Data Suppression Request Form

DATA SUPPRESSION REQUEST FORM AND SERVICE AGREEMENT

Recitals

WHEREAS, Requestor requires suppression, removal, or restricted access to certain data records maintained by Data Holder to protect privacy, comply with applicable directives, or address inaccurate records; and

WHEREAS, Data Holder has agreed to receive and process a suppression request under the terms set forth in this form and to take commercially reasonable steps to suppress, delete, or otherwise render inaccessible the identified data subject to the limitations and conditions herein; and

WHEREAS, the parties intend for this document to constitute a binding agreement governing the scope, timing, compensation, confidentiality, and legal framework for the suppression services described below.

Parties

Scope of Work

The Data Holder will undertake commercially reasonable efforts to identify and suppress the data described below within its systems and any downstream systems under its direct control, subject to limitations set forth in this Agreement.

Data Suppression Details

Dataset Identifier:

Time range for suppression: From to

Payment Terms

Compensation for suppression services: Amount $.

Late payment penalty: on overdue amounts.

Term and Termination

Effective date: . Term ends on: .

Either party may terminate this Agreement for material breach that is not cured within days following written notice. Termination does not relieve Requestor of payment obligations for services performed prior to termination.

Confidentiality

Each party shall maintain in strict confidence all non-public information disclosed in connection with this request and shall not disclose such information to third parties except (i) to perform its obligations under this Agreement, (ii) to its professional advisors bound by confidentiality, or (iii) as required by law. Confidential information does not include information that is or becomes publicly available through no breach of this Agreement.

The Data Holder will not use the suppressed data for any purpose other than fulfilling the suppression obligations and compliance verification, and will implement reasonable administrative, physical, and technical safeguards to protect suppressed data.

Representations and Warranties; Limitations

Requestor represents that it is authorized to request suppression of the listed records and that the information provided is true and accurate to the best of its knowledge. Data Holder represents that it will perform suppression using industry-standard techniques where applicable.

Except as expressly set forth herein, neither party makes warranties of any kind. Data Holder is not responsible for suppression of records maintained by unaffiliated third parties beyond its control, nor for backups or archival media that cannot be readily altered without undue burden.

Governing Law; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

This document, together with any written attachments signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous communications, proposals, and agreements, whether oral or written.

Certification and Authorization

By submitting this form, the Requestor certifies under penalty of perjury that the Requestor is authorized to make this suppression request for the records identified, that the information provided is accurate, and that Requestor understands that knowingly providing false information may subject the Requestor to legal liability.

Record of Processing and Verification

Data Holder will provide a written confirmation of actions taken and a description of any records that could not be suppressed within days after completion of suppression activities, subject to payment in full.

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