Subject Access

Form SA1 (Subject Access Request Form)

Application for access to your personal data held on West Yorkshire Police systems under Section 7(1)(a) & 7(1)(b)(i) & 7(1)(c)(i) of the Data Protection Act 1998 (Subject Access).

If you require a copy of your conviction history record including all information held on the Police National Computer such as arrests, criminal convictions, cautions, reprimands, final warnings, non-convictions, no further action outcomes or a letter confirming that no information is held on the Police National Computer applications need to be made to ACRO at

IMPORTANT NOTE: We cannot accept the document unless it is signed, the £10 fee paid and identification supplied. See page 4 for full details of fees and identification.

Fields marked with an* are mandatory and must be completed.

  1. Personal Information

1.1 *Title: Mr Mrs Miss Ms Other (specify)
1.2 *Forename(s)/Given name(s):
1.3 *Surname/Family name:
1.4 Maiden/Other names:
1.5 Height:
1.5 *Date of birth:
1.6 *Place of birth: Town: Country:
1.7 *Gender: Male Female Other
  1. Contact Details

2.1 Telephone number:
2.2 *Current Address:
*Post Code:
2.3Alternative Correspondence
Only complete this box if you wish correspondence not to be sent to above home address.
*Post Code:
2.4If you would like someone to act on your behalf please enclose written consent including their address.
2.5Previous Addresses (for the last ten years) If necessary use separate sheet of paper.
2.6 Email address:
Please tick this box if you would prefer general correspondence to be sent via
email.
Please note disclosure of documents will not be made by email and no personal information will be included unless you have a secure address under the GPMS system.
  1. Your request:To help us find the personal data you require and which may be held on West Yorkshire Police systems please supply as much detail as possible in the boxes below. Please continue on a separate sheet of paper if necessary.

3.1 Specify exactly what information you require?

Crime Report – report of the incident
Call Log – calls to and from West Yorkshire Police
Statements/interview – a statement/interview givento West Yorkshire Police
Other (Please specify)
The Data Protection Act means that in certain circumstances West Yorkshire Police may decide not to provide you with some personal data. For example we will not provide personal data if we feel releasing it to you would be likely to prejudice policing purposes, and we may not provide you with information that identifies other individuals.
3.2 Specify the date(s) of the incidents (please supply approximate dates if you cannot be certain)?
3.3Where did this happen and how was it reported?
3.4Relevant reference number(s) i.e. crime reference, custody reference.
The following section is not compulsory however, it could assist us in locating the information requested.
3.5 Were you:
A victim/informant/witness
Arrested/convicted/charged for an offence
A member of or previous employee of West Yorkshire Police
  1. Declaration & Signature

The Information supplied in this application is correct and I am the person to whom it relates. I accept that the information will be used for the purpose of administering this request and to ensure the accuracy of Police systems.
4.1*Signature:
*Date:
  1. Checklist

Please ensure you have included with the form:

Fee of £10 cheque or postal order payable to West Yorkshire Police.
DO NOT SEND CASH.
Photocopy of one of the following forms of identification with name and current address.

Driving licence (please note a driving licence cannot be used for both current address and date of birth identification)
Bank statements (dated within the previous 3 months)
Utility bills (dated within the previous 3 months)
Rent agreements (dated within the previous 3 months)
Other
PLEASE DO NOT SEND ORIGINAL DOCUMENTS.
AND
Photocopy of one of the following forms of identification with name and date ofbirth.

Passport/identity card
Valid driving licence (please note a driving licence cannot be used for both current address and date of birth identification)
Birth/adoption certificate
Other
PLEASE DO NOT SEND ORIGINAL DOCUMENTS.

Signed letter of authority if you require us to correspond with another person on your behalf.

Please send completed applications to: West Yorkshire Police, Disclosure Unit, PO Box 9, Laburnum Road, Wakefield, WF1 3QP

If you need assistance with how to complete this form or are unsure what is a suitable proof of identity please contact West Yorkshire Police Disclosure Unit 01924 296006.

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