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Information Request Form
(Freedom of Information Act / Environmental Information Regulations)

Please complete the form below, providing as much detail as possible, to enable us to
identify and locate the information requested.

Please Note: Fields marked with an Asterisk (*) are required.

Details of the Applicant

Title

Forename ^*

Surname ^*

House or Flat number or name ^*
Building Name (if applicable)
Street Name ^*
Village or Area (if applicable)
Post Town ^*
Postcode (e.g. LE3 8RA) ^*

Telephone (day)

Telephone (evening / weekend)

Mobile

E-mail Address

If this application is being made on behalf of an organisation, please give details below

Name of Organisation

Details of Request

Please provide as much detail as possible of the information you require. This will assist us in processing your request quickly and efficiently. Where appropriate, please include names, dates, file references, site locations and descriptions to enable us to identify and locate the required information. We may contact you for further information if your request is ambiguous.

Please indicate in what format you would like the information to be supplied ^*

Details of information required ^*

Internet e-mail and web based e-forms are not secure media as messages can be intercepted and read by someone else. Please bear this in mind when deciding whether to send information by either of these methods. Postal addresses for Leicestershire County Council are available from http://www.leics.gov.uk/contact_us.htm

The contents of this form will be emailed to someone at the County Council who may then respond to your email.

Please refer to the County Councils Privacy Policy (www.leics.gov.uk/privacy)

Personal data supplied on this form will be held on computer and will be used in accordance with the Data Protection Act 1998 for statistical analysis, management, planning and in the provision of services by the County Council and its partners.

The County Council will treat all information as confidential.

From time to time we would like to send you some information about services and ask you to take part in customer surveys.
Do you wish to take part in any surveys?