DATA SUBJECT ACCESS REQUEST FORM

Duchess International Hospital collects, holds, and processes certain personal data about our Patients, Business Contacts, Potential Customers, Suppliers and Contractors (“data subjects”). As a data subject, you have a right, under Nigeria Data Protection Regulation (NDPR 2019) and Nigeria Data Protection Act (NDPA 2023) to find out about the use of your personal data as follows:

Confirmation that your personal data is being processed by us
Access to your personal data
How we use your personal data and why
Details of any sharing or transfers of your personal data
Retention period for your personal data and any other information we hold about you

The process of finding this out is known as a subject access request.

Kindly complete the form and provide requested information accurately and comprehensively information

Note: By completing this form, you consent that Duchess Hospital will use your personal data to process your request and provide you with a relevant response to your inquiries.

First Name

Last Name

Phone

Address

Details of Request:

Details of Request

Message

Terms

I confirm that I have read and understood the Duchess Data Subject Access Request Form and the Data Privacy and Protection Policy. In consideration of all the information stated herein, I certify that the information provided in this Form is correct to the best of my knowledge and that I am the person to whom it relates.

DATA SUBJECT ACCESS REQUEST FORM

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