ÖZEL SEÇİL SÖNMEZ AĞIZ VE DİŞ SAĞLIĞI POLİKLİNİĞİ LTD. ŞTİ. KVKK Access / Information Request Form
1. General Information
Under Article 20 of the Constitution of the Republic of Turkiye, everyone has the right to request the protection of personal data concerning them. This right includes being informed about such data, accessing it, requesting its correction or deletion and learning whether it is used in line with the purposes of processing.
Natural persons defined as “data subjects” under Law No. 6698 may apply to the data controller in order to exercise the rights listed in Article 11 of KVKK. As a rule, an application must first be submitted to the data controller before a complaint can be filed with the Board.
ÖZEL SEÇİL SÖNMEZ AĞIZ VE DİŞ SAĞLIĞI POLİKLİNİĞİ LTD. ŞTİ. makes this form available in order to assess the applications of data subjects and provide the necessary response.
2. Right to Apply
2.1. Application Topics
Under Article 11 of KVKK, applications may be made on the following matters:
To learn whether your personal data is being processed,
To request information if your personal data has been processed,
To learn the purpose of processing and whether the data is used in accordance with that purpose,
To learn the third parties to whom your personal data is transferred domestically or abroad,
To request correction of incomplete or inaccurate personal data,
To request deletion, destruction or anonymization of personal data under Article 7 of KVKK,
To object to a result against you arising exclusively from the automated analysis of processed data,
To request compensation if you suffer damage due to the unlawful processing of your personal data.
2.2. Situations Outside the Scope of the Right to Apply and Grounds for Refusal
The exceptions set out in Article 28 of KVKK and the mandatory recording and retention obligations under healthcare legislation remain reserved. Applications may be rejected in whole or in part for reasons such as violating the rights and freedoms of others, requiring disproportionate effort, concerning publicly available information or inability to verify identity / authority.
3. Request of the Applicant
You may mark the applicable rights below and add your explanation regarding the request.
| REQUEST NO | SUBJECT OF THE REQUEST | RELEVANT ARTICLE OF THE LAW | INFORMATION REQUESTED FROM YOU | SUPPORTING DOCUMENT YOU MAY PROVIDE | MARK |
|---|---|---|---|---|---|
| 1 | I request information on whether my personal data is processed and, if so, for which purposes. | KVKK Art. 11/1 (a, b, c) | None | None | ☐ |
| 2 | If my personal data is transferred to third parties in Turkiye or abroad, I want to learn who those third parties are. | KVKK Art. 11/1 (ç) | None | None | ☐ |
| 3 | I believe that my personal data is incomplete or inaccurate and request its correction. | KVKK Art. 11/1 (d) | Please specify the data to be corrected and the correct information. | You may attach current and accurate documents supporting your request. Additional information may be requested for identity verification. | ☐ |
| 4 | I believe that the reasons requiring the processing of my personal data no longer exist and request deletion / destruction / anonymization. | KVKK Art. 11/1 (e) | Please state the reason for your request and which action you request. | You may attach information explaining your request and any supporting documents. Requests may be assessed in a limited way where legal retention obligations continue. | ☐ |
| 5 | I believe that an unfavorable result has arisen against me through the exclusive automated analysis of my personal data and I object to it. | KVKK Art. 11/1 (g) | Please explain the process to which you object. | You may attach information and documents supporting your request. | ☐ |
| 6 | I believe that I have suffered damage because my personal data was processed unlawfully and I request compensation. | KVKK Art. 11/1 (h) | Please describe the alleged unlawful act and your request. | You may attach any information and documents supporting your damage claim. | ☐ |
| 7 | I have another request under KVKK. | Please state your request in detail. | You may attach supporting documents, if any. | ☐ |
4. Application Methods
You may submit your application by one of the following methods:
| Application Method | Address / Channel | Information to State During Submission |
|---|---|---|
| Wet-Signed Application in Person | Akdere Mah. Mehmet Ali Altın Cd. No: 85/D 06630 Mamak / Ankara | You may write “Application Under the Personal Data Protection Law” on the envelope. |
| Notification Through a Notary | Akdere Mah. Mehmet Ali Altın Cd. No: 85/D 06630 Mamak / Ankara | You may write “Application Under the Personal Data Protection Law” on the envelope. |
| Application with Secure Electronic Signature / Mobile Signature | Dtsecilsonmez@gmail.com | Your application must be signed with a secure electronic signature or mobile signature. You may write “KVKK Application” in the subject line. |
| Application from the Email Address Registered in Our System | Dtsecilsonmez@gmail.com | The application must be sent from the email address that you previously notified to the clinic and that is registered in our system. |
5. Information for Identification and Contact
It is recommended that the following information be completed in full so that the application can be confirmed as belonging to the right person and concluded properly.
Full Name:
Turkish ID Number (Passport Number for Foreign Nationals):
Your Relationship with Our Institution: ☐ Patient ☐ Employee / Former Employee ☐ Job Application ☐ Other
Residence / Work Address for Notification:
Mobile Phone:
Email Address:
Has your relationship with our institution ended?: ☐ Yes ☐ No
Relevant unit / process for your request:
6. Method and Period for Responding to Applications
Applications are finalized free of charge as soon as possible and no later than 30 (thirty) days, depending on their nature. If the transaction requires an additional cost, the tariff determined by the Board may be charged.
In order to ensure personal data security, additional information or documents may be requested where necessary for identity and authority verification. If the records within the scope of access contain data belonging to third parties, the response may be provided by masking or summarizing.
If your application is not answered within 30 days, if the response is considered insufficient or if the request is rejected, the data subject may file a complaint with the Board within 30 days from learning the response and, in any event, within 60 days from the application date.
Method of Delivery of the Response to You
☐ I want it sent to my address.
☐ I want it sent to my email address.
☐ I want to collect it in person.
Applicant Full Name:
Application Date:
Signature: