DATA ACCESS REQUEST FORM – Request made by a Relevant

DATA ACCESS REQUEST FORM – Request made by a Relevant Person
Please provide us with your particulars so that we can verify your identity in order to process this request.
1.
Your name (in full)
2.
Your residential/mailing
address
3.
Your contact details
Contact No.:
Fax No.:
Email Address:
4.
Your NRIC No./Passport No.
(please attach a copy of your NRIC or Passport for verification)
5.
16-digit IKEA FAMILY or
småles membership number of
the individual (if applicable)
6.
Residential/mailing address of
the individual
7.
Please state the nature of the
individual’s relationship with
Ikano Pte Ltd
(please attach a copy of the membership card for verification)
 A current/ former customer
 A current/ former employee
 A current/ former vendor/ supplier/ distributor/ business partner/ service
provider
 Other (specify) ______________________________
* tick and/or delete where applicable
8.
Please state the nature of your
relationship with the individual
 Parent
 Guardian
 Spouse
 Child
 Legal Representative
 Other (specify) ______________________________
* tick and/or delete where applicable
9.
Current age of the individual
(if under 18 years old based
on birth year)
10.
Please provide a description of
the personal data you are
requesting access to, and any
relevant additional information
which can assist us in
providing you with a copy of
the personal data you are
requesting for.
Please specify if you would like
to simply view the personal
data or to receive a copy of
the personal data.
 View
12.
Fee - please send a
cheque/postal order made
payable to Ikano Pte Ltd.
Please refer to points 2, 3 and 4 under Important Notes below.
13.
Please enclose with this form
an authorization letter from
the Individual as proof of your
authority to act on behalf of
the Individual
14.
Please sign this form and
check that information you
have provided is accurate.
11.
Kindly send this form together
with any relevant supporting
documents and the cheque/
postal order to the DPO.
Please refer to points 2, 3 and
4 under Important Notes
below.
 Receive a copy
 By ticking this box, I hereby declare and confirm that all information and
supporting documents provided by me in connection with this Access
Request are true, accurate and complete. I understand that it will be
necessary for Ikano Pte Ltd to verify my identity and that Ikano Pte Ltd
may contact me for more detailed information in order to locate the
personal data requested and I consent to the collection, use and disclosure
of the personal data that I have provided in this form for the purpose of
complying with my Access Request.
Date
: _____________________
Important Notes:
(1)
Please note that Ikano Pte Ltd reserves the right to restrict access to certain personal data or refuse to
comply with your Data Access Request as may be permitted under the Personal Data Protection Act 2010.
We can only provide you with personal data that is in our possession or under our control. To process this
request, the information in this form may need to be given to third party service providers to Ikano Pte
Ltd.
(2)
Depending on the nature and scope of the work required to process your access request, Ikano Pte Ltd
may be required to impose a fee to recover its administrative costs. This will be assessed on a case-bycase basis by our Data Protection Officer. Where such a fee is to be imposed, a written estimate of the fee
will be provided to you for your consideration. In such a case, please communicate your agreement to the
payment of the fee in writing. If you do not agree to the payment of the fee, Ikano Pte Ltd will not be able
to process your Data Access Request.
(3)
Please also note that in certain instances where a fee is to be collected, Ikano Pte Ltd may require a
deposit to process your Data Access Request. You will be notified if such a deposit is required when Ikano
Pte Ltd provides you with a written estimate of the fee. In such an event, Ikano Pte Ltd will not be able to
process your Data Access Request until such a deposit is collected.
(4)
Kindly note that (2) and (3) above do not apply if Ikano Pte Ltd does not charge a fee your Data Access
Request.
(5)
Personal data collected on this form is required to enable your Data Access Request to be processed, and
will only be used in connection with such request.
For official use only:
Received by :
_____________________________________ Date : ______________
Verified by : ______________________________________
Remarks :
Date : ______________