Consent Withdrawal Request Form

I. Request to Withdraw Consent

Under the Personal Data Protection Act of 2012 ("PDPA"), you are entitled to withdraw your consent of personal data from Coinut

Proof of Identity

To help us establish your identity, your application must be accompanied by two pieces of identification that between them clearly show your name and current address. This is a security measure to prevent fraud / theft of personal data and to ensure we are releasing information to you and not to a third party.

Please upload one identification document and one proof of current addres:

1. Identification Document

Passport
National Registration Identity Card (NRIC)
Driving License
Birth or Adoption Certificate

2. Proof of Address
Latest copy (within the last three months) of:

Bank Statement or Credit Card Statement
Utility Bill
Telecommunications Bill

Click or drag files to this area to upload. You can upload up to 5 files.
Click or drag files to this area to upload. You can upload up to 5 files.

II. Purpose for withdrawal of consent:

To help us to deal with your request quickly and efficiently please provide as much detail as possible about (1) what personal data and (2) what purposes or use you wish to withdraw consent for. If possible, please let us know when you originally consented.

III. Declaration

I am requesting to withdraw my previously provided consent given to Coinut. I confirm that the information provided in this form is correct and that I am the data subject whose name appears in this form. I understand that my request will not be valid until I have provided proof of identity, enough information to locate the personal data I want, and where applicable, the administrative fees required by Coinut.