Application Withdrawal & Deregistration — Entity Portal

SECTION 1 — APPLICATION / REGISTRATION DETAILS

Request Category*

Withdrawal of Pending Registration Application

Voluntary Cancellation / Deregistration of Registered Entity

Application Reference Number or Registration Certificate Number*

Enter the application reference or existing certificate number.

Registered Legal Name of Entity*

Category of Entity*

Current Data Handler Role*

SECTION 2 — CONTACT & REPRESENTATIVE PARTICULARS

Authorized Contact Person*

Official Contact Email*

Official Contact Phone*

Registered Physical Address

SECTION 3 — REASONS & GROUNDS

Primary Reason for Withdrawal or Deregistration*

Effective Date of Cessation / Withdrawal*

Date on which processing ceased or withdrawal becomes effective.

Factual Justification and Context*

Detailed explanation supporting this application withdrawal or deregistration request.

SECTION 4 — DATA DISPOSAL & DATA SUBJECT SAFEGUARDS

Status of Personal Data Previously Held / Processed*

All personal data has been securely deleted / destroyed

Personal data transferred to a lawful successor / acquiring entity

Personal data was irreversibly anonymized for analytical/statistical purposes

Personal data retained solely to meet specific legal / statutory retention duties

Summary of Data Sanitization or Transfer Protocol*

Briefly describe the measures taken to securely sanitize, delete, or transfer personal data.

Notification to Affected Data Subjects*

Data subjects have been formally notified of cessation or data transfer

Not applicable / no personal data collected or processed

Notification process currently in progress

SECTION 5 — SUPPORTING DOCUMENTATION & DECLARATION

Supporting Proof / Resolution / Notice*

Upload Board Resolution, BRS Dissolution / Deregistration notice, or official cessation letter.

Full Legal Name of Declarant*

Official Capacity / Designation*

I solemnly declare that the statements made in this request are true and accurate pursuant to the Data Protection Act, 2019.*

I hereby formally request the Office of the Data Protection Commissioner (ODPC) to process this application withdrawal / deregistration notice and certify that all statutory obligations under the Act and Regulations have been complied with.

Application Withdrawal / Deregistration Form

SECTION 1 — APPLICATION / REGISTRATION DETAILS

SECTION 2 — CONTACT & REPRESENTATIVE PARTICULARS

SECTION 3 — REASONS & GROUNDS

SECTION 4 — DATA DISPOSAL & DATA SUBJECT SAFEGUARDS

SECTION 5 — SUPPORTING DOCUMENTATION & DECLARATION