International Pharmaceutical Innovators in Oncology

Data Subject Request Form

Request for Data Subject Rights under the General Data Protection Regulation and / or the Data Protection Act 2018.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone

Email(Required)

Details of Request(Required)

Please indicate which right(s) you wish to request by marking ✓ in the appropriate box or boxes below.

Right to erasure

Right to restrict processing

Right to object

Right not to be subject to automated processing or profiling

Right to withdraw consent

The details of my request are

Declaration(Required)

I declare that all the details I have provided in this form are true and complete to the best of my knowledge.

First Last

Date(Required)

Please note that we will follow up to verify your identity

Alternativly you may download this form and submit.

By post to Questum Acceleration Centre Ballingarrane Science and Technology Park, Clonmel, Co. Tipperary, E91 V329