Data Subject Application Form

DETAILS OF THE APPLICANT (DATA SUBJECT) WHOSE PERSONAL DATA IS PROCESSED

REQUEST DETAILS

In line with the requests I have specified in this application form, I request that my application to your company be evaluated pursuant to Article 13 of the Personal Data Protection Law No. 6698 (KVKK) and Article 10 of the Regulation on the Processing of Personal Health Data and Ensuring Privacy, and that I be informed;

By electronic mail ☐

By post ☐ I hereby request that information be provided to me.

Name Surname :

Date :

Signature :

You may be contacted if additional information is needed in the course of evaluating your request. Please submit any information, documents or materials you wish to add as an annex to your application. Your application will be concluded free of charge within thirty (30) days at the latest, starting from the date your request reaches us, and the response will be sent to you by the method you have specified. However, should the process require an additional cost, we reserve the right to charge a fee in the amounts determined under the relevant legislation.

You may deliver the application form to us;

1. 1by printing it out, completing it with a wet signature and applying in person at our Company together with a photocopy of your identity document, or by post or through a notary public to the address ( Müftü Mah. Şehit Ömer Halisdemir Bulvarı No: 18 Ereğli ZONGULDAK),
2. 2by e-mail with the subject “KVKK Başvuru” to our registered electronic mail (KEP) address (ugursaglikhizmetleri@hs01.kep.tr),
3. 3by using the e-mail address previously notified to the data controller by the data subject and registered in the data controller's system,
4. 4or by means of software or an application developed for the purpose of making applications.