The information collected on this form is recorded in a file computerized by [identity and contact details of the controller] for [processing purposes]. The legal basis for processing is [legal basis for processing].

The data collected will be communicated to the following recipients only: [data recipients].

The data is kept for [data retention period provided for by the controller or criteria for determining it].

You can access the data concerning you, rectify it, request its deletion or exercise your right to limit the processing of your data. (depending on the legal basis of the processing, also mention: You can withdraw your consent to the processing of your data at any time; You can also object to the processing of your data; You can also exercise your right to the portability of your data )

Visit the website for more information on your rights.

To exercise these rights or for any questions about the processing of your data in this device, you can contact (if applicable, our data protection officer or the department responsible for exercising these rights): [email address, postal address, telephone numbers, etc.]

If you believe, after contacting us, that your "Data Protection" rights are not respected, you can file a complaint with the CNIL.