Data Subjects’ Request Form

You have the right to request the execution of the rights attributed by articles 12 to 22 of the GDPR regarding the personal data we may hold about you. This type of request is called a "Data Subject Request" ("DSR"). If you wish to make a DSR, please fill in this form.

"Data Subject": natural identifiable person whose personal data is subject of the requested right

1. DATA SUBJECT'S FULL NAME

Title (Mrs/Ms/Mr)

First name of the Data Subject

Last name of the Data Subject

2. DATA SUBJECT'S DATE OF BIRTH

3. DATA SUBJECT'S CURRENT ADDRESS OF RESIDENCE

Street and number

City

Zip/Postal Code

Country

4. DATA SUBJECT'S TELEPHONE NUMBER

Phone number:

5. WHICH RIGHT(S) WOULD YOU LIKE TO EXERCISE?

Right to Information and Access to my personal data

Right to Rectification of my personal data

If you wish to change the personal data related to your account, you can do so on the Road User Portal (http://rup.satellic.be/), under 'MY ACCOUNT' and 'Manage Account'

Right to Erasure of my personal data

Right to Restriction of the processing of my personal data

Right to Portability of my personal data

Right to Object to a processing based on public interest or on a legitimate interest

Right to Object to an automated individual decision making, including profiling

6. DESCRIBE PRECISELY WHICH PERSONAL DATA YOU ARE REQUESTING OR RELATING TO WHICH PERSONAL DATA YOU WANT TO EXERCISE YOUR RIGHT(S). GIVE AS MANY DETAILS AS POSSIBLE: E.G. "I NEED A COPY OF ALL THE E-MAILS EXCHANGED WITH SATELLIC BETWEEN DATE X AND DATE Y"

If we do not receive sufficient information to locate the data you are requesting or the data relating to which you want to exercise your right(s), we may not be able to comply with your request.

7. ARE YOU THE DATA SUBJECT (NATURAL IDENTIFIABLE PERSON WHOSE PERSONAL DATA IS SUBJECT OF THE REQUESTED RIGHT) OR ARE YOU HER/HIS REPRESENTATIVE?

I am the Data Subject

I am a representative of the Data Subject

8. I CONFIRM THAT I AM THE DATA SUBJECT

First name

Last name

E-mail address to which the personal data must be sent:

Date:

Attach a copy of your ID card/passport

Maximum 8 files.
16 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.

Signature

8. THE DATA SUBJECT MUST GIVE YOU AN AUTHORISATION TO BE HER/HIS AUTHORISED REPRESENTATIVE BY FILLING IN THIS SECTION. AS THE DATA SUBJECT, I HEREBY GIVE MY AUTHORISATION TO THE FOLLOWING PERSON (AUTHORISED REPRESENTATIVE) TO EXERCISE MY RIGHTS REGARDING THE PERSONAL DATA EXPRESSED IN THIS REQUEST:

First name of the authorised representative

Last name of the authorised representative

Name of the Data Subject giving the authorisation:

First name

Last name

Date:

Copy of the Data Subject's ID card/passport

Maximum 8 files.
16 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.

Signature of the Data Subject

9. I CONFIRM THAT I AM AN AUTHORISED REPRESENTATIVE OF THE DATA SUBJECT AND I FILL IN MY NAME AND E-MAIL ADDRESS:

First name of the authorised representative

Last name of the authorised representative

E-mail address to which the personal data must be sent:

Date:

Copy of the ID card/passport of the authorised representative

Maximum 8 files.
16 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.

Signature of the authorised representative

We will make every effort to process your Data Subject’s Request as quickly as possible and reply to you within 30 calendar days. However, if you have any queries whilst your request is being processed, please do not hesitate to contact us at the following address: dataprivacy@satellic.be