Data Subject Request

Name Of Requester:

RELATIONSHIP WITH THE COMPANY:

AMERISOURCEBERGEN BUSINESS UNIT TO WHICH THIS REQUEST RELATES:

Start Date of Employment:

End Date of Employment:

Date of Application:

Employee Number:

Nature of Request:

Email:

Telephone:

Comments:

By the submission of this request and the requested information, I hereby

CONFIRM THAT I AM THE PERSON WHOSE NAME AND IDENTITY ARE REFERENCED ABOVE; AND,

CONSENT TO THE PROCESSING OF SUCH PERSONAL DATA FOR THE PURPOSE OF FULFILLING THE REQUEST UNDER THE CALIFORNIA CONSUMER PRIVACY ACT WHICH IS REFERENCED ABOVE.