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:
12/3/2020 ]

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:



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.