To whom it may concern,

This notice is to inform you that I would like to have my personal data deleted from your records. My contact information is as follows:

Full Legal Name: ________
Address:

________

Telephone Number: ________
Email: ________

The reason I am requesting deletion of my personal data is as follows: consent is being revoked for personal data processing.

The information that I am specifically aware of, that you process or retain, is as follows:

________

If you process other personal data that belongs to me, which I may not be aware of, please consider this request to apply to that data, as well. I would like all of my personal data deleted from your systems.

Please respond in writing to confirm that my request has been honored.

Sincerely,

________