This form can be used to request that we restrict processing of your personal information. Your request will be processed within 30 calendar days upon receipt of a completed form and proof of identity. There is no charge for this request.
Please note that completion of this form is not compulsory, however it assists us fulfil your request by ensuring that all required information is provided.
There may be instances where it is not possible for us to restrict processing of your information, such as to comply with a legal obligation. Where this is the case, we will contact you and explain fully the reasons.
If you would like to receive this form by post, or if you would like us to e-mail you a copy of this form, please contact us by e-mailing email@example.com or by calling 01484 411040.
Identity check: In order to prevent fraudulent applications, we request that you provide us with evidence of your identity, in the form of a birth certificate, passport or driving licence, or an official letter addressed to you (e.g. bank statement, recent utilities bill or council tax bill). If you have changed your name, relevant documents evidencing the change should be supplied. The information you supply will only be used for the purposes of fulfilling this request.
SECTION 1: Please complete your details below (the data subject). If you are applying on behalf of someone else, please fill in the details of the data subject below and not your own:
Please upload proof of identity
SECTION 2: If you are applying on behalf of someone else (i.e. the data subject), please provide details below. Otherwise, skip to Section 3.
Please note that if you are not the data subject, but an agent appointed on their behalf, you will need to provide evidence of your identity – as well as that of the data subject and proof of your right to act on their behalf.
Please upload proof of identity
Please upload proof of legal authorisation to act on behalf of the data subject
SECTION 3: FURTHER INFORMATION
Data Subject Declaration:
I certify that the information provided on this form is correct to the best of my knowledge and that I am the person to whom it relates. I understand that the Format Me Not Children’s Hospice is obliged to confirm proof of identity/authority and it may be necessary to obtain further information in order to comply with this request. By submitting this form, I am requesting that processing of my information is restricted (to the level which I specified in Step 3), however understand that there may be certain instances where this is not possible (such as for legal obligations).
Authorised person – Declaration (if applicable):
I confirm that I am legally authorised to act on behalf of the data subject. I understand that the Format Me Not Children’s Hospice is obliged to confirm proof of identity/authority and it may be necessary to obtain further information in order to comply with this request. By submitting this form, I am requesting that processing of the data subject information is restricted (to the level which I specified in Step 3), however understand that there may be certain instances where this is not possible (such as for legal obligations).
Warning: a person who unlawfully obtains or attempts to obtain data is guilty of a criminal offence and is liable to prosecution.
* Please be aware that if you wish us to post confirmation to you, we will take every care to ensure that it is addressed correctly. However, we cannot be held liable if the information is lost in the post or incorrectly delivered or opened by someone else in your household