Subject Access Request Form - Wave Life Sciences

If you want to know what personal information Wave has about you, please enter your details:

"*" indicates required fields

Title*

Name*

Forename(s) Surname

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number*

Email Address*

While normally, Wave cannot accept requests in respect of your Personal Data from anyone else, including members of your family, if there is a protected legal relationship in place (for example: Parent or Caregiver), then you may submit a request on behalf of the individual for whom you have the protected legal relationship. If this is applicable to you, in addition to your information, please provide the information for the individual for whom you are submitting the request as well as the protected legal relationship you have with the individual.

If you are submitting a request to know what personal information, Wave has about the person with whom you have a protected legal relationship,

Please Enter That Individual’s Details:

Title

Name

Forename(s) Surname

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number

Email Address

Please Enter Details About the Protected Legal Relationship:

Protected Legal Relationship

INFORMATION BEING REQUESTED*

Please provide specific details (along with any relevant dates) of the information being requested and any additional information that may help us to locate your Personal Data and to confirm your identity (or to locate the Personal Data of the Individual for whom this request is being submitted and to confirm that individual’s identity).

By completing this form, you are making a subject access request under the GDPR for Personal Data collected, processed, and held about you, or the individual for whom this request is being submitted, by us that you are entitled to receive.

Please review the following IMPORTANT INFORMATION

Wave, collects, holds, and processes certain Personal Data about our consultants, agents, contractors, and participants in our scientific research such as clinical trials (“data subjects”). As a data subject, you have a legal right, under EU Regulation 2016/679 General Data Protection Regulation (“GDPR”) to find out about our use of your Personal Data as follows:

Confirmation that your Personal Data is being processed by us;
Access to a copy of your Personal Data;
What the purposes for the processing are, the categories and legal basis
How we use your Personal Data and why;
Existence of automated decision-making including explanations as to what this means
Details of any sharing or transfers of your Personal Data;
How long we hold your Personal Data; and
Details of your rights under the GDPR including, but not limited to, your rights to withdraw your consent to our use of your Personal Data at any time and/or to object to our processing of it.
Details and evidence of the protected legal relationship.
Evidence of identification, ex: photographic id, national number, driver’s license, passport, other types of identification as requested.

No fee is payable under normal circumstances. We reserve the right to charge a reasonable fee for requests that are manifestly unfounded, excessive, or repetitive. Such charges will be based only on the administrative cost that we will incur in order to respond.

On receiving your correspondence, Wave Life Sciences is likely to request evidence of your identity, to ensure your personal data and information connected with it is not provided to anyone other than you.

After receiving your subject access request, we may contact you to request additional supporting information and/or proof of your identity and/or protected legal relationship. This helps us to safeguard your privacy and Personal Data.

We will respond to all subject access requests within one month of receipt and will aim to provide all required information to you within the same period. If we require more information from you, or if your request is unusually complicated, we may require more time and will inform you accordingly.

Please note that Personal Data from participation in clinical trials is pseudonymised (i.e. we cannot identify you by name, only by your subject identification number). This makes it impossible for us to match data to you. If you still want to make a subject access request, you must contact your study doctor first and give written consent for your name and subject identification number to be matched up by your study doctor. Your study doctor should then contact the Data Protection Officer, [email protected]. We will require a copy of your consent. Even if your consent is given, we may be unable to directly identify your data or, where it is aggregated with other data subjects, we will be unable to provide it as to do so would risk the privacy of other people. If the study is ongoing, we may be delayed in disclosing the requested information until after the study has completed or until after you have withdrawn your consent to continuing to participate in the study (note, that all data collected prior to your withdrawal from the study may also not be able to be disclosed until completion of the study).

Please note that the copy of the submitted form emailed to you will include any sensitive information that you include in your form submission, and that transmission of that information by unencrypted email involves various risks, including that the information may be intercepted, altered, or used by third parties without detection or authorization. By requesting that a copy of the submitted form be emailed to you, you acknowledge and accept these risks.

DECLARATION

By clicking submit, you confirm that you are the data subject named in this Subject Access Request Form or that you are legally authorized to make this request on their behalf based on your protected legal relationship. You warrant that you are the individual named and will fully indemnify Wave, for all losses and expenses incurred if you are not.

Signature (First name, Last name)*

Date*

This field is for validation purposes and should be left unchanged.