Archfine LLC
Data Subject Rights Request

PURPOSE OF THIS FORM

This form allows you to exercise your rights under applicable data protection laws, including the General Data Protection Regulation (GDPR), California Consumer Privacy Act (CCPA), and other privacy regulations. You may use this form to:

• Request access to your personal information

• Request correction of inaccurate personal information

• Request deletion of your personal information

• Request restriction of processing of your personal information

• Object to processing of your personal information

• Request data portability

• Withdraw consent for data processing

• Opt-out of the sale or sharing of personal information

SECTION 1: YOUR INFORMATION

Please provide the following information to help us identify you and process your request:

Personal Details

Full Legal Name:* ______________________________________

Previous Names (if applicable): ______________________________________

Date of Birth:* ______ / ______ / __________

Email Address Associated with Your Account:* ______________________________________

Alternative Email Address (for correspondence): ______________________________________

Phone Number: ______________________________________

Mailing Address:*

Street Address: ______________________________________

City: ______________________________________

State/Province: ______________________________________

Postal/Zip Code: ______________________________________

Country: ______________________________________

Account Information

Do you have an account with us?
☐ Yes  ☐ No

If yes, please provide:

Account Username/ID: ______________________________________

Approximate Date of Account Creation: ______ / ______ / __________

If no, please describe your relationship with our company:

☐ Website visitor
☐ Newsletter subscriber
☐ Former customer
☐ Other: ______________________________________

SECTION 2: TYPE OF REQUEST

Please select the type of request you wish to make (check all that apply):

Access Request

☐ Right to Access: I request a copy of all personal information you hold about me, including:

• What personal data you process

• Why you process it

• Who has access to it

• How long you will keep it

• Where you obtained it

• Whether it has been shared with third parties

Correction/Rectification Request

☐ Right to Rectification: I request that you correct inaccurate or incomplete personal information you hold about me.

Please specify the information that is inaccurate and provide the correct information:

Deletion Request

☐ Right to Erasure (Right to be Forgotten): I request that you delete all personal information you hold about me.

Reason for deletion request (optional):

☐ The data is no longer necessary for the purpose it was collected
☐ I withdraw my consent
☐ I object to the processing of my data
☐ My data has been unlawfully processed
☐ Other: ______________________________________

Restriction Request

☐ Right to Restriction of Processing: I request that you restrict the processing of my personal information.

Reason for restriction request:

☐ I contest the accuracy of my personal data
☐ The processing is unlawful but I don't want my data erased
☐ You no longer need my data but I need it for legal claims
☐ I have objected to processing and verification is pending
☐ Other: ______________________________________

Objection Request

☐ Right to Object: I object to the processing of my personal information.

Grounds for objection:

☐ Processing based on legitimate interests
☐ Direct marketing
☐ Scientific/historical research or statistical purposes
☐ Other: ______________________________________

Data Portability Request

☐ Right to Data Portability: I request that you provide my personal information in a structured, commonly used, and machine-readable format.

Preferred format:

☐ CSV
☐ JSON
☐ XML
☐ PDF
☐ Other: ______________________________________

Would you like us to transmit the data directly to another service provider?

☐ Yes, transmit to: ______________________________________

☐ No, send to me

Consent Withdrawal

☐ Withdraw Consent: I withdraw my consent for the processing of my personal information where processing is based on consent.

Specify the processing activities for which you withdraw consent:

☐ Marketing communications (email)
☐ Marketing communications (SMS)
☐ Marketing communications (phone)
☐ Personalized advertising
☐ Analytics tracking
☐ Sharing data with third parties for marketing purposes
☐ All consent-based processing
☐ Other: ______________________________________

California/Nevada Specific Rights

☐ Do Not Sell or Share My Personal Information (CCPA/CPRA): I request that you stop selling or sharing my personal information with third parties.

☐ Limit Use of Sensitive Personal Information (CPRA): I request that you limit the use and disclosure of my sensitive personal information.

☐ Opt-Out of Sale (Nevada Privacy Law): I opt-out of the sale of my personal information.

SECTION 3: APPLICABLE LAW

Which data protection law applies to your request?

☐ General Data Protection Regulation (GDPR) – European Union
☐ UK General Data Protection Regulation (UK GDPR) – United Kingdom
☐ California Consumer Privacy Act (CCPA) – California, USA
☐ California Privacy Rights Act (CPRA) – California, USA
☐ Virginia Consumer Data Protection Act (VCDPA) – Virginia, USA
☐ Colorado Privacy Act (CPA) – Colorado, USA
☐ Connecticut Data Privacy Act (CTDPA) – Connecticut, USA
☐ Utah Consumer Privacy Act (UCPA) – Utah, USA
☐ Nevada Privacy Law (SB 220) – Nevada, USA
☐ Personal Information Protection and Electronic Documents Act (PIPEDA) – Canada
☐ Other: ______________________________________

If located in the EU/EEA or UK, which country/region are you in?

