InsightsIQ · Tumaini Haven PATIENT SUPPORT PROGRAMME

Data Rights Request Form

Fomu ya Maombi ya Haki za Data

Under the Kenya Data Protection Act, 2019, you have the right to see, correct, delete or restrict how we use your personal data, to object to its use, to receive a copy of it, and to withdraw a consent you gave us. Use this form to make any of those requests. There is no charge, and exercising a right will never affect the care or support you receive.

Chini ya Sheria ya Ulinzi wa Data ya Kenya, 2019, una haki ya kuona, kurekebisha, kufuta au kuzuia jinsi tunavyotumia data yako binafsi, kupinga matumizi yake, kupokea nakala yake, na kuondoa idhini uliyotupa. Tumia fomu hii kufanya ombi lolote kati ya hayo. Hakuna malipo, na kutumia haki yako hakutaathiri huduma unayopokea.

1 · Who is making the request — Anayefanya ombi

We ask for these so we can confirm it is really you before releasing or changing any data. / Tunaomba haya ili kuthibitisha ni wewe kweli kabla ya kutoa au kubadilisha data yoyote.

2 · What you are asking for — Unachoomba (tick all that apply)

3 · Details of your request — Maelezo ya ombi lako

4 · How should we reply? — Tukujibu vipi?

5 · Declaration & signature — Tamko na sahihi

I confirm the information above is true and that I am the person named (or authorised to act for them). / Ninathibitisha taarifa hapo juu ni za kweli na kwamba mimi ndiye niliyetajwa (au nimeidhinishwa kumwakilisha).

Where to send this form / Wapi kutuma fomu hii

📞 Phone: +254 740 554 372
👤 Data Protection Officer: Florence · support.tumaini@insightsiq.co

We will respond as soon as possible, and in any case within the timeframe required by the Data Protection Act (we aim to reply within 30 days). If we cannot act on your request, we will explain why.

You also have the right to complain to the Office of the Data Protection Commissioner (ODPC)www.odpc.go.ke, complaints@odpc.go.ke. Pia una haki ya kulalamika kwa Ofisi ya Kamishna wa Ulinzi wa Data (ODPC).