Form for Exercising the Rights of Data Subjects

Name of the Data Subject*

Please enter a valid First Name

Surname of the Data Subject*

Please enter a valid last name

Name of the legal representative of the Data Subject (if applicable)

Identity card of the Data Subject*

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Identity document or equivalent document of the Legal Representative (if applicable)

Address of the Data Subject or the Representative*

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Email Address*

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Telephone number of the Data Subject*

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Telephone number of the Representative

State the right you wish to exercise*

Request for access to information check

Request to update and rectify personal data check

Request to erase information check

Request to object to the processing of personal data check

Request to suspend the processing of personal data check

Personal data portability check

Request to not be subject to a decision based solely or partly on automated processing check

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Description of the reason for the request*

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Copy of the Identify Card of the Data Subject*

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Copy of the Identify Card of the Representative*

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Documents that support the request*

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I hereby authorize PEREZ BUSTAMANTE & PONCE ABOGADOS to respond to my request at the mailing address and/or email address recorded in this form.

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