Personal Data Request Form
Should you wish to download the Personal Data Request Form click here
| REQUEST FOR INFORMATION ON PERSONAL DATA | TALBA GHAL INFORMAZZJONI DWAR DATA PERSONALI | ||
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For eTars purposes |
Ghal skopijiet tal-eTars |
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| You can obtain additional information on eTars on this link. | Tista’ tigbor aktar informazzjoni dwar eTars f’din il-Link. | ||
| Please use Block Capitals to complete this form. All information will be treated in strict confidence. | Jekk joghgbok imla din il-formula b’ittri kbar. L-informazzjoni li taghtina tinzamm kunfidenzjali. | ||
| PERSONAL DETAILS | DETTALJI PERSONALI | ||
| We will use these details to identify any personal data relating to you held in eTars and report this back to you. | B’dawn id-dettalji personali ser insibu l-informazzjoni personali li tinvovi lilek fl-eTars, biex nibghatuhilek. | ||
| Name | Isem | ||
| Surname | Kunjom | ||
| Identity card number | Numru tal-karta tal-identita | ||
| Current address | Indirizz kurrenti | ||
| Town/village | Belt/villagg | ||
| Country | Pajjiz | ||
| Postal code | Kodici postali | ||
| ACCIDENT DETAILS | DETTALJI DWAR INCIDENT | ||
| We will use these accident details to identify any personal data on motor accidents to which you were involved. | B’dawn id-dettalji dwar l-incident ser insibu l-informazzjoni personali dwar incidenti li jinvolvu lilek. | ||
| Accident date | Data tal-incident | ||
| Vehicle registration number | Numru ta’ registrazzjoni | ||
| Make/model | Ghamla/mudel | ||
| Signature of Data subject | Firma tas-suggett tad-dejta | ||
| Name in block letters | Isem b’ittri kbar | ||
| Address | Indirizz | ||
| If you held a different previous address to the current one, please add this to the back of this form. | Jekk kellek xi indirizz differenti minn dak kurrenti, zid dan fuq il-pagna ta’ wara. | ||
| The completed form with a copy of your identity card should be sent to:Malta Insurance Association 43A/4 St Paul’s Buildings, West Street Valletta |
Din il-formula ghandha timtela u tintbghat flimkien ma’ kopja tal-karta tal-identita tieghek lil:Malta Insurance Association 43A/4 St Paul’s Buildings, Triq il-Punent Valletta |
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