Data Portability Request Form

Request for Transfer of Data Under Article 20 of the General Data Protection Regulation (GDPR)

Section 1 – Requestor Details

Section1notes

- This section includes details of the individual / company submitting this request.
- All fields marked as * are mandatory.

Are you the Data Subject? *

Yes

section1notes2

If you are the data subject, please enclose evidence of your identity with this form. Acceptable forms of identity are copies of either 1) driving licence; 2) passport; or 3) birth certificate

section1notes3

If you are acting on behalf of the data subject, please enclose their written authority with this form together with evidence of their identity i.e. copies of either their 1) driving licence; 2) passport; or 3) birth certificate. Please also provide the declaration set out in Section 4 of this form, typed on your company letterhead and signed, as evidence of your identity.

Company

Full Name of the Point of Contact *

Correspondence Address *

Postcode *

Telephone Number

Email Address *

What is your relationship with the data subject? *

Why are you making this request for information on their behalf? *

Section 2 – Data Subject Details

Section 2 notes

- This section includes details of the individual whose personal data is requested
- A separate form must be completed for each data subject
- All fields marked as * are mandatory.

Title

Full Name *

Current Address *

Postcode *

Telephone Number

Email Address *

Date of Birth

Previous Name(s) (if any)

Previous Address (if at current address for less than 2 years)

Is/Was the data subject a QBE employee? *

Yes

notes

If you have selected ‘Yes’ to the previous question, please also provide the following details:

NI Number *

Employee ID

Section 3 – Details of the Request

Case Reference ID

Who should we provide the requested personal data to? *

Requestor, as indicated in Section 1 above

Data Subject, as indicated in Section 2 above

Other Party

note

If you have selected ‘Other Party’ above, please provide following details

Name of Other Party / Company

Full Name of Point of Contact *

Correspondence Address

Postcode

Telephone Number

Email Address *

Please provide any relevant information that will help us identify and specifically locate your personal data

Section 4 – Declaration (Mandatory)

Enclosed Documents (PDF files only)

I am the data subject / authorised by the data subject named above and hereby request under the provisions of the GDPR that QBE EO provide a portable copy of personal data, as specified in Section 3 of this form. I have enclosed the required documents stated in Section 1 above and hereby confirm that all the information supplied in this form is accurate to the best of my knowledge. *

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