Data Subject Access Request Form

Requester Name (Data Subject) and Contact Information

Please provide your information in the space provided below. We will only use the information you provide on this form to identify you and the personal data you are requesting access to, and to respond to your request.

Name:

Other names

Home address

Date of birth

Telephone number:

Email address

Are you a current or former employee?

If yes, please provide your employee identification number and approximate dates of employment

Unique information:

Proof of Data Subject's Identity

We require proof of your identity before we can respond to your access request. To help us establish your identity, you must provide identification that clearly shows your name, date of birth, and current address. We accept a photocopy or a scanned image of one of the following as proof of identity: passport or photo identification such as a driver's license, national identification number card, or birth or adoption certificate. If you have changed your name, please provide the relevant documents evidencing the change. If you do not have any of these forms of identification available, please contact datarequest@abbeyfield.com for advice on other acceptable forms of identification. We may request additional information from you to help confirm your identity and your right to access, and to provide you with the personal data we hold about you. We reserve the right to refuse to act on your request if we are unable to identify you.

Identification documents:

Information requested

To help us process your request quickly and efficiently, please provide as much detail as possible about the personal data you are requesting access to.

Please include time frames, dates, names, types of documents, file numbers, or any other information to help us locate your personal data. For example, you may specify that you are seeking:

Employment records or personnel records between specific dates.
Personal data held by one of Abbeyfield’s homes.
Medical records.
E-mail or other electronic communications (specify the approximate dates and times).
Invoicing information.
Photographs.
Video footage.
Correspondence between yourself and an Abbeyfield employee between specific dates.

We will contact you for additional information if the scope of your request is unclear or does not provide sufficient information for us to conduct a search (for example, if you request "all information about me"). We will begin processing your access request as soon as we have verified your identity and have all of the information we need to locate your personal data.

Requested information:

How would you like to receive the information:

By email

By post

Signature and acknowledgment

By clicking the signature button below I confirm that the information provided on this form is correct and that I am the person whose name appears on this form. I understand that:

The Abbeyfield Living Society must confirm proof of identity and may need to contact me again for further information;
My request will not be valid until The Abbeyfield Living Society receives all of the required information to process the request; and
I am entitled to one free copy of the personal data I have requested, and acknowledge that for any further copies I request, The Abbeyfield Living Society may charge a reasonable fee based on administrative costs.

Yes, I give permission to store and process my data

Data Subject Access Request

Requester Name (Data Subject) and Contact Information

Proof of Data Subject's Identity

Information requested

Signature and acknowledgment

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