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Data Subject Access Request Form


The Data Subject Access Request Form is designed to facilitate data subjects’ requests for access to their personal data in accordance with the Protection of Personal Information Act (POPIA). This form enables [Your Organization Name] to efficiently handle and respond to data subject access requests while ensuring compliance with data protection regulations.

Request Details:

  1. Requester Information:
    • Full Name: [Placeholder]
    • Email Address: [Placeholder]
    • Phone Number: [Placeholder]
    • Address: [Placeholder]
  2. Request Type: [Access/Correction/Deletion/Portability]
  3. Description of Request: [Brief Description of Requested Information]
  4. Additional Information: [Any Additional Details Provided by the Requester]


To ensure the security and accuracy of personal data, [Your Organization Name] may require verification of the requester’s identity. Please provide the following information for verification purposes:

  • Date of Birth: [Placeholder]
  • Identification Document Type: [ID/Passport/Driver’s License]
  • Identification Document Number: [Placeholder]
  • Any Additional Information: [Other Information for Verification]


I, [Requester’s Full Name], hereby certify that the information provided in this Data Subject Access Request Form is true, accurate, and complete to the best of my knowledge.

Signature: [Signature Field]

Date: [Date]


The Data Subject Access Request Form streamlines the process for data subjects to exercise their rights under POPIA and enables [Your Organization Name] to fulfill its obligations regarding data subject access requests. By promptly responding to such requests and providing access to personal data as required by law, we demonstrate our commitment to transparency and data protection compliance.

You can customize this template by replacing the placeholders with relevant information such as the requester’s details, description of the request, verification information, and signature field. Additionally, you may include any additional fields or sections specific to your organization’s requirements or applicable regulations.

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