REQUEST FOR INFORMATION

Please specify which information listed in the table you would like to receive.

If you want to receive all of the information mentioned in the table, please select the word “Yes” in all items.

Should you send the table back without any selections, we will assume that you are not requesting any information.

I would like to receive the following information:

Information concerning the set of data, information concerning the data administrator (name, registered office)	Yes No
Information concerning the purpose, scope and method of processing data contained in the data set	Yes No
Information concerning the contents of data processed in the set and since when the data have been processed	Yes No
Information on the source from which the data originate	Yes No
Information about the method of provision of the data, in particular information about data recipients or categories of data recipients	Yes No
First Name and Surname:
E-mail:
Phone: