RELEVANT PERSON (PERSONAL DATA OWNER)
APPLICATION FORM FOR THE PROTECTION OF PERSONAL DATA
In accordance with Article 11 of the Personal Data Protection Law No. 6698 (“Law”), you can submit your applications regarding the following requests to us using the methods and procedures explained in this Form.
You can exercise your rights using the methods and forms specified below.
| METHOD / PROCEDURE | ADDRESS | DESCRIPTION |
| Written Application | It can be submitted in person with a wet signature or via notary. | Dr. Sinan Akyürek "Harbiye Mah. Teşvikiye Cad. No: 19 /13 Şişli / ISTANBUL | The relevant details and documents specified in this form will be provided, and "KVKK relevant person application" will be written on the application envelope/notification. |
| Application via Registered Electronic Mail (REM) | It can be submitted via registered electronic mail (REM). |
| The relevant details and documents specified in this form will be included in the REM message content, and "KVKK Relevant Person Application" will be written in the subject line. |
| Application via Email | It can be submitted via email containing a mobile signature/e-signature. | drsinanakyurek@gmail.com | The relevant details and documents specified in this form will be included in the email content, and "KVKK Relevant Person Application" will be written in the subject line. |
If you submit an application in accordance with the procedure and principles specified in this form, your requests will be concluded free of charge within the shortest time possible, and within a maximum of thirty days, depending on the nature of the request. However, if the process incurs additional costs, a fee may be charged based on the tariff determined by the Personal Data Protection Board.
Our responses will be delivered to you in written or electronic form. Therefore, please specify the channel and the related details through which you would like us to contact you.
| Name |
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| Surname |
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| Identity Number |
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| Phone |
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| Address |
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| REM Address / Email |
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| I request that the response be sent to me via the method I specify below. (Please select one) |
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| REM | Email | Address (Courier) |
Please specify your relationship with our company by answering the following questions to evaluate your application.
Reason for Relationship
| - Patient/Consultant/Relative of Patient
- Visitor
- Intern
- Supplier Representative/Employee
- Employee/Job Applicant
- Former Employee
- Job Application/CV Submission
- Other...
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Explanation (source of relationship, department you are in contact with, date, duration of the relationship, contract details, etc.)
:……………………………………………………………………………………………………………………………………………………………
INFORMATION TEXT
This application form has been prepared to evaluate and conclude your application, to determine your relationship with our Clinic, to address the requests included in your application, to identify your personal data as the relevant person, and to respond to your application accurately and within the legal timeframe. Our Clinic reserves the right to request additional information and documents for identity and authorization verification and for evaluating the application. The information and documents related to your requests must be provided by an authorized person and must be accurate and up-to-date. In cases where an unauthorized application is made or the information provided is not accurate or up-to-date, our Clinic will not be held responsible and reserves the right to reject the application. The information and documents specified in this form will be processed by our Clinic solely for the purposes of evaluating, responding to, and concluding the application made under Article 13 of the Law. The information obtained in this context may be collected verbally, in writing, electronically, or physically. The relevant information may be shared with third parties or companies providing services (e.g., law offices) for the purpose of concluding the application. You may exercise your rights under Article 11 of the Law following the procedures and conditions specified in this form.
Data Controller: Dr. SINAN AKYÜREK
Applicant Relevant Person (Personal Data Owner) Full Name:
Application Date:
Signature:
