DATA SUBJECT APPLICATION FORM

As Derman Sağlık Hizmetleri ve Medikal Ürünleri Limited Şirketi (Brand name is Maslak Medical Center, hereinafter referred to as Maslak Medical Center), we would like to point out that you have the rights granted to data owners as specified in Article 11 of the Law on Protection of Personal Data No. 6698 (“Law” ) . Our Clinic, which is the data controller in accordance with Article 13 of the Law, has published the Clarification Text on the Protection of Personal Data  on the website https://www.maslaksaglik.com regarding the processing conditions, 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 the 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, and you can submit your requests to us in written form and in Turkish using the application method shown in this Application Form.

With the Application Form, you can make the following requests:

1. Learning whether your personal data is processed,
2. If your personal data has been processed, requesting information about them,
3. Learning the purpose of processing your personal data and whether they are used in accordance with the purpose,
4. Knowing the third parties to whom personal data is transferred at home or abroad,
5. Requesting correction of personal data if it is incomplete or incorrectly processed,
6. Requesting the deletion or destruction of personal data, which has been processed in accordance with the law and legislation, in the event that the reasons for processing disappear,
7. Requesting notification of the transactions made pursuant to subparagraphs (e) and (f) to third parties to whom personal data has been transferred,
8. Objecting to the emergence of a result against the person himself by analyzing the processed data exclusively through automated systems,
9. Demanding the compensation of the damage in case of loss due to unlawful processing of personal data.

APPLICATION PATH

In accordance with Articles 11 and 13 of the Law, applications to be made in our Clinic, which has the title of data controller, can be submitted to: Ayazağa, Mustafa Kemal Atatürk Cd 1-2, 34396 Sarıyer/İstanbul by printing out this form at https://www.maslaksaglik.com. or through a notary public,

or

• It will be done by sending your registered e-mail (KEP) address or secure electronic signature, mobile signature, or by using your e-mail address previously notified to our Clinic and registered in our data recording system, to the [email protected] e-mail  address  .

1. Applicant Contact Information

1. Relationship Between Applicant and Clinic
2. Please indicate your relationship with our Clinic. ( Patient, patient’s relative, visitor, employee candidate, former employee, business partner, third party company employee  )

1. Request

Please write your request regarding your application.

ATTACHMENTS  (If any, list the additional documents related to your application below)

1. Application Answer

Please choose the way in which 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 controller Clinic and/or its representative; Applications made by other methods are deemed to have been made on the date the application is received by the data controller.
• 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, up to 10 pages of your application will be finalized free of charge. For answers over 10 pages, a fee is charged for each page exceeding the tariff determined by the Personal Data Protection Authority.

We hereby inform you that we reserve the right to request additional documents regarding your application, in order 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 :