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The Regulation of 10th December 2014 by the Minister of Administration and Digitalisation on data protection officer appointment and dismissal patterns

Warsaw, 29th December 2014

Item 1934

REGULATION OF MINISTER OF ADMINISTRATION AND DIGITALISATION 

of 10th December 2014

on data protection officer appointment and dismissal patterns

 

            Acting on the basis of the art. 46 f) of the Act of 29th September 1997 on the protection of personal data (Journal of Laws of 2014 item 1182 and 1662) it is hereby declared:

§ 1. Following patterns are being established:

1)      notification to registration by the Inspector General for Personal Data Protection of data protection officer appointment, in the form indicated in Appendix 1;

2)      notification to registration  by the Inspector General for Personal Data Protection of data protection officer dismissal, in the form indicated in Appendix 1;

§ 2. Regulation comes into force on 1st January 2015.

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX 1

PATTERN

Notification

to registration by the Inspector General for Personal Data Protection of data protection officer appointment

Date of notification:………………

(filled in by the Inspector General for Personal Data Protection)

Part A. Indication of the data controller

Name of the data controller and its address of establishment or surname, name and address of residence of data controller and its number from the National Official Business Register (REGON)  - if any.

  1. Data Controller
  2. REGON
  3. Address:

street:

home number:                   apartment number:

postal code:

city:

 

Part B. Personal data of data protection officer and the date of its appointment

  1. Surname and name:
  2. PESEL identification number if any, or name and number of document stating identity:

PESEL:

name of document stating identity:         number of document stating identity:

  1. Correspondence address if other than one indicated in Part A of the Notification:

street:

home number:                  apartment number:

postal code:

city:

  1. Date of data protection officer appointment:

 

 

Part C. Declaration of data controller that data security officer fulfils the conditions laid down by the Act

I hereby declare that the data protection officer indicated in Part B of the notification:

¨  has full capacity to perform legal acts and enjoys full civil rights,

¨  has relevant knowledge in the field of personal data protection,

¨  has not been punished for an intentional offence,

¨  reports directly to the head of an organisational unit or to a person being the controller.

 

(data, signature and seal of the data controller) *

Clarifications:

*   not to be filled in if the notification is send through electronic communication means

** in case of affirmative answer square has to be filled with the following sign: “X”.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX 2

Pattern

notification to registration  by the Inspector General for Personal Data Protection of data protection officer dismissal

Date of notification:………………

(filled in by the Inspector General for Personal Data Protection)

Part A. Indication of the data controller

 

Name of the data controller and its address of establishment or surname, name and address of residence of data controller and its number from the National Official Business Register (REGON)  - if any.

  1. Data Controller
  2. REGON
  3. Address:

street:

home number:                   apartment number:

postal code:

city:

 

Part B. Personal data of data protection officer

  1. Surname and name:
  2. PESEL identification number if any, or name and number of document stating identity:

PESEL:

name of document stating identity:         number of document stating identity

 

Part C. Date and reason for dismissal of data protection officer

 

  1. Date of dismissal of data protection officer
  2. Reason for dismissal of data protection officer

 

(date, signature and seal of data controller) *

Clarifications:

*  not to be filled in if the notification is send through electronic communication

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