Data Subject Request Form​

Polypid Ltd. and its affiliates value the privacy rights of individuals. As required under applicable data protection laws, including without limitations, the EU General Data Protection Regulation (“GDPR”) and the California Consumer Privacy Act (“CCPA”) (collectively, “Privacy Regulations”), individuals have certain rights regarding the processing of their personal data (depending on the applicable jurisdiction).

In order to submit a data subject request (“DSR”) pursuant to the applicable Privacy Regulations, please complete and send this form to our privacy team at: privacy@Polypid.com. If additional information is necessary, we will contact you using the contact information you provided in this form.

Information provided in connection with this DSR will be processed solely for the purpose of responding to the DSR and fulfilling your request, and will be deleted immediately thereafter (unless otherwise required under applicable laws). For more information, please review our Privacy Policy.

    CONTACT INFORMATION

    YOUR REQUEST

    Please check the applicable box:
    I would like to receive information as to why and how you are processing my personal data.I would like to receive a copy of the personal data that you process with respect to me or that you transfer to third parties.I believe that my personal data that you retain is incorrect and I would like to correct it.I would like you to delete my personal data that you hold.I would like you to stop processing my personal data and withdraw consent.I would like you to stop sending me direct marketing.Other.

    Substantiate the request - please provide additional information about your request:

    VERIFICATION OF IDENTITY
    We may request proof of identity depending on the right you wish to exercise.

    Please provide proof of address so we can confirm the applicable Privacy Regulations in your jurisdiction (in order to do so please attach one of the following to this form: utility bill, bank statement, driver’s license, or tax document).

    If you are a participant in one of our clinical trials, please contact your medical team for assistance.