In accordance with Articles 11 and 13 of the Personal Data Protection Law No. 6698 (KVKK) and the Communiqué on the Procedures and Principles of Application to the Data Controller, relevant persons may submit their requests regarding their personal data to the data controller SERKA SAĞLIK HİZMETLERİ LİMİTED ŞİRKETİ through this form.
A. APPLICANT'S IDENTITY AND CONTACT INFORMATION
- Name - Surname: ............................................
-T.R. Identity Number / Passport Number: ............................................
- Notification Address: ............................................
- Phone Number: ........................................
- E-mail Address: ............................................
- Your Relationship with Our Organization (Patient / Visitor / Employee Candidate / Other): ............................................
B. SUBJECT OF CLAIM
Please mark your request(s) within the scope of KVKK article 11 or explain below:
( ) I want to know whether my personal data is being processed or not.
( ) If it has been processed, I request information about it.
( ) I want to know the purpose of processing and whether it is used in accordance with its purpose.
( ) I want to know the third parties to whom it is transferred domestically/abroad.
( ) If it was processed incompletely/incorrectly, I want it to be corrected.
( ) I want it to be deleted/destroyed.
( ) I want the correction/deletion transactions to be notified to the third parties to whom they have been transferred.
( ) I object to the situation that was found to be against me as a result of analysis by automatic systems.
( ) I request compensation for the damage I have suffered due to illegal processing.
Explanation regarding your request: ............................................
............................................
C. APPLICATION CHANNELS
You can submit the completed form using one of the following methods:
1. With a signed petition in person or through a notary: Merkez Mah. Istanbul Cad. To No:16 K:1 D:1 Bağcılar/İstanbul,
2. By Registered Electronic Mail (KEP): to serkasaglik@hs02.kep.tr,
3. Via secure electronic signature, mobile signature or your e-mail address registered in our system: kvkk@bagcilardis.com.
D. EXPLANATIONS
In order for your application to be evaluated, the information proving your identity must be accurate and complete. Our organization may request additional documents if it has doubts about the identity of the applicant. Your application will be finalized free of charge within thirty (30) days at the latest, depending on the nature of the request; However, if the process requires an additional cost, the fee at the tariff determined by the Personal Data Protection Board may be charged. If an application is made on behalf of a third person, a document showing that the applicant is specifically authorized in this regard (power of attorney, etc.) must be attached to the form.
Applicant Name-Surname / Signature: ............................................
Application Date: ......./......./20..........