Data subject request form

This form is intended only for individuals living in jurisdictions where data subject requests apply. The use of this form is optional. However, completing this form will enable us to process your request more efficiently. By choosing to complete this form, you understand that Cook Group will process your personal information to authenticate identity and respond to your request.

Please see our Privacy Statement for data protection notices relating to our collection and use of your data.

Country/Region *

First Name *

Last Name *

Email / Agent’s Email:

Are you an authorized agent?: *

(e.g., an attorney representing a client)

YesNo

Request type: *

Select at least one option and provide details in the field below

Request details: *

To help us complete your request, please provide as many details as possible to assist us in locating your personal data, especially:

The type of data requested (e.g., employee data, job application data, marketing data, likeness or recording, etc.)
Your relationship to Cook Group and which Cook business, location, or entity
List any Cook system or service that is related to the requested data
Any relevant dates or timelines involved, etc.

Confirmation of understanding: *

By selecting “I understand” below and submitting this form, you confirm that, to the best of your knowledge, the information provided is correct and this request is valid.

I understand

* Required Fields

California privacy

Privacy@CookGroup.com

888-888 Attn: Chief Privacy Officer

California privacy:

By mail:

Chief Privacy Officer

Cook Group Incorporated

P.O. Box 1608

Bloomington, Indiana 47402-1608 USA

Europe

Email Adress label

DataProtectionEurope@CookMedical.com

Phone number label

+353 61 334440 to speak with the company’s EU Data Protection Officer

Europe Mail Address:

Cook Ireland Ltd.

Attn: European Data Protection Officer

O’Halloran Road

National Technological Park

Castletroy, Limerick, Ireland