Application Form

To exercise your rights within the scope of the rights listed in Article 11 of the Law No. 6698 on the Protection of Personal Data (“Law”), in accordance with Article 13 of the Law and Article 5 of the Communiqué on Application Procedures and Principles to the Data Controller, you must fill out this form and submit it to Orthodontist Bengi Kaya Mert (“Orthodontist”) through one of the following methods.

As the “Data Controller,” with tax identification number 5310320971 and located at Teşvikiye Mah. Şakayık Sok. Ihlamur Palas No:42/7 Şişli, Istanbul, and registered with the Mecidiyeköy Tax Office, we show the utmost care necessary for the security of your personal data. Accordingly, we process your personal data in the manner explained below and within the limits prescribed by the Law.

1. To identify the applicant’s identity, the identity document (ID card, driver’s license, passport, etc.) must be personally submitted with a wet signature to our company,
2. Submitted via a notary public to the application address,
3. Submitted to bengikayamert@hs01.kep.tr from the data subject’s registered electronic mail,

Your applications submitted to our company through one of the methods specified above will be answered free of charge within a maximum of thirty (30) days at the latest, depending on the nature of the request, and this response will be notified to you by the method you have chosen below. If the request also requires a cost, a fee may be charged to you in accordance with the tariff determined by the Personal Data Protection Board.

Identity and Contact Information

The following information must be filled in for us to contact you and verify your identity.

Please select the option that best describes your relationship with our company, and in the details section, provide the current status of this relationship, the period during which the relationship took place if it has ended, and the contact information of the company if applicable.

Please select the method by which you want to receive our response to your application:

☐ a) I want to receive it in person (If you want to receive it by proxy, a notarized power of attorney or authorization document is required.)

☐ b) I want it to be sent to my address.

☐ c) I want it to be sent to my e-mail address.

The information and documents provided by you within the scope of this application must be accurate, up-to-date and the application must be made by properly authorized individuals. Otherwise, our company will not be responsible for any requests resulting from incorrect information or unauthorized applications. Our company may request additional information or documents from you in order to evaluate your application and ensure the security of your personal data.

Applicant (Personal Data Subject) Name:
Application Date:
Signature: