Application form

Devam Sağlık Hizmetleri Ltd.Şti.

APPLICATION FORM ACCORDING TO THE LAW ON THE PROTECTION OF PERSONAL DATA

 

Application date : …. / …. / ……

  1. Identity and Contact Information of Data Owner

Name surname

:

 

TR Identity / Passport / Identity Number

:

 

Address for service

:

 

Mobile phone

:

 

Phone number

:

 

Fax Number

:

 

E-mail address

:

 

Continue Health Services Tic.Ltd.Şti.

Your Relationship with

:

Customer:

Worker:

Other:

Your Answer

Notification Method

:

Mail:

and Mail:

Fax:

2. Subject of Request

You can write your request for personal data by using the “Request Subject” section below. Add information and documents, if any, to the Form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I declare and undertake that the information and documents I have submitted in the application are correct, that your company may request additional information and documents to finalize my application, and that if it requires a cost, I may have to pay the fee determined by the Personal Data Protection Board.

In line with the requests I have mentioned above, my application will be evaluated and I will be informed.

Please be given.

*If the personal data owner has not reached the age of 19, his/her parents or guardian, if he/she is under guardianship, his/her guardian, persons to whom the data subject has given express power of attorney can apply if they document this situation.

 

 

Applicant Relevant Person

Name Surname : Signature :

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Application Method

 

APPLICATION PATH

ADDRESS TO APPLY

TO BE SHOWED ON THE APPLICATION

INFORMATION

1. Written Application in person with wet signature or Application via Notary Public

Akcay Mahallesi Lale Caddesi No: 107/1

EDREMIT/BALIKESİR

“Personal Data Protection Law Information Request” will be written in the subject part of the application.

 

2. Via Registered Electronic Mail (KEP)

 

devamsaglik@hs03.kep.tr

“Personal Data Protection Law Information Request” will be written in the subject part of the e-mail.

  

3. Application with the E-Mail Address Found in Our System

 

korfezidariisler@devadis.com

“Personal Data Protection Law Information Request” will be written in the subject part of the e-mail.

  
     

 

 

Demand

 

  1. Find out if your company processes personal data about me
  2. If Devam Sağlık Hizmetleri Ltd.Şti. if it processes personal data about me, about these data processing activities

I’m requesting information.

  1. If Devam Sağlık Hizmetleri Ltd.Şti. If personal data is processed about me, I would like to learn the purpose of processing them and whether they are used for this purpose.
  2. If my personal data is transferred to third parties at home or abroad, knowing these third parties

I want.

  1. I think that my personal data is incomplete or incorrectly processed and I need to correct them.
  2. Although my personal data has been processed in accordance with the provisions of the law and other relevant laws, I think that the reasons for its processing have disappeared and within this framework, I request the deletion or destruction of my personal data.
  3. Correction of my personal data, which I think is incomplete or incorrectly processed, by third parties to whom it is transferred.
  4. Kişisel verilerimin kanun ve ilgili diğer kanun hükümlerine uygun olarak işlenmiş olmasına rağmen, işlenmesini gerektiren sebeplerin ortadan kalktığını düşünüyorum ve bu çerçevede kişisel verilerimin üçüncü kişiler nezdinde de silinmesinin veya yok edilmesinin bildirilmesini talep
  5. Devam Sağlık Hizmetleri Ltd.Şti. tarafından işlenen kişisel verilerimin münhasıran otomatik sistemler vasıtasıyla analiz edildiğini ve bu analiz neticesinde Şahsım aleyhine bir sonuç doğduğunu düşünüyorum. Bu sonuca itiraz ediyorum.
  6. Kişisel verilerimin Kanuna aykırı işlenmesi nedeniyle zarara uğradım. Bu zararın tazminini talep

ediyorum.

Doldurmuş olduğunuz bu başvuru formu, Devam Sağlık Hizmetleri Tic.Ltd.Şti. ile olan ilişkinizi tespit ederek, varsa, Şirketimiz tarafından işlenen kişisel verilerinizle ilgili olarak eksiksiz ve isabetli olarak ilgili başvurunuza doğru ve kanuni süresi içerisinde cevap verilebilmesi için düzenlenmiştir. Hukuka aykırı ve haksız bir şekilde veri paylaşımından kaynaklanabilecek hukuki risklerin bertaraf edilmesi ve özellikle kişisel verilerinizin güvenliğinin sağlanması amacıyla, kimlik ve yetki tespiti için Devam Sağlık Hizmetleri Tic.Ltd.Şti.

reserves the right to request additional documents and information (such as a copy of an identity card or driver’s license). In the event that the information regarding your requests you have submitted within the scope of the form is not correct and up-to-date, or an unauthorized application is made, our Company does not accept any responsibility for such false information or requests arising from unauthorized applications, or for any failures that may occur during the delivery of our answers to the addresses you have specified.

Devam Sağlık Hizmetleri Tic.Ltd.Şti. will be filled by

History: …. / …. / ………

Recipient’s Name and Surname: ……………………………………… …………………

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