PERSONAL DATA PROTECTION APPLICATION FORM

Personal Data Protection Application Form

PERSONAL DATA PROTECTION LAW NO. 6698 (PDPL)

PERSONAL DATA ACCESS/INFORMATION REQUEST FORM

Please fill in the application form below clearly and completely and with a wet signature in order to fulfill the requests to be made within the scope of the Personal Data Protection Law (“KVK Law”),

On behalf of BARAN KUL; By mail to the address “Bahçelievler Mahallesi D-100 Yanyol Sokak No 14/809 Bahçelievler/Istanbul”,

Application should be made by sending an e-mail to baran.kul@hs01.kep.tr via mobile signature/secure electronic signature.

Detailed information about the application processes can be obtained by sending an e-mail to barankul.muhasebe@gmail.com.

 

The application will be answered as soon as possible and within 30 days at the latest. If the information and documents you have submitted to us are incomplete or illegible, you will be contacted to clarify your application. As a result of the clarification of the application, the 30-day process, which is the response time to the request, will begin.

 

 

1. IDENTITY AND CONTACT INFORMATION OF THE PERSONAL DATA SUBJECT

Name and surname:

T.R. Identification number:

Phone number:

Address:

Email Address:

Your Relationship with the Clinic:

Employee, employee candidate, ex-employee, intern, third-party company employee, Patient, Patient Relatives, business partner)

 

2. INFORMATION ON CHOOSING THE RIGHT TO BE USED BY THE PERSONAL DATA OWNER

(Please tick the box(s) next to the expression appropriate to your request) I would like to learn whether the Klinik processes personal data about me.

If the Clinic processes personal data about me, I request information about these data processing activities.

If the Clinic processes personal data about me, I would like to learn about the purpose of processing and whether they are used in accordance with the purpose of processing.

If my personal data is transferred to third parties at home and abroad, I would like to know the purpose of the transfer and the third parties.

I think that my personal data is incomplete or incorrectly processed and I would like them to be corrected.

Although my personal data has been processed in accordance with the law and other relevant laws, I want my personal data to be deleted.

I want my personal data that I think is incomplete and wrongly processed to be corrected by the third parties to whom it was transferred.

I want my personal data, which I requested to be deleted, to be deleted by the transferred third parties.

I believe that my personal data processed by the clinic is analyzed exclusively through automatic systems and as a result of this analysis, there is a result against me. I object to this conclusion.

3. EXPLANATION ABOUT THE REQUEST (Please specify your request under the KVK Law and the personal data subject to your request in detail.)

 

4. ATTACHMENTS

Please indicate if there is any document you want to support your application.

…………………..…………….………………………….……………………………….………………….… …………………………………………………………………………………………………. …………………………………………………………………………………………………….

5. PLEASE SELECT THE METHOD TO BE NOTIFIED OF YOUR RESPONSE TO YOUR APPLICATION

I want it sent to my address.

I want it sent to my e-mail address.

I want to receive it by hand.

6. APPLICANT'S STATEMENT

This application form has been prepared in order to provide an accurate and legal response to your application by determining your relationship with our Clinic and, if any, fully identifying your personal data processed by our Clinic. Our Clinic reserves the right to request additional documents and information (Identity card, copy of driver's license or power of attorney, etc.) for identification and authorization determination, in order to eliminate legal risks that may arise from illegal and unfair data sharing and especially to ensure the security of your personal data. In the event that the information regarding your requests you submit within the scope of the form is not correct and up-to-date, or an unauthorized application is made, our Clinic does not accept any liability for such false information or requests originating from unauthorized applications. All responsibility arising from unlawful, misleading or false applications belongs to the applicant.

Personal Data Owner / Person Applying on Behalf of Someone Else

Name and surname                       :

Application date             :

Signature:

If you are applying on behalf of someone else, please send the documents showing that you are authorized to apply (such as the parent/guardian of the personal data owner, the document showing that he/she is the legal representative of the power of attorney stating that he/she is legally authorized to receive personal health information) in the annex of the application. In order for these documents to be considered valid, they must be issued or approved by the competent authorities.