IN ACCORDANCE WITH THE LAW ON THE PROTECTION OF PERSONAL DATA

DATA SUBJECT APPLICATION FORM

In the Law No. 6698 on the Protection of Personal Data ("Law"), personal data owners (hereinafter referred to as "Data Owner"), who are defined as the data subject, are granted certain rights regarding the processing of their personal data in Article 11 of the Law.

Pursuant to paragraph 1 of Article 13 of the Law; applications to be made to Dr. Melis Esin Ülger (our practice), who is the data controller, regarding these rights must be submitted to us in writing or by other methods determined by the Personal Data Protection Board ("Board").

This form has been prepared to facilitate your exercise of your right to obtain information by making an application in accordance with Article 11 of the Law on the Protection of Personal Data.

In order to fulfill your request under the Law on the Protection of Personal Data ("KVKK"), you must fill out the application form below clearly and completely and submit it to us in writing.

In this context, applications to be made to Dr. Melis Esin Ülger "in writing" should be made by filling out this form;

• By application of the Applicant in person or by proxy,
• Through a notary,
• If your e-mail address is registered in our practice and/or it can be confirmed that the sending e-mail address belongs to you "[email protected]" by sending it to the e-mail address

must be forwarded to us. Applications made by regular mail (PTT) or courier/cargo companies will be processed upon receipt. However, it is recommended not to apply with such methods that cannot be identified or proven.

Below, information on how written applications will be delivered to us is provided specific to the written application channels.

Pursuant to paragraph 2 of Article 13 of the Law on the Protection of Personal Data, the applications submitted to us will be responded free of charge within thirty (30) days from the date of receipt of the request by one of the above-mentioned methods (confirming the identity of the sender for applications made by regular e-mail). However, in the event that an additional cost arises, Dr. Melis Esin Ülger reserves the right to charge you a fee according to the tariff to be determined by the Personal Data Protection Board. If the information and documents you submit to us are incomplete or incomprehensible, you may be contacted to clarify your application. Our responses will be delivered to the applicant in writing or electronically in accordance with Article 13 of the Law on the Protection of Personal Data.

 1. IDENTITY AND CONTACT INFORMATION OF THE APPLICANT

The information requested by this form is necessary for the correct identification of your identity, to conduct detailed research on your request and to communicate the result of your application to you ("Purpose") and may be processed for this Purpose. Therefore, please provide accurate and complete information. Your requested personal data will not be used in any way other than to fulfill the Purpose.

2. YOUR RELATIONSHIP WITH US

3. INFORMATION ON THE SELECTION OF THE RIGHT TO BE EXERCISED BY THE APPLICANT

(Please check the box(es) next to the statement appropriate to your request)

4. EXPLANATION OF THE APPLICANT'S REQUEST

Please specify in detail your request under the Law on the Protection of Personal Data and the personal data subject to your request:

5. APPENDICES

Please indicate if there are any documents you would like to base your application on.

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If there are supporting documents/documents for your request, these documents/documents should also be attached to the form. If you are applying as an individual, please attach a copy/photocopy of the documents certifying your identity (identity card, driver's license, passport, etc.) to the form. If the application is made through a proxy, a copy of the power of attorney containing special authorization must be attached to the form.

A. HOW YOU WILL BE NOTIFIED OF THE RESPONSE TO YOUR APPLICATION

• I want it to be sent to my address (In this case, you need to write your address information).

• I want to pick it up in person.
• I want it sent to my e-mail address.

(In case of delivery by proxy, there must be a notarized power of attorney or authorization certificate).

The response to your application will be sent to your e-mail address indicated above via e-mail, registered mail with return receipt requested or notary public, depending on your preference. If no preference is made, Dr. Melis Esin Ülger will determine the response method.

This application form has been prepared in order to determine your relationship with Dr. Melis Esin Ülger, to determine your personal data processed by Dr. Melis Esin Ülger, if any, and to respond to your relevant application correctly and within the legal period. In order to eliminate legal risks that may arise from unlawful and unfair data sharing and especially to ensure the security of your personal data, Dr. Melis Esin Ülger reserves the right to request additional documents and information (copy of identity card or driver's license, etc.) for identification and authorization. In the event that the information regarding your requests submitted within the scope of the form is not accurate and up-to-date or an unauthorized application is made, Dr. Melis Esin Ülger does not accept any liability for the requests arising from such incorrect information or unauthorized application. All responsibility arising from unlawful, misleading or false applications belongs to you.

B. SIGNATURE OF THE APPLICANT

In line with the requests I have stated above, I request that my application to Dr. Melis Esin Ülger be evaluated in accordance with Article 13 of the Law on the Protection of Personal Data and that I be informed.