Data Subject Processing Restriction Request Form

Article 18 of the EU General Data Protection Regulation (Regulation (EU) 2016/679) (GDPR) grants you the right to restrict certain personal data processing by Medochemie Limited (hereinafter referred to as “Medochemie”) subject to limited exceptions. 
We require that you submit this request electronically via email to dpo@medochemie.com.
We expect to respond to your request within one month of receipt of a fully completed form and proof of identity.
For more information on your rights under the GDPR, please see Medochmie’s Data Subject Rights Policy and Privacy & Cookie Police available at: www.medochemie.com.
I. Requester Name (Data Subject) and Contact Information
Please provide the data subject’s information in the space provided below. If you are making this request on the data subject’s behalf, you should provide your name and contact information in Section III.
We will only use the information you provide on this form to identify you and the personal data associated with your processing restriction request, and to respond to your request.
First and last name:

Any other names that you have been known by (including nicknames):

Home address:

Date of birth:

Telephone number:

Email address:

If you are a current or former employee of Medochemie, please provide your employee identification number and your approximate dates of employment:

Please provide other unique identifiers or related information to help us locate your personal data (for example, government identification number or customer account number):

II. Proof of Data Subject’s Identity
We require proof of your identity before we can respond to your data processing restriction request. To help us establish your identity, you must provide identification that clearly shows your name, date of birth, and current address. We accept a photocopy or a scanned image of one of the following as proof of identity: passport or photo identification such as national identification number card. If you have changed your name, please provide the relevant documents evidencing the change.
If you do not have any of these forms of identification available, please contact Ms. Giota Andreou at 00357 25 852696 or dpo@medochemie.com for advice on other acceptable forms of identification.
We may request additional information from you to help confirm your identity and your data processsing restriction request.
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III. 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.
First and last name:

Home address: 

Date of birth:

Telephone number:

Email address:

We accept a photocopy or a scanned image of one of the following as proof of your identity: passport or photo identification such as a driver’s license, national identification number card. If you do not have any of these forms of identification available, please contact Ms. Giota Andreou at 00357 25 852696 or dpo@medochemie.com for advice on other acceptable forms of identification. We may request additional information from you to help confirm your identity if necessary.
We also require proof of the data subject’s identity before we can respond to the request. To help us establish the data subject’s identity, you must provide identification that clearly shows the data subject’s name, date of birth, and current address. We accept a photocopy or a scanned image of one of the following as proof of identity: passport or photo identification such as national identification number card. If the data subject has changed his/her name, please provide the relevant documents evidencing the change.
We accept a copy of the following as proof of your legal authority to act on the data subject’s behalf: a written and notarized 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.
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IV. Request to Restrict Personal Data Processing
Under Article 18, you have the right to request that we restrict the processing of your personal data, subject to certain limited exceptions provided by the GDPR or local law.
If you object to processing that we perform under Articles 6(1)(e) or 6(1)(f), we will restrict the challenged processing activity pending verification of whether Medochemie’s or any third party’s legitimate interests override your interests.
To help us process your request quickly and efficiently, please provide us below with as much detail about the personal data you are requesting us to restrict the processing of and the above ground or grounds you are relying on for your processing restriction request.
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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 a processing restriction for “all information about me”). We will begin processing your restriction request as soon as we have verified your identity and have all of the information we need to locate your personal data.
Applicable law may allow or require us to refuse to act on your request, or we may have destroyed, erased, or made your personal data anonymous in accordance with our record retention obligations and practices. If we cannot comply with your processing restriction request, we will inform you of the reasons why, subject to any legal or regulatory restrictions. 
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V. Signature and 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) Medochemie Limited must confirm proof of identity and may need to contact me again for further information; and (2) my request will not be valid until Medochemie Limited receives all of the required information to process the request.
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Signature
__________________________________
Date
VI. Authorized Person Signature
I, _____________________________, confirm that I am authorized to act on behalf of the data subject. I understand that Medochemie Limited must confirm my identity and my legal authority to act on the data subject’s behalf, and may need to request additional verifying information. 
I understand that: (1) Medochemie Limited must confirm proof of identity and may need to contact me again for further information; and (2) my request will not be valid until Medochemie Limited receives all of the required information to process the request.
__________________________________
Signature
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Date]
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