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Data Subject Access Request Form - Template Form

✓ Valid in Ireland

Create your Data Subject Access Request Form - Template Form for use in Ireland. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.

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Data Subject Access Request Form - Template Form
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________,
________
email address: ________



________,
________

________



Re: Data Subject Access Request

For the attention of: Data Controller for ________

I, ________ (the Data Subject) am writing to request access to personal data generated or held by your organisation, whether that be in computer or manual form, concerning me. This right is exercised pursuant to Art 15 of the General Data Protection Act and the Irish Data Protection Acts 1998 to 2018 (the Data Protection Law).


Data Subject Information:

Full name: ________
Date of Birth: ________
Address:
________
Proof of address: utility bill
Proof of identification: copy of passport


Information Requested Pursuant to Art 15 of the GDPR (incorporated by the Data Protection Act 2018):

1. Confirmation that my 'personal data' as defined under Art 4(1) of the GDPR, is being processed by ________.

2. The location or locations where my personal data is being processed.

3. The different categories of personal data held about me, the Data Subject, specifically if the data held is categorised as: general personal data, 'special category' or 'sensitive' personal data or if it pertains to any legal or criminal record.

4. The purpose or purposes for which the personal data is being processed.

5. The respective rentention periods for each item or the whole of my personal data, and any criteria employed to determine the retention periods. It is recalled that the retention period should be no longer than is necessary for the purposes for which the data is processed.

6. The source or sources of the personal data held about me.

7. All parties within your organisation and all third parties to whom my personal data has been disclosed or been accessible.

8. Information about the existence of any automated decision making based on the personal data held, the manner in which those automated decisions are made and the consequences of those decisions.

9. Information about the existence of, and how to exercise the following rights under the GDPR:

a. the right to erasure;
b. the right of rectification;
c. the right to restrict processing;
d. the right to object


Specific Data Requested:

I request copies of ALL data pertaining to me held by your organisation in computer or manual form, including video footage, photographs, etc.

In particular, I request access to the following:

________


Kind regards,




______________________________________

________

The following document is being attached to the present Data Subject Access Request in order to prove the identity of the Data Subject: copy of passport

The following document is being attached to the present Data Subject Access Request in order to prove the address of the Data Subject: utility bill

Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.