CSL Data Privacy Online Request Form

Enter your first name

Enter your last name

Enter your phone number

Please enter your mailing address. Address must include: Street Address City / Town / Locality State / Territory / Province Postal Code Country

Enter your email address

Please Confirm Email Address

Can we contact you by email regarding this request?
Yes No

This is how we will contact you and provide any information regarding your request.

How would you prefer that we contact you and provide any information regarding this request?
Postal Mail Phone Other

Is this request regarding your own Personal Data?
Yes No

Can you provide proof of identification?
Yes No

Please attach copy of your identification (e.g., photo ID, passport, or another proof of identification).

Please provide an explanation. Be advised, your request may be delayed until verification of your identity is obtained.

Please answer the following questions regarding the person for whom you are requesting information.

Enter the first name of the person for whom you are requesting information

Enter the last name of the person for whom you are requesting information

Please list any former/ alternative names of the person for whom you are requesting information.

Please list any former/ alternative names

For which CSL entity are you requesting information? (Select one)

What is the relationship with the CSL entity? (Select one)

Provide a unique CSL Identifier to help us locate your data. (Select one)
Patient/Donor ID Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Health Care Provider (HCPs) Number Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Clinical Trial Investigator ID Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Clinical Trial Subject ID Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Employee ID User ID Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Applicant Number Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Contractor or Contingent worker User ID Other I do not have a unique CSL Identifier

Provide a unique CSL Identifier to help us locate your data. (Select one)
Third party vendor/supplier number Other I do not have a unique CSL Identifier

Please specify:

Provide a unique CSL Identifier to help us locate your data. (Select one)
Other I do not have a unique CSL Identifier

Please specify:

What type of identifier is this?

What type of request are you making? (Select one)

Enter a clear description of what action you are seeking. Note: In your response to the following question, please provide detail on how the data is currently recorded/listed as well as how you would like data to be changed.

What type(s) of data is this request regarding? (Select all that apply)

General Contact Information (e.g., Name & Initials, Personal Directory Information such as email, address, and phone number)

(please specify):

Personal Information (e.g., Personal characteristics such as racial or ethnic origin, age, place of birth, gender identity, religious or philosophical belief, and sexual orientation, Household information such as estimated income, number of cars owned, dwelling type, Sensitive Personal Data such as criminal records, account usernames)

(please specify):

Personal Identification Information (e.g., Government Issued Identification such as driver’s license, passport number, national identity card)

(please specify):

Digital Information (e.g., account login information, Cookie Identifiers)

(please specify):

Health Information (e.g., medical history, genetic information, visit history, insurance, information, adverse reactions to medications)

(please specify):

Employment Information (e.g., occupation, compensation, performance reviews)

(please specify):

Education and Professional Qualification Information (e.g., education history, academic record, professional identifiers )

(please specify):

Family/Caregiver information (e.g., information related to dependents such as the name, age, and/or gender of a child or caregiver)

(please specify):

Financial Information (e.g., credit card information, financial transactions, credit history)

(please specify):

Clinical Trial Information (e.g., study information, treatments provided as part of a study, patient outcome, treatment dates)

(please specify):

Financial Reporting Information (e.g., Financial statements, Customer Pricing)

(please specify):

Other

(please enter a brief description):

Is there a specific CSL system or application you would like us to search to evaluate your request?
Yes No

please specify

By checking this box, I certify that I understand that before complying with this request, CSL may require me to provide:

a. Proof of my identity;
b. If I am making this request as a relevant person on the behalf of someone else, proof of the individual’s identity and further proof of my status as a relevant person; and
c. Such further information as may be reasonably required for CSL to complete the request.

Please note: missing or incomplete information may result in a rejection of the request or a delay in the completion of the request.

Except with the prescribed consent of the individual concerned, the Personal Data provided in this form will be used only for the purposes of processing this request and other directly related purposes. All information collected as a function of this request will be deleted 120 calendar days after the request has been closed, unless required for continuing legal requirements.

Make a Personal Data Request