Data Subject Access Request

Data Subject Access Request Form

Data Subject Access Request

1. Your first name(Required)

2. Your last name(Required)

3. Date of birth(Required)

4. Your email address(Required)

5. Telephone

6. Current Address

To help us search for the information you require, please let us know as much as details as possible of (e.g. copies of emails between X date and X date, …). If we do not receive sufficient information to locate the data you require, we may be unable to comply your request.

7. Details of Data Requested

8. Data Recipient(Required)

Is the information going to be sent to the data subject or his/her representative?

To the Data Subject

To the Representative

9. Confirmation(Required)

I confirm that I am the Data Subject

Date Signed(Required)

10. Identity Verification

Copy of ID and Proof of Address must be enclosed (including a government issued ID document)

Data Subject's ID(Required)

Drop files here or

Accepted file types: png, gif, jpg, jpeg, pdf, Max. file size: 2 MB.

Data Subject's Proof of Address(Required)

Drop files here or

Accepted file types: png, gif, jpg, jpeg, pdf, Max. file size: 2 MB.

If question 8 was answered with “To the Representative”, the Data Subject (whose data is being requested) must give written authorisation for the information to be released to his/her authorised representative.

11. Data Subject Authorisation

I hereby give my authorisation to the below name to request access to my personal data.

Signed:

This section must be filled by the Representative of the Data Subject.

12. Representative Confirmation

I confirm I am the representative of the Data Subject.

Date(Required)

13. Data Address

The address where personal data is to be sent is:

This form collects your personal details to record and process your enquiry in our system. Check out our Privacy Policy to see how we protect and manage your submitted data, and to find how to Withdraw Consent. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Please tick this box to consent to Guided Ultrasonics Ltd holding all the information provided in this form on our database and using it as outlined in the Privacy Policy.