Data Deletion Request Form

DATA DELETION REQUEST FORM

Client Name:     Service Provider Name:

Client Contact Address:

Effective Date:     Request Reference/ID:

RECITALS

WHEREAS, Client Name: asserts that certain personal or business data under the custody or control of Service Provider Name: (the "Provider") should be permanently deleted or rendered irrecoverable; and

WHEREAS, the parties desire to set forth the scope, schedule, responsibilities and certifications governing the deletion, destruction and verification of such data to ensure legal compliance and to minimize residual risk.

WHEREAS, the Provider agrees to undertake deletion activities under the terms and conditions set forth in this Data Deletion Request Form (the "Agreement").

SCOPE OF WORK

The Provider shall permanently delete, destroy, or irreversibly anonymize the data described below, and shall certify completion in writing in accordance with the schedule set forth in this Agreement.

PAYMENT TERMS

As consideration for the deletion services, Client agrees to pay Provider the amounts and according to the schedule set forth below. All amounts are payable in lawful currency of the United States unless otherwise agreed in writing.

TERM AND TERMINATION

This Agreement commences on the Effective Date and continues until the deletion and certification obligations described in the Scope of Work are complete, unless earlier terminated in accordance with this Section.

Commencement Date:     Target Completion Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered not less than days prior to the proposed termination date. Either party may terminate immediately for material breach by the other party if the breach remains uncured for a period of thirty (30) days after receipt of written notice specifying the breach.

Upon termination, Provider shall (i) cease any further processing of the data subject to deletion, (ii) return to Client any data that Client is entitled to receive in non-deleted form, and (iii) promptly complete deletion activities for data already targeted for deletion and provide certification as required herein, unless compliance with a lawful obligation prevents deletion.

CONFIDENTIALITY

Each party shall maintain the confidentiality of Confidential Information disclosed in connection with this Agreement and shall not disclose such Confidential Information except to its employees, contractors or agents who have a need to know and who are bound by confidentiality obligations at least as protective as those herein. "Confidential Information" includes the contents of the data to be deleted, technical deletion methodologies, and any certification reports issued under this Agreement, but does not include information that is (a) publicly known through no breach by the receiving party; (b) already lawfully in the possession of the receiving party; or (c) independently developed without use of the disclosing party's Confidential Information.

CERTIFICATION AND REPRESENTATIONS

Client hereby represents and warrants that it has the authority to request the deletion of the data identified in the Scope of Work and that the deletion will not conflict with any contractual or legal obligation to retain the data. Client confirms identity by selecting one of the following:

I confirm I am the data owner or an authorized representative with legal authority to request deletion.

I confirm the data is not subject to a legal hold, pending litigation, or other lawful retention requirement (or I have disclosed any such holds in the Scope of Work).

DATA DELETION PROCEDURES AND VERIFICATION

Provider shall apply industry-appropriate deletion or destruction procedures to ensure data is irrecoverable. Provider shall maintain a record of deletion actions and shall provide Client a written Certificate of Deletion that identifies the data deleted, the date deletion was completed, the deletion methods used, and the identity of persons performing the deletion.

GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws rules. The parties hereby submit to the exclusive jurisdiction of the state and federal courts located in that state for resolution of disputes arising under this Agreement.

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations, and communications, whether oral or written, regarding the deletion and destruction of the data described herein. Any amendment or modification must be in writing and signed by both parties.

INDEMNIFICATION

Each party shall indemnify, defend, and hold harmless the other party from and against any losses, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising out of the indemnifying party's breach of this Agreement, willful misconduct, or negligence in connection with deletion activities, except to the extent such losses result from the other party's gross negligence or willful misconduct.

ACKNOWLEDGMENT

By signing below, the undersigned certify under penalty of perjury that they are authorized to execute this Agreement on behalf of the named parties, that the information in this request is true and complete to the best of their knowledge, and that they understand the legal consequences of deletion including potential irretrievability of deleted records.

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