MSA Dental Clinic

Application Form

A. Rights of the Data Subject

Under Article 11 of the Personal Data Protection Law No. 6698 and relevant regulations, everyone has the right to apply to our clinic, as the data controller, regarding the following matters:

a) Learn whether personal data is processed,
b) Request information about personal data processing,
c) Learn the purpose of data processing and whether it is used in accordance with its purpose,
ç) Learn third parties to whom personal data has been transferred,
d) Request correction of incomplete or inaccurate personal data,
e) Request deletion or destruction of personal data under conditions specified in Article 7,
f) Request notification of corrections or deletions to third parties,
g) Object to processing that results in unfavorable consequences solely through automated systems,
ğ) Request compensation for damages caused by unlawful processing.

B. Procedure and Principles for the Data Subject’s Application to the Data Controller

According to Article 13 of the KVKK and the Communiqué on Application Procedures and Principles to the Data Controller published in the Official Gazette on 10.03.2018, applications regarding these rights should be submitted to our clinic using the following methods or other methods specified by the Personal Data Protection Authority:

The data subject can apply using:

  • Written application,
  • Secure electronic signature,
  • Registered Electronic Mail (KEP) address,
  • Mobile signature,
  • The e-mail address previously provided to the data controller.

The application must include the following:

  • Full name and signature if written,
  • Turkish ID number or nationality, passport number, or identity number (for foreigners),
  • Residential or business address for notification,
  • E-mail address, phone, and fax number (if available),
  • The subject of the request.

Applications will be processed within thirty days at the latest and without charge. However, if there is a cost for the process, a fee based on the tariff set by the Authority may be charged.
Applications must be made by the individual themselves, and if a third party is applying on their behalf, a power of attorney must be provided.

CONTACT INFORMATION

Title: Msa Ağız ve Diş Sağlığı Hizmetleri LTD. ŞTİ.
Address: İçerenköy Mahallesi, Küçükbakkalköy Yolu Caddesi, Coşkun Apartmanı No: 56-58 A, 34752, Ataşehir, İSTANBUL
Contact e-mail: info@msadentalclinic.com

Name -Surname

 

T.C. Identity No:

For foreigners: Nationality and Passport No:

 

Notification Address

 

Phone

 

E-mail Address or Registered E-mail Address

 

Application Date

 

Your Relationship with Us

        Employee

      Patient

        Job Applicant

Job Application Date:

      Business Partner / Supplier

        Former Employee

Years Worked:

      Other:

Unit Previously Contacted

 

Subject of Request

 

Preferred Method for Responding to the Application

Send to my address.

Contact me via e-mail.

I wish to collect it in person.

The data subject declares and commits that the documents and information provided in this application are accurate and up-to-date. The information and documents provided in the application form will be processed and protected under the Personal Data Protection Law (KVKK) for the limited purposes of evaluating the application, responding to it, delivering the response, and verifying identity and address.

Signature:

Date:

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