Hospis Malaysia Personal Data Access Request Form (Page 2 of 3) in pdf

Hospis Malaysia Personal Data Access Request Form Page 2

[c]

Please describe the nature of your relationship with the Data Subject:

____________________________________________________________________

______________________________________________________

[d]

Please state the basis of your requiring the personal data of the Data Subject:

____________________________________________________________________

______________________________________________________

[e]

Please enclose with this Form an authorisation letter from the Data Subject as proof

of your authority to act on behalf of the Data Subject.

[3]

THE PERSONAL DATA SOUGHT

Please provide a description of the personal data requested for, and any relevant additional

information which can assist us in providing you with a copy of your personal data.

Please specify if you would like to simply view the personal data or to receive a copy of the personal

data

( )

View

( )

Copy required

[4]

Declaration

______________________________________________________hereby

confirm

that

the

information given in this Form and any documents enclosed are true and accurate. I understand that it

will be necessary for Hospis Malaysia to verify my / the Data Subject’s identity and that Hospis

Malaysia may contact me or the Data Subject for more detailed information in order to locate the

information required.

Signed: _____________________________

Date: _______________________________

Hospis Malaysia Personal Data Access Request Form Page 2