Personal Data Deletion/Erasure Request Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area/Country Code
Phone Number
Nature of Request
Please Select
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Request to Delete/Erase Personal Data
Specific Personal Data Requested for Deletion/Erasure (Please list the data or types of data you wish to review or revise)
Reason for Deletion/Erasure = (if applicable) - Please provide a brief explanation of why you are requesting the deletion/erasure of your personal data.
Authorization and Signature
By signing below, I confirm that the information provided in this form is accurate and that I am the data subject or an authorized representative of the data subject. I understand that once my personal data is deleted/erased, it cannot be recovered.
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: