Application Form for the Protection and Processing of Personal Data

Dear applicant,

This application form has been prepared to determine your relationship with our workplace, to identify any personal data processed by our workplace, if any, and to provide a correct and legal response to your relevant application within the legal deadline.

To eliminate legal risks that may arise from unlawful and unjust data sharing and, especially, to ensure the security of your personal data, our workplace reserves the right to request additional documents and information (such as identity card or driver’s license copy, etc.) for the purpose of identifying and authorizing you. Our workplace does not accept responsibility for requests arising from incorrect information or unauthorized applications.

Please follow the guidelines below and fill in the relevant fields:

A. Fill in the following information about the applicant:

  • Full Name
  • Turkish Identification Number (For foreigners, passport number or, if available, identification number)
  • Phone Number
  • Email
  • Address

B. Specify your relationship with our workplace.

☐ Employee ☐ Visitor ☐ Patient / Potential patient ☐ Employee candidate ☐ Other:

………………………………………………

C. Specify your application request.

Request No Request Subject Your Choice

I want to know if my personal data is being processed by your workplace. [PDPA Article 11/1 (a)] ☐

If my personal data has been processed by your workplace, I request information regarding this. [PDPA Article 11/1 (b)] ☐

I want to know the purpose of processing my personal data and whether it is being used for that purpose. [PDPA Article 11/1 (c)] ☐

If my personal data is being transferred to third parties, either domestically or abroad, I want to know who these third parties are. [PDPA Article 11/1 (ç)] ☐

I believe my personal data has been processed incorrectly or incompletely, and I request correction. Please submit a petition specifying the personal data you want to be corrected and provide supporting documents with accurate and complementary information (such as a copy of your ID card, proof of residence, etc.). [PDPA Article 11/1 (d)] ☐

I believe that the reasons requiring the processing of my personal data have ceased to exist, and within this framework, I request: a) Deletion of my personal data. b) Anonymization of my personal data. [PDPA Article 11/1(e)] ☐

I want the procedures performed in accordance with the correction request (Request No 5) to be notified to third parties to whom my personal data has been transferred. [PDPA Article 11/1 (f)] ☐

I want the procedures performed in accordance with the deletion or destruction request (Request No 6) to be notified to third parties to whom my personal data has been transferred. [PDPA Article 11/1 (f)] ☐

I believe that my personal data has resulted in an adverse outcome against me through the analysis exclusively by automatic systems. I object to this outcome.

Please submit a petition regarding the analysis result you believe is against you and provide supporting documents. [PDPA Article 11/1 (g)] ☐

I have suffered damage due to the unlawful processing of my personal data. I request compensation for this damage.

Please submit additional documents related to the matter subject to illegality. (Court decision, Board decision, documents showing the amount of material damage, etc.) [PDPA Article 11/1 (ğ)] ☐

Please provide any additional comments if you have any.

D. Choose the method of notifying the response to your application. ☐ I want it to be sent to my address. ☐ I want to receive it in person from the data controller. (In case of receiving it on behalf of someone else, a notarized power of attorney or authorization document must be presented.) ☐ I want a response sent to my email address.

E. Applicant Declaration Based on the information, documents, and requests I have provided in the application form, I request that information be provided to me by evaluating my application to the data controller in accordance with the provisions of the Law and the Application Communiqué. In this context, I declare and undertake that the information and documents I have provided to you with this application are accurate and up-to-date, that your workplace may process my personal data to conclude my application, may request additional information and/or documents, and that I may be required to pay a fee determined by the Personal Data Protection Board if additional costs arise.

Applicant’s Full Name :

Application Date :

Signature :