Listing Review Request Form

Before completing this form please ensure you have read the accompanying guidance notes. All sections marked * are essential; please complete all other sections as fully as you can. An electronic version of this form and the guidance notes may be downloaded from: 
https://www.gov.uk/how-to-challenge-our-decision-to-list-or-not-list-a-building

Sharing of Information with interested parties

Information submitted by you in this review request may be shared with other interested parties as part of the consultation process of a review and/or in response to a request for information. Such disclosure will be subject to the statutory provisions of the Freedom of Information Act 2000, the Environmental Information Regulations 2004 and those regarding the safeguarding of personal information such as Data Protection Act 2018 and General Data Protection Regulation 2018. Please see Section H below.

Section A – Key dates*

Date of the decision notification letter from Historic England

Date of this review request

Section B – Applicant information *

Name (including name of organisation representing where applicable)

Your contact address including postcode

Preferred telephone number

	Alternative telephone number
     	
E-mail address

Section C – Details of the building *

Building name as it appears on the Historic England advice report

Building address as it appears on the Historic England advice report

Historic England case reference number (not the list entry number)

Section D – Brief summary of your grounds for review *

     

	

Section E – Full, concise grounds for review *
Please refer to relevant supporting documentation where appropriate

     

	
Please continue on a separate sheet if necessary
Section F – Supporting documentation
Please list the titles of any supporting documentation submitted. You should not submit documents previously considered during the listing assessment or documents known to already be in the possession of Historic England or DCMS.

	
Please continue on a separate sheet if necessary

Section G – Substantiated threats to the building

Is the building the subject of a planning application, or the subject of existing planning permission or consent?
	Yes / No

Is the building the subject of pre-application discussions with the local authority? 		
	Yes / No / Not known

Has the owner given formal notice to the local authority of their intent to demolish?
	Yes / No 

Please give brief details of any above threats:

	

Section H - Freedom of Information Act 2000, Environmental Information Regulations 2004 & Review Consultation

The Department for Digital, Culture, Media and Sport is subject to the Freedom of Information Act 2000 (FOIA) and the Environmental Information Regulations 2004 (EIR). Both regimes require us to disclose information in certain circumstances where we receive a request to do so. Any personal information that we receive must be processed in accordance with the Data Protection Act 2018 (DPA) and General Data Protection Regulation 2018 (GDPR). More information on each of these regimes is available on the Information Commissioner’s website: http://www.ico.gov.uk/

Information provided to us by you may be published or disclosed in accordance with the access to information regimes (these are primarily the FOI, EIR and the DPA). In addition, consultation with interested third parties on the information provided by you may be necessary as part of the review process.

For the purposes of FOIA or EIR requests, and for review consultation, the information disclosed by you in this application will be presumed, in the absence of an explanation to the contrary, not to be confidential.
 
If you want the information provided by you to be treated as confidential, please explain to us why you regard it as confidential (see Section I below). If we receive a request for disclosure of the information under FOIA or EIR we will take full account of any such explanation provided by you but we cannot give an assurance that confidentiality can be maintained in all circumstances as the Department is required to act in accordance with its obligations under the FOIA, EIR and the associated Code of Practice. An automatic confidentiality disclaimer generated by your IT system will not, of itself, be regarded as binding upon the Department.
Please note that in certain circumstances, a review may not be possible without disclosure of information provided by you to interested third parties.

Data Protection Act 2018 and General Data Protection Regulation 2018
The information you provide, including personal details, and any information obtained from other sources will be retained by DCMS, in hard copy form and /or electronically. 

DCMS will process your personal data in accordance with the DPA and, in the majority of circumstances, this will mean that your personal data will not be disclosed to third parties under an FOIA or EIR request or as part of a review consultation.

You can also make a complaint to the Information Commissioner, who is an independent regulator.
Information Commissioner's Office 
Wycliffe House 
Water Lane 
Wilmslow 
Cheshire SK9 5AF
casework@ico.org.uk 
Telephone: 0303 123 1113
Textphone: 01625 545860
Monday to Friday, 9am to 4:30pm

Section I – Information regarded by you as confidential 
If you regard the information you have submitted in support of a review to be confidential please explain why below. Please remember that, in certain circumstances, a review may not be possible without disclosure of information provided by you to interested third parties.

	
Please continue on a separate sheet if necessary

Submitting your listing review request
Please submit your completed Review Request Form with any supporting evidence, preferably by e-mail, to: review.requests@DCMS.gov.uk (file attachments may not exceed 24 MB). Documents submitted by e-mail do not need to be provided in hard-copy as well.

If you do not have access to e-mail, or your documents exceed the 24MB limit, review requests may be posted to:

The Listing and Scheduling Review Team,
Department for Digital, Culture, Media & Sport,
4th Floor
100 Parliament Street
London
SW1A 2BQ