WHO: UAB Audimas Brand

Registered office address: Raudondvario pl. 80, LT-47182 Kaunas

E-mail address: [email protected]

REQUEST

ON THE EXERCISE OF THE RIGHTS OF THE DATA SUBJECT

Date: ____________________________

If you have any questions regarding the completion of this data subject's request, please contact the Data Protection Officer of UAB Audimas Brand by e-mail [email protected] .

I.         DATA SUBJECT DETAILS:
(In capital letters, enter your details that will allow us to identify you in order to process your application; the date of birth is required only if the application is submitted upon arrival at the office of UAB Audimas Brand)

Name:

Surname:

Phone number.:

El. mail:

Date of birth :

II.         DETAILS OF THE DATA SUBJECT REPRESENTATIVE:

(TO BE COMPLETED ONLY WHEN THE REQUEST IS SUBMITTED THROUGH THE REPRESENTATIVE; IN CAPITAL LETTERS, enter your details as the data subject's representative, which will allow us to identify you in order to fulfill your representative's request; the date of birth is required only if the request is submitted to Brand Office)

Name:

Surname:

Phone number.:

El. mail:

Date of birth:

Basis of representation (eg power of attorney):

III.         DATA SUBJECT REQUEST:
(Indicate which of the following rights you wish to exercise)

   Be aware of your data processing;

   Access your personal data and obtain a copy of the processed personal data;

   Require the deletion of your personal data;

   Require the correction of your personal data;

   Transfer your personal data;

   Restrict the processing of your personal data;

   Disagree with the processing of your personal data;

   Revoke consent previously given;

   Disagree with a decision made on the basis of automated decision-making and profiling, and require personal intervention to make a decision;

* Please fill in the fields below marked with an asterisk only if you choose to exercise the relevant specified right upon request.

* If you wish to exercise your right to know about the processing of your personal data , please indicate for what purpose your personal data is processed and what information you want to know about the processing (duration of processing, recipients, etc.)

* If you wish to exercise your right of access to your personal data and to receive a copy of the personal data processed , you may indicate what specific information about your personal data you wish to have access to. Indicate clearly if you wish to receive a copy of the data.

* If you request the deletion of your personal data , please indicate which personal data (or categories of personal data) you wish to delete and the reasons for the request for deletion:

* If you request the correction of your personal data , fill in the table for each data requested to be corrected:

Inaccurate information about you

Accurate personal information

* If you request the transfer of your personal data , please indicate to whom (indicating the name and code of the legal entity, name, surname, date of birth of the natural person; contact details (e-mail address, telephone number, address)) we should provide your personal data; you can also indicate what personal data you intend to transfer (on what basis are processed (processed in the course of your contract; processed on your consent; collected for a specific period; processed for certain purposes; categories of personal data)

* If you request a restriction on the processing of your personal data , please indicate in relation to which personal data you wish to restrict the processing and for what reasons

* If you wish to object to the processing of your personal data , please indicate for what purpose you do not consent to the processing of personal data, and if you do not consent to the processing of only certain categories of personal data, please indicate which specific categories of personal data you do not consent to

* If you wish to revoke a consent that has previously been given to you , please indicate for which purpose the processing of personal data you wish to revoke the consent

* If you intend to disagree with a decision made on the basis of automated decision-making and profiling and request personal intervention, please indicate in respect of which decision you seek to exercise this right.

You may provide other information if you believe it is necessary for us to process your request or may facilitate the exercise of your rights:

IV.         METHOD OF RECEIVING AN ANSWER:
(Indicate how you would like to receive an answer. If you do not indicate your preferred method of receiving an answer, we will provide an answer in the same form as we received the request)

    By email ____________________________________________________.

    By mail to _______________________________________________________.

    By personal collection at the office of UAB Audimas Brand at Raudondvario pl. 80, LT-47182 Kaunas.

V.         THE FOLLOWING DOCUMENT (S) SUBMITTED FOR IDENTIFICATION:
(To be filled in if the application is submitted at the office of UAB Audimas Brand, at Raudondvario pl. 80, LT-47182 Kaunas)

DATA SUBJECT DOCUMENT:

    Identity Card;

    Passport.

DOCUMENTS OF THE DATA SUBJECT'S REPRESENTATIVE (IF THE REQUEST IS MADE THROUGH THE REPRESENTATIVE):

Representative of the data subject or data subject (if the request is made through a representative)

name (in CAPITAL LETTERS), signature. When a request for the exercise of a data subject’s rights is made by e-mail [email protected] , this application is attached in pdf format and signed with a qualified electronic signature of the applicant (representative).