Data Subject Application Form
As Ester Clinic, we would like to state that you have the rights specified in Article 11 of the Personal Data Protection Law No. 6698 (“Law”) and granted to data owners. Our Clinic, the data controller, by Article 13 of the Law, has published the Clarification Text on the Protection of Personal Data on the website https://www.esterclinic.com.tr regarding the processing conditions, data security, and data security and destruction procedures and principles.
As a data subject, you can send us your requests regarding personal data within the scope of Article 13 of the Law and Article 5 of the Communiqué on Application Procedures and Principles to Data Controller using this Data Owner Application Form (“Application Form”).
DATA SUBJECT-RELATED PERSON RIGHTS
The rights granted to you by the Law as a data owner are as follows: You can submit your requests to us in written form and Turkish using the application method shown in this Application Form.
With the Application Form, you can make the following requests:
a) Learning whether your personal data is processed or not,
b) If your personal data has been processed, requesting information about them,
c) Learning the purpose of processing your personal data and whether its purpose uses them,
d) Knowing the third parties to whom personal data is transferred in the country or abroad,
e) Requesting correction of personal data if it is incomplete or incorrectly processed,
f) Requesting the deletion or destruction of personal data, which has been processed under the Law and legislation, in case the reasons for processing disappear,
g) Requesting notification of the transactions made according to subparagraphs (e) and (f) to third parties to whom personal data has been transferred,
h) Objecting to the emergence of a result against the person himself by analyzing the processed data exclusively through automated systems,
i) Request compensation for the damage in case of loss due to the unlawful processing of personal data.
APPLICATION PATH
Following Articles 11 and 13 of the Law, applications to be made to our Clinic, which is the data controller, can be submitted by printing out this form at https://www.esterclinic.com.tr will be done by:
• With a wet-signed petition, in writing to the address Merkez Mahallesi, Marmara Caddesi, Marmara İş Hanı No: 12, İç Kapı No: 76, Avcılar – İstanbul or through a public notary,
or
• Sending it to info@esterclinic.com.tr using your registered electronic mail (KEP) address or secure electronic signature, mobile signature, or e-mail address previously notified to our Clinic and registered in our data recording system.
A. Applicant Contact Information
Applicant | |
Name | |
Last name | |
T.R. Identification number | |
If the Applicant is Foreign Passport Number | |
Place of Residence/Workplace Address | |
Phone and Fax Numbers | |
E-mail Address | |
B. Relationship Between Applicant and Clinic
C. Please indicate your relationship with our Clinic. (Patient, patient’s relative, visitor, employee candidate, former employee, business partner, a third-party company employee, etc.)
☐ Patient | ☐ The relatives of the patient |
☐ Visitor | ☐ supplier |
☐ Former Employee Years Worked: | ☐ Person Applying for a Job / Sharing a Resume Date: |
☐ Third Party Company Employee Company and position information: | ☐ Other: |
The unit you have contacted at our Clinic: Topic: | |
D. Demand
Please write your request regarding your application.
ATTACHMENTS (If any, list the additional documents related to your application below)
1-
2-
E. Application Response
Please choose how you will respond to your application.
☐ I want it to be sent to my place of residence/work address.
☐ I want it to be sent to my e-mail address.
☐ I want to receive it by hand (Without a power of attorney, no response is given to someone else’s application. For hand deliveries, it must be received from the Clinic within the legal response time. Otherwise, no responsibility will be accepted.).
• Written applications on the date of notification of the document to the Data Control Office and/or its representative; Applications made by other methods are deemed to have been made on the date the data controller receives the application.
• The response to the application you have made will be sent to the address you have chosen within 30 (thirty) days from the notification of your request, at the latest.
• If you request a written response to your application, your application of up to 10 pages will be finalized free of charge. For answers over ten pages, a fee is charged for each page exceeding the tariff determined by the Personal Data Protection Authority.
We inform you that we reserve the right to request additional documents regarding your application to determine your personal data processed by our clinic and to respond to your application accurately and completely. We are not responsible for any errors or damages that may arise due to inaccurate, incomplete, or outdated information you have provided.
Applicant (Personal Data Owner Relevant Person)
Name Surname :
Application date :
Signature :