You have the right to request for personal data we may hold about you. This is known as a Data Subject Access Request ("DSAR"). A data subject is an individual who is the subject of the personal data. If you wish to make a DSAR, please complete this form and return it to us by post or simply click on the submit button at the end of this form.
if sending by post, please use the following address: 50 Place de la cité, CP 1071 Sherbrooke, QC, J1H 4G9
1. Data Subject's Full Name
2. Data Subject's Date of Birth
3. Data Subject's Current Address
Data Subject's Email Address
4. Data Subject's Telephone Number
5. Details of data requested
6. To help us search for the information you require, please let us know the data you require with as much detail as possible (e.g. copies of emails between <date> and <date>). If we do not receive sufficient information to locate the data you require, we may be unable to comply with your request.
7. Is the information going to be sent to the data subject or his/her representative?
8. Consent for processing personal data and electronic consent.
By checking an "I agree" box below, you agree that: The documents that are subject to this consent are solely for your authorized personal purposes. You are under no obligation to deliver documents electronically in the future. You can convert any paper document into electronic form and destroy the original paper document or convert any electronic document to a paper document. The retained form of a converted document shall be deemed to be an original for all purposes. Any converted document shall remain fully enforceable in accordance with its terms. If there is an inconsistency between this consent and any provision of another document, the terms of this consent will prevail. You consent to receive and sign documents electronically through the Metatracer and Upperity systems and any and all documents electronically signed by you through these systems are valid and enforceable as if they contained your handwritten signature.
I am as a result of this consenting that Metatracer, an application of Mercues Innovations Inc., a subsidiary of Raymond Chabot Grant Thornton & Co s.e.n.c.r.l., processes my personal data and to Metatracer sharing my personal information with Upperity to ascertain my identity. I am aware and I was informed that Metatracer, an application of Mercues Innovations Inc., a subsidiary of Raymond Chabot Grant Thornton & Co s.e.n.c.r.l., uses the services of a third party to verify my identity. I understand and agree that this process requires the use of a copy of my ID and proof of address (including a government-issued ID document) to ascertain my identity and that these documents must match the identity verification process that Metatracer and Upperity require me to complete. I consent to my personal data being shared with Upperity, the Metatracer's trusted third party. I am aware and I was informed that I might withdraw my consent at any time by using the "DATA SUBJECT CONSENT WITHDRAWAL FORM", either by sending it via email at rprp@mobilus.com or by post at the address above-mentioned. I agree If you complete this form on paper, please complete and sign below: Signature: ______________________________________________________ Print Name: _____________________________________________________ Date: ___________________________________________________________
9. (To be filled out if question 7 is answered with "To the representative") The Data Subject (whose data is being requested) must give written authorization for the information to be released to his/her authorized representative.
I hereby, by checking the "I agree" box below, give my authorization for (fill out the name of the authorized representative) to request access to my personal data. I agree Signature: Print Name: Date:
10. (To be filled out by the representative of the data subject) I confirm that I am the authorized representative of the Data Subject.
Name of authorized representative and address where personal data is to be sent: Name: Address: I hereby, by checking the "I agree" box below, confirm that I am the authorized representative of the Data Subject. I agree If you complete this form on paper, please print, complete and sign below: Signature: Print Name: Date:
We will make every effort to process your data subject access request as quickly as possible within 30 calendar days. However, if you have any queries whilst your request is being processed, please do not hesitate to contact us at this email address: rprp@mobilus.com
