Data Subject Application Form

Document

Last Updated:14.09.2026

Under the Turkish Personal Data Protection Law No. 6698 (“KVKK”), data subjects defined as “Data Subjects” are granted various rights under Article 11 of the Law.

By completing this form, you may submit your requests regarding your rights under the KVKK to the data controller, Specialist Dentist Çağrı Şibal.

Application Methods and Communication Channels

You may submit this completed and signed form to us using one of the following methods:

Written Application by Hand Delivery or Through a Notary Public:
You may deliver the form bearing your wet-ink signature in person or send it through a notary public to the following address:

Avcılar Exclusive, Mansuroğlu Mah., 288/4. Sk. No: 9/1, A Blok, Office: 39, 35535 Bayraklı / İzmir, Türkiye.

By Email:
You may send your application, signed with a secure electronic signature or mobile signature, or from an email address previously registered in the data controller’s systems, to the KVKK application email address published on www.cagrisibal.com.

IMPORTANT NOTE: Applications must be submitted personally by the data subject or through a legally authorised representative. For applications submitted on behalf of another person, documentation evidencing authority to act, such as a power of attorney, parental authority, guardianship, or similar legal representation, may be required. The data controller may request additional information or documents in order to verify the identity of the applicant. The applicant shall be responsible for any consequences arising from the submission of incorrect, misleading, or unauthorised information.

1. Applicant Information

Please complete the following fields fully and legibly.

Full Name:
....................................................................................................

Turkish Republic Identification Number / Passport Number:
....................................................................................................

Notification / Full Address:
....................................................................................................

....................................................................................................

Mobile Telephone:
....................................................................................................

Email Address:
....................................................................................................

Your Relationship with Specialist Dentist Çağrı Şibal

[ ] Patient
[ ] Patient Relative / Legal Representative
[ ] Website Visitor
[ ] Employee
[ ] Job Applicant
[ ] Supplier / Service Provider
[ ] Other: ....................................................................

Is your relationship ongoing?

[ ] Yes

[ ] No

Year the Relationship Ended: ....................................................

2. Your Request Under the KVKK

Please state your request under the KVKK below as clearly and in as much detail as possible.

Indicating the personal data category, processing activity, or period to which your request relates will help us assess your application more efficiently.

....................................................................................................

Subject of Your Request

You may select one or more of the options below, as applicable:

[ ] I would like to learn whether my personal data are being processed.

[ ] If my personal data are being processed, I request information regarding such processing.

[ ] I would like to learn the purpose for which my personal data are processed.

[ ] I would like to learn whether my personal data are being used in accordance with the purpose of processing.

[ ] I would like to learn the third parties to whom my personal data have been transferred.

[ ] I request the correction of my personal data that have been processed incompletely or inaccurately.

[ ] I request the deletion or destruction of my personal data subject to the conditions prescribed by applicable legislation.

[ ] I request that the correction, deletion, or destruction of my personal data be notified to third parties to whom my personal data have been transferred.

[ ] I object to any outcome arising against me as a result of the analysis of my personal data exclusively through automated systems.

[ ] I request compensation for damages I have suffered as a result of the unlawful processing of my personal data.

[ ] Other: ............................................................................................

Documents Supporting Your Application

If you have any additional documents relating to your application, please specify them below.

Appendix 1:
....................................................................................................

Appendix 2:
....................................................................................................

Appendix 3:
....................................................................................................

3. Method by Which You Wish to Receive the Response

Please select how you would like the response to your application to be delivered.

[ ] By Email
I would like the response to be sent to the email address stated in this form.

[ ] By Post
I would like the response to be sent to the physical address stated in this form.

[ ] Collection in Person
I would like to collect the response personally from the application address.

Where the response is collected by an authorised representative, appropriate documentation evidencing the authority to represent the applicant may be required.

4. Applicant’s Declaration

I request that my application submitted under the KVKK in accordance with the requests stated above be evaluated and that I be provided with a response within the period prescribed by applicable legislation.

I declare that the information and documents I have provided in this application are accurate, up to date, and relate either to me personally or to the person whom I am legally authorised to represent.

I acknowledge that I have been informed that the personal data necessary for receiving my application, verifying my identity and, where applicable, my authority to represent another person, evaluating my request, and providing me with a response may be processed solely for these purposes.

Applicant’s Full Name:
....................................................................................................

Application Date:
…… / …… / 2026

Signature:
....................................................................................................

Data Controller Contact Information

Data Controller: Specialist Dentist Çağrı Şibal
Title: Orthodontist / Specialist Dentist
Website: www.cagrisibal.com
Telephone: +90 532 505 40 08
Address: Avcılar Exclusive, Mansuroğlu Mah., 288/4. Sk. No: 9/1, A Blok, Office: 39, 35535 Bayraklı / İzmir, Türkiye