General
You may submit your requests within the scope of your rights specified under Article 11 of the Personal Data Protection Law No. 6698 (the “Law”) to our Company using this form through one of the methods described below, in accordance with Article 13 of the Law and Article 5 of the Communiqué on the Procedures and Principles of Application to the Data Controller.
Application Method:
You, as data owners, in accordance with Articles 11 and 13 of the KVKK, can submit your requests regarding the implementation of the KVKK to our Institution, which is the data controller, by:
In person by filling out this Application Form in writing and personally delivering it to “Halaskargazi Mah. Halaskargazi Cad. Lotus Plaza, No: 38-66 İç Kapı No: 119 Şişli / İSTANBUL”, or by mail to the registered electronic mail (KEP) address [email protected]
with a secure electronic or mobile signature, or to our Institution’s previously notified electronic mail address registered in our system, with the subject “Personal Data Protection Law Information Request.”
Information Related to Data Owner:
In order to conduct necessary research and evaluations regarding your application and to find solutions to the issue, you are required to fill in the fields below accurately and completely:
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Name Surname (Signature in written application)
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Turkish ID No/Passport No
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Notification Address
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E-mail/Phone/Fax No
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Subject of Request
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The personal data you provided above is processed in order to evaluate and finalize this Application Form and to contact you.
Please mark the appropriate option regarding your relationship with our Institution and indicate whether the current relationship continues as of the application date.
Patient
Business Partner Visitor Employee
Other
(My relationship with the Institution continues as of the application date.
My relationship with the Institution has ended as of the date I have specified.
Requests Of the Data Owner:
As the data owner, please specify the subject(s) you would like to be informed about within the scope of Articles 11 and 13 of the KVKK, the method of transmission of our responses to you, and additional information you would like to add, if any, reflected in the table below. The documents related to the specified subject should be attached to the Application Form.
Select the Method of Notification of Your Response
I want the response to be sent to the postal address I provided in section 2. [ ]
I want the response to be sent to the email address I provided in section 2. [ ]
For applications to be made by third parties on behalf of the data owner, a notarized power of attorney must be sent to us along with this Application Form, and for applications to be made on behalf of those under guardianship and children, copies of documents certifying the custody/guardianship relationship must be sent to us together with this Application Form.
