Data Protection Act s28(3) form (agreed by ACPO and the ISP Industry)

BLANKSHIRE POLICE

Police Headquarters, The Green, Much-Binding-in-the-Marsh, AM3 4XX Phone: 01034 123456 Fax: 01304 123457

REQUEST FOR DISCLOSURE OF PERSONAL DATA

Under section 28(3) of the Data Protection Act 1984 c.35

To: [note 1] ISP reference: [note 2]

Please provide the data concerning the following subject [note3]:

Please provide the following information:

Name and address

Account name or number

Other (specify): [note 4]

Offence being investigated:

Reason that the information is necessary [note 5]:

I certify that completing the above section would itself prejudice the prevention or detection of crime [note 6].

pages of further information [note 7] are attached.

I certify that the data is required for the prevention or detection of crime or for the apprehension or prosecution of offenders, and that failure to disclose the data would be likely to prejudice these matters.

The requested data are required for case reference [note 8] but may be used for any other investigation for which the above declaration applies.

I understand that if any information on this form is omitted or wrong I may be committing an offence under section 5(6) of the Data Protection Act.

Signed:	Date:
Name and number:	Rank

Authorised:	Date:
Name and number:	Rank:

This application must be authorised by a person who is senior to the requesting officer, and of a rank no lower than Inspector. See note 9.

NOTES (to appear on back of form)

REQUEST FOR DISCLOSURE OF PERSONAL DATA

Under section 28(3) of the Data Protection Act 1984 c.35

Note 1: give the company name here, and any particular contact name on the covering letter or fax.

Note 2: this space is reserved for the information provider.

Note 3: give here the identifying information that you have available. It will be assumed that you want information on all accounts matching that information.

If specifying an IP address, you must attach an explanation why an IP address is being specified.
If specifying a URL, a printout of the page should be attached to the request (if possible) to enable the ISP to confirm the URL is correct.

Note 4: state here what specific information is being requested and why. Do not ask for "all information known about the account" or something similar. If in doubt, discuss the matter with the ISP's contact before making the request.

Note 5: give here enough information that the recipient can make a decision whether to disclose in accordance with your declaration.

Note 6: if this applies, tick the box to the left and leave the previous section blank.

Note 7: tick this if you have attached any information mentioned in these notes, or any other material that the ISP may find useful for processing the request. Show how many pages have been attached, number those pages, and place the case reference (see note 8) on each page.

Note 8: give here a case number, file number, case name, or any other reference that identifies the investigation being made. It is not necessary to specify the details of the case or any other names.

Note 9: the authorising officer must be senior to the requesting officer and of the rank of Inspector or above. You must give full details of both officers.

See also the Guidance notes on the use of the form prepared by the ACPO/ISP committee.