Personal Data Subject Application Form

EFC HEALTH SERVICES TRADE INC.

PERSONAL DATA SUBJECT APPLICATION FORM

PERSONAL DATA OWNER APPLICATION FORM

Pursuant to Article 11 of the Personal Data Protection Law No. 6698 (“KVKK”) and the rights specified in Chapter III of the European Union General Data Protection Regulation (“GDPR”), you may submit your application to our company by one of the methods explained below using this form.

Method	Contact Information	Description
By Hand Delivery	Tevfikbey Mah. 2321 St. No:4 Küçükçekmece/ ISTANBUL	When delivering the Personal Data Application Form by hand, please bring one of the documents identifying your identity such as a driver’s license, identity card, passport, etc.
Notarized Courier	Tevfikbey Mah. 2321 St. No:4 Küçükçekmece/ ISTANBUL	In case the Personal Data Application Form is sent with notarized documents; the date on which the courier reaches our company shall be deemed as the date of receipt for processing. In this context, your courier must be sent as registered mail with return receipt.
E-mail	[email protected]	After the Personal Data Application Form is sent to us by e-mail, identity verification may be carried out by checking the systems or contacting you to confirm your identity information.

Your applications submitted to us will be answered within thirty days from the date your request reaches us, depending on the nature of the request, pursuant to paragraph 2 of Article 13 of the Law. Our responses will be delivered to you in writing or electronically in accordance with Article 13 of the relevant Law.

Your Identity and Contact Information /YOUR IDENTITY AND CONTACT INFORMATION

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

Full Name	/Name Surname

TR Identity Number, Passport Number /TR Identity No
Address for Notification /Notification Address
Mobile Phone /GSM


E-mail Address /E-mail Address

Data Controller Applied To /	Applied Data Supervisor

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

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

Department you have been in contact with within our Company:………………….…………………………………………………………

Subject: ……………………………………..…………………………………….………………………………………………………………..

☐ I am a Former Employee	☐ I Made a Job Application / Shared My Resume
Years Worked : ………………………………………….	Date : …………………………………………………………………..
☐ Other:	☐ I Am an Employee of a Third Party Company
……………………………………………………..	Please specify the company and position
	you work for
	………………………………………………………………………………

Please specify your request within the scope of the Law in detail:

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

……………………………………………………………………………………………………………………………………………………………

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

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

I would like it to be sent to my address.

I would like it to be sent to my e-mail address.

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

I would like to receive it by hand.

(In case of receipt by proxy, a notarized power of attorney or authorization document is required.)

This application form has been prepared in order to determine your relationship with our Company and, if any, to fully identify your personal data processed by our Company, and to respond to your relevant application correctly and within the legal time limit. In order to eliminate legal risks that may arise from unlawful and unfair data sharing and especially 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 identification and authorization purposes. If the information regarding your requests submitted within the scope of the form is not accurate and up-to-date or if an unauthorized application is made, our Company does not accept liability for requests arising from such incorrect information or unauthorized application.

Name and Surname of Applicant (Personal Data Subject):

Application Date:

Signature: