Dat1 Form – Fill Out and Use This PDF

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Section 2. Personal Data Sought

A.Tick here if you wish to access your personal data regarding Convictions/ Cautions held by PSNI. (Also known as a Criminal Record Check).

B.Tick here if you wish to access your personal data re Convictions/Cautions held on the Police National Computer (only required if you have resided in England, Scotland or Wales)

C.Tick here if you wish to access your personal data other than the above. To help us find any information that may be held about you, please supply additional details in the box below (and continue on a separate sheet if you need to). To assist us, you are advised to include, where relevant, a description of the information you are looking for, crime reference or incident number, a description of the circumstances in which you had contact with the Police – for example were you the person reporting an offence or incident, a witness, a victim, a correspondent an offender etc, dates, times and any other information you have that can assist us in finding the information you seek.

Please note failure to provide sufficient details may result in your application being returned to you for clarification.

Section 3. Proof of Identity Documents

To establish your identity, your application must be accompanied by at least two official documents, which between them should clearly

show your name, current address and date of birth (e.g. Driving Licence, Passport, Medical Card, Birth/Adoption Certificate, Bank Statement, or Utility Bill). It is advised that you send photocopies of original documents.

Section 4. Declaration

The information which I have supplied in this application is correct and I am the person to whom it relates.

Signature

Date …………………………………………..

Warning – a person who impersonates another or attempts to impersonate another may be guilty of an offence

Section 5. Check List

1.Have you signed and dated your application form?

2.Have you included copies of at least two official documents?

3.Have you included payment? (made payable to PSNI)

Should any advice or guidance be required in completing this application, please contact:

The Data Protection Office, PSNI HQ, 65 Knock Road, Belfast, BT5 6LE

Telephone 02890 561616

Email: AccessToInformation@psni.pnn.police.uk

For Office Use Only

To be completed by the Data Protection Office:

Receipted by: Name

Receipt Number

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NOTES TO ASSIST YOU IN COMPLETING THE SUBJECT ACCESS FORM

1.Details of Prosecutions, Convictions, Cautions, Reprimands & Warnings is the information that is normally required for emigration purposes, etc. If this is what you require, please tick the box in Section 2 (A) of the application form.

2.If you require information held on the Police National Computer system, which cover England, Scotland and Wales, please tick the box in Section 2 (B).

3.If you require information from any other PSNI system, please give details in Section 2 (C), or contact the

Data Protection Unit on the phone numbers/email address below for more assistance.

4.Your application must be accompanied by at least two forms of identification. Between them, they should bear a combination of your name, address, and date of birth (e.g. Driving Licence, Passport, Medical Card, Birth/Adoption Certificate, Bank Statement, or Utility Bill). It is advised that you send photocopies of original documents – PSNI cannot be held accountable for original documents lost in the post.

5.List any previous addresses that you have lived at in the last 10 years. If you have any convictions more than 10 years old, please provide any other previous addresses.

6.A fee of £10 sterling must be included with your application. You are encouraged to pay by cheque or postal order, as the PSNI cannot be held responsible for cash sent through the post. Cheques and postal orders should

be made payable to the PSNI. Postal orders must be UK postal orders.

Note: We can only accept cheques/money orders drawn in pounds sterling.

7.Failure to supply any of the above items will delay the processing of your application.

8.Forward the completed form with the required documentation to the address shown below. Unfortunately we cannot accept applications by email at this time.

9.The purpose of the Police National computer is to provide a national facility to the Police Service and other law enforcement agencies, in order to assist with the prevention and detection of crime; the apprehension and prosecution of offenders; the protection of life and property, and the maintenance of law and order. Information may be obtained from a variety of sources for example, members of the public, Police Officers or external agencies and may be disclosed to other agencies only in line with their statutory powers, for example the Court Service, the Home Office or the Probation Service.

The PSNI complies with the requirements for the handling and safekeeping of personal information, as outlined within the Data Protection Act 1998.

10.These notes are only a guide. The law is set out in the Data Protection Act obtainable from OPSI (Office of Public Sector Information) or www.legislation.gov.uk

If you require any further information or assistance please contact:

The Data Protection Office, PSNI HQ, 65 Knock Road, Belfast, BT5 6LE Telephone 02890 561616 Email:AccessToInformation @psni.pnn.police.uk

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