Data subject request form

Your information*

Details of the person requesting the information or action

2a. Are you the Data Subject?* (check box that applies)

I am the Data SubjectI am making request on another’s behalf as an authorized agent and I have their permission to do so

Rights request* (check box that applies)

Which right do you conform to exercise?

Right to confirmRight to withdrawal consent (where consent was the basis for processing)Right to request accessRight to restrict processingRight to data portabilityRight to request deletionRight to request correctionRight to appealRight to object

Description of request*

Certification*

I declare that the information given by me is correct to the best of my knowledge, and that I am entitled to make the request identified above under the laws applicable to me.