Data Breach Notification

FIELDS MARKED WITH * ARE MANDATORY



(Applicable in case a preliminary notification has already been submitted)(PLEASE USE THE EXACT FORMAT THAT WAS GIVEN IN THE ACKNOWLEDGEMENT EMAIL)

(Applicable in case a preliminary notification has already been submitted)

(Applicable in case a preliminary notification has already been submitted)

About you


Contact details

UNLESS PROVIDED IN A PRELIMINARY NOTIFICATION




(Please make sure the email address is correct)
(Please make sure the email address is correct)






Involvement of other entities outside the data controller for the service concerned by the data breach


(Joint controllers, processors, other autonomous data controllers).







Timeline



(Describe how you became aware of the breach).

(If applicable)
(If breach is not notified within 72 hours)
(If required)

About the breach (TICK AS APPROPRIATE)


Nature of incident (TICK AS APPROPRIATE)



Cause of breach














(If applicable)

Type of breached data (TICK AS APPROPRIATE)


Regular data

(If required)

Special categories of data

About the data subjects (TICK AS APPROPRIATE)


(If required)

About the measures in place BEFORE the breach


Consequences (TICK AS APPROPRIATE)


Breach of confidentiality



 

 

 


Breach of integrity






 



Breach of availability


 



 



Physical, material or non-material damage or significant consequences to the data subjects


Taking Action


Communication to data subjects








Max size: 6MB



Description of measures allowing to skip information of data subjects


 




Measures taken to address the breach


   


Cross border and other notifications


 


 


 



 



 





Max size: 6MB




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