1o χλμ Σίνδου – Χαλάστρας 1st km – T +30 2310 777800 Τ.Κ. 57400 Σίνδος GR 57400 Sindos F +30 2310 777807 Τ.Θ. 100 PO Box 100 E [email protected] Θεσσαλονίκη ,

APPLICATION for the use of RIGHT TO ERASURE OF PERSONAL DATA – “RIGHT TO BE FORGOTTEN” (1-April.2018) General Data Protection Regulation – GDPR 679/2016

This application is filled in by the Natural, i.e. the Subject of Personal Data, if he/she wishes to make use of his/her rights with regards to the article 17 of the Regulation 679/2016 concerning the deletion of his/her personal data maintained and processed by DELTA 4 SA as a CONTROLLER under this Regulation. The Subject of Personal Data has to fill in the following fields, sign and submit the completed Application to DELTA 4 SA, while ensuring that the submission is made in a way that does not compromise the confidentiality of his/her personal data.

Name & Family Name Tel.

Data for deletion Reason for deletion (a – f)

Reason for deletion: (a) the personal data are no longer necessary in relation to the purposes for which they were collected or otherwise processed; 4.5.2016 EN Official Journal of the European Union L 119/43 (b) the data subject withdraws consent on which the processing is based according to point (a) of Article 6(1), or point (a) of Article 9(2), and where there is no other legal ground for the processing; (c) the data subject objects to the processing pursuant to Article 21(1) and there are no overriding legitimate grounds for the processing, or the data subject objects to the processing pursuant to Article 21(2); (d) the personal data have been unlawfully processed; (e) the personal data have to be erased for compliance with a legal obligation in Union or Member State law to which the controller is subject; (f) the personal data have been collected in relation to the offer of information society services referred to in Article 8(1).

Signature Date

F.02 Application Erasure of Personal Data Page 1