DATA SUBJECT ACCESS REQUEST (DSAR) FORM

Pursuant to the General Data Protection Regulation (GDPR)

INTRODUCTION

This form enables you to exercise your rights under the General Data Protection Regulation (GDPR). Please complete the relevant sections and submit to our Data Protection team.

Organization: [COMPANY NAME]
Data Protection Contact: [EMAIL]
Address: [ADDRESS]

Response Timeline: We will respond to your request within one month. Complex or multiple requests may require an extension of up to two additional months, in which case we will inform you within one month.

SECTION A: YOUR INFORMATION

A.1 Personal Details

A.2 Identification

To protect your personal data, we must verify your identity. Please provide:

☐ Government-issued photo ID (passport, driver's license, national ID card)

☐ Proof of address dated within the last 3 months (utility bill, bank statement)

Important: We may request additional verification if necessary.

A.3 Relationship with Our Organization

How have you interacted with our organization?

☐ Customer/Client

☐ Employee (current or former)

☐ Website user

☐ Subscriber/Member

☐ Contractor/Supplier

☐ Job applicant

☐ Other (please specify): _________________________________

Account number or reference (if known): _________________________________

SECTION B: YOUR REQUEST

B.1 Right of Access (Article 15)

☐ I request confirmation of whether you process my personal data

☐ I request access to my personal data

Please provide specific details about the information you are seeking:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Pursuant to Article 15(1), I request the following information:

☐ The purposes of the processing

☐ The categories of personal data concerned

☐ The recipients or categories of recipients to whom the data has been disclosed

☐ The envisaged period for which the data will be stored (or criteria used to determine that period)

☐ Information about my rights (rectification, erasure, restriction, objection)

☐ The right to lodge a complaint with a supervisory authority

☐ Where data was not collected from me, available information on its source

☐ The existence of automated decision-making, including profiling, and meaningful information about the logic involved

☐ If transferred to a third country, information about the appropriate safeguards

B.2 Right to Rectification (Article 16)

☐ I request correction of inaccurate personal data

Please specify the data that is inaccurate and the correct information:

☐ I request completion of incomplete personal data

Please specify the incomplete data and the information to be added:

_____________________________________________________________________________
_____________________________________________________________________________

B.3 Right to Erasure (Article 17)

☐ I request deletion of my personal data

Please indicate the grounds for your request (select all that apply):

☐ The personal data is no longer necessary for the purpose for which it was collected

☐ I wish to withdraw my consent (and there is no other legal basis for processing)

☐ I object to the processing and there are no overriding legitimate grounds

☐ The personal data has been unlawfully processed

☐ The personal data must be erased to comply with a legal obligation

☐ The personal data was collected in relation to the offer of information society services to a child

Please specify the data you want deleted (if applicable):

_____________________________________________________________________________
_____________________________________________________________________________

B.4 Right to Restriction of Processing (Article 18)

☐ I request restriction of processing of my personal data

Please indicate the grounds for your request:

☐ I contest the accuracy of the personal data (restriction for the period enabling verification)

☐ The processing is unlawful, but I oppose erasure and request restriction instead

☐ You no longer need the personal data, but I need it for legal claims

☐ I have objected to processing (pending verification of whether your legitimate grounds override mine)

Please specify the data for which you request restriction:

_____________________________________________________________________________
_____________________________________________________________________________

B.5 Right to Data Portability (Article 20)

☐ I request a copy of my personal data in a portable, machine-readable format

☐ I request that you transmit my personal data directly to another controller

If transmitting to another controller, please provide:

Controller Name: _________________________________

Controller Contact: _________________________________

Note: This right applies only where processing is based on consent or contract AND is carried out by automated means.

B.6 Right to Object (Article 21)

☐ I object to processing of my personal data

Please indicate the basis for your objection:

☐ Processing based on legitimate interests (Article 6(1)(f)) - Please specify your grounds:

_____________________________________________________________________________

☐ Processing for direct marketing purposes (absolute right - no grounds required)

☐ Processing for scientific/historical research or statistical purposes (specify grounds related to your particular situation):

_____________________________________________________________________________

B.7 Right Regarding Automated Decision-Making (Article 22)

☐ I request information about automated decision-making and/or profiling

☐ I request human intervention in an automated decision

☐ I wish to express my point of view regarding an automated decision

☐ I wish to contest an automated decision

Please describe the automated decision you are concerned about:

_____________________________________________________________________________
_____________________________________________________________________________

SECTION C: ADDITIONAL INFORMATION

C.1 Time Period

If your request relates to a specific time period, please specify:

From: _____________ To: _____________

☐ All time periods

C.2 Specific Systems or Departments

If your request relates to specific systems, services, or departments, please specify:

_____________________________________________________________________________

C.3 Format Preference (for Access/Portability Requests)

Preferred format for receiving information:

☐ Electronic (PDF/email)

☐ Paper (postal mail)

☐ Machine-readable format (CSV, JSON, XML)

☐ Other: _________________________________

C.4 Additional Comments

Please provide any additional information that may help us process your request:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

SECTION D: DECLARATION

I declare that:

☐ The information I have provided in this form is accurate and complete

☐ I am the data subject or am authorized to act on behalf of the data subject

☐ I understand that providing false information may be a criminal offense

☐ I understand that the organization may contact me to verify my identity or clarify my request

If acting on behalf of another person (Authorized Representative):

☐ I am authorized to act on behalf of the data subject

Please provide:
- Proof of authorization (e.g., power of attorney, written authorization)
- The data subject's identification documents

Data Subject's Name (if different): _________________________________

Relationship to Data Subject: _________________________________

SECTION E: SUBMISSION

Signature: _________________________________

Print Name: _________________________________

Date: _________________________________

SUBMISSION METHODS

Please submit this completed form and supporting documents to:

☐ Email: [PRIVACY EMAIL]

☐ Online Portal: [URL]

☐ Mail:
[DATA PROTECTION OFFICER/TEAM]
[COMPANY NAME]
[ADDRESS]

FOR OFFICIAL USE ONLY

DOCUMENT CONTROL

Legal Review: ☐ Completed Date: _________ Reviewer: _________

This form is provided for compliance with the General Data Protection Regulation. It does not constitute legal advice.