DATA SUBJECT APPLICATION FORM
Dentekiz Clinic, we would like to point out that you have the rights granted to data owners as
specied in Arcle 11 of the Law on the Protecon of Personal Data No. 6698 (“Law”). Our Clinic,
which is the data controller in accordance with Arcle 13 of the Law, has published the Claricaon
Text on the Protecon of Personal Data on the website hps://www.dentekiz.com regarding the
processing condions, data security and destrucon procedures and principles.
As a data subject, you can send us your requests regarding personal data within the scope of Arcle
13 of the Law and Arcle 5 of the Communiqué on Applicaon Procedures and Principles to Data
Controller, using this Data Owner Applicaon Form (“Applicaon Form”).
DATA SUBJECT RELATED PERSON RIGHTS
The rights granted to you by the Law as a data owner are as follows, and you can submit your
requests to us in wrien form and in Turkish using the applicaon method shown in this Applicaon
Form.
With the Applicaon Form, you can make the following requests:
a) Learning whether your personal data is processed or not,
b) If your personal data has been processed, requesng informaon about them,
c) Learning the purpose of processing your personal data and whether they are used in accordance
with its purpose,
d) Knowing the third pares to whom personal data is transferred in the country or abroad,
e) Requesng correcon of personal data if it is incomplete or incorrectly processed,
f) Requesng the deleon or destrucon of personal data, which has been processed in accordance
with the law and legislaon, in the event that the reasons for processing disappear,
g) Requesng nocaon of the transacons made pursuant to subparagraphs (e) and (f) to third
pares to whom personal data has been transferred,
h) Objecng to the emergence of a result against the person himself by analyzing the processed data
exclusively through automated systems,
i) To request the compensaon of the damage in case of loss due to the unlawful processing of
personal data.
APPLICATION PATH
In accordance with Arcles 11 and 13 of the Law, the applicaons to be made in our Clinic, which is
the data controller, can be made by prinng out this form at hps://www.dentekiz.com:
• Atakoy 7-8-9-10. In wring to the address Kısım Mahallesi, Çobançeşme E-5 Yanyol Caddesi, No:
20/1, A Block, Floor: 13, Flat: 167, Ataköy Towers, Bakırköy-İstanbul, or through a notary public,
or
• Your registered e-mail (KEP) address or secure e-signature will be sent to the info@dentekiz.com e-
mail address using your mobile signature or your e-mail address previously noed to our Clinic and
registered in our data recording system.
A. Applicant Contact Informaon
Başvuru Sahibi
Name
Surname
ID Number
If the Applicant is Foreign
Passport Number
Domicile/Workplace Address
Telephone and Fax Number
Email Address
B. Relaonship Between Applicant and Clinic
C. Please indicate your relaonship with our Clinic. (Paent, paent's relave, visitor, employee
candidate, former employee, business partner, third party company employee, etc.)
☐ Patient
☐ Relatives of the patient
☐ Visitor
☐ Supplier
☐ Former Employee
☐ Person Applying for a Job / Sharing a Resume
Years Worked:
History:
The unit you have contacted at our clinic:
Subject:
D. Demand
ATTACHMENTS (If any, list the addional documents related to your applicaon below)
1-
2-
E. Applicaon Response
Please choose the way in which you will respond to your applicaon.
• I want it to be sent to my domicile/work address.
• ☐ I want it to be sent to my e-mail address.
• ☐ I want to receive it by hand (Without a power of aorney, no response is given to someone
else's applicaon. For hand deliveries, it must be received from the Clinic within the legal
response me. Otherwise, no responsibility will be accepted.).
• Wrien applicaons, on the date of nocaon of the document to the Data Controller
Clinic and/or its representave; Applicaons made by other methods are deemed to have
been made on the date the applicaon is received by the data controller.
• The response to the applicaon you have made will be sent to the address you have chosen
within 30 (thirty) days from the nocaon of your request, at the latest.
• If you request a wrien response to your applicaon, your applicaon up to 10 pages will
be nalized free of charge. For answers over 10 pages, a fee is charged for each page
exceeding the tari determined by the Personal Data Protecon Authority.
We hereby inform you that we reserve the right to request addional documents regarding
your applicaon, in order to determine your personal data processed by our Clinic and to
respond to your applicaon accurately and completely. We are not responsible for any errors
or damages that may arise due to inaccurate, incomplete or outdated informaon you have
provided.
Applicant (Personal Data Owner Relevant Person)
Name surname :
Applicaon date :
Signature :
