Personal data breach notification form

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  • Data Breach Information
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A. Type of notification

Please read the user guide on how to notify a Personal Data Breach before filling out this form.
Please also read the specific data protection notice.
A.1 Type of notification
Select 'comprehensive' when this is a complete notification.
Select 'in phases' when this is an initial, incomplete, notification, further information to follow (Art. 34(4) of the Regulation 2018/1725)
A.2 In phases
Follow-up: The is a follow-up to initial notification
Conclusive: This is the final information for the incident
In case of a follow-up or conclusive type of notification, please indicate if available the Case File number provided by the EDPS.
A.3 Registration number of data breach in your register
Art 34(6) of the Regulation 2018/1725

B. Data Controller EUI

B.1 Name of the organization (EUI)

C. Data Processor

Indicate if the data breach was reported by the processor