Go Back

PERSONAL DATA OWNER APPLICATION FORM

Within the Scope of Personal Data Protection Law No. 6698

DATA CONTROLLER INFORMATION

Company Name: ClinicCRM Software and Technology Inc.
Address: Levent Mahallesi, Büyükdere Caddesi, No:123, 34394 Şişli/İstanbul
Email: kvkk@cliniccrm.net
Phone: 0850 123 45 67

1. APPLICANT INFORMATION

2. YOUR RELATIONSHIP WITH OUR COMPANY

Customer
Potential Customer
Business Partner
Job Candidate
Former Employee
Visitor
Supplier Representative
Other

3. REQUEST SUBJECT (KVKK Article 11)

Please check the right(s) you wish to exercise:

a) I want to know whether my personal data is being processed.
b) I request information regarding my processed personal data.
c) I want to learn the purpose of processing my personal data and whether they are used in accordance with their purpose.
d) I want to know the third parties to whom my personal data is transferred domestically or abroad.
e) I request correction of my personal data if it has been processed incompletely or incorrectly.
f) I request deletion/destruction of my personal data within the framework of conditions stipulated in Article 7 of KVKK.
g) I request notification of operations under paragraphs (e) and (f) to third parties to whom my personal data has been transferred.
h) I object to a result that occurs against me by analysis of my processed data exclusively through automated systems.
i) I demand compensation for damage I suffered due to unlawful processing of my personal data.

4. REQUEST DETAILS

Please explain your request in detail:

5. RESPONSE METHOD

I want it to be sent to my address by mail.
I want it to be sent to my email address.
I want to pick it up in person.

6. ATTACHMENTS

Please specify the documents attached to your application:

* A copy of ID is required.

DECLARATION

In accordance with the requests I have stated above, I kindly request that my application to the company be evaluated pursuant to Article 13 of the Personal Data Protection Law No. 6698 and that I be informed.

I declare and undertake that the information and documents I have provided in this application form are accurate and up-to-date, and that I will provide additional information and documents that the company may request.

Not: Note: This form has been prepared for use in applications to the data controller within the scope of the Personal Data Protection Law No. 6698. Your application will be concluded as soon as possible and within 30 days at the latest, depending on the nature of the request.

How to Download?

  1. Click the "Print / Save as PDF" button
  2. In the window that opens, select "Save as PDF" as the destination
  3. Click Save to download the form as PDF
  4. Fill out and sign the downloaded form
  5. Send via the specified channels along with a copy of your ID