Part A
| Title | Miss |
| Surname | Pastrana-Dix |
| Forename(s) | Jennifer |
| Date of Birth | 12-01-2004 |
| National Insurance Number | PJ668659D |
| If you were previously known by any other name, please provide details: | |
| Surname | |
| Forename(s) | |
| If you are ‘looked-after’ (in care), please provide details of your responsible Local Authority: | |
| Nation | England |
| Local Authority | |
| We need an email address to acknowledge that we have received the information you have completed on this form. If you do not have your own email address, please provide an email address where you are happy for an acknowledgement to be sent. If you would prefer not to receive an acknowledgment, please use the following email address in this field – dpfoi.noack@hmrc.gov.uk Please note: if this field is left blank your form will not be accepted. | |
| Email address | jenniferpdix@hotmail.com |
| Current address: | |||
| Address line 1 | 14 Dominic Drive | Address line 2 | Cotteridge |
| Address line 3 | Kings Norton | Postcode | B30 1DW |
| City | Birmingham | County | West Midlands |
| Please indicate below your previous address if applicable: | |||
| Address line 1 | Address line 2 | ||
| Address line 3 | Postcode | ||
| City | County | ||
| If you are under 16 please indicate contact details for a responsible adult: | |
| Forename(s) | |
| Surname | |
Part B
Please provide details of the account provider and registered contact for my Child Trust Fund
Part C
IMPORTANT: Please enter in the space below the following information:
- Any HM Revenue & Customs office addresses and reference numbers
- Any other details you feel will assist us in tracing and retrieving your Child Trust Fund information.
Further details:
Part D
I declare that I am the person named in Part A and that I am entitled to request personal information under the terms of the Data Protection Act 2018.
I also hereby give my consent to HM Revenue & Customs to disclose information held on my Child Trust Fund to The Share Foundation Ltd. (reg. charity 1108068, address: 1st Floor, Ardenham Court, Oxford Road, Aylesbury HP19 8HT) who are acting on my behalf in making this request, including confirmation that account provider details have been supplied to me.
I also authorise The Share Foundation to provide my contact information to my account provider once its identity has been established, and my account provider to provide confirmation to The Share Foundation of the date when I have taken control of my account.
Signed: ............................................. <<< You must tick the box above and sign here!
Date: ................................... dd/mm/yyyy