Data Access Request Form

1.

2.

3.

4. Are you requesting the correction, amendment or modification of personal data? YesNo

Are you requesting the deletion of personal data? YesNo

Are you requesting a copy of personal data held by ? YesNo

Are you requesting restriction of processing of personal data? YesNo

Are you requesting the portability of personal data? YesNo

5. To help us search for the information you require, please let us know the data you require with as much detail as possible (e.g. copies of emails between ____________(date) and _____________(date). If we do not receive sufficient information to locate the data you require, we may be unable to comply with your request.

6. Is the information going to be sent to the data subject or his/her representative?
To the data subjectTo the representative

7.I confirm that I am the Data Subject.

Please attach a copy of your ID and address proof documents:

8. I hereby give my authorization for _________ (fill out the name of the authorized representative) to request access to my personal data.

9. Name of authorized representative and address where personal data is to be sent:

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