DATA SUBJECT ACCESS REQUEST (DSAR) FORM

If you wish to exercise any of your data privacy rights with respect to your Personal Information that, in your reasonable belief, is being collected, processed, or stored by Energy Resource Management Corp. (“EnergyRM”), please complete this DSAR Form and email it along with the required proof to EnergyRM at privacy@energyrm.com. Please note that if the information you submit is not complete or otherwise is not sufficient for EnergyRM to respond to your request, EnergyRM may ask you for additional information. Additionally, EnergyRM may ask you for additional information to verify your identity. The time period for our response to your DSAR will begin when you submit the satisfactory completed DSAR Form and provide us with sufficient information to respond to your request.
A. DATA SUBJECT DETAILS
Current last name/surname:*
Any previous names:
First name(s):*
Current address on file with EnergyRM:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous address, if applicable, on file with EnergyRM:
Telephone Number:*
Email address:*
Date of birth:*
MM slash DD slash YYYY
ID Provided*
Drop files here or
Max. file size: 128 MB.
e.g. driver’s license; copies of your utility bills sent to the address provided above for the last 3 months, etc. We need this information to ensure that we disclose your Personal Information only to you or a person authorized by you.
Name of relationship with EnergyRM:*
Please describe the nature of your legal relationship with EnergyRM:(e.g. Are you an employee of EnergyRM? Are you an EnergyRM client/employee of EnergyRM’s client? Are you an end user of the EnergyRM Platform, related services, or other EnergyRM web-based services or products? Are you a vendor of EnergyRM? Are you our certified partner? Are you or were you an independent contractor of EnergyRM? etc.)
Details of data requested:*
Reason for your request:*
- Right to access (Please let me know what personal information you collect about me);
- Right to be informed of processing activities (Please let me know how you use my personal information);
- Right to rectify incorrect data (Some of my personal information you are using is inaccurate and it needs to be corrected);
- Data erasure right/right to be forgotten (I want you to delete all my personal information you are processing or storing);
- Processing restriction (I only want you to process my personal information for certain specific purposes);
- Objection to processing (I request that you stop processing my personal information);
- Consent withdrawal (I have provided my consent for you to process my personal information but now I want to withdraw my consent);
- Portability right (I want you to transfer my personal information to the third party I will identify in this DSAR);
- The right to know if you sell my personal information to a third party (Please let me know to whom you sell my personal information);
- The right to object to the sale of my personal information (If you sell my personal information to a third party, I want you to stop doing it);
Please specify the legal basis upon which you are requesting information and/or which of your legal data privacy rights you wish to exercise
Please provide any additional details:
How would you like us to communicate with you?*
Please let us know how you would like us to communicate our response to you: for example, by regular mail, email, fax, etc.; please provide the necessary contact details.
B. DETAILS OF PERSON REQUESTING THE INFORMATION
If not the data subject whose personal information is processed by EnergyRM. If you are the data subject, proceed to section C.
Are you acting on behalf of the data subject?
If ‘yes’ do you have any legal authority to submit a DSAR on behalf of the data subject?
Please submit proof of your legal authority as part of this DSAR
Identify the document you are submitting as proof of your legal authority to submit this request on behalf of the data subject:
Max. file size: 128 MB.
3. If ‘yes’ please state your relationship with the data subject
e.g. legal guardian, attorney
Name
First name(s) Last name/surname
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone Number:
Email address:
C. COMMENTS
Please provide any additional detail that may help us respond to your DSAR
D. DECLARATION
If you are the data subject identified in Section A., please sign this declaration below:
Signature: Date:

I am the undersigned and the person identified in Section A. (Data Subject Details) above, hereby request that EnergyRM provide me with the data about me as specified above and otherwise respond to my requests concerning my personal data as specified in my DSAR.
If you are submitting the DSAR form on behalf of the data subject identified in Section A. (Data Subject Details), please sign the declaration below:
Signature: Date:

I am the undersigned and the person identified in Section B. (Details of Person Requesting Information) above, hereby request that EnergyRM provide me with the data about the data subject identified in Section A. of this DSAR Form and otherwise respond to my requests concerning personal data of the data subject as specified in this DSAR.

Signature:	Date:

Signature:	Date:

DATA SUBJECT ACCESS REQUEST (DSAR) FORM

A. DATA SUBJECT DETAILS

B. DETAILS OF PERSON REQUESTING THE INFORMATION

C. COMMENTS

D. DECLARATION