.         GENERAL

This Application Form has been prepared by Op. Dr. Esra Çabuk Cömert ("Institution") as the data controller in order to evaluate and resolve the applications to be made by you, the data subjects, as soon as possible, effectively and comprehensively in accordance with Articles 11 and 13 of the Personal Data Protection Law No. 6698 ("KVKK").


Pursuant to Articles 11 and 13 of the KVKK, you, the data subjects, may submit your requests regarding the implementation of the KVKK to our Institution, which acts as the data controller;

Ø By filling out this Application Form in writing in person,

Ø By mail to Beştepe Mahallesi Yaşam Caddesi No:13/A 82 Yenimahalle/ANKARA address,

Ø To the KEP address  bilgi@esracabukcomert.com   with a secure electronic or mobile signature,

Ø To our e-mail address previously notified by our Institution and registered in our system with secure electronic signature or mobile signature

Along with the title "Personal Data Protection Law Information Request".


In order to make the necessary research and evaluations regarding your application and to develop solutions to the issue, you must fill in the fields below correctly and completely:


Name and Surname (Signature on written application)


Turkish ID No / Passport No


Notification address


E-Mail/ Phone/Fax No


Subject of Request



Your personal data that you have submitted to us above are processed in order to evaluate and finalize this Application Form and to contact you.

Please check the appropriate option regarding your relationship with our organization and indicate whether the relationship is currently ongoing.


Business Partner Visitor Employee

Other (...................... )

My relationship with the institution continues as of the date of application..........................................................  My relationship with the institution has ended as of          date .



As a data subject, please specify the subject(s) you would like to be informed about within the scope of Articles 11 and 13 of the KVKK, the method of transmission of our responses to you and any additions you would like to add in the fields reflected in the table below. You are required to attach the information and documents related to the issue you have specified to the Application Form.



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Last Update Date: 11.01.2024