PIKSEL GIRISIM BILGI TEKNOLOJILERI VE DANISMANLIK A.S.
PERSONAL DATA PROTECTION REQUEST FORM
GENERAL EXPLANATIONS
Personal data owners, who are defined as “data subject”(hereinafter referred to as “Applicant”) within the Law on the Protection of Personal Data no. 6698 (the “Law”) are entitled to make certain Requests regarding the processing of their personal data according to Article 11 of the Law. In accordance with the first paragraph of Article 13 of the Law, applications to be made to our Company, acting in its capacity as data controller, concerning these rights shall be made in writing or by any other means determined by Personal Data Protection Board (“Board”).
Within this context, all applications to be made to our Company shall be communicated to us “in writing” by using this form to be delivered to our Company;
- Via Personal delivery of the Applicant,
- Through a notary public,
- By means of signed by the Applicant with the “secure electronic signature” defined in the Law on Electronic Signature no. 5070 and sent to the registered e-mail address of the Company, is forwarded to us by printing-out herein form.
The following information contains explanations on how to communicate the written applications to our Company through the written application channels.
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Application Channels
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Address for Applications
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Information to be mentioned over the course of Application Submission
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Personal Application (By personal delivery of Applicant with a document proving his/her identity.)
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Kore şehitleri Caddesi, Yüzbaşı Kaya Aldoğan Sokak, No:20 D:6 Esentepe- Şişli/İstanbul
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Applicants shall write “Information Request within the scope of Law on the Protection of Personal Data” on the envelope.
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Notification via notary public
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Kore şehitleri Caddesi, Yüzbaşı Kaya Aldoğan Sokak, No:20 D:6 Esentepe- Şişli/İstanbul
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Applicants shall write “Information Request within the scope of Law on the Protection of Personal Data” on the notification envelope.
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Application with Secure Electronic Signature [“SES”] [Application through Registered Electronic Mail (“REM”) signed with SES]
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pikselbilisim@hs03.kep.tr
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Applicants shall put “Information Request within the scope of Law on the Protection of Personal Data” on the subject of the e-mail.
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In addition, following the announcement of the other channels to be determined by the Board, the Company will announce how the applications will be received through these channels.
Applications that has been submitted to the Company will be replied within the thirty days from the date on which the application was received by the Company. However, if the transaction requires an additional cost, the fee in the tariff determined by the Board will be charged by our Company. In accordance with Article 13 of the Law, respond to your request will be sent to you in writing or electronically.
A. Applicant’s Identity and Contact Information
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Name and Surname:
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Turkish Republic Idenfication Number:
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Phone Number:
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E-mail Address:
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Address:
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B. Please select your relationship with our Company from the options below. (Customer, Business Partner, Employee Candidate, Former Employee, Third Party Employee, Shareholder etc.)
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□ Customer
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□ Present Employee
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□ Supplier/Customer
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□ I have made Job Application/Shared Curriculum Vitae
Date of the Job Application:
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□ Former Employee
Employment Dates:
From: …./…./..… To: …./..../..….
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□ Others:
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□ Third Party Firm Employee
Please indicate the information of firm and position you worked
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Please indicate the unit you are in contact with:
Subject of the Request:
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C. Please provide details of your request and the nature of the personal data subject to the request in accordance with the Law.)
D. Please select the channel you want to be notified by our Company regarding the response to your application:
□ I want the response to be sent to my address
□ I want the response to be sent via e-mail
(If you choose the e-mail channel, we will be able to respond to you faster.)
□ I want to receive it in person
(In case of submission of request by proxy, it is required to have a notarized power of attorney or certificate of authority.)
This application form was drafted to respond to your application within legal period in a correct manner by identifying the relationship between you and our Company and, if any, detecting any of your personal data processed by our Company. Our Company reserves the right to request additional documents and information (copy of the identity card or driver's license) for identification and authorization purposes to eliminate legal risks that may arise from data sharing in an illegal and unlawful manner, and particularly, to ensure the security of your personal data. In the event that the information submitted within the application form is not accurate or up-to-date or the request is made by an unauthorized third party, our Company declines responsibility for any claim that may arise in consequence of such incorrect information or unauthorized application.
Applicant’s (Personal Data Owner) Name and Surname:
Date of application:
Signature: