Data Subject Access Request (DSAR) Form

Data Subject Access Request (DSAR) Form

As stipulated by the General Data Protection Regulation (GDPR), you the data subject is entitled and well within your rights to obtain from our establishment, confirmation as to whether or not we are processing your personal data, how this processing is done, details as to for what purposes, categories and disclosures of such data. This form can be used to request information about, and access to any personal data we hold about you. Completed forms can be returned by accessing the details that can be found at the end of this document.
Section 1: Data Subject Details
Name*

First NameLast Name
Date of Birth:

MonthDayYear
Date
Email Address*
example@example.com
Telephone/Mobile Number:

Country CodeArea CodePhone Number
Proof of Identity (attach a copy of one of the following – birth certificate, drivers’ license or passport):

Cancelof
Current Address:*

Street Address

Street Address Line 2

CityState / County

Postal / Zip CodeCountry
Previous Address:

Street Address

Street Address Line 2

CityState / County

Postal / Zip CodeCountry

Section 2 (a): Request Type
INFORMATION
UPDATE
SUSPEND PROCESSING
DELETE
Section 2 (b): Additional Information
Based on your selected option above in Section 2 (a), please provide (if applicable) additional relevant information here to help us process your request:

Section 3: Representative Details
Full Name

First NameLast Name
Relationship to Data Subject:
Telephone/Mobile No:

Country CodeArea CodePhone Number
Email:
example@example.com
Address

Street Address

Street Address Line 2

CityState / County

Postal / Zip CodeCountry
Heads up! The initial email you'll receive from us could land in Gmail's Promotions tab or the Spam folder.
Section 4: Declaration

I confirm that I am authorised to represent the named data subject:
Representative’s Name:
Signature:

Clear
Section 5: Confirmation
Data Subject’s Name:
Date:

MonthDayYear
Date
Signature:

Clear
Should be Empty:

Section 1: Data Subject Details