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Individual Data Request Form
– Client Representative

*By completing this form, I hereby warrant that I am a client representative authorized to make this request on behalf of an individual in my company and understand that data entered into the request form must be kept as a legal record of receipt.

* Denotes required field
Official Client Representative
Please complete the fields below.
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Data Subject Information
Please complete the fields below for the data subject in the context of the company in which the s/he was employed at the time of data capture.
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Please enter the number this image
 Security code