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Data Privacy Request Form | PDF | Career & Growth
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Data Privacy Request Form

This document is a data privacy request form for Delos Santos Medical Center. It requests the individual's name, address, contact information, and relationship to the organization. The individual must select the type of data privacy request, such as accessing, updating, deleting personal data. The individual consents to the organization using their data to process the request according to the organization's data privacy policy. The organization may require identity verification before fulfilling the request.

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355 views1 page

Data Privacy Request Form

This document is a data privacy request form for Delos Santos Medical Center. It requests the individual's name, address, contact information, and relationship to the organization. The individual must select the type of data privacy request, such as accessing, updating, deleting personal data. The individual consents to the organization using their data to process the request according to the organization's data privacy policy. The organization may require identity verification before fulfilling the request.

Uploaded by

qwertyuiopkmrr
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DATA PRIVACY REQUEST FORM

Important: Proof of Identity must accompany this Request Form and in proper cases,
letter of authorization signed by the ward or absentee if there’s any.

Full Name* Date requested*

Address

Contact number * Email address*

Put on the box which applies to you:


Customer/Client Employee Former Employee Intern Business
    Partner

Supplier Job Applicant Representative/Guardian Other/s 
   Please specify:____________

Type of Query

 Access to personal data


 Update or correction of personal data
 Request export of personal data
 Restrict or object to the use of personal data
 Delete personal data
 Question about Privacy Management Program
 Withdraw consent in processing personal data

Please specify request here:

__________________________________________________________________
________________________________________________________________________
________________________________________________________________________

I hereby agree that Delos Santos Medical Center can use my data for the purpose of dealing with
my request, in accordance with the Data Privacy Policy of Delos Santos Medical Center, I
understand that Delos Santos Medical Center may require me to verify/validate my identity before
fulfilling the request.

___________________________
Data Subject

Action Taken:

__________________________________________________________________
________________________________________________________________________

Date Accomplished: ___________


Name and Signature of processor: __________________

Should you have questions or concerns regarding this, you may contact our Data Protection
Officer via email at privacy@dlsmc.ph or you may call us at +63 889-DLSMC (35762) ext.
8828.

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