KVKK Başvuru Formu

APPLICATION FORM TO THE DATA CONTROLLER
General Explanations

Within the scope of Article 11 of the Law No. 6698 on the Protection of Personal Data (KVKK), everyone, in the capacity of data controller

Dr. Süleyman ÖZER has the right to apply to Dr. Süleyman ÖZER on the following issues:

a. To learn whether personal data is processed or not

b. Request information if personal data has been processed,

c. The purpose of processing personal data and whether they are used for their intended purpose

learning,

d. To know the third parties to whom personal data are transferred domestically and abroad,

e. To request correction of personal data in case of incomplete or incorrect processing

f. To request the deletion or destruction of personal data within the framework of the conditions stipulated in Article 7 of the KVKK.

g. To request notification of the transactions made pursuant to articles e and f above to third parties to whom personal data are transferred,

h. By analyzing the processed data exclusively through automated systems, it is possible to make a claim against the person himself/herself.

objecting to the outcome

i. In the event that personal data is damaged due to unlawful processing of personal data, the damage

demanding redress.
Processing of Personal Data Related to the Application

With this application form, we hereby provide the data controller with an application form limited to the purpose of identifying the applicant and managing the application, and

personal data (Name, Surname, Turkish ID number or passport number, telephone number, e-mail address,

address, signature, power of attorney document) are processed. Such data, if necessary, depending on the nature of the application request

can only be shared with the relevant units/persons and Institutions/Organizations authorized by law.

Contact Information of the Applicant

Please indicate your relationship with our clinic.

□ Visitor

□ Patient

□ Business partner

□ Employee

□ Former Employee (Years of employment)

□ Employee Candidate (Application Date)

□ Third Party Company Employee (Company name and position information)

□ Other

Person/Unit you are in contact with in our clinic :

Subject :

Detailed Explanation About the Application (Write your requests in detail and attach the documents, if any.)

Pursuant to Article 13 of the LPPD, data subjects may submit their requests in writing or

They should transmit it by other methods to be determined by the Personal Data Protection Board. In this context, the applications to be made to our Clinic

After filling out this form, applications can be submitted to us by taking a printout of it and choosing one of the following methods

can be forwarded.

Name

Surname

Turkish Identity Number (Passport if Foreign National

Number)

Telephone Number

Email address

Address
How would you like to be notified of our response to your application?

– I want it to be sent to my e-mail address (if you choose this method, we will respond to you faster).

– I would like to receive it by hand (in case it is received by proxy, a notarized power of attorney or authorization

document must be submitted).

– I want it to be sent to my address.

This application form, by determining your relationship with our Clinic; If any, your personal data processed by our Clinic

and has been prepared in order to respond to your application correctly and within the statutory period. Unlawful

and to eliminate the legal risks that may arise from unfair data sharing and especially to

In order to ensure the security of your data, it reserves the right to request additional documents (identity card, etc.) to our Clinic for identification and authorization.

for identification and authorization. The information regarding your requests you submit within the scope of the form is accurate and up-to-date.

or in the event of an unauthorized application, our Clinic will not be liable for any damages arising from such misinformation or unauthorized application.

does not accept any responsibility for any claims.

In addition, except where required by the nature of the work performed, please provide information and documents containing personal data

Do not share. If there is personal data in the documents sent, delete the relevant personal data from the document in question

or share it anonymously.Although it is not required by the nature of the work, the personal information you have shared

We have no responsibility for the data.

Finalization of your application

Pursuant to Article 13/2 of the LPPD, your application submitted to us will be processed as of the date it is received by our Clinic, depending on the nature of the request.

will be finalized within 30 (thirty) days. Your response will include the information you have requested and marked in this form.

Application Method

Application Address

What needs to be done

Apply in person at our clinic

(authenticating documents

must be brought)

Harbiye Mah. Valikonagi Cad.

Uğur Apt. No:14 Interior Door No:2

Şişli/ISTANBUL

The envelope should be marked “Personal Data

Protection Information Request”

must be written.

By registered letter with return receipt/notary public

notification

Harbiye Mah. Valikonagi Cad.

Ugur Apt. No:14 Interior Door No:2

Sisli/ISTANBUL

The notification envelope should be marked “Personal

Data Protection Information Request”

should be written.

By e-mail

I’ve been to our clinic

and that our clinic

registered in the e

using your mailing address

to be communicated in writing

The subject of the email is “Personal

Data Protection Information Request”

should be.
2 methods will be delivered to you. If this section is left blank, the method by which the request has reached us

you will be returned to you.

Declaration of the Applicant

In line with the requests I have stated above, my application to your clinic regarding the Protection of Personal Data

I kindly request that I be evaluated and informed in accordance with Article 13 of the Law.

I hereby declare and undertake that the information and documents I have provided to you in this application are accurate, up-to-date and belong to me.

I would like to

Name-Surname of the applicant ;

Name-Surname :

Signature :

Application Date :