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DATA SUBJECT APPLICATION FORM
GENERAL EXPLANATIONS
Pursuant to Personal Data Protection Law no. 6698 (“KVKK” or the “Law”), rights of the
personal data owners, defined as data subjects, or of legal representatives of these persons
(“Applicant” or “Data Subject”) to file requests relating to the processing of personal data
have been regulated by Article 11 of KVKK.
Pursuant to the first paragraph of Article 13 of KVKK; the requests concerning such rights shall
be made in writing or via other methods specified by the Turkish Personal Data Protection
Board (“Board”) will be made to LÖSEV Lösemili Çocuklar Sağlık ve Eğitim Vakfı (“Lösev
Vakıf”), which is the data controller. Depending on the nature of your request, it shall be
replied to within the shortest time possible or within thirty days at the latest as of the receipt
date of your request to LÖSEV. However, if the transaction requires an additional cost, a fee
may be charged in accordance with Article 7 of the Communiqué on Application Procedures
and Principles to Data Controller (“Communique”).
APPLICATION METHOD
● Application by Post or in Person: Application can be made in person or via post by
the Applicant with the completed and signed application form and authentication
documents and post to the address of “Turgutlu Sokak, Büyükesat Mahallesi, No:30
Çankaya/Ankara”.
● Application via Registered Electronic Mail (REM): Application can be made by
sending the application form to (……….@...........) by signing with the REM address
defined in the Electronic Signature Law No. 5070.
● Application via Electronic Mail by Using Mobile Signature or Registered
Electronic Mail: Application can be made by a petition, or if desired by Application
Form, signed by the Applicant by using a mobile signature or REM and sending it via
e-mail to the address of kvkk@losev.org.tr.
The application can also be made through a notary or legally valid methods that provide the
opportunity to verify the identity. It is recommended to comply with the issues mentioned above
in applications as much as the method allows since it will increase the likelihood of the
application to be concluded affirmatively and in a short time.
We would like to remind you that you could get a faster response if you write
“Information/Rectification Request Under the Law of Personal Data Protection” on
the application envelope or in the subject part of the e-mail.
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APPLICATION FORM
DATA SUBJECT INFORMATION
Name Surname:
Nationality:
☐ Turkish
☐ Other: (If other, please specify) ….
Turkish Citizenship Number:
Passport No / Foreign Identity No:
Address:
REM (Registered Electronic Mail)
Address:
E-Mail Address:
Telephone No / Fax No:
YOUR RELATION WITH LÖSEV VAKFI
☐ Lösev Vakfı Employee / Former
Employee
Working Years:
☐ Employee Candidate
(I shared my resume)
Application Date:
Where the Application was made and additional
explanation if any:
☐ Patient
Explanation:
☐ Patient Relative
Explanation:
☐ Volunteer
Explanation:
☐ Visitor
Explanation:
☐ Donator
Explanation:
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☐ Board Members
Explanation:
☐ Business Associates
Explanation:
☐ State Employees
Explanation:
☐ Supplier’s
Representative/Employee
Explanation:
☐ Third Parties Who Have Notified
Explanation:
☐ Other
Explanation:
APPLICATION CONTENT
LÖSEV Lösemili Çocuklar Sağlık ve Eğitim Vakfı
Turgutlu Sokak, Büyükesat Mahallesi, No:30 Çankaya /
Ankara
1. ☐I would like to learn whether my personal data
is being processed.
2. ☐If my personal data has been processed, I
request information regarding this.
3. ☐I would like to learn the purpose of processing
my personal data and whether they are used for
their intended purposes.
4. ☐I would like to learn about the third parties to
whom my personal data is transferred in the
country or abroad.
5. ☐I want my personal data to be deleted or
destroyed or anonymized within the framework of
the conditions stipulated by law.
6. ☐Due to the incomplete or incorrect processing of
my personal data, I would like them to be
corrected. (Please provide detailed information
about your personal data that you want to be
corrected in the explanation section.)
7. ☐If changes are made to my personal data upon
my request, I would like to be notified of this to
the third parties to whom my personal data has
been transferred.
8. ☐I request compensation for the damage I have
suffered due to the unlawful processing of my
personal data. (Please provide detailed
information in the explanation section about which
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data processing activity, when, and how your
damage occurred.)
EXPLANATIONS:
If requests 6 or 8 are selected, the scope of the application shall be specific, explicit and
understandable in order to respond fully to your application.
ANNEXES:
Please indicate if you share information and
documents in the attachment.
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Reply Method to Your Application
(In case any reply method has not been preferred, the application shall be replied in the
method as it was submitted.)
◻ I would like the result of the application to be sent by post to my residential / workplace
address
(By sending to the address specified in the application)
◻ I would like it to be sent to the e-mail address I specified in the application form.
(We will be able to respond to you faster if you choose the e-mail method.)
◻ I would like to receive it in person or through my proxy*.
(In case of receipt by proxy, a notarized power of attorney or certificate of authorization is
required.)
This application form has been prepared so that your requests can be replied to accurately,
thoroughly, and within the time specified in the law. The data controller reserves the right to
request additional documents and information (copy of identity card or driver's license, etc.)
for the determination of the identity and authority, for the elimination of the legal risks that may
occur due to illegal and unfair data sharing, and especially ensuring the protection of your
personal data. The data controller does reject your application if the information regarding your
requests submitted within the scope of the form is not accurate and up-to-date, is incorrect/
contains misleading information, or the application is made without authorization and legal
remedies will be taken against the person who performs irregular transactions by the data
controller.
Date:
Applicant’s Name Surname:
Signature:
(E-signature can be used for
applications made through REM.)
Please kindly attach information about your relationship with the Applicant and/or a power of
attorney reflecting your authorization, identity register copy, or the relevant document.