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DPA Mandate

Thank you. Your information has been received and recorded and we will respond to you shortly.

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    Mandate to authorise Welfare Scotland to act on your behalf


    Your details

    PLEASE NOTE
    The following information relates to the matter you are asking us to assist you with.

    The term 'Data Controller' refers to the organisation or agency we will be contacting on your behalf - e.g. Glasgow City Council or Department for Work and Pensions. Please use the full name of the agency to ensure your mandate is clear and has full legal effect.
    PLEASE NOTE
    This next section requires you to generalise the issue you are asking us to assist you with. This is important as it will be imported into the mandate which we will send to the agency or organisation we will be assisting you with. If you are unsure what to write here, please contact us in advance.

    For example:

    PIP entitlement enquiry.

    Council tax issues.

    HMRC overpayments.

    --Select--
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    Rob
    Rob
    David
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    Soc Sec Rec
    Soc Sec Rec

    Text of the mandate
    I YOUR NAME of YOUR ADDRESS authorise XXX of Welfare Scotland to liaise with the data controller on my behalf insofar as it relates to NATURE OF ISSUE. I nominate XXX of Welfare Scotland as my authorised third-party agent to make enquiries, provide and receive information and make representations on my behalf.

    To assist you in locating my information to record and give effect to this mandate, I provide the following: DOB, EMAIL and TELEPHONE NUMBER.

    I understand this mandate will continue until withdrawn by me or my authorised third-party agent, following the conclusion of the matter they are assisting me with.

    Welfare Scotland is a non-profit organisation registered in the UK. Reg no. SC574987. My authorised third-party agent, XXX may be contacted at [email protected]

    Signed on this day, XXX

    YOUR SIGNATURE.
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