Report a Data Breach

  • Start
  • Preview
  • Complete
1 of 3 (0%)
Indicates required field
Data Controller Information
Provide information about the data controller
Enter the name of the data controller
Enter the name of the data controller contact person
Address of Data Controller
Enter the address of the data controller
Data Controller Contact Number
Enter the data controller contact number
Enter data controller email address
Data Controller Type/Scope
Enter the data controller Type/Scope
Data Protection Officer Information
Provide information about the DPO
Enter the name of the data protection officer (if known)
Address of Data Protection Officer
Enter the address of the data protection officer
Data Protection Officer Contact Number
Enter the data protection officer contact number
Enter the data protection officer eMail address
Data Processor Information (where applicable or known)
Enter information about the data processor
Enter name of the data processor
Enter the name of data processor contact
Address of Data Processor
Enter the address of the data processor
Data Processor Contact Number
Enter the data processor contact number
Enter the data processor eMail address
Data Processor Type/Scope
Enter the data processor type/scope
Third Party or Other Involved Entity Information
Provide information about any other entity involved in the data breach
Is there another entity involved in this data breach?. (If yes, complete the information below) 
Enter the name of other/third party entity
Enter name of third party contact
Address of Other/Third Party Entity
Enter address of other/third party entity
Third Party Contact Number
Enter the third party contact number
Enter the third party eMail address
Third Party Entity Type/Scope
Enter the third party entity type
Data Processing Information
Provide information about the data that was breached.
Approximate number of individuals whose personal data are processed, referring exclusively to the processing activity affected by the personal data breach
Provide details on the processing activity affected by the breach and the location of the  personal data about individuals
Data Breach Details
Provide details about the data breach and any associated impact &  consequences
Indicate the date and time on which you became aware of the breach
How was the breach detected?
Origin of the Data Breach
Provide information about the origin of the data breach
Cause of the Data Breach (Check all that apply)
Provide information about the cause of the breach