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✂
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This data access request is made in my capacity as a “relevant person” on behalf of the Data Subject as
follows:
the Data Subject is a minor and I have parental responsibility over the Data Subject;
the Data Subject is incapable of managing his/her own affairs and I have been appointed by a
court to manage those affairs;
the Data Subject is mentally incapacitated within the meaning of section 2 of the Mental Health
Ordinance (Cap. 136), and :-
(i) I have been appointed under section 44A, 59O or 59Q of that Ordinance to be his/her
guardian; or
(ii) I have been vested the guardianship of the Data Subject or I have to perform the functions
of the appointed guardian under section 44B(2A) or (2B) or 59T(1) or (2) of that
Ordinance; or
I am authorized in writing by the Data Subject to make this data access request on his/her behalf.
(Please give a tick in the appropriate box)
In proof of my above capacity, I hereby enclose the following:-
copy of birth certificate
copy of court order
written authorization
others, please specify :
_________________________________________________________________
(Please tick and complete where appropriate)
Part IV: The Requested Data
This data access request is made under section 18(1) of the PDPO for the following personal data of
the Data Subject, except those specifically excluded under Part V of this Form:-
Description of the Requested Data
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:
Date around which or period within which the Requested Data was collected (if known):
The name of the branch or staff member of the Data User who collected the Requested Data (if known):
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Please specify clearly and in detail the personal data requested (e.g. personal data contained in appraisal reports, medical records,
credit reports) including further information, if any, such as the particular incident or transaction in association with it, the
circumstances under which the personal data was collected or held, etc. to facilitate the location of the Requested Data. Too
general a description of the Requested Data, such as “all of my personal data”, may render the request being refused by the Data
User pursuant to section 20(3)(b) of the PDPO where the Data User is not supplied with such information as it may reasonably
require to locate the personal data to which the request relates.
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Part VIII: Further Infor atio and Payment
I understand that before complying with this request, you may require me to provide
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:
(a) proof of my identity;
(b) proof of the Data Subject’s identity if I am making this request as a relevant person and further
proof of my status as a relevant person;
(c) such further information as may be reasonably required for you to locate the Requested Data;
(d) payment of a fee charged under section 28 of the PDPO
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.
Part IX:
Use of Personal Data
Except with the prescribed consent of the individual concerned, the personal data provided in this Form
will be used for the purpose of processing this data access request and other directly related purposes
only.
___________________________
___________________________________________
Date
Signature of the Requestor
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Failure to p ovide the i formation as required by the Data User under th s P t may result in the data access request being refused,
or not bei g complied with to the de ired extent.
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S ctions 28(2) and (3) of the PDPO provide that a fee may be charged for complying with a data acces request mad under s ction
18(1)(a) or (b), whi h fee shall not be xcessive. According to section 28(5) of th PDPO, compliance with data ccess request
may b refused unl ss and until ny such fee has be n paid.
Form OPS003 (revised 09/2012)