US – Personal Data Access Request Form | Morris Cerullo World Evangelism

US – Personal Data Access Request Form

Complete this form to request a copy of personal identifiable information (“data”) about you (“the data subject”) held in our records, or on behalf of a person you are legally authorized to represent.

We will make every effort to respond within 30 days of the latest of the following:

Our receipt of your written request; or
Our receipt of any further information we may ask you to provide to verify your request.

The information you supply in this form will be used only for the purposes of identifying you as the authorized party to make this request and to reference the data as you requested.

SECTION 1: Person initiating this request.

Full Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Confirm Email

* Morris Cerullo World Evangelism ("MCWE") may need to contact you about your request.

Section 2: Are you the data subject?

Please tick the appropriate box and read the instructions following it. *

Yes, I am the data subject. I enclose proof of my identity (see below). Please go to section 4.
NO, I am acting on behalf of the data subject. I have enclosed the data subject’s written authority and proof of the data subject’s identity and my own identity (see below). Please go to section 3.

IMPORTANT: To ensure we are releasing data to the right person you must provide proof of your identity and address. Please supply us with a photocopy or scanned image (do not send the originals) of one of the following: Proof of Identity Passport, photo driving license, national identity card, birth certificate.

If you are unable to meet the identity verification requirements, we reserve the right to refuse to grant your request.

Please upload your proof of identification here. (JPG, PDF) (40MB Max) *

Click or drag a file to this area to upload.

SECTION 3: Details of the data subject (if different from section 1)

Please note: If your request is on behalf of another person, you must provide a scanned or printed copy of a duly authorized Power of Attorney to act on their behalf in the matter. If you cannot provide such a document, we must see the written consent of that person before we can fulfill your request.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Confirm Email

SECTION 4: Data you are seeking.

Please describe the information you are seeking. Include any relevant details you think will help us to identify the information you require.

We will make every effort to provide you a satisfactory outcome if you meet all the above identification and authorization conditions, following all pertinent government regulations for access to this data.

SECTION 5: Declaration

Please note that any attempt to gain access to personal information through misrepresentation may result in prosecution.

I confirm that I have read and understood the terms of this request form and certify that the information given in this application to MCWE is true. I understand that it is required by law for MCWE to confirm my / the data subject’s identity and it may be necessary to obtain more detailed information in order to locate the correct personal data.

Please use your finger (if touch enabled), mouse or pen to provide your signature in the box below.

Signature *

Clear Signature

Date *

DOCUMENT Checklist: Have you: *

Completed the request form in full?
Included document(s) as proof of correct information and authorization (if applicable)?
Signed and dated the request form?
Included a photocopy of Official/State photographic identity

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