Data Subject Rights

Version: 1.0 Effective Date: ..............

This form allows individuals ("Data Subjects") to exercise their privacy rights regarding personal data processed by:

Company Name: .............. Address: .............. Email: .............. Data Protection Officer (DPO): ..............

Please complete this form and submit it to:

Email: .............. Postal Address: ..............

SECTION 1: APPLICANT INFORMATION

Full Name:

Email Address:

Phone Number:

Postal Address:

Country:

Relationship to the Organisation:

• □Customer

• □Employee

• □Former Employee

• □Vendor

• □Partner

• □Website User

• □Mobile App User

• □Other

Please Specify:

SECTION 2: IDENTITY VERIFICATION

To protect personal information, we must verify your identity before processing requests.

Documentation Provided:

• □National ID

• □Passport

• □Driver's License

• □Company Identification Card

• □Other

Specify:

Reference Number:

NOTE:

Identity documents shall only be used for verification purposes and shall be securely deleted when no longer required.

SECTION 3: TYPE OF REQUEST

Please select the right you wish to exercise.

• □Right of Access

Request a copy of personal information held about you.

• □Right to Rectification

Request correction of inaccurate or incomplete personal information.

Details:

• □Right to Erasure ("Right to be Forgotten")

Request deletion of personal data.

Reason:

• □Right to Restrict Processing

Request limitation of processing.

Reason:

• □Right to Object

Object to certain processing activities.

Reason:

• □Right to Withdraw Consent

Withdraw previously provided consent.

Please specify:

• □Right to Data Portability

Request personal data in a structured, commonly used, machine-readable format.

Preferred Format:

• □CSV

• □Excel

• □JSON

• □PDF

• □Other

Specify:

• □Right Not To Be Subject To Automated Decision-Making

Request review of automated decisions affecting you.

Provide Details:

• □Request Information About Data Sharing

Request information regarding third parties with whom personal data has been shared.

• □Other Request

Please Describe:

SECTION 4: DESCRIPTION OF REQUEST

Please provide sufficient details to help us identify the information requested.

SECTION 5: RELEVANT IDENTIFIERS

Please provide any identifiers that may assist in locating your information.

Customer Number:

Account ID:

Username:

Email Used in Platform:

Phone Number Used:

Other Identifiers:

SECTION 6: PREFERRED RESPONSE METHOD

• □Email

• □Secure Portal

• □Postal Mail

• □In-Person Collection

• □Other

SECTION 7: AUTHORISED REPRESENTATIVE

If making this request on behalf of another individual:

Representative Name:

Relationship:

Organisation:

Phone:

Email:

Authority Documentation Attached:

• □Power of Attorney

• □Written Authority

• □Court Order

• □Other

SECTION 8: DECLARATION

I confirm that:

• The information provided in this form is accurate.
• I am the data subject identified above or am authorised to act on their behalf.
• I understand that additional verification may be required before this request is fulfilled.

Signature:

Date:

FOR INTERNAL USE ONLY

Request Reference No:

Date Received:

Identity Verification Status:

• □Verified

• □Additional Information Required

• □Rejected

Reason:

Rights Requested:

Assigned To:

Target Completion Date:

Response Date:

Outcome:

• □Fulfilled

• □Partially Fulfilled

• □Rejected

Reason:

Approved By:

DATA SUBJECT RIGHTS INFORMATION

The Company will respond to verified requests within:

.............. days

unless a lawful extension applies.

Requests may be refused where:

• Identity cannot be verified.
• The request is manifestly unfounded.
• The request is excessive.
• Applicable law permits refusal.
• Compliance would adversely affect the rights of others.

Where a request is refused, reasons will be provided unless prohibited by law.

For privacy concerns contact:

Data Protection Officer:

....................................

Email:

....................................

Telephone:

....................................