Request of the data subject

REQUEST OF THE DATA SUBJECT

 

Identification of the data subject

Name and surname: __________________________________________________________

Residence: __________________________________________________________

Email address: __________________________________________________________

 

 

Subject of the request – I want to execute (please mark the chosen requests by cross)

 

1. Right of access  

 

 I would like to know types of personal data, which you process for purpose of:

• fulfilment of contract
• direct marketing
• sending commercial communication
• other: _______________________________________________________________

 

 I would like to know all personal data, which concerns me and which you process but I do not want to receive a copy of these personal data.

 

 I would like to know all personal data, which concerns me and which you process and furthermore I request copy of these personal data stored for purpose of (mark):

• user identification
• marketing
• other:___________________________________________________________________

 

1. Right to rectification 

 

 I would like to rectify following personal data: ______________________________________

Current value of the data is: ___________________________________________________

 

 I would like to add following personal data: _________________________________________

1. Right to erasure 

 

 I would like my following personal data not to be process any further:

 

_________________________________________ (which personal data shall be affected by eradication) and erase them from yours systems. I understand that this request cannot be fulfilled if the storage of personal data is an obligation arising from law or is based on controller’s legitimate interest.

 

1. Right to limitation of processing

 

 I would like to limit following processing: ___________________________________________ (description of processing, which you would like to limit) of my following personal data

_________________________________________ (which personal data shall the limitation concern).

 

1. Right to data portability

 

 I want transfer following/all personal data, which you process in relation to me: _______________________________________________________________________________

The personal data will be provided as data record in csv., doc. or .pdf format.

 

Personal data:

 

 send to e-mail address, which I used during registration

 send to e-mail address, which is listed on the last page of this request

 send to following e-mail address:____ ______________________

 transmit by other way (fill in): __________________________________

 

 

1. Right to object to processing

 

 I object to following processing of my following personal data: ____________________ ______________________________________________________________________________

 

Note (specification of your request): ________________________________________________

 

Request reason

If you are requesting an execution of right to erasure, right to limitation of processing or right to object to processing, please state a brief justification of your request. If no justification is presented, your request is most likely deemed to be denied.

 

 

Address for notification about the request decision

All requested information please provide to

 e-mail address, which I used during registration

 following e-mail address:

____________________________@__________________________

 

 

 

In _______________ on _______________

 

 

 

_________________________________

Signature of requester