Mandate for the release of information under the Data Subject Access provisions of the Data Protection Regulations

Client Insurer
Full Name: Insurer
Miss Anna Bozkiewicz Esure
Name:
Client 9 Turstone Court Leeds Insurer The Equinox 19 Cadogan Street Glasgow G2
Address: Address:
LS10 3DH 6QQ

Telephone: Telephone: 0344 2090472.

Date of Policy:
24/12/1985 56509840
Birth:
NI Number SJ128364A Start Date:
Accident Cover:
14/03/2021
Date:
Employer
Employer Clipper Logistics Name:
Name:

Employer Barlby Rd. Address:

Address: YO8 5BL

Previous Solicitor DVLA

Solicitors DVLA
Name: Name:

Ref No: Licence No:

Solicitors DVLA
Address: Address:

I hereby consent to the above named establishments releasing any details or records that may be kept by them to

Wosskow Brown Solicitors LLP The John Banner Centre 620 Attercliffe Road Sheffield S9 3QS
or any other party instructed by them in support of my claim arising out of an accident which occurred on the aforementioned
date.
In the case of the DVLA I authorise them to supply any information, with the exception of any medical information that may be
held, on it’s driver computer record relating to myself or/and my driving entitlement, past and present, including any valid
endorsements, disqualifications etc (within the meaning of the Road Traffic Offenders Act 1988). I request the information to be
sent to Wosskow Brown Solicitors LLP or their representatives. I hereby authorise the provider of my policy of motor
insurance to release to Wosskow Brown Solicitors LLP any details they may require to be able to progress my claim and
for Wosskow Brown Solicitors LLP to share information that they may obtain with them.
Access to this information is required in accordance with the Data Protection Act 2018 within 30 days.

Signed ..............................................................................

Date