APPLICATION FORM ACCORDING TO THE LAW ON THE PROTECTION OF PERSONAL DATA ​ ​ Application date :

 

........... / ........... / ............... □ "Request for Personal Data" □In case of "Request for Personal Data" belonging to someone else (if they have not reached the age of 19, their parents or guardian, if under guardianship, their guardian, persons to whom the data subject has given express power of attorney in this regard) A. Contact information of the Applicant: Name and surname: ............................................... ..................... Signature:………………………………………………..…. Date of Birth:……….../ .......... / ............ T.C. Identification number : ............................................... ........ Phone number: ....................................... .................................................................. .................................................................. ............ E-mail address: ............................................. .................................................................. .............................................. Address: ................................................. .................................................................. .................................................................. ........... B. Owner of the requested Personal Data: Name and surname : ............................................... .................................................................. .................................................................. .. Date of Birth:……….../ .......... / ............ T.C. Identification number : ............................................... ........ Phone number : ....................................... .................................................................. .................................................................. ............ E-mail address: ............................................. .................................................................. ............................................... Address: ................................................. .................................................................. .................................................................. 

C. Please indicate your relationship with Yücelen Hospitals. (such as patient, ex-employee, third party, employee of the company serving Yucelen Hospital) Those who receive health care at Yücelen Hospital will be full □ I was treated as an outpatient ☐ I was treated as an inpatient ☐ I had an operation ☐ Other: ………………………………………….. Health Units Served: .…………………………………………..…………………..………………………….………… .. ..... ............................................... .... ..... ...... .................................................................. . . . . ................................................. .............. ................................ .. ................ .................................................. .............. .. ...................... Those working at Yücelen Hospital will fill it. □ Current Employee ☐ Previous Work Years : ....................................... ☐ Other: ............................................... ……………………… D. Please specify your request under the Personal Data Protection Law in detail: .………………..………………..…………………………. ………………………………. ......................... .................................................................. . . . . ................................................. .............. ................................ .. ................ .................................................. .............. .. ...................... Please choose the method of notifying you of our response to your application: □I want it sent to the address. □I want it sent to my e-mail address. □I want to receive it by hand. 12 (If requested by proxy, a power of attorney or a document showing the authority of the authorized person is required.) Explanation By filling out this form,

• You can personally deliver a signed copy to Marmaris Bulvarı Kötekli Mahallesi 65 Sokak 22/C-1 48000 Menteşe / MUĞLA address, send it through a notary public,

• To register at gursoyturizmasaat@hs02.kep.tr electronically or with a secure electronic or mobile signature.

• You can send it to gursoyturizmasaat@hs02.kep.tr with a secure electronic or mobile signature, via your registered e-mail address or your e-mail address registered in our system. This application form you have filled in has been prepared in order to determine your relationship with Yücelen Hospitals and to respond to your application accurately and within the legal timeframe, regarding your personal data, if any, processed by Yücelen Hospitals. Yücelen Hospitals reserves the right to request additional documents and information (such as a copy of your identity card or driver's license) for identification and authorization in order to eliminate legal risks that may arise from illegal and unfair data sharing and especially to ensure the security of your personal data. Yücelen Hospitals does not accept any responsibility for the wrong information or requests originating from unauthorized applications, or for any failures that may occur during the delivery of our answers to the addresses you have specified, if the information regarding your requests you have submitted within the scope of the form is not correct and up-to-date or an unauthorized application is made. To be filled by the hospital. History: ............ / ........... / ............... Recipient's Name and Surname: ............................................. .................... Signature: ............................ .............................................

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