SA1A (Rev 01/17) INTERNET
DATA PROTECTION ACT 1998
APPLICATION FOR ACCESS TO YOUR PERSONAL DATA
HELD BY STAFFORDSHIRE POLICE.
Please Note: Our application forms change periodically. If you have obtained the form some time before applying please
check it is still the version which must be used when you are ready to apply.
Your Subject Access rights
Subject to certain exemptions, you have a right to be told whether Staffordshire Police holds any information about you
(your 'personal data') and a right to be provided with a copy of that information within a 40 day period.
The Data Protection Act means that in certain circumstances Staffordshire Police may decide not to provide you with some
personal data. For example, we will not provide personal data if we feel releasing it to you would be likely to prejudice
policing purposes, and we may not provide you with information relating to other individuals (third party information).
If you think that information held about you may identify another person, it is advisable to obtain and include their written
consent and a copy of one form of identification, showing their name and address, with your application, to enable the
release of such information to yourself
If you wish to exercise those rights please read the following guidance below.
What Information Do You Require?
Criminal History Check
Do not use this form if you wish to apply for personal information relating to you that may be held on the Police National
Computer (PNC). You will need to obtain a copy of your PNC conviction history using the ACRO Subject Access
Application Form. This will include details of arrested persons, offenders, suspected offenders, cautioned, reprimanded
and warned persons awaiting trial. The form is available on our website. If you require further assistance regarding this
form, please contact ACRO on 0845 60 13 999
Staffordshire Police held Information
If you wish to apply for personal information relating to you, for example, in cases where you have been a victim, a witness,
or an offender, to an incident reported to Staffordshire Police, you will need to complete a Staffordshire Police Subject
Access Request Form (SA1A) (attached). In Section 3 of the form, state what information you require and provide enough
details for us to be able to locate this information.
Visa or Employment Purposes
If you require this information in order to obtain a visa for travel or immigration to Australia, Belgium, Canada, Cayman
Island, New Zealand, South Africa or the USA, you should apply for a Police Certificate through the ACRO website at
www.acro.police.uk.
If this information is required for employment purposes then you should obtain a basic level check online from the Disclosure
Scotland website at www.mygov.scot/organisations/disclosure-scotland.
The Disclosure and Barring Service (DBS) [formally the Criminal Records Bureau (CRB)] checks are for people who are
applying to work with children and vulnerable adults. Normally this type of check will be performed by your employer or
other registered organisation. For further information please visit www.homeoffice.gov.uk/dbs.
SA1A (Rev 01/17) INTERNET
Evidence of Character
Police Forces within the United Kingdom DO NOT issue documents variously described as “Certificates of Good Conduct”
or “Police Clearance Certificates”. Nor do they provide other evidence of good character. It should therefore be noted that
the exercise of your rights under Subject Access provisions of section 7 of the Data Protection Act 1998 will NOT provide
you with a certificate of this nature.
Proof of identity
Staffordshire Police needs to be satisfied that you are who you say you are. Consequently Section 3 asks you to provide
evidence of your identity and address by supplying copies of at least two official documents which between them provide
sufficient information to prove your name, date of birth, current address and signature.
PLEASE DO NOT SEND ORIGINAL DOCUMENTS THROUGH THE POST
Fee
Your Subject Access application will cost £10.00. You are encouraged to pay by cheque or UK postal order made payable
to: ‘OPCC STAFFORDSHIRE’. Please note that we do not accept credit or debit cards, Overseas Postal Orders or Foreign
Currency. Please do not send cash by post.
A Bankers Draft is acceptable if applying from abroad.
Please supply a stamped addressed envelope if you require a receipt and confirmation that your application has
been received. If this is not provided then the receipt will be sent out with your response.
Returning this form
The completed form, with the appropriate fee, minimum of two proofs of identity documents, (name and date of birth & name
and current address), should be returned by post (not e-mailed) to:
Central Disclosure Unit (Subject Access)
Staffordshire Police,
Staffordshire Police Headquarters
Weston Road
Stafford
ST18 0YY
Please DO NOT take completed application forms to Staffordshire Police Headquarters, or any other Staffordshire Police
station as the form cannot be accepted at any of these locations.
