DPA Mandate

Mandate to authorise Welfare Scotland to act on your behalf

Your details

*Name

*Email

*Phone Number

*Full Postal Address

*Date of Birth

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.

*Name of Data Controller
The full name of the agency or organisation you are asking us to speak to

*Data Controller's Reference Number
Your account number, reference number or national insurance number (if benefit related)

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.

Nature of issue we are assisting with
PLEASE READ GUIDANCE NOTES ABOVE

Which caseworker is assisting you?
If you have not been allocated a caseworker yet, please contact us before submitting this form

Rob

David

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I understand this mandate will continue until withdrawn by me or my authorised third-party agent, following the conclusion of the matter they are assisting me with.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

SIGN HERE