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European Data Protection Supervisor
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Wojciech Wiewiórowski
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Personal data breach notification form
Print
Personal data breach notification form
Current
General
Data Breach Information
Preview
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.2 In phases
Initial
Follow-up
Conclusive
Follow-up: The is a follow-up to initial notification
Conclusive: This is the final information for the incident
Reference Case File
In case of a follow-up or conclusive type of notification, please indicate if available the Case File number provided by the EDPS.
A.3 Registration number of data breach in your register
Yes
No
Art 34(6) of the Regulation 2018/1725
Reg. No
B. Data Controller EUI
B.1 Name of the organization (EUI)
B.1 Name of the organization (EUI)
- Select -
Agency for the Cooperation of Energy Regulators
Authority for European Political Parties and European Political Foundations
Bio-based Industries Joint Undertaking
Clean Sky 2 Joint Undertaking
Community Plant Variety Office
Computer Emergency Response Team for the EU institutions, bodies and agencies
Council of the European Union
Court of Justice of the European Union/Court of Justice
ECSEL Joint Undertaking
European Agency for Safety and Health at Work
European Agency for the Operational Management of Large-Scale IT Systems in the Area of Freedom, Security and Justice
European Asylum Support Office
European Banking Authority
European Border and Coast Guard Agency
European Central Bank
European Centre for Disease Prevention and Control
European Centre for the Development of Vocational Training
European Chemicals Agency
European Climate, Infrastructure and Environment Executive Agency
European Commission
European Committee of the Regions
European Council
European Court of Auditors
European Data Protection Board
European Data Protection Supervisor
European Defence Agency
European Economic and Social Committee
European Education and Culture Executive Agency
European Environment Agency
European External Action Service
European Fisheries Control Agency
European Food Safety Authority
European Foundation for the Improvement of Living and Working Conditions
European GNSS Agency
European High-Performance Computing Joint Undertaking
European Innovation Council and SMEs Executive Agency
European Institute for Gender Equality
European Institute of Innovation and Technology
European Insurance and Occupational Pensions Authority
European Investment Bank
European Investment Fund
European Maritime Safety Agency
European Medicines Agency
European Monitoring Centre for Drugs and Drug Addiction
European Ombudsman
European Parliament
European Personnel Selection Office
European Public Prosecutor's Office
European Research Council Executive Agency
European Research Executive Agency
European School of Administration
European Securities and Markets Authority
European Training Foundation
European Union Agency for Fundamental Rights
European Union Agency for Law Enforcement Cooperation
European Union Agency for Law Enforcement Training
European Union Agency for Network and Information Security
European Union Agency for Railways
European Union Aviation Safety Agency
European Union Institute for Security Studies
European Union Intellectual Property Office
European Union Satellite Centre
Fuel Cells and Hydrogen 2 Joint Undertaking
Fusion for Energy Joint Undertaking
IMI 2 Joint Undertaking
Office of the Body of European Regulators for Electronic Communications
Publications Office of the European Union
SESAR Joint Undertaking
Shift2Rail Joint Undertaking
Single Resolution Board
Translation Centre for the Bodies of the European Union
Other…
Enter other…
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
No
C.1 Name of the organization
C.2 Address
C.3 Contact person
C.4 Telephone
C.5 Email
C.6 Data protection Officer
C.7 Telephone
C.8 Email
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