CCTV Request Details
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CCTV Request Form / Ffurflen Gais Hawliau Unigolion

I am the subject of the CCTV
I am requesting on behalf of somebody else

SECTION 1: DATA SUBJECT DETAILS / ADRAN 1: MANYLION AM YR UN SY’N CYFLWYNO’R CAIS

Title / Teitl:*
First Name / Enw Cyntaf:*
Surname / Cyfenw:*
House Number / Rhif Tŷ:*
Address-1 / Cyfeiriad-1:*
Address-2 / Cyfeiriad-2:*
Town / Tref:*
Post Code / Cod Post:*
E-Mail / E-bost:*
Phone No / Rhif Ffôn:

Section 2: DETAILS OF THE APPLICANT MAKING THE REQUEST (if applicable) / Adran 1: Eich Manylion

Applicant Title / Teitl yr Ymgeisydd:
Applicant First Name / Enw Cyntaf yr Ymgeisydd:
Applicant Surname / Cyfenw yr Ymgeisydd:
Company/Contact Name / Enw'r Cwmni/Cyswllt:
Applicant House Number / Rhif Tŷ'r Ymgeisydd:
Applicant Address 1 / Cyfeiriad yr Ymgeisydd 1:
Applicant Address 2 / Cyfeiriad yr Ymgeisydd 2:
Applicant Town / Tref yr Ymgeisydd:
Applicant Post Code / Cod Post yr Ymgeisydd:
Applicant Phone Number / Rhif Ffôn yr Ymgeisydd:
Applicant E-mail/ E-bost yr Ymgeisydd:
Insurance Ref (if applicable) / Cyf Yswiriant (os yn berthnasol):
We are only able to provide footage on the individual whose subject within this request. Any other information and persons will be pixelated in line with the Data Protection Act 2018. If you require non-pixelated footage, your request should be dealt with by an insurance/solicitor company or by the police. - Dim ond y ffilmiau sy’n ymwneud â’r unigolyn sydd yn destun y cais hwn y gallwn eu darparu. Bydd unrhyw wybodaeth neu unigolion eraill yn cael eu picseli yn unol â Deddf Diogelu Data 2018. Os oes angen ffilmiau heb eu picseli arnoch, dylai eich cais gael ei drafod gan gwmni yswiriant/cyfreithiwr neu gan yr heddlu.

Section 3: REQUEST DETAILS / Adran 1: Eich Manylion

Incident Date:*
Incident From Time:*
Incident To Time:*
Incident Location:*
Vehicle Registration:*
3rd Party Vehicle Registration (If Applicable) Cofrestru Cerbyd Trydydd Parti (os yw'n berthnasol):
Incident Details:*

SECTION 4: SUPPORTING DOCUMENTS / ADRAN 4: DOGFENNAU ATEGOL

In order for your request to be processed, Cardiff Council requires / Er mwyn prosesu eich cais, mae Cyngor Caerdydd angen:

1-A clear copy of valid photographic ID (i.e. Passport, Driver’s License) / Copi clir o ID ffotograffig dilys (h.y. Pasbort, Trwydded Yrru)
2-Proof of address, dated within the last 3 months (i.e. Bank statement, utility bill) / Prawf o’ch cyfeiriad, wedi’i ddyddio o fewn y 3 mis diwethaf (h.y. Cyfriflen banc, bil trydan wy/dŵr)

It is sufficient for Insurers and Solicitors to tick the box in section 5: Third Party Declaration. - Mae'n ddigon i Yswirwyr a Chyfreithwyr dicio’r blwch yn adran 5: Datganiad Trydydd Parti.
I confirm that I have inserted copies of the above (please tick)
Attach a file
/Atodwch ffeil

SECTION 5: DECLARATION / ADRAN 5: DATGANIAD GWRTHRYCH Y DATA


In exercise of the right granted to me under the terms of the Data Protection Act 2018, I request that you provide me with a copy of the information above. I understand that only an insurance company or solicitor requesting the information can receive footage of the data subject.

I confirm that I am the data subject, or that the data subject is aware their personal data will be processed for purposes indicated above and that I consent to act on behalf of the data subject in requesting this information.

I understand that Cardiff Council have one calendar month to respond to my request. This timeframe is statutory, unless there are circumstances in which this timeframe requires extension, or where further information from myself is required.

We will contact you directly, if the circumstances above occur.

I have read and understood the terms of this Data Subject Declaration and consent for my personal details to be submitted to the Information Governance Team.


Dan Ddeddf Diogelu Data 2018 hoffwn arfer fy Hawliau Unigol, fel y manylwyd arnynt yn adran dau.

Rwyf yn cadarnhau mai fi yw gwrthrych y wybodaeth hon ac nid rhywun sy’n gweithredu ar fy rhan, ac yn deall bod gan Gyngor Caerdydd un mis calendr i ymateb i fy nghais.

Mae’r cyfnod hwn yn statudol, oni bai bod amgylchiadau sy’n mynnu bod angen ymestyn y cyfnod, neu bod angen i mi gyflwyno gwybodaeth bellach.

Byddwn yn cysylltu â chi yn uniongyrchol os digwydd yr amgylchiadau uchod.

Rwyf wedi darllen a deall telerau’r Datganiad Gwrthrych Data hwn ac yn rhoi caniatâd i’m manylion personol gael eu cyflwyno i’r Tîm Llywodraethiant Gwybodaeth.
Tick to Consent / Ticiwch i roi Caniatâd
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