E-Patches & Crests

A Division of 1497202 Alberta Ltd.

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Personal Information Removal Request Form

For privacy reasons, you may have the right to ask for certain personal information relating to you to be removed. When you make your request, we will balance the privacy rights of the individual concerned with the interest of our company. For example, we may decline, for legal reasons, to remove certain information about financial transactions, and orders.

Have you filed a previous request?
If you (or the relevant individual) have already asked us to remove URLs containing similar content, we can help you more quickly if you reply to the email we sent you (or the relevant individual) instead of sending a new notice.

Full Legal Name

Your own name, even if you are making the request on behalf of someone else who you are authorized to represent. If you are representing someone else, you must have the legal authority to act on their behalf.

If you are submitting this request on behalf of someone else, please specify your relationship to that person (for example: "parent", "attorney"). We may ask for documentation confirming that you are authorized to represent this person.

Your legal relationship to the person on whose behalf this request is made

IDENTIFY THE PERSONAL INFORMATION YOU WANT REMOVED AND ITS LOCATION

Please enter one URL per line (Max 1000 lines)

For each URL you provided, please explain:

(1) how the personal information identified above relates to the person on whose behalf this request is made; and
(2) why you believe the personal information should be removed

For example: "(1) This page is about me because a, b, and c. (2) This page should be removed because x, y, and z."

SWORN STATEMENTS

E-Patches & Crests will use the personal information that you supply on this form (including your email address ) and any personal information you may submit in further correspondence for the purposes of processing your request and meeting our legal obligations. We may share details of your request with data protection authorities, but only when they require these details to investigate or review a decision that we have made. That will normally be because you have chosen to contact your national DPA about our decision. Where URL(s) have been removed from our Search results as a result of your request, we may provide details to the relevant webmaster(s) of the URL(s) that have been removed.

Please note that if you are signed into your E-Patches & Crests Member Account, we may associate your submission with that account.

SIGNATURE


MM/DD/YYYY (e.g. "12/19/2010")

e.g. John A. Smith
By typing your full name above, you are providing us with your digital signature, which is as legally binding as your physical signature. Please note that your signature must exactly match the first and last names that you entered at the top of this web form in order for your submission to be successful.
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