DATA PRINCIPAL RIGHTS REQUEST FORM

[Company Letterhead/Logo]

Effective Date: [Insert Date]

This Data Principal Rights Request Form (“Form”) is provided by [Company Name] (“Data Fiduciary”) to enable individuals (“Data Principals”) to exercise their rights under the Digital Personal Data Protection Act, 2023 (“DPDP Act”). The Data Fiduciary is committed to safeguarding your privacy and processing your requests promptly and transparently.

SECTION 1: CONTACT INFORMATION

Please provide your contact details to enable us to process your request.

Full Name:

Email Address:

Phone Number:

Postal Address:

Preferred Contact Method: Email Phone Postal Mail

SECTION 2: RELATIONSHIP WITH THE COMPANY

Please indicate your relationship with the Data Fiduciary:

Employee
Former Employee
Customer
Vendor/Contractor
Other:

SECTION 3: RIGHTS REQUESTED

Under the DPDP Act, you have the following rights. Please mark the rights you wish to exercise:

Right to Access: Obtain a summary of your personal data being processed and the identities of any third parties with whom your data has been shared.

Right to Correction and Completion: Correct inaccurate data or complete incomplete personal data.

Right to Erasure: Request deletion of your personal data that is no longer necessary for the purpose for which it was collected.

Right to Withdraw Consent: Revoke consent for specific data processing activities.

Right to Nomination: Nominate any other individual to exercise your rights in the event of death or incapacity.

Right to Grievance Redressal: Register a grievance with the Data Fiduciary regarding any act or omission.

SECTION 4: DETAILS OF THE REQUEST

Please provide details of your request to help us process it efficiently. Specify the data you wish to access, correct, or delete, and include relevant dates, reference numbers, or additional context.

SECTION 5: VERIFICATION OF IDENTITY

To protect your privacy and ensure the security of your personal data, we must verify your identity. Please attach one of the following documents:

Government-issued photo ID (e.g., Aadhaar Card, Passport, Voter ID).
Other document establishing identity:

SECTION 6: AUTHORIZED REPRESENTATIVE / NOMINEE (IF APPLICABLE)

If you are submitting this request on behalf of another individual, please provide:

Full Name of the Data Principal:

Your Relationship with the Data Principal:

Authorization Document:

Attach a signed letter or legal document authorizing you to act on behalf of the Data Principal (or proof of Nomination).

SECTION 7: DECLARATION

By signing this form, I confirm that the information provided is accurate and that I am the Data Principal or authorized to act on their behalf. I understand that the Data Fiduciary may contact me for further clarification and that my request will be processed in accordance with the DPDP Act.

Signature:

Date:

SECTION 8: SUBMISSION DETAILS

Please submit this form and the required documents through one of the following methods:

Email: [Insert Grievance Officer / DPO Email Address]
Postal Mail: [Insert Company Address]
In-Person: [Insert Office Address, if applicable]

SECTION 9: FOR COMPANY USE ONLY

Date Received:

Request Reference Number:

Action Taken:

Processed By:

Date of Completion:

This form ensures that your data rights are respected and requests are handled diligently. For questions or assistance, contact our Grievance Officer / Data Protection Officer at:

Email: [Insert Email]
Phone: [Insert Number]
Address: [Insert Address]