Data Subject Request Form

DATA SUBJECT REQUEST FORM

Assoc. Prof. Dr. Nilay u015eengu00fcl We would like to inform you that you have the rights granted to data subjects as specified in Article 11 of the Personal Data Protection Law No. 6698 (u201cthe Lawu201d). Pursuant to Article 13 of the Law, our Clinic, acting as the data controller, has published the u201cPrivacy Notice Regarding the Protection of Personal Datau201d on its website, nilaysengul.com, detailing the conditions for the processing of personal data, data security, and the procedures and principles for data destruction.

As a data subject, you may submit your requests regarding personal data under Article 13 of the Law and Article 5 of the Communiquu00e9 on the Procedures and Principles for Applications to the Data Controller using this Data Subject Request Form (u201cRequest Formu201d) to us.

RIGHTS OF DATA SUBJECTS

As a data subject, the rights granted to you under the Law are as follows; you may submit your requests to us in writing and in Turkish using the application procedure outlined in this Application Form.

You may submit the following requests using the Request Form:

1. To find out whether your personal data has been processed,
2. If your personal data has been processed, to request information regarding such processing,
3. To learn the purpose of the processing of your personal data and whether it is being used in accordance with that purpose,
4. To know the third parties to whom your personal data has been transferred, whether within or outside the country,
5. Request the correction of your personal data if it has been processed incompletely or incorrectly,
6. To request the erasure or destruction of personal data processed in accordance with the law and regulations, should the grounds for such processing no longer exist,
7. To request that the actions taken pursuant to subparagraphs (e) and (f) be notified to the third parties to whom your personal data has been transferred,
8. To object to a decision made solely through the automated analysis of processed data that results in a negative outcome for the individual,
9. To request compensation for damages suffered as a result of the processing of personal data in violation of the Law.

APPLICATION PROCEDURE

Requests to be submitted to our Clinic, which acts as the data controller pursuant to Articles 11 and 13 of the Law, must be made by printing out this form available at nilaysengul.com and submitting it:

• Memorial u015eiu015fli Hospital, u015eiu015fli / Istanbul, either in writing or through a notary public,

or

• by sending it to the email address info@nilaysengul.com using your Registered Electronic Mail (KEP) address, a secure electronic signature, a mobile signature, or the email address you previously provided to our Clinic and which is registered in our data recording system.

1. Data Subject Information

Data Subject
First Name
Last Name
Turkish ID Number
If the Applicant is a Foreign National, Passport Number
Residence/Work Address
Phone and Fax Numbers
Email Address

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1. Relationship Between the Applicant and the Clinic
2. Please specify your relationship with our clinic. (Patient, patientu2019s relative, visitor, job applicant, former employee, business partner, employee of a third-party company)

u2610 Patientu00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0	u2610 Family member
u2610 Visitor	u2610 Supplier
u2610 Former Employee Years of Service:u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0	u2610 Job Applicant/Person Who Submitted a Resume Date:
u2610 Third-Party Company Employee Company and position information:	u2610 Other:
Department you contacted at our clinic: Subject:

1. Request

Please describe your request regarding your application.

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ATTACHMENTS (If applicable, please list any supporting documents related to your application below)

• u00a0
• u00a0

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1. Response to Application

Please select how you would like to receive a response to your application.

u2610 I would like it sent to my home or work address.u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0u00a0

u2610 I would like it sent to my email address.

u2610 I would like to pick it up in person (A response to the application will not be provided to a third party without a power of attorney. For in-person pickups, the document must be collected from the Clinic within the statutory response period. Otherwise, no liability will be accepted.).

• Written requests are deemed to have been made on the date the document is served to the data controller, the Clinic, and/or its representative; requests made through other methods are deemed to have been made on the date the request reaches the data controller.
• The response to your request will be sent to the address you have selected no later than 30 (thirty) days from the date we receive your request.
• If you request a written response to your request, your request will be processed free of charge for up to 10 pages. For responses exceeding 10 pages, a fee will be charged for each additional page in accordance with the tariff set by the Personal Data Protection Authority.

We hereby inform you that we reserve the right to request additional documents in order to identify the personal data processed by our Clinic in connection with your request and to ensure that your request is answered accurately and completely. We are not liable for any errors or damages that may arise due to the information you provide being incorrect, incomplete, or out of date.

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Applicant (Data Subject)

First Name Last Name :

Date of Request :

Signature :