SECTION 4: SPECIFIC DATA CATEGORIES (OPTIONAL)

If your request relates to specific categories of data, please specify:

☐ Contact information (name, email, phone, address)
☐ Account information (username, password, account settings)
☐ Payment information (billing address, payment method details)
☐ Transaction history (purchases, subscriptions)
☐ Usage data (log files, IP addresses, browser information)
☐ Communication data (emails, support tickets, chat logs)
☐ Profile information (preferences, interests, demographics)
☐ Marketing data (email open rates, campaign interactions)
☐ Cookie and tracking data
☐ Location data
☐ Device information
☐ All personal data held about me
☐ Other: ______________________________________

Date range for data request (if applicable):

From: ______ / ______ / __________ To: ______ / ______ / __________

SECTION 5: VERIFICATION OF IDENTITY

To protect your privacy and security, we need to verify your identity before processing your request.

Please provide ONE of the following to verify your identity:

☐ I am requesting data associated with the email address I provided above, and I have access to this email account for verification purposes.

☐ I have attached a copy of a government-issued ID (driver's license, passport, national ID card) with sensitive information redacted except for name and date of birth.

☐ I will provide additional information when contacted by your team to verify my identity.

Additional verification information (if available):

Last 4 digits of payment method on file: __ __ __ __

Recent transaction date: ______ / ______ / __________

Recent transaction amount: ______________________________________

SECTION 6: AUTHORIZED REPRESENTATIVE (IF APPLICABLE)

If you are submitting this request on behalf of another person, please complete this section:

Your Name: ______________________________________

Your Relationship to Data Subject:

☐ Parent/Legal Guardian (for minor)
☐ Legal Representative (Power of Attorney)
☐ Authorized Agent
☐ Executor of Estate
☐ Other: ______________________________________

Please attach documentation proving your authority to act on behalf of the data subject:

☐ Power of Attorney
☐ Legal Guardianship Documentation
☐ Written Authorization from Data Subject
☐ Other: ______________________________________

SECTION 7: PREFERRED METHOD OF RESPONSE

How would you like to receive our response?

☐ Email (to the email address provided above)
☐ Postal mail (to the mailing address provided above)
☐ Secure online portal (we will provide access instructions)
☐ Other: ______________________________________

SECTION 8: ADDITIONAL INFORMATION

Please provide any additional information that may help us process your request:

SECTION 9: DECLARATION

Please read carefully and check the box to confirm:

☐ I declare that the information provided in this form is accurate and complete to the best of my knowledge.

☐ I understand that providing false or misleading information may result in the rejection of my request.

☐ I understand that the company will need to verify my identity before processing my request and may contact me for additional information.

☐ I understand that the company will respond to my request within the timeframe required by applicable law (typically 30 days, with possible extensions).

☐ I understand that certain requests may be denied if exceptions or limitations apply under applicable law, and that I will be informed of the reasons for any denial.

☐ I have read and understand the company's Privacy Policy, available at: [Privacy Policy URL]

Signature: ______________________________________

Printed Name: ______________________________________

Date: ______ / ______ / __________

SUBMISSION INSTRUCTIONS

Please submit this completed form using ONE of the following methods:

Email:

Send to: [Your DSAR Email Address]
Subject line: "Data Subject Access Request"

Postal Mail:

[Your Company Name]
Attn: Privacy/Data Protection Officer
[Your Company Address]
[City, State/Province, Postal Code]
[Country]

Online Portal:

Submit through our secure online form at: [DSAR Form URL]

Important Notes:

• Attach any supporting documentation (ID verification, authorization documents)

• Keep a copy of this form for your records

• You will receive an acknowledgment of receipt within [X] business days

• We will respond to your request within the timeframe required by applicable law

WHAT HAPPENS NEXT?

1. Acknowledgment: We will acknowledge receipt of your request within [X] business days.

2. Verification: We will verify your identity using the information provided. We may contact you for additional verification if necessary.

3. Processing: We will process your request in accordance with applicable data protection laws.

4. Response: We will respond to your request within the legally required timeframe (typically 30 days, with possible extensions for complex requests).

5. Follow-up: If we need to extend the response time or deny your request, we will inform you of the reasons and your right to appeal or file a complaint with a supervisory authority.

YOUR RIGHTS

You have the right to:

• Lodge a complaint with your local data protection authority if you believe your rights have been violated

• Appeal our decision if your request is denied in whole or in part

• Contact us at any time with questions about this process

Data Protection Authority Contact Information:

EU/EEA: Find your local authority at: https://edpb.europa.eu/about-edpb/board/members_en

UK: Information Commissioner's Office (ICO)
Website: https://ico.org.uk
Helpline: 0303 123 1113

California: California Privacy Protection Agency
Website: https://cppa.ca.gov
Phone: (916) 266-1770

Canada: Office of the Privacy Commissioner of Canada
Website: https://www.priv.gc.ca
Phone: 1-800-282-1376

QUESTIONS OR ASSISTANCE

If you need help completing this form or have questions about your data protection rights, please contact us:

Privacy/Data Protection Officer
Email: [Your Privacy Email]
Phone: [Your Phone Number]
Online: [Your Website Support URL]

FOR OFFICE USE ONLY

Request Reference Number: ______________________________________

Date Received: ______ / ______ / __________

Received By: ______________________________________

Identity Verified: ☐ Yes  ☐ No  Date: ______ / ______ / __________

Request Type: ______________________________________

Assigned To: ______________________________________

Response Due Date: ______ / ______ / __________

Response Date: ______ / ______ / __________

Status: ☐ Pending  ☐ In Progress  ☐ Completed  ☐ Denied  ☐ Partially Denied

Notes: ______________________________________