GDPR Data Request Form
GDPR entitles individuals rights under the law. One of which is the right to have one's personal information erased from our records. In this regard, we will do our best to provide you with prompt service from receiving this request together with the relevant information in order for us to properly match the information and process the request as soon as possible. Rest assured that the information that you shall supply here will be used for the purpose of identification of the data subject only.
Name of Data Subject
First Name
Last Name
Address of Data Subject
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address of Data Subject
example@example.com
Date of Birth of Data Subject
-
Month
-
Day
Year
Date
Are you the Data Subject?
Yes
No, I am submitting the request on behalf of the data subject
Take your Photo
Upload Your Valid Government Issued Identification
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a Photo of the Authorization Letter of the Data Subject
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Drag and drop files here
Choose a file
Cancel
of
Upload the Valid Government Issued Identification of the Data subject
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Given the sensitive nature of this action, we will need some information in order for the processing of the request can be done. We would like to hear from you the reason why you or your principal wishes for the data to be erased.
Please indicate the reason for the request
The information is no longer necessary from which it was collected.
No longer consenting to the processing of data
Objection to the processing of data in accordance with Article 21 of the GDPR
Did not give consent to the processing of personal data
You are, or the data subject is a minor
Other
Information Erasure
I would like to erase all my information
I would like to erase only a specific information
Which information would you like to erase from our records
First Name
Last Name
Address
Email
Other
I confirm that I have the full capacity and authority to exercise this request and I am aware of the implications of such such as being unable to be provided better services. I understand the necessit for me to confirm my identity or the data subject's identity in order to obtain and process the necessary information as I have requested.
Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: