Personal data breach Detection Form
EN
HU
SRB
RO
Identifier details
Personal data breach Source
customer
employee
external
supplier
Please choose from the list!
Name
*
:
Surname
*
:
Country
*
:
City
*
:
Address
*
:
E-mail address
*
:
Telephone
*
:
Breach details
Data Breach occurred
*
:
Nature of personal data
*
:
Name
Address
Date of birth
ID N°
E-mail
Financial Details
Health data
Policy N°
Insurance/claims details
Others
Breach Classification:
Data breach details
*
:
