Withdrawal of consent of the legal representative - Engie

Withdrawal of the consent of the legal representative to the processing of the student’s personal data
according to § 15 of Act No. 18/2018 Coll.

signature surname /

Name and surname of the legal representative

First

Last

Name and surname of pupil / student

First

Last

Address of the legal representative

Address Line 1

City

State / Province / Region

Postal Code

Pupil/student address

Address Line 1

City

State / Province / Region

Postal Code

Email of the legal representative

Name of school

I hereby revoke the consent of ENGIE Services a.s., with registered office at Jarošova 1, 831 03 Bratislava, ID No.: 35 966 289, registered in the Commercial Register kept by the District Court Bratislava I, Section : Sa, Insert No.: 3744/B, pursuant to Art. 6(1)(a) of the EU EPaR Regulation No. 2016/679 and pursuant to Act No. 18/2018 Coll. on the Protection of Personal Data and on Amendments and Additions to Certain Acts ( hereinafter referred to as " the Act ") with the processing of personal data of my son/my daughter/the person entrusted to me

Place of signature