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Data Subject Access Request Form

DATA SUBJECT ACCESS REQUEST FORM

Revalize, Inc. and its affiliates (“Revalize”) values the privacy and security of our customers, employees and suppliers. If you are a citizen of the European Economic Area, Switzerland or the United Kingdom you have rights under applicable data protection laws (GDPR, UK GDPR or FDPA) to access your personal data held by Revalize, including the right to obtain confirmation that we process your personal data, receive certain information about the processing of your personal data, and obtain a copy of the personal data we process. If you are a California resident, you have certain rights under the California Consumer Privacy Act (“CCPA”).

If you would like to make a Data Subject Access Request, please complete and submit the form below. If you are a California resident and would like to exercise your rights under CCPA, please complete the webform here. If you have any questions about your rights as a data subject, please see our Privacy Policy.

If you are requesting access to the specific pieces of information that Revalize processes about you, we may need to authenticate your identity before proceeding with your request, which may include instructions to submit identity credentials through a secure form. We expect to respond to your request within one month of receipt of proof of identity.

Section 1: Data Subject’s details

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country
If you are completing this request on behalf of a data subject, please complete their details above and complete your details in Section 2 below.

2. Requests Made on a Data Subject's Behalf

Please complete this section of the form with your name and contact details if you are acting on the data subject’s behalf.

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country

We accept a copy of the following as proof of your legal authority to act on the data subject’s behalf: a written consent signed by the data subject, a certified copy of a power of attorney, or evidence of parental responsibility.

We may request additional information from you to help confirm the data subject’s identity. We reserve the right to refuse to act on your request if we are unable to verify your legal authority to act on the data subject’s behalf.

3. Information Requested

To help us process your request quickly and efficiently, please provide as much detail as possible about the personal data you are requesting access to. Please include time frames, dates, names, types of documents, file numbers, or any other information to help us locate your personal data. Please use the box below to set out the personal data you are seeking access to.

For example, you may specify that you are seeking (please tick relevant box(es)):

Please let us know of the date range you would like us to search:

We will contact you for additional information if the scope of your request is unclear or does not provide sufficient information for us to conduct a search (for example, if you request “all information about me”). We will begin processing your access request as soon as we have verified your identity and have all the information we need to locate your personal data.

Please us the following box to provide us with any further details of your request:

In response to your request, we will provide you with the information in accordance with GDPR, UK GDPR and the Swiss FDPA (as applicable), including information on:

The purposes of processing. Categories of personal data processed.
Recipients or categories of recipients who receive personal
data from us.		 How long we store the personal data, or the criteria we use to
determine retention periods.
Information on the personal data's source if we do not collect
it directly from you.		 Whether we use automated decision-making, including profiling,
the auto-decision logic used, and the consequences of this processing.
Your rights to:
request correction or erasure of your personal data;
restrict or object to certain types of processing with respect to your personal data;
and make a complaint with the local data protection authority.		  

If the information you request reveals personal data about a third party, we will either seek that individual’s consent before responding to your request, or we will redact that individual’s personal data before responding. If we are unable to provide you with access to your personal data because disclosure would violate the rights and freedoms of third parties, we will notify you of this decision.

Applicable law may allow or require us to refuse to provide you with access to some or all of the personal data that we hold about you, or we may have destroyed, erased, or made your personal data anonymous in accordance with our record retention obligations and practices. If we cannot provide you with access to your personal data, we will inform you of the reasons why, subject to any legal or regulatory restrictions.

4. Acknowledgment

I confirm that the information provided on this form is correct and that I am the person whose name appears on this form. I understand that:

  1. Revalize must confirm proof of identity and may need to contact me again for further information;
  2. My request will not be valid until Revalize receives all of the required information to process the request; and
  3. I am entitled to one free copy of the personal data I have requested, and acknowledge that for any further copies I request, Revalize may charge a reasonable fee based on administrative costs.

If I am signing as an authorized person, I confirm that I am authorized to act on behalf of the data subject. I understand that Revalize must confirm my identity and my legal authority to act on the data subject’s behalf and may need to request additional verifying information.