www.mib.org.

uk

Confidential – Not to be disclosed to Unauthorised Personnel

ENQUIRY MADE UNDER THE DATA PROTECTION ACT 1998

Our Ref:
Your Ref:

TO: MIB

FROM: (organisation / individual requesting information)

Details of Information Required:
Name of person(s):
Address:
Postcode:
Claim Reference No:
Date of Accident:
Location of Accident:

The Information Required and why: (details of what information is required)

Nature of Enquiry: (description of why you want the information)

This legal gateway / policing purpose for requesting this information under the provisions of the
Data Protection Act 1998:

Section 29(3). I confirm that the information requested is required for the purpose of the
prevention and detection of crime, or the apprehension or prosecution of offenders and that the
information is not likely to be available in a reliable form from any other source

Section 35(2) I confirm that the information requested is necessary for the purpose of
obtaining legal advice, or is necessary for the purpose of establishing, exercising or defending
legal rights, or in connection with legal proceedings and that the information is not likely to be
available in a reliable form from any other source

Should you fail or refuse to provide the information requested it will not be possible to progress
the investigation and this will result in a substantial risk of prejudice to the purposes for which
the information is sought.

Motor Insurers’ Bureau A Company Limited by Guarantee - Registered in England at the address below - No 412787

Linford Wood House, 6-12 Capital Drive, Milton Keynes, MK14 6XT
Tel: 01908 830001 Fax: 01908 671681 DX: 142620 Milton Keynes 10 Email: enquiries@mib.org.uk
 I am authorised to make this application and it is my view that disclosure of the requested
information is necessary and compatible with the section of the Data Protection Act 1998
named above. I am aware of the provisions of Section 55 of the Data Protection Act 1998,
regarding the unlawful obtaining of personal data.

Requestor (This is the named individual requesting the information who has the responsibility
for using the information as defined by the Data Protection Act 1998)
Print Name: Job Title:

Signed: Date:
Contact Telephone Number:

Information Disclosed

Supervisor Approval Required Yes No

Name: Position: Signature:
Individual Disclosing Information
Name: Position: Signature:
Date:

Please return this form to dataprotection@mib.org.uk

Motor Insurers’ Bureau A Company Limited by Guarantee - Registered in England at the address below - No 412787

Linford Wood House, 6-12 Capital Drive, Milton Keynes MK14 6XT
Tel: 01908 830001 Fax: 01908 671681 DX: 142620 Milton Keynes 10 Email: enquiries@mib.org.uk