DATA PROTECTION ACT, 2020 - APPLICATION FOR ACCESS TO PERSONAL DATA

1. First Name of Data Subject: *

2. Middle Name of Data Subject: *

3. Last Name of Data Subject: *

4. Is the Applicant different from Data Subject? *

4 a). First Name of Applicant: *

(If different from data subject)

4 b). Middle Name of Applicant: *

(If different from data subject)

4 c). Last Name of Applicant: *

(If different from data subject)

5. Date of Birth: *

Month

Day

Year

6. TRN: *

7. Gender: *

8. Home Address: *

(Please indicate the address to which correspondence related to your application should be sent).

9. Mailing Address:

10. Telephone No.: *

11. Email Address: *

12. Confirm Email Address: *

13. I would like to: *

be informed whether the personal data of the above named data subject is being processed by you or on your behalf;

be given a description of the: •personal data of the above named data subject which is being processed; •purpose(s) for which the data are being, or are to be, processed; and •recipients or classes of recipients to whom the data are or may be disclosed;

have the personal data of the above named data subject made available to me and to be advised of the source of the data (if known);

be informed of the logic involved in the automated decision which was taken regarding the data subject;

have the personal data of the above named data subject transmitted to the following data controller(s):

13 a). Name of Data Controller: *

13 b). Address of Data Controller: *

13 c). Telephone of Controller: *

13 d). Email of Data Controller: *

14. I would like to have the personal data of the above named data subject made available in the following format: *

photocopy

electronically

Other...

14. I would like to have the personal data of the above named data subject made available in the following format: Other...

Disclaimer

Your data is being processed to facilitate this Data Subject Rights Request. Please note that before processing your request, we may need to verify your identity to ensure that we are disclosing personal data to the correct individual. This may involve requesting additional information from you or asking you to provide proof of your identity. Your data provided in this form will be stored securely on JCA systems for as long as is required to respond to your request and to execute any further requests from you. We will make every effort to respond to your data subject rights request in a timely manner and within the timeframe specified by applicable data protection laws. By submitting this form, you agree to the JCA’s processing of your data.