Application Form for Exercising the Right to Rectify Personal Data

APPLICATION FORM FOR EXERCISING THE RIGHT TO RECTIFY PERSONAL DATA

Application to rectify personal data

Name of the person responsible for the file: Manuel Molina Clavero

Address of the office where the data is to be accessed: C/ Escorxador, s/n · 43003 Tarragona

APPLICANT'S DETAILS

Mr/Ms ...... (of legal age) Address ...... Post Code ...... City...... Identity card/passport number ...... (photocopy attached)

I STATE: That I wish to exercise my right to access my personal data, in accordance with article 15 of Organic Law 15/1999 and all other applicable regulations.

LEGAL REPRESENTATIVE'S DETAILS

(if the applicant is disabled or not of legal age)

Mr/Ms ...... (of legal age) Address ...... Post Code ...... City...... Identity card/passport number ...... (photocopy attached), as the legal representative of the applicant, in accordance with the attached accrediting documentation,

I STATE: That I wish to exercise the right to access of the individual that I represent, in accordance with article 15 of Organic Law 15/1999 and all other applicable regulations.

I REQUEST:

1. That you rectify free of charge and within ten days of receiving this application the incorrect data regarding me that you hold in your files. The data that I wish you to rectify are specified in the accompanying annex and refer to the documents that accompany this application and that demonstrate the accuracy of the new data.

3. That you inform me in writing to the address indicated when you have made the necessary rectifications.

4. That, if the individual responsible for the file considers that my application may not be upheld, you still inform me and give me your reasons for this decision within ten days so that I may lodge the appeal specified in article 18 of the Law if I choose to do so.

Documentation attached:

A photocopy of identity card/passport

A photocopy of identity card/passport of the legal representative (if the applicant is disabled or not of legal age)

Photocopy of legal representative's accrediting documentation (family record or legal ruling of guardianship if applicant is not of legal age, and legal ruling of disability if applicant is disabled)

Accompanying annex specifying the reasons why I oppose the handling of my data.

Accompanying annex detailing the data that is to be rectified.

Documentation demonstrating the accuracy of the new data (if appropriate)

[place] ...... [date]......

Signature

-The personal data provided by the users, as well as their names, surnames and tax identification numbers, will be recorded in a personal data file owned by the Universitat Rovira i Virgili (URV). This file is the responsibility of the URV.

-Personal data is gathered in order to process applications for exercising the rights specified in Organic Law 15/99.

-The data contained in the file will be used solely by the URV, and will not be ceded to any other person, entity or institution.

-It is possible, without incurring any cost, to exercise the rights of access, rectification, removal and opposition in the legally established manner. To exercise this right, the interested party can contact the URV (c/ Escorxador, s/n, 43003 Tarragona).