Personal Data Breach Claim
This form is for you to complete if you believe your personal data has been compromised by a third party and you wish to bring a civil claim for compensation. At this stage we ask that you do not include any sensitive personal data which may have been involved in the breach when completing this form. For example, if the effect of the breach was that your sensitive medical health records have been wrongly disclosed to someone else, please do not provide us with what the specific details are. This type of information is known as ‘special category’ data and we may ask for it later.
About The Breach
What has happened?
When did the breach happen
What type of your personal information was included in the breach? (tick all that apply)
Please give details of anything else you believe is relevant