GreenSquare Group – Subject Access Request Form

Accessing your information under the General Data Protection Regulation

Under the General Data Protection Regulation you have the right to know what information we hold about you. You can use this form to request this information. This is called a Subject Access Request (SAR). The person whom the information is about is called a ‘Data Subject’.

We will acknowledge your request within five days of receiving your payment and send you a full written response to your request within 30 days.

1.  Data Subject information

Please fill in the details of the person you are requesting information about – known as the ‘Data Subject’:

*Full name:
*Date of birth
*Current Address:
(for correspondence)
*Postcode:
*Address which SAR relates to if different
*Postcode:
Phone number:
Email address:

* Denotes required information

2.  Relationship to Data Subject

Are you:

The Data Subject (you are looking for information about yourself)? Go to section 4.

The representative of the Data Subject (are you asking for information about someone else)? In this case you must complete section 3 below and ensure the authorisation on page 4 is completed. We will not process a SAR for a third party without authorisation.

3.  Requester details

If you are asking on behalf of someone else (the Data Subject), please fill in your own details below:

*Your full name:
*Your Address:
*Postcode:
Phone number:
Email address:
*Relationship to Data Subject:

* Denotes required information

4.  Nature of information

If possible, please tell us the nature of the information you are looking for. The more detail you can give us, the easier it will be for us to find the information. If you can restrict your request to a particular service, period of time or incident this will help us process your request quickly and efficiently.

5.  Proof of identity

Depending on the circumstances we may need to ask you for additional information to prove your identity. This could include requesting photographic ID such as a passport, driving licence or bus pass; or asking for additional account information for example. If we tell you that we require additional proof of identity we will not be able to process the SAR until we have received this.

6.  Information format and collection

Please note that information produced as a result of a SAR is normally provided in hard copy format and is out sent by special delivery to the address of the Data Subject, or the address of the authorised representative, as appropriate. Please ensure that you provide the correct postal address for this correspondence. You may nominate to collect the information from one of our offices. If this is your preference please tick this box and indicate below which GreenSquare office you would prefer to collect the information from:

Barbury House, Swindon

Barns Road, Oxford

Methuen Park, Chippenham

Green Farm Business Park, Gloucester

If you wish to collect your information you will be required to provide identification at the time of collection. We will provide further information in our acknowledgement to you.

Please note that information will be available to collect for a period of three months. After this time it will be destroyed and a new SAR will need to be submitted if required.

Please send completed information and payment to:

The Information Compliance Manager

GreenSquare Group

Methuen Park

Chippenham SN14 0GU

Please mark envelope ‘Private and Confidential’.

Email queries to:

7.  Signature

I confirm that the information I have given on this form is true to the best of my knowledge. I understand that providing false information, impersonating or attempting to impersonate another person may make me guilty of a criminal offence and subject to prosecution.

Signature / Print name / Date
Person making application

The information supplied in connection with this application will only be used to administer this request.

Authorisation for a Subject Access Request on behalf of a third party

If there is a power of attorney in place between the person requesting the information and the Data Subject you may provide evidence of this instead of completing the sections below.

The signature of the Data Subject on this authorisation must be independently witnessed by a person at least 18 years of age and not related to the Data Subject.

I ……………………………………………… (print name of person about whom data is being requested – the Data Subject)

Hereby authorise

……………………………………………….. (the person named above / making the request) to request and receive my personal information on my behalf

Signed …………………………………………………………………..

Date ………………………………………………………………

______

Signature witnessed by ………………………………………………….. (print name)

Signature ………………………………………………………………………….

How you are known to the Data Subject ……………………………………………….....

I am 18 years of age or older

Note: you must not be a relative or life-partner of the Data Subject. Giving false information may make you guilty of a criminal offence and subject to prosecution.

GreenSquare Group – Subject Access Request Form 2