Personal data request / complaint form

Your name:

Address (physical and electronic):

Please check the residence address or¨ workplace address¨ to which the answer should be sent

If this is the address of the workplace, please provide the name of the company:

In order to help us identify systems that may contain information about you, please tick the boxes below that describe your relationship with Repos Production :

¨ Individual - Consumer or client

¨ Former employee or contractor

¨ Employee's family member, dependent person, beneficiary or emergency contact person

¨ Employee of a commercial customer or a commercial partner of Repos Production

¨ Employee of a supplier or seller of Repos Production

¨ Job seeker

¨ Other - please describe

If your information may be under another name, please provide that name and the reason for the change:

Please present or include valid identification to allow us to verify your name, address and possibly your status as a representative or trusted third party

Details of your request

If you request access to your personal data, please specify the personal data that is the subject of the request and confirm that it can be sent by email to the address above:

If you request data portability, please specify the personal data that are the subject of the request and confirm that they may be sent by e-mail, if technically possible, to the address of a new controller as indicated below:

If you request the rectification of your personal data, please specify below the personal data to be rectified and provide the justification for this request:

If you request the limitation of the processing of your personal data, please specify the processing in question and provide the justification for this request:

If you request the deletion of your personal data, please specify below the personal data to be deleted and provide justification for this request:

If you object to the processing of your Personal Data, please specify below the processing in question and provide justification for this objection:

Details of your Complaint

In the case of a Complaint, please detail it below:

The information collected in this form is intended for the Legal Department and Data Contact of the limited company Repos Production, whose registered office is located at Rue des Comédiens, 22, 1000 Brussels, and registered with the Crossroads Bank for Enterprises under number 0535.709.224, represented by Mr Thomas Vermeir, as joint controllers of the processing of your personal data, to answer your complaint or to assert your rights as a data subject.