Personal Data Owner Application Form

NASMED PRIVATE HEALTH SERVICES TRADE INC.

PRIVATE EGEPOL HOSPITALS GROUP

PERSONAL DATA OWNER APPLICATION FORM

In accordance with Article 11 of the Law on the Protection of Personal Data No. 6698 (“KVKK”) and Section III of the European Union General Data Protection Regulation (“GDPR”), you can submit your application to our company by one of the methods explained below with this form.

Applications submitted to us will be answered within thirty days from the date your request reaches us, as required by Article 13(2) of the Law. Our responses will be delivered to you in writing or electronically as stipulated by Article 13 of the Law.

Your Identity and Contact Information

Please fill in the fields below so we can contact you and verify your identity.

Please indicate your relationship with our company (customer, business partner, job applicant, former employee, third-party company employee, shareholder, etc.)

☐ Customer ☐ Business Partner
☐ Visitor    ☐ Other: ……………………………..

The unit you are in contact with within our company: …………………………

Subject: ……………………………………..

☐ I am a former employee          ☐ I applied for a job / Shared my CV
Years Worked: ………………    Date: ………………

☐ Other:                                      ☐ I am an employee of a third-party company
……………………………….     Please specify the company and position you work in: ……………………………….

Please specify your request in detail under the Law:

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Please select the method by which you would like to be notified of our response to your application:

☐ I want it sent to my address.

☐ I want it sent to my email address.

(If you choose the email method, we will be able to respond to you more quickly.)

☐ I want to receive it in person.

(If collected by proxy, a notarized power of attorney or authorization document is required.)

This application form has been prepared to determine your relationship with our company, to identify your personal data processed by our company completely, and to respond to your related application accurately and within the legal period. To eliminate legal risks that may arise from unlawful and unfair data sharing and to ensure the security of your personal data, our company reserves the right to request additional documents and information (copy of identity card or driver’s license, etc.) for identity and authority verification. If the information regarding your requests submitted within the scope of this form is not correct or up-to-date, or an unauthorized application is made, our company does not accept any responsibility for such incorrect information or unauthorized application.

Applicant (Personal Data Owner) Name-Surname:

Application Date:

Signature: