Form CISIC - Information Security or Cybersecurity Incident Reporting Form

Data Processor:

Dual Borgstena Trim Czech Republic s.r.o., with registered office at F. Cejky 427, 73801, Frýdek, Místek, CZECH REPUBLIC, taxpayer no. CZ29446457.

Legal basis:

Compliance with the duties to implement technical and organizational information security and cybersecurity measures, as well as the duties to manage security incidents or data breaches,contained in the legal regimes of the General Data Protection Regulation, the Cyberspace Security Legal Regime and other applicable rules in the field of Information Security.

Incident reporting:

The protection and security of the data processed at Dual Borgstena Trim Czech Republic is a priority for this organization.
To this end, and in order to be able to react quickly and effectively to any occurrence indicating a possible information security or cybersecurity incident, we have implemented an internal incident management system, and this form is an important tool for communication/information from the outside.

The Data Protection Officer of Dual Borgstena Trim Czech Republic is the internal person responsible for the incident management process with regard to personal data, and can be contacted directly via email at dataprotection@borgstena.com.
The Dual Security Manager of Dual Borgstena Trim Czech Republic is responsible for the internal incident management process in terms of information security and cybersecurity and can be contacted directly via email cyber.security@borgstena.com.
In these terms, we request and appreciate that, if you detect, become aware of, or have indications, by any means, of the practice of any facts or of any anomalous occurrence, which has or may have a negative impact on the security of the data processed by Dual Borgstena Trim Czech Republic, you inform us immediately by filling out this form.
Once completed, this form should be addressed to the Security Manager of [Entidade], using one of the following communication channels:

a) e-mail: cyber.security@borgstena.com (if you choose this method of contact, please write "CISIC Form" in the "Subject" field).

b) by post: F. Cejky 427, 73801, Frýdek, Místek, CZECH REPUBLIC (if you choose this method of contact, you must send this form by registered mail, so that the date of receipt can be verified).

c) delivery in person: F. Cejky 427, 73801, Frýdek, Místek, CZECH REPUBLIC (if you choose this method of contact, please be accompanied by an identification document).

Description of the anomalous/suspicious facts*

Describe the anomalous/suspected facts as fully as possible, by indicating/characterizing the types of personal data affected, the categories of data subjects affected, the damage recorded and the person/s responsible (or suspected) for the facts described. Every detail can be important.

Indicate when you became aware of the anomalous/suspicious facts described above:

Date*

IIndicate when you became aware of the facts.

Time

Indicate when you became aware of the facts.

If you do not know when the anomalous/suspicious events previously described occurred, indicate:

Don't know.

Awareness of anomalous/suspicious facts*

Describe as fully as possible all the circumstances relating to your knowledge of the facts described above. Every detail can be important.

Indicate when you became aware of the anomalous/suspicious facts described above:

Date*

Indicate when you became aware of the facts.

Time

Indicate when you became aware of the facts.

Other information/observations

We would like to thank you for the information you have provided through this form, which willbe dealt with by the Safety Officer of Dual Borgstena Trim Czech Republic with the utmost attention and speed.

If you have any questions about this form, please contact us using the contact details you prefer.

The Security Officer, within the limits of the law, will keep your identity confidential, and theprocessing of your data will be carried out exclusively for the purposes of managing security or cybersecurity incidents, under the terms of the Data Protection Policy accessible at www.borgstena.com and will respond, in conjunction with the Data Protection Officer, to any request to exercise dataprotection rights received through any of the aforementioned communication channels.

The Participant (optional):

Name

Time

Citizen card no.

Valid until

Landline

Cell phone

Email

example@example.com

Information Security or CybersecurityIncident Reporting Form