Receiving your reply
A response to your application will be sent to you by Staffordshire Police within 40 days of receipt of your completed
application.
Further Information
Please be advised that Staffordshire Police will not be held responsible for any identity documents or monies lost in the
post. Please only send copies of identity documents through the post.
These notes are for guidance only. The law is set out in the Data Protection Act 1998 obtainable from
www.legislation.gov.uk. Further guidance and advice may be obtained from The Information Commissioner’s Office,
Internet: www.ico.gov.uk or telephone number: 0303 123 1113.
Further information can be found on the Data Protection section of the Staffordshire Police Website
(http://www.staffordshire.police.uk/info_advice/freedom_of_information/data_protection/subject_access)
If you would prefer this form in another language or in another format please contact us on the below number.
If you need guidance or assistance in completing a Subject Access form please
contact The Central Disclosure Unit, Subject Access on 01785 232195
Please retain this advice sheet until you have received your response.
SA1A (Rev 01/17) INTERNET
STAFFORDSHIRE POLICE SUBJECT ACCESS REQUEST
OFFICIAL USE ONLY
Request for information about you, held by
Staffordshire Police
(PLEASE USE BLOCK CAPITALS AND BLACK INK)
Section 1. About Yourself
Title:
Mr
Mrs
Miss
Ms
Other (please state):
Surname/Family name:
First name(s):
Maiden/Former name(s):
Date of Birth:
Place of Birth:
Gender:
Male
Female
Town/County
Height:
Country
Home Address:
(This is the address to which all replies
will be sent unless you specify
otherwise below)
Postcode:
Daytime Tel. No.(s):*
Mobile:
Home:
Email Address:*
*Not mandatory, but these will assist us if we need to get back in touch with you to discuss your application to prevent any unnecessary delay.
Alternative Delivery Address:
(Only complete if you wish your reply to be sent
to an address different to your current address.
You will need to provide us with evidence of
your connection with this address).
Postcode:
Previous Address(es):
Please include any addresses for which you were living at, for the period of the information you are requesting.
Please continue on a separate sheet if you need to.
The information supplied in connection with this application will be used for the purpose of administering this request and to ensure the
accuracy of Police systems.
Section 2. Proof of Identity Documents
To help establish your identity your application must be accompanied by copies of at least two different official documents
which between them provide sufficient information to prove your name, date of birth, current address and signature.
For example, a combination of driving licence, medical card, birth/adoption certificate, passport and any other official
documents which show those details.
PLEASE DO NOT SEND ORIGINAL DOCUMENTS THROUGH THE POST
SA1A (Rev 01/17) INTERNET
Section 3. Information You Require
What is the reason for requiring this information? NB - Please do not use this form if you require your conviction history.
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Please describe the information you seek together with any other relevant information to help us identify the information
you require (continue on a separate sheet if you need to).
For example:
A description of the information you are looking for
A description of the circumstances in which you had contact with the Police – e.g. were you a person reporting an
offence or incident; a witness, a victim, a correspondent, an offender etc?
Do you have a crime reference or incident number?
Dates and times
Any other information you can provide which may assist us in finding the information you seek
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Section 4. Declaration (to be signed by the applicant)
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.
CHECK
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Have
Have
Have
Have
you completed the relevant sections on this form?
you signed the form?
you enclosed copies of at least two forms of identification document?
you enclosed the £10 (ten sterling pounds) fee? Payable to OPCC Staffordshire.
Please note a failure to provide the correct details may result in your application being rejected and returned to you.
For official use only
Check that the form has been completed and is legible and you are satisfied with the applicant's identity. Then
complete the form below accordingly.
Date Application received: __________________
Identification documents checked?
Method of Payment
YES/NO
CHQ/PO/CASH
Person Completing: ___________________________
Identity Documents returned?
YES/NO/NA
Receipt Number: ________________________
Collar No.:___________
Location: ______________________
Details of Documents: Driving Licence/Passport/Medical Card/Utility Bill/Bank Statement/Birth or Marriage Certificate/V5/Other