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:
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,
Turkish Identity Number
If the Applicant is Foreign Passport Number
Telephone and Fax Number
☐ Relatives of the patient
☐ Former Employee
☐ Person Applying for a Job / Sharing a Resume
☐ Third Party Company Employee
Company and position information:
The unit you have contacted at our clinic:
Please write your request regarding your application.
ATTACHMENTS (If any, list the additional documents related to your application below)
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.).
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 :