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* 1. Company Name 

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* 2. Do you have appropriate date protection policies, procedures and processes in place?

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* 3. Do you have appropriate security measures in place to safeguard any personal data you process on our behalf?

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* 4. Do you have a robust data breach management procedure in place should this personal data be compromised?

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* 5. Please attach your privacy notice here

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* 6. Name of company employee responsible for data protection:

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* 7. Name and position of person completing this form:

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* 8. Signature (Please enter your full name in the text box below)

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* 9. Date

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