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Interliva Application Form

APPLICATION FORM FOR DATA SUBJECTS TO EXERCISE THEIR RIGHTS WITHIN THE FRAMEWORK OF THE LAW NO. 6698 ON THE PROTECTION OF PERSONAL DATA

Within the scope of Law No. 6698 on the Protection of Personal Data, in order for your request as a data owner to be fulfilled by the data controller, you can fill out the application form below clearly and completely and send it with wet signature to “Kartaltepe Mah. İncirli Caddesi Limon Çiçeği Sokak No. 1 Bakırköy-İstanbul” by hand, through a notary public or by registered mail with return receipt requested.

Your application will be answered within 30 days at the latest. In case of problems or deficiencies in the information and documents you submit, you will be contacted and the information and documents will be requested to be completed and forwarded to us. Until the information and documents are fully transmitted to us, the thirty (30) day period specified in Article 13/2 of the Law regarding the finalization of the request will be suspended.

In order to prevent errors and to ensure the security of your personal data, INTERLIVA has the right to request additional documents and information (copy of identity card or driver’s license or Passport etc.) for identification and authorization.

The information and documents you specify in this form are requested in order to accurately determine your relationship with us and to provide you with a complete response within the legal period.

    PERSONAL DATA OWNER'S IDENTITY INFORMATION

    Your Name and Surname

    T.C Identity No:

    Cell Phone:

    Address:

    E-mail:

    Your Relationship with Us:

    For Patient, Patient Candidate, Client:

    Last service received, activity content:

    Date:

    for Employee / Former Employee / Candidate:

    Period of employment (years)

    Year of application for candidates:

    For Business Partners

    Company name:

    Subject of cooperation:

    REQUESTS OF THE APPLICANT (Article 11 of the Law No. 6698 on the Protection of Personal Data)

    Data from INTERLIVA, which is the Data Controller pursuant to Article 11 of the Personal Data Protection Law No. 6698 below The rights you can request as the owner are specified. According to the rights you have chosen, the data controller will evaluate your request and legal will forward it to you in writing within a period of time.

    Request No

    Subject of Request (Check the Relevant Section)

    1 KVKK Md.11/1-a

    2 KVKK Md.11/1-b

    3 KVKK Md.11/1-c

    4 KVKK Md.11/1-ç

    5 KVKK Md.11/1-d

    6 KVKK Md.11/1-e

    YOUR REQUEST (You can only select one box here.)

    7 KVKK Md.11/1-f

    8 KVKK Md.11/1-f

    9 KVKK Md.11/1-g

    10 KVKK Md.11/1-ğ

    In addition to the above-mentioned requests listed in the KVKK, the following rights are available within the scope of GDPR provisions for European Union citizens or persons concerned in the GDPR application area.

    11 GDPR m.17

    12 GDPR m.18

    13 GDPR m.20

    EXPLANATION ABOUT THE REQUEST

    Please provide any additional explanation you would like to make about the request or requests you have stated above.

    ANNEXES

    ANNEXES If there is a document related to your application, please send a copy of it as an attachment to the form.

    In order to enforce the rights of the personal data owner regulated in Article 11 of the Personal Data Protection Law No. 6698 and stated above and to make an evaluation by INTERLIVA, which is the data controller within this framework, in accordance with Article 13 of the Law, you must provide us with the necessary information and documents according to the subject of your request.

    For example; As stated in request No: 5 above, in order to correct your personal data that you think is incomplete and incorrectly processed, you must provide us with documents showing the correct and complementary information of your personal data (copy of identity card, copy of passport, certificate of residence, etc.).

    DECLARATION OF THE APPLICANT (Article 13 of the Law on the Protection of Personal Data)

    I request that this application I have made to INTERLIVA in the capacity of Data Controller be evaluated in accordance with Article 13 of the Personal Data Protection Law No. 6698 and that I be informed. I request that the reply be sent to my postal address specified on the first page of the form.

    This total "Application Form for Data Subjects to Exercise Their Rights" consists of 4 pages in total.

    The relevant person making the application (Personal Data Owner)

    Name and Surname:

    Application Date:

    Signature