Notification form: Data breach

Contact details

Last name * 
First name * 
Email address *   
Phone number (only to contact you related to this data breach) * 
Staff member of UAntwerpen * 

Description of the data breach and involved individuals

Description data breach * 

Involved individuals * 


Moment of determination * 

Is the data breach still going on? * 

Start date  

End date  

Estimated time of day (this can be periods) * 

Type of incident

Categories of data

General data

Sensitive data:

*  required fields
The Data Protection Office collects this personal data for the follow-up of data breaches. Under no circumstances will this information be passed on to third parties. This data is is kept as long as necessary for the follow-up of the data breach. The data is also kept for the inventory of data breaches. If you want to change and anonymize your personal data, please contact More info about our privacy policy: