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Data Erasure Request Form


The Data Erasure Request Form allows data subjects to request the deletion or erasure of their personal data from the records of [Your Organization Name] in accordance with the Protection of Personal Information Act (POPIA). This form enables [Your Organization Name] to efficiently handle and respond to data erasure requests while ensuring compliance with data protection regulations.

Request Details:

Requester Information:

  • Full Name: [Placeholder]
  • Email Address: [Placeholder]
  • Phone Number: [Placeholder]
  • Address: [Placeholder]

Description of Request:

  • [Brief Description of Data to be Erased]

Additional Information:

  • [Any Additional Details Provided by the Requester]


To ensure the security and accuracy of personal data, [Your Organization Name] may require verification of the requester’s identity. Please provide the following information for verification purposes:

  • Date of Birth: [Placeholder]
  • Identification Document Type: [ID/Passport/Driver’s License]
  • Identification Document Number: [Placeholder]
  • Any Additional Information: [Other Information for Verification]


I, [Requester’s Full Name], hereby certify that the information provided in this Data Erasure Request Form is true, accurate, and complete to the best of my knowledge.

Signature: [Signature Field]

Date: [Date]

The Data Erasure Request Form streamlines the process for data subjects to exercise their rights under POPIA and enables [Your Organization Name] to fulfill its obligations regarding data erasure requests. By promptly responding to such requests and deleting or erasing personal data as required by law, we demonstrate our commitment to transparency and data protection compliance.

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