Data Subject Right Request Form
Part I: Information of Data Subject Request
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Detail of Data Subject Request |
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First – Last Name |
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Address |
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Telephone No. |
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¨ In case the request is the Data Subject
I have attached following documents for identify authentication and my address verification of Data Subject in order to process my right of requisition accordingly. The document for identify authentication are;
¨ Copy of Identification Card (In case of Thai Nationality)
¨ Copy of Passport (In case of Foreigner)
¨ Copy of House Registration (In case of Thai Nationality)
¨ In case of requestor is representative of data subject owner
I am the representative of Mr/Mrs/Ms……………………………………………………… who is the data subject. By this, I have provided the document to testify the empowerment and address of the requestor and data subject. Then the company can proceed accordingly.
¨ Letter of Empowerment
¨ Copy of Identification Card of both Representative and Data Subject Owner (Thai Nationality)
¨ Copy of Passport of both Representative and Data Subject Owner (Foreigner)
¨ Copy of House Registration (Thai Nationality)
I am willing to answer all enquiries from the company or provide more additional document as needed. If the information I have provided is not clear or cannot be identified as the true data subject or representative, I acknowledge that the company have right to reject my requisition.
Part 2 : Request Rights of Data Subject Owner
o Withdraw the Consent
o To Access and/or obtain the copy of personal data
o To disclose the data forwarder or the personal data being kept without consent of data subject.
o To rectify the personal data to remain accurate, up-to-date, complete and not mis-leading
o To transfer Personal Data
o To erase or destroy the personal data or anonymize the personal data to become the anonymous data
o To restrict the use the personal data.
o To object the collection, use or disclosure of the personal data.
Part III: Types of Personal Data Requested by Data Subject
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Types of Personal Data |
Storage Locations (If known)
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1 |
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2 |
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3 |
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Part IV: Reasons and Evidence Document Used for the Requisition
I hereby provide reason in using my right with documents and information attached for company to consider and process as per my requisition.
¨ Reasons in using my rights are………………………………………………………………………………...
………………………………...……………………………………………………………………………...……….………………………………………………………………………………………………………………………………………...
¨ By this, I have provided evidence /information for my requisition (please demonstrate, if any) …
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Part V: Rights Reserved of Controller
I acknowledge that if there is/are the cases below, my requisition will be refected.
(1) I cannot demonstrate clearly whether I am Data Subject or representative of the Data Subject.
(2) The requisition is not proper i.e. Data Subject has no right to access the personal data or the company does not have the information as requested.
(3) The requisition is repeat and/or irrelevant i.e. the requisition is requested on the same items.
(4) The personal data stored is for the purpose of freedom in demonstrating opinion, or historical document purpose, or public interests or related to research that have been managed to protect rights of data subject owner. This is to include the any activities / procedures for the company benefit or the company has stored such a personal data as fully authorized by government in order to meet with section 26 paragraph 5 of Personal Data Protection Act.
(5) The personal data stored is in accordance rights described by law, proceed by law, request by law and raise the right request by law.
I acknowledge that normally there will be no cost in submitting such a requisition However, if it appears that the requisition requested is not proper or relevant, the company may charge the fee accordingly.
And I am aware that the company will take time process the case within 30 days from the date of receiving requisition.
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Acknowledgement and Consent |
I have read and understood the detail in this requisition carefully and confirm that all information notified to the company is/are correct. I understand that there will be processing to verify and proof on information submitted and if the information is wrong or there is an intention to fake information, I will be subject for prosecution. The company may ask for additional information from me to further check accordingly to proceed and then give permission.
With this, I hereby sign an evidence.
Signature …………………………………………………………. Requestor
(……………………………………………………..).
Date …………………………………………………………………
