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 * 


Timeline

Determination
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







Other
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 privacy@uantwerpen.be. More info about our privacy policy: www.uantwerpen.be/disclaimer.