Subject Access Request (SAR) Application Form - On Behalf of Someone Else

Information:

If you are requesting your own personal data, please complete the personal form instead.

You are allowed to request copies of the personal data we hold for people other than yourself only if you have the authority to do so.

To do this you will need to provide us with proof of your authority to act on that person’s behalf. For example, this could be signed and dated authorisation from them, a court order, or an enacted Power of Attorney for Health and Wellbeing.

Please note that if you are providing consent from the data subject, this must be signed and dated within the last 6 months and must be in the form of a digital or “wet” signature. A simply typed name cannot be accepted for the purposes of proof of authority. 

If you’re making the request on behalf of someone else, we will still need to know who you are, and your contact details in case we need to get in touch with you.

We will also require your proof of identification:

  1. Copy of photographic identification (e.g. passport or driving licence). Please note, any photographic identification must be valid and in date – expired identification is not valid
  2. Copy of a utility bill from the last 6 months showing your name and current postal address. Please note we are unable to accept mobile phone bills as proof of address.

Without it, we will not be able to action and progress your request.

Please note that the timescale for responding to your request cannot start until we receive all this information.

 

Including postcode
You can enter up to 250 characters

Including postcode
You can enter up to 250 characters

You will be asked to provide proof during the next step

Such as a passport or a driving license (supported file types: .pdf, .docx, .png and .jpg)

From the last 6 months showing your name and current postal address (supported file types: .pdf, .docx, .png and .jpg)

Supported file types: .pdf, .docx, .png and .jpg

Please tell us your preferred communication method

 

Please tell us about the personal data / special category data are you requesting

It is very important that you are as specific as possible about your request.

If it is unclear what you are asking for, or too general, we will contact you, as we will not be able to action and progress your request.

Please note that the timescale for responding to your request cannot start until we receive this.

Is there a date range of the personal data / special category data you’re asking for?

You can enter up to 2000 characters

You can enter up to 2000 characters

 

Final check before sending your request

Please confirm that you have completed all required steps before submitting.

Including: (i) a copy of photographic identification (e.g. passport or driving licence) and (ii) a copy of a utility bill from the last 6 months showing your name and current postal address

Written authorisation from them, a court order, or an enacted Power of Attorney for Health and Wellbeing

Have you provided which ICB Service Area and/or Department, a date range, and anything else to help us with our search?

Without these things, we will not be able to action and progress your request.

Please note that the timescale for responding to your request cannot start until we have everything needed.

 

Declaration and Signature of Applicant

I have completed this Subject Access Request form to the best of my ability.

 

Once you have completed the necessary fields above, press the button below to submit your request.