Personal data breach notification form

Current General
Data Breach Information
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Complete

A. Type of notification

Please read the user guide on how to notify a Personal Data Breach before filling out this form.
Please also read the specific data protection notice.

A.1 Type of notification

Comprehensive

In phases

Select 'comprehensive' when this is a complete notification.
Select 'in phases' when this is an initial, incomplete, notification, further information to follow (Art. 34(4) of the Regulation 2018/1725)

A.3 Registration number of data breach in your register

Yes

Art 34(6) of the Regulation 2018/1725

B. Data Controller EUI

B.1 Name of the organization (EUI)

B.2 Address

B.3 Contact person

B.4 Telephone

B.5 Email

B.6 Data protection officer

B.7 Telephone

B.8 Email

C. Data Processor

Indicate if the data breach was reported by the processor

Yes