Personal Data Deletion Request - Template, Sample Form Pro · US-law
✓ Valid in United States · drafted to comply with local law
Create your Personal Data Deletion Request - Template, Sample Form for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.
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________
VIA ________
To: ________
Attn: Privacy Officer / Data Protection Officer
________
Email: ________
RE: REQUEST TO DELETE PERSONAL INFORMATION AND TO WITHDRAW CONSENT TO PROCESSING
To whom it may concern,
§ 1. Purpose of This Request. This notice constitutes a formal verifiable consumer request to delete my personal information (also referred to as “personal data”) maintained, processed, sold, or shared by your organization, and to withdraw any consent previously given for the processing of my personal information. I submit this request pursuant to my rights under all applicable federal and state data protection and consumer privacy laws, including, where applicable, the California Consumer Privacy Act, as amended by the California Privacy Rights Act (Cal. Civ. Code §§ 1798.100 et seq.), and any analogous statute of the state of ________ or other jurisdiction in which I reside.
§ 2. Identity of the Requesting Individual. My identifying and contact information is as follows:
Full Legal Name: ________
Date of Birth (for verification): ________
Address:
________
Telephone Number: ________
Email: ________
Account / Customer Reference (if any): ________
§ 3. Verification of Identity. I understand that you may require verification of my identity before processing this request, as permitted by applicable law. I am willing to provide reasonable additional information to verify my identity; however, I request that you do not require me to create an account in order to submit or process this request, and that any information provided for verification be used solely for that purpose and deleted thereafter.
§ 4. Basis for the Request. The basis for this request is that I am withdrawing and revoking any consent previously given for the collection, processing, retention, sale, or sharing of my personal information, and I object to the continued processing of my personal information.
§ 5. Personal Information at Issue. Without limiting the scope of this request, I am specifically aware that you process or retain the following categories of my personal information:
________
§ 7. Statutory Time for Compliance. I request that you confirm receipt of this request within ten (10) business days and complete this request within the time period required by applicable law (generally not more than forty-five (45) days, subject to any permitted extension upon timely written notice).
§ 9. Written Confirmation. Please respond in writing to the address or email above to confirm that this request has been honored and to describe the actions taken in response, as required by applicable law.
§ 10. No Retaliation. I understand and assert my right not to be subjected to any discrimination or retaliation for exercising my privacy rights, as prohibited by applicable law.
§ 11. Reservation of Rights. Nothing in this request shall waive or limit any of my rights under any applicable federal or state law, all of which are expressly reserved. I may pursue any remedies available to me if this request is not honored within the time required by law.
Sincerely,
______________________________
________
Date: ________
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