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Access Request Form
Request for Personal Data
A. YOUR DETAILS
Last Name
First Name
Telephone Contact Number
Email Address
Please indicate your relationship with us
Current/former customer
Current/former employee
Other – please indicate
Please indicate any relevant dates when the relationship existed
B. DATA REQUESTED
Please describe the Personal Data which you are seeking as precisely as you can:
Data Range for Search:
to
C. PROOF OF IDENTITY
Upon receipt of this request, CDB’s IT Governance Manager will be in contact with you to make the necessary arrangements to provide proof of your identity by showing originals of one of the following:
Passport
Driver’s license
National identification card
Further information about how your request will be handled is available on our website at:
www.caribank.org/privacynotice
D. DATA PROTECTION STATEMENT
The data gathered in this form will be used to process your request for personal data. It will be held by CDB’s IT Governance Manager and may be transferred to other parts of CDB for the purposes of verifying your identity or processing your request for data. The data will be held for seven (7) years from the date when we respond to your request, unless your request forms part of an ongoing case, in which case the data will be kept for as long as necessary for the purposes of managing that case.
E. SIGNATURE
I certify that I am the person named on this form and that I wish to be provided with the data which I have specified relating to myself under CDB’s Personal Data Privacy Policy. I will not publish any data which is supplied to me without prior permission from CDB or the copyright owner (if copyright is not owned by CDB except where permitted by law).
Name (Electronic Signature):
Date: