Data Subject Access Request Form (DSARF)

Name

First

Last

Email

You are submitting this request as

The person whose name appears above.
An agent authorized by the consumer to make this request on their behalf.
The parent / guardian of the person, whose name appears above.. Please provide your name in the comment box below

Name of parent or guardian

First

Last

Under the rights of which law are you making this request?

Other law provision to which you making this request?

I am submitting a request to ___________

Please leave details regarding your action request or question.

I confirm that

Under penalty of perjury, I declare all the above information to be true and accurate.

I confirm that (copy)

I understand that the deletion or restriction of my personal data is irreversible and may result in the termination of services with My Great New Website / App.

I confirm that (copy)

I understand that I will be required to validate my request by email, and I may be contacted in order to complete the request.

GDPR Agreement

I consent to having this website store my submitted information so they can respond to my inquiry.