Assoc. Prof. Dr. Andaç Aykan Clinic

GENERAL INFORMATION

Under the Turkish Personal Data Protection Law No. 6698 (“KVKK”), individuals defined as data subjects (“Applicant”) are granted certain rights regarding the processing of their personal data under Article 11 of the Law.

Pursuant to Article 13 of the Law, applications regarding these rights must be submitted to our Clinic (data controller) in writing or through other methods determined by the Personal Data Protection Board.

Written applications may be submitted by:

• Personal delivery by the Applicant
• Through a notary
• Via registered electronic mail (KEP) signed with a secure electronic signature

APPLICATION METHOD

MethodAddressRequired NoteIn-person applicationAbdi İpekçi Street No: 2/14, Nişantaşı, Istanbul“Information Request under the Personal Data Protection Law”Registered mailSame addressSame note requiredNotary notificationSame addressSame note required

Your request will be evaluated and responded to within 30 days from the date it is received, in accordance with Article 13 of KVKK.

Responses will be provided in writing or electronically. Applications are free of charge; however, if additional costs arise, a fee may be charged according to the tariff determined by the Board.

A. APPLICANT CONTACT INFORMATION

• First Name:
• Last Name:
• Turkish ID Number:
• Phone Number:
• Email:
• Address:

B. RELATIONSHIP WITH OUR CLINIC

Please select:

• ☐ Patient / Client / Customer
• ☐ Business Partner
• ☐ Visitor
• ☐ Former Employee
• ☐ Job Applicant
• ☐ Employee of a Third-Party Company
• ☐ Other: ___________________________

Department you have been in contact with:

Years worked (for former employees):

Company and position (for third-party employees):

Subject:

C. PLEASE SPECIFY YOUR REQUEST UNDER KVKK

NoRequestLegal BasisSelection1I would like to know whether your Clinic processes my personal dataArt. 11/1 (a)☐2If my data is processed, I request information about such processingArt. 11/1 (b)☐3I would like to know the purpose of processing and whether it is used accordinglyArt. 11/1 (c)☐4I would like to know the third parties to whom my data is transferred (domestic/international)Art. 11/1 (ç)☐5I request correction of incomplete or incorrect personal dataArt. 11/1 (d)☐6I request deletion or destruction of my personal dataArt. 11/1 (e)☐7I request correction of my data also for third parties to whom it has been transferredArt. 11/1 (f)☐8I request notification to third parties regarding deletion/destructionArt. 11/1 (f)☐9I object to automated processing that results in a negative outcome for meArt. 11/1 (g)☐10I request compensation for damages due to unlawful processingArt. 11/1 (h)☐

Detailed Description of Request:

D. PREFERRED METHOD OF RESPONSE

• ☐ Send to my address
• ☐ Send via email
• ☐ Deliver by hand

(Note: Choosing email allows for a faster response.)

IMPORTANT NOTICE

This form is prepared to accurately identify your relationship with our Clinic and to determine your personal data processed by us, so that your request can be evaluated correctly and within the legal timeframe.

To prevent unlawful data sharing and ensure data security, the Clinic reserves the right to request additional documents (such as ID copy or driver’s license).

The Clinic shall not be held responsible for incorrect or unauthorized applications.

DECLARATION

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

I consent to the processing of the information provided in this form solely for the purpose of evaluating and responding to my application, verifying my identity, and delivering the response in accordance with Article 13 of KVKK.

Applicant Name & Surname:
Date:
Signature:

‍