Allergan GDPR Data Subject Rights Request Form
The information requested on this form will allow Allergan to identify your data on its processing systems.
Also, it guarantees only requests from a legitimate source are processed.
The personal data collected on this form will be used only to support the request and will not be used for other purposes.
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REQUESTOR INFORMATION
Details of the Person the Request is For

* Mark Indicates Required Field

Title
First Name*
Last Name*
Affiliation/Business/Clinic Name
Street Address*
Town/City*
State / County / Province
Zip Code*
Country*
E-Mail Address
Phone
Submitting for Another Person?
If you are submitting this form on behalf on another person, you can include your details here. For the rest of the sections contained within this form, please, include the information of the person the data relates to.
Submitter E-Mail Address
Submitter First Name
Submitter Last Name
Relationship to the data subject that permits you to make this request
Allergan Employee (Date request was received by you?)
Date request was received by you:
3/30/2020 ]

To be able to identify your personal data in our systems it would be helpful if you can share some specific details about yourself .

In what role do you believe that Allergan has collected and processed your personal data?*

State Others

If possible, list the website(s) you have registered or other activity(ies) and interaction(s) you have had with Allergan and provide a description and details of the extent of your request, including relevant time period:


Your Request
The GDPR includes a number of rights that can be exercised by you. Let us know what type of request you would you like to make regarding personal data we process on you.

Request Type*

Rectification changes to be made and other relevant information:


Your Consent
You can modify your voluntary consent for those activities you wish to consent to (Opt-IN) and those you wish to stop (Opt-OUT)

Opt-IN (Provide Consent)
State Other
Opt-OUT (Withdraw Consent)
State Other

Invitation by email to Allergan-sponsored event and Registration
Allergan may collect your personal data, including contact data and your professional business data, to invite you by email and register you for an Allergan-sponsored event. Your consent is required for Allergan to use your personal data for these Allergan-sponsored email event invitation and registration purposes. Your consent is voluntary, but if you do not consent we will not be able to contact you by email regarding Allergan events. If you consent, check “Opt-in”. If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my personal data, including contact data and my professional business data, for Allergan to invite me and register me for an Allergan-sponsored event.
If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my personal data, including contact data and my professional business data, for Allergan to invite me and register me for an Allergan-sponsored event.
Invitation by email to non-Allergan-sponsored event and Registration
Allergan may collect your personal data, including contact information and your professional business data, for third parties to share non-Allergan-sponsored event invitation and registration details with you. If you consent, Allergan will securely share your personal data, including your contact information, with the third party organizing the event for them to send you event invitation and registration information. . If you consent, check “Opt-in”. If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my personal data, including contact data and my professional business data, for Allergan to share with third parties for the third-parties to send me even invitation and registration details.
If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my personal data, including contact data and my professional business data, for Allergan to share with third parties for the third-parties to send me even invitation and registration details.
Transparency and financial Disclosure
Allergan may collect your personal data, specifically your contact data, professional business data, and information regarding any payments and transfers of value to you by Allergan, to comply with Allergan’s transparency reporting and financial disclosure obligations. Unless the reporting/disclosure is required by law, your consent is required for Allergan to use and disclose your personal data for these purposes. If you choose not to consent, Allergan will only report anonymized and aggregated data as part of this transparency reporting obligation, unless reporting your identifiable data is required by law. If you consent, check “Opt-in”. If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com
If you choose not to consent, Allergan will only report anonymized and aggregated data as part of this transparency reporting obligation, unless reporting your identifiable data is required by law. If you consent, check “Opt-in”. If you wish to withdraw your consent or opt-out, you can access again this form/link or send an email to IR-EUDPO@allergan.com
By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my personal data, including my contact data, professional business data, and information about any payments or transfers of value to me from Allergan for Allergan’s transparency reporting and financial disclosure obligations.
Product and service direct marketing by Mobile
Allergan may collect your personal data, including your contact details, to send you direct marketing by SMS or text messages to your mobile device. Your consent is required for Allergan to use your personal data for these direct marketing purposes. Your consent is voluntary and if you choose not to consent, then Allergan will not be able to send you information related to their products and services by the methods described above. If you consent, check “Opt-in”. If you wish to withdraw your consent, you can unsubscribe or opt out of receiving similar emails by accessing again this form/link or by sending an email to IR-EUDPO@allergan.com.. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my contact details to allow Allergan to send me direct marketing via SMS/text message, for Allergan’s products and services.
If you wish to withdraw your consent, you can unsubscribe or opt out of receiving similar emails by accessing again this form/link or by sending an email to IR-EUDPO@allergan.com.. By checking “Opt-in” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my contact details to allow Allergan to send me direct marketing via SMS/text message, for Allergan’s products and services.
Product and service direct marketing by Email
Allergan may collect your personal data, including your contact details, to send you direct marketing by email. Your consent is required for Allergan to use your personal data for these direct marketing purposes. Your consent is voluntary and if you choose not to consent, then Allergan will not be able to send you information related to their products and services by the methods described above. If you consent, check “Opt-in.” If you wish to withdraw your consent, you can unsubscribe or opt out of receiving similar emails by accessing again this form/link or by sending an email to IR-EUDPO@allergan.com. By checking “Opt-in,” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my contact details to allow Allergan to send me direct marketing via email for Allergan’s products and services.
If you wish to withdraw your consent, you can unsubscribe or opt out of receiving similar emails by accessing again this form/link or by sending an email to IR-EUDPO@allergan.com. By checking “Opt-in,” I authorize Allergan, or any contracted third parties acting on its behalf, to collect my contact details to allow Allergan to send me direct marketing via email for Allergan’s products and services.

Preferred Contact Type
In order to contact you with any further queries about this request and/or provide you with the outcome, please, indicate your preferred method.

Communication Channel*
Same As Above
Email Address
Confirm Email
Postal Street Address
Postal Town/City
Postal State / Postal County / Postal Province
Postal Zip Code
Postal Country

Identity Verification


LEGAL
Attestation: By submitting this GDPR Data Subject Rights Request form, I certify that I am completing this form in good faith on behalf of myself or on behalf of another person who I am entitled to act on behalf of. I further acknowledge that depending on the nature of my request, an Allergan plc employee/representative may need to contact me using the information I have provided to help process my request. Additionally, I understand that my personal data I have submitted in this request form will be transferred to other Allergan affiliates and contracted third parties acting on behalf of Allergan worldwide to process my request. Some of these Allergan affiliates and contracted third parties acting on behalf of Allergan may be in countries that do not ensure an adequate level of data protection.
Nevertheless, all of Allergan’s affiliates and contracted third parties are required to treat the personal data you submit as part of this request in accordance with Allergan’s Privacy Statement and Terms of Use (which can be found at https://www.allergan.com), including Allergan’s commitment to comply with the terms of the EU-US and Swiss-US Privacy Shield certifications and other applicable cross-border data transfer mechanisms. For further details on how Allergan process your data you can access the Allergan privacy policy available here.