Application Form.
Prof. Dr. Mustafa ÖZDEMİR Specialist in Dermatology and Venereal Diseases
Ataköy 7-8-9-10. Section District Çobançeşme E-5 Parallel Road Ataköy Towers B Block No:76 Bakırköy/Istanbul
Information Text Regarding Applications to be Made Concerning the Protection and Processing of Personal Data The Personal Data Protection Law No. 6698 grants certain rights to data subjects, defined as individuals under the Personal Data Protection Law. In Article 11 of the Personal Data Protection Law, the following rights are granted to data subjects: “the right to learn whether personal data have been processed, to request information if personal data have been processed, to learn the purpose of personal data processing and whether they have been used for their purpose, to know the third parties to whom personal data have been transferred, to request the correction of personal data in case of incomplete or incorrect processing, and to request the deletion or destruction of personal data within the framework of the conditions stipulated in the law and to request the notification of such transactions to third parties to whom personal data have been transferred, to object to the occurrence of a result against the person by analyzing the processed data exclusively through automated systems, and to demand the compensation of damages in case the person incurs damages due to the unlawful processing of personal data.”
Within the framework of these rights, the data subject must submit their requests to the data controller in writing or through other methods determined by the Data Protection Authority. For written applications, we kindly request that you use the form provided in the attachment and submit your application to us through the communication channels listed below.
The communication channels for written applications are as follows:
Application Method Address for Submission of Application
Information to be Specified in Application Submission
In-person Application (The applicant personally visits and submits the application, providing proof of their identity)
Ataköy 7-8-9-10. Section District Çobançeşme E-5 Parallel Road Ataköy Towers B Block No:76 Bakırköy/Istanbul
“Request for Information Pursuant to the Personal Data Protection Law” should be written on the envelope.
Notary Public Delivery
Ataköy 7-8-9-10. Section District Çobançeşme E-5 Parallel Road Ataköy Towers B Block No:76 Bakırköy/Istanbul
“Request for Information Pursuant to the Personal Data Protection Law” should be written on the notary public envelope.
In written applications, the date of delivery of the documents to the data controller is considered the application date.
If the data subject submits their application to us in accordance with the procedure, we will respond to the relevant request free of charge within the shortest time and no later than 30 (thirty) days, depending on the nature of the request. However, if the processing of the request requires an additional cost, a fee may be charged in accordance with the tariff determined by the Personal Data Protection Board.
I present this information to you. Yours sincerely.
Data Controller Specialist in Dermatology and Venereal Diseases Prof. Dr. Mustafa ÖZDEMİR
[14:28, 19.01.2022] Go Global: Prof. Dr. Mustafa ÖZDEMİR Specialist in Dermatology and Venereal Diseases
Ataköy 7-8-9-10. Section District Çobançeşme E-5 Parallel Road Ataköy Towers B Block No:76 Bakırköy/Istanbul
Application Form Regarding the Protection and Processing of Personal Data Dear applicant,
The application form at hand has been prepared in order to determine your relationship with our workplace, to identify any personal data processed by our workplace if applicable, and to ensure that a response is provided to your relevant application correctly and within the legal time frame.
In order to eliminate legal risks that may arise from unlawful and unjust data sharing and, in particular, to ensure the security of your personal data, we reserve the right to request additional documents and information (such as a copy of your identity card or driver’s license, etc.) for the purpose of verifying your identity and authorization. Our workplace does not accept responsibility for requests arising from incorrect information or unauthorized applications regarding the information provided in the form.
Please fill in the relevant fields by following the instructions below.
A. Fill in the following information about the applicant. Full Name
ID Number (For foreigners, passport number or, if applicable, ID number)
Phone Number
Address
B. Specify your relationship with our workplace.
☐ Employee ☐ Visitor ☐ Patient / Potential patient ☐ Employee candidate ☐ Other:
………………………………………………
C. State your application request.
Request Number Request Subject Your Choice
I want to know if my personal data are processed by your workplace. [Personal Data Protection Law, Article 11/1 (a)] ☐
If my personal data have been processed by your workplace, I request information regarding this. [Personal Data Protection Law, Article 11/1 (b)] ☐
I want to know the purpose of processing my personal data and whether they are used for their intended purpose. [Personal Data Protection Law, Article 11/1 (c)] ☐
If my personal data are being transferred to third parties, I want to know who these third parties are. [Personal Data Protection Law, Article 11 /1 (ç)] ☐
I believe my personal data are incomplete or incorrect, and I request their correction. Please provide a letter specifying the personal data you want to be corrected and include supporting documents with correct and supplementary information. (e.g., a copy of your ID card, residence permit, etc.) [Personal Data Protection Law, Article 11 /1 (d)] ☐
I believe that the reasons requiring the processing of my personal data have ceased to exist, and in this context, I request that my personal data be: a) Deleted. b) Made anonymous. [Personal Data Protection Law, Article 11 /1 (e)] ☐
I want the transactions carried out in accordance with my correction request (Request No. 5) to be notified to third parties to whom my personal data have been transferred. [Personal Data Protection Law, Article 11/1 (f)] ☐
I want the transactions carried out in accordance with my deletion or destruction request (Request No. 6) to be notified to third parties to whom my personal data have been transferred. [Personal Data Protection Law, Article 11/1 (f)] ☐
I believe that a result has arisen against me by analyzing my personal data processed by your workplace solely through automated systems. I object to this result.
Please send a letter regarding your objection to the analysis result you believe is against you, along with supporting documents. [Personal Data Protection Law, Article 11 /1 (g)] ☐
I have suffered damages due to the unlawful processing of my personal data. I request the compensation of these damages.
Please submit documents related to the breach of law. (Court decision, Board decision, documents showing the amount of material damage, etc.) [Personal Data Protection Law, Article 11/1 (ğ)] ☐
If you have any additional comments, please write them down.
D. Choose the method for us to notify you of our response to your application. ☐ I want it to be sent to my address. ☐ I want to receive it in person from the data controller. (In the case of receiving on behalf of someone else, a notarized power of attorney or authorization document is required.) ☐ I want a response to be sent to my email address.
E. Statement of the Applicant In accordance with the information, documents, and requests specified in the application form, I request that my application to the data controller be evaluated in accordance with the provisions of the Law and the Application Regulation, and that I be informed accordingly. In this context, I declare and undertake that the information and documents I have provided to you with this application are correct and up-to-date, that your workplace may process my personal data in order to conclude my application, that you may request additional information and/or documents, and that, if necessary, I may be required to pay a fee in accordance with the tariff determined by the Personal Data Protection Board.
Applicant’s Name and Surname:
Application Date:
Signature: