GDPR Erasure Request Form

GDPR Erasure Request Form
GDPR entitles individuals rights under the law. One of which is the right to have one's personal information erased from our records.
In this regard, we will do our best to provide you with prompt service from receiving this request together with the relevant information in order for us to properly match the information and process the request as soon as possible.
Rest assured that the information that you shall supply here will be used for the purpose of identification of the data subject only.
Name of Data Subject
First NameLast Name
Address of Data Subject
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Email Address of Data Subject
example@example.com
Date of Birth of Data Subject
MonthDayYear
Date
Are you the Data Subject?
YesNo, I am submitting the request on behalf of the data subject
Take your Photo
Upload Your Valid Government Issued Identification
Cancelof
Upload a Photo of the Authorization Letter of the Data Subject
Cancelof
Upload the Valid Government Issued Identification of the Data subject
Cancelof
Given the sensitive nature of this action, we will need some information in order for the processing of the request can be done. We would like to hear from you the reason why you or your principal wishes for the data to be erased.
Please indicate the reason for the request
The information is no longer necessary from which it was collected.No longer consenting to the processing of dataObjection to the processing of data in accordance with Article 21 of the GDPRDid not give consent to the processing of personal dataYou are, or the data subject is a minorOther
Information Erasure
I would like to erase all my informationI would like to erase only a specific information
Which information would you like to erase from our records
First NameLast NameAddressEmailOther
I confirm that I have the full capacity and authority to exercise this request and I am aware of the implications of such such as being unable to be provided better services.
I understand the necessit for me to confirm my identity or the data subject's identity in order to obtain and process the necessary information as I have requested.
Name
First NameLast Name
Signature
Clear
Date
MonthDayYear
Date
Should be Empty: