Are you contacting the Data Protection Commission in relation to an access request related concern?

You have a right to obtain a copy of personal data that an organisation holds in relation to you.

Please complete this section if you have asked an organisation for a copy of your personal data (or a copy of the data of an individual or individuals that you represent), and you have not received a response or are dissatisfied with the response you have received.

Part One Your Details

Your Details

Full Name: *

Email Address: *

Your Phone number:

Your Postal Address, including Eircode/Postal Code:

What is your country of residence? *

Please select Republic of Ireland Non EU/EEA Country Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Italy Latvia Liechtenstein Lithuania Luxembourg Malta Norway Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden

Please Specify *

Details about the organisation to which your concern relates

Name of the organisation *:

Name / Email / Role of any contact within the organisation:

Reference number provided by the organisation (if any):

Have you complained to us about this specific matter before?

Yes

No

Please enter the reference number of your original complaint *

What was the outcome of your original complaint? *

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Part TwoPlease outline details of your access request:

Have you made an access request?*

Yes

No

Please make an access request to the organisation.

Was your access request made over one month ago? *

Yes

No

Please allow the organisation one month (from the date on which it received your request) in which to respond

Please enter the date of your access request: *

Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year

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Part Three Your Complaint

Why are you dissatisfied?*

I have not received a response to my access request

The organisation has not provided all the data that I have requested

The organisation has cited exemptions to my right to access my data

I am dissatisfied for another reason

Have you sent a reminder letter?*

Yes

No

If you have not sent a reminder letter to the organisation in relation to your request, we recommend that you do so in the first instance, as this may result in the fastest resolution of your concern

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What date did you send the reminder letter? *

Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year

Have you raised this in writing with the organisation? *

Yes

No

Please write to the organisation setting out the personal data you know or believe to exist but which has not been supplied

Please outline details of your access request:*

• your relationship with the organisation;
• the context in which the data was created;
• any other relevant info about the specific data sought

Please provide copies of all relevant correspondence, including a copy of the original access request and a letter of authority (if contacting DPC on behalf of another individual)

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