Personal Data Removal Request Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Under the EU General Data Protection Regulation (GDPR) and other certain regulations, you are or may be entitled to request that Protective Industries, Inc. and/or its subsidiaries erase any personal data we hold. We will do our best to respond promptly and in any event within one month of the following: Our receipt of your written request; or Our receipt of any further information we may ask you to provide to enable us to comply with your request, whichever happens to be later. The information provided by you inb this form will be used only for the purpose of identifying any relevant personal data that you are requesting that we erase, as well as for responding to your request or following up to request any further information needed to meet your request. Section 1: Details of the requestor Full Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Email Address *Section 2: Are you the data subject? Please select the appropriate option below: Checkboxes *YES, I am the data subject. I understand that I may be asked to furnish further proof of my identity (continue with Section 4)NO, I am acting on behalf of the data subject. I understand that I may be asked to furnish further proof of both the data subject's identity and my own identity, in addition to the written authority of the data subject. (continue with Section 3)Please note: If appropriate, we may request further proof of your identity and/or proof of address information. Examples of valid identification may include a scanned or photocopied image of photo identification such as a passport, driver’s license or national identity card. Valid address proof may include a recent utility, bank or credit card statement or similar items. If we are not satisfied with your claim upon review of any such requested materials, we reserve the right to refuse to grant your request. Section 3: Details of the data subject (if different from Section 1) Full NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone NumberEmail AddressSection 4: Reason for erasure request Given the sensitive nature of erasing personal data, GDPR Article 17(1) requires certain conditions to be met before a request may be considered. Please select the reason(s) you wish for your data to be erased. If you have any supporting or justifying documentation, please select the final box and we will follow up with you after the request is received. Please tick the appropriate box(es): *You feel your personal data is no longer necessary for the purposes for which we originally collected it.You no longer consent to our processing of your personal data.You feel your personal data has been unlawfully processed.You feel we are subject to legal obligation of the EU or Member State that requires erasure of your personal data.You are a child, you represent a child, or you were a child at the time of the data processing and you feel your personal data was used to offer you information society services.I have supporting or justifying documentation - please contact me to submit.Section 5: What information do you wish to erase? Please describe the information you are requesting we erase. Please include any details that you believe will help us identify any relevant information. *Please note: In certain circumstances, where erasure would adversely affect the freedom of expression, contradict a legal obligation, act against the public interest in the area of public health, act against the public interest in the area of scientific or historical research, or prohibit the establishment of a legal defense or exercise of other legal claims, we may not be able to erase the information you requested in accordance with Article 17(3) of the GDPR. In such cases you will be informed promptly and given full reasons for that decision. While in most cases we will be happy to erase the personal data you request, we nevertheless reserve the right, in accordance with Article 12(5) of the GDPR, to charge a fee or refuse the request if it is considered to be “manifestly unfounded or excessive.” However, we will make every effort to provide you with the erasure of your personal data if suitable. Section 6: Scope of Request Please select below the Protective Industries business(es) with which you have interacted. *Caplugs (U.S.)Caplugs (Canada)Caplugs (Mexico)Caplugs (EU)Caplugs (Australia)MedbioEvergreen ScientificMokonTri-Star ProtectorsAll of the AboveOther (enter)Other Protective Industries BusinessSection 7: Declaration and submission By clicking to submit below, I confirm that the information I have provided here is true and that I am authorized to make the request on behalf of myself or the data subject (if not myself). I also understand and consent to Protective Industries, Inc. and/or its representative(s) contacting me to obtain any further details, information, documentation or clarification that is necessary to locate and remove my and/or the data subject’s personal data. Submitted by (full name): *Date *Submit