MEDYAPIM Personal Data Protection Law Request Form

Information

Pursuant to Article 11 of the Personal Data Protection Law No. 6698, certain rights regarding the processing of personal data have been established. Data subjects have the right to be informed about the data that is collected and processed.

Application Process	Address	Information
In-Person Application (The applicant must come in person and present a valid form of identification)	Levent, Chrysanthemum St. No. 82, 34330 Beşiktaş/Istanbul	The envelope must be marked “Request for Information Under the Personal Data Protection Act.”
Service of process through a notary public or by certified mail with return receipt	Levent, Chrysanthemum St. No. 82, 34330 Beşiktaş/Istanbul	The service envelope must be marked “Request for Information Under the Personal Data Protection Act.”
Signed with a “secure electronic signature” and sent via Registered Electronic Mail (KEP)	medyapim@hs01.kep.tr	The subject line of the email should read “Request for Information Under the Personal Data Protection Act.”

Information About the Applicant

Please enter your contact information and requests based on how you would like to be contacted:

First Name, Last Name:
Turkish ID Number:
Email:
Contact Phone Number (optional):
Address (optional):
Please indicate your relationship with our organization:	Employee, Job Applicant, Family Member, Intern, Parent / Guardian / Representative, Supplier Employee, Supplier Representative, Freelancer, Project Employee, Visitor, Product or Service Recipient, Potential Product or Service Recipient, Person Mentioned in the News, Overseas Supplier Representative, Overseas Supplier Employee, Contestant
Applicant’s Requests: Please specify your request in detail in accordance with the Personal Data Protection Law.
Method of Reporting the Answer:	I would like to receive a response by mail at my address. (If you would like to receive a response by mail at your address, please enter your address information completely and accurately as requested above.) I would like to receive a response via email. (If you select the email option, we will be able to respond to you more quickly.) I would like to pick it up in person. (If the delivery is to be made by a representative, a notarized power of attorney or authorization document is required.)

This application form has been prepared to identify your relationship with our Institution and to ensure that we can provide a complete, accurate, and timely response to your request regarding any personal data processed by our Institution, if applicable. To mitigate legal risks that may arise from unlawful or unjustified data sharing, and particularly to ensure the security of your personal data, our institution reserves the right to request additional documents and information (such as a copy of your ID card or driver’s license) for the purpose of verifying your identity and authority, using one of the application methods specified in the Privacy Notice. If the information provided regarding the requests you submit through this form is inaccurate or out of date, or if an unauthorized request is made, our institution assumes no liability for any claims arising from such incorrect information or unauthorized requests.

The Relevant Individual Making the Request (Data Subject)

First Name, Last Name:		Application Deadline:
Signature: