Subject Access Request

About You
I am the data subject (the person to whom the personal data relates to)I am not the data subject but have sufficient authority to request on their behalf (i.e. parent/guardian, legal guardian etc.)

If you are the data subject please upload proof of identity confirming your name and address e.g. passport, driving license, birth certificate or 2 official letters; if you are the data subject please provide documentation proving your relationship to the data subject or giving you written authority.

Details of the Data Subject (the person to whom the personal data relates to)
Title*
MrMrsMasterMissMsMx

First name*

Last name*

Address 1*

Address 2*

Town*

Postcode*

Date of Birth*

Telephone Number

E-mail Address*

The data subject a patient/service user of Dougie Mac

The data subject is deceased

Your Details (if different from above)

Title
MrMrsMissMasterMsMx

First name

Last name

Address 1

Address 2

Town

Postcode

Telephone Number

E-mail Address

The data subject is deceased

Details of Information Required:
Please put as much information as you can about the type of information you are requesting about the data subject: for example dates, systems, relationships with the organisation or specific documents. This will help us to identify the information you require.

Declaration:
The information I have supplied in this request is correct, I am the person whom the data relates to or am a representative on their behalf. I understand Douglas Macmillan Hospice may need to obtain further information in order to meet this request.

Date: