Please complete the data and information, print, sign and submit your request to:

REDSYS SERVICIOS DE PROCESAMIENTO, S.L.

                                                                                    For the attention of Data Protection Representative
c/ Francisco Sancha 12; 28034 Madrid dpd@redsys.es

1)	APPLICANT DETAILS (complete the fields marked with *):

*	Name and surnames:
*	ID Card/ NIE (Foreign Citizens Id No.) / Passport:
*Postal Address:
*E-Mail Address:
*	Address for notification purposes (Choose between Postal Address or Email Address):

If the applicant is a minor or incapacitated person or exercises the right through a voluntary representative, DETAILS OF THE REPRESENTATIVE:

*	Name and surnames:
*	ID Card/ NIE (Foreign Citizens Id No.) / Passport:
*Postal Address:
*E-Mail Address:
*	Address for notification purposes (Choose between Postal Address or Email Address):

2)	REQUESTS:

The right not to be the subject of decisions based solely on automated processing, including the elaboration of profiles, that produce legal effects in my person or affect me significantly in a similar way, and the right to be notified within a maximum period of one month, in written form, the result of the present application.

3)	DATA AND / OR TREATMENTS TO WHICH YOUR APPLICATION REFERS:

4)	DOCUMENTATION PROVIDED (mark as appropriate):

	  Photocopy of ID Card/ NIE (Foreign Citizens Id No.) / Passport:
	
	Document accrediting the representation	
	Other: (specify)	

5)	REMARKS AND ADDITIONAL COMMENTS:

In………………………..	on……………….........................., 20……

Signed:………………………………………………………………………….

INSTRUCTIONS FOR THE COMPLETION OF THE FORM FOR THE EXERCISE OF THE RIGHT NOT TO BE SUBJECT TO INDIVIDUAL AUTOMATED DECISIONS, INCLUDING THE PREPARATION OF PROFILES

1.	Any interested party will have the right not to be the subject of a decision based solely on automated processing, including profiling, which produces legal effects on him/her or which significantly affects him/her in a similar way.

2.	The above will not apply if:
a.	The decision is necessary for the conclusion or execution of a contract between the interested party and Redsys;
b.	It is authorized by the Union or Member State Law which applies to Redsys and which also  provides for adequate measures to safeguard the rights and freedoms and legitimate interests of the person concerned, or
c.	It is based on the explicit consent of the interested party.

3.	In the cases referred to in section 2, letters a) and c), Redsys will adopt the appropriate measures to safeguard the rights and freedoms and legitimate interests of the interested party, at least the right to obtain human intervention by Redsys, to express its point of view and to challenge the decision.

4.	The decisions referred to in paragraph 2 will not be based on the special categories of personal data, unless the consent of the interested party has been obtained or the treatment is necessary for reasons of essential public interest, and appropriate measures have been taken to safeguard the rights and freedoms and the legitimate interests of the interested party.

5.	It is necessary to provide a photocopy of the ID Card or equivalent document that proves the identity and is considered valid by law, so that the person responsible for the treatment can carry out the timely verification. In case it is acted through

legal or voluntary representation must be provided, in addition, an ID Card and document proving the representation of the representative. Notwithstanding the foregoing, when Redsys has reasonable doubts in relation to the identity of the person filing the request, it may request that the additional information necessary to confirm the identity of the interested party is provided.

6.	The deadline for answering your request, which is a maximum of one month from receipt, may be extended for another two months if necessary, taking into account the complexity and the number of applications received. Redsys will inform the applicant of any such extension within one month of receipt of the request, indicating the reasons for the delay.

7.	When the applicant submits the application by electronic means, the information will be provided by electronic means in a commonly used format where possible, unless the applicant indicates that it is otherwise provided.

8.	In the event that Redsys does not comply with the request made through this form, it will inform you without delay, and no later than one month after receipt of the request, on the reasons for not acting and the possibility of submitting a claim, before the supervisory authority (in the case of Spain, before the Spanish Agency for Data Protection) and to bring legal actions.

9.	The information provided, as well as any communication and any request exercised in accordance with current regulations on data protection will be free of charge. When the requests are manifestly unfounded or excessive, especially due to their repetitive nature, Redsys may:
a.	Charge a reasonable fee depending on the administrative costs incurred to
facilitate the information or communication or perform the requested action, or
b.	Refusing to act on the request.