Data Subject Application Form
GENERAL EXPLANATIONS
Personal Data Subjects defined as the data subject in the Personal Data Protection Law No. 6698 (“PDP Law”) have been granted the following rights;
Getting detailed information about your rights for the protection of your personal data,
to learn whether his/her personal data are processed or not,
• to demand for information as to if your personal data have been processed,
• to learn the purpose of the processing of your personal data and whether these personal data are used in compliance with the purpose,
• to know the third parties to whom your personal data are transferred in country or abroad,
• to request the rectification of the incomplete or inaccurate data, if any,
• to request the erasure or destruction of your personal data under the conditions referred to in the law,
• to object to the occurrence of a result against the person himself/herself by analyzing the data processed solely through automated systems,
• to claim compensation for the damage arising from the unlawful processing of your personal data.
Pursuant to the first paragraph of the 13th article of the PDP Law, the applications to be made regarding these rights to the Özel Yaşam Diyaliz Merkezi (hereinafter referred to as the "Dialysis Center"), which is the data controller, shall be submitted in writing via this Personal Data Subject Application Form or the Personal Data Protection Board.
APPLICATION METHOD
In this context, applications to be made to our center in “written” form, may be forwarded, by printing out this form;
with the personal application of the Applicant,
through a notary.
Below, information regarding how written applications will be delivered to us, specific to the written application channels, is given. You can submit your requests within the scope of your rights listed in Article 11 of the Law on the Protection of Personal Data No. 6698 (“Law”) to our institution with this form, using one of the methods described below, in accordance with Article 13 of the Law and Article 5 of the Communiqué on Application Procedures and Principles to Data Controllers.
Applications can be made in writing or electronically, using the methods listed below, after filling out the 'Data Subject Application Form' of ÖZEL YAŞAM DİYALİZ at the address 'www.yasamdiyaliz.com.tr'.
In case of a written request;
You can submit a original signed copy of the Data Subject Application Form to the ÖZEL YAŞAM DİYALİZ MERKEZİ in person with a document identifying your identity, or by proxy with a notarized power of attorney, which indicates that you are authorized to apply for the rights listed under Article 11, or you can submit it via a notary public on the website or you can send it to the relevant address specified in the application form. Apart from this, you can make a written application personal with wet signature.
Note: A request for information will be written on the envelope/notification within the scope of the Law on the Protection of Personal Data.
This application form has been prepared in order to determine your relationship with our institution, to fully determine your personal data, if any, and to respond to your relevant application in a full, correct and legal time. In the event that the information regarding your requests you submit within the scope of the form is not correct and up-to-date or an unauthorized application is made, our institution does not accept any liability for such false information or requests arising from unauthorized applications.
YOUR IDENTITY AND CONTACT INFORMATION
Please fill in the fields below so that we can contact you and verify your identity. (If you are applying on behalf of someone else, please send the documents showing that you are authorized to apply (such as a document showing that you are the parent/guardian of the personal Data Subject, power of attorney) in the annex of the application.
SUBJECT OF REQUEST
Please write your request regarding your personal data clearly below. Information and documents related to the subject should be attached to the application.
Choose the Method of Notifying You of the Answer;
I want it sent to my postal address.
I want it sent to my e-mail address.
I want it sent to my fax number.
In line with the requests I have stated above, I request that my application made to your Institution be evaluated in accordance with Article 13 of the Law and I would like to be informed.
I declare and undertake that the information and documents I have provided to you in this application are correct and up-to-date and I have been informed that your Institution may request additional information in order to finalize my application, and that I may have to pay the fee determined by the Personal Data Protection Board if it requires additional costs.