Data Subject Request (DSR) Form

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Please fill out the below Roche / Genentech Data Subject Request (DSR) form and describe your request. This form is directed to US residents who have certain rights as data subjects in relation to their personal data under some state or federal laws.

If your request is to access, obtain copies of, correct, amend, rectify, or erase your personal data, or to limit the transfer of your data to certain 3rd parties, we may need to contact you and request additional information to verify your identity before processing your request. Additionally, depending on the scope of your request, we may be limited in how we can respond.

Information collected via this form and related to your request will be handled by Roche / Genentech's data protection officers and their teams, and our privacy operations teams. It will be used solely for the purpose of answering your question(s), and processing and (if possible) completing your request. Information provided on this form is not intended to be used for any other purpose or shared with other parties unless necessary to fulfill your request.

For additional information about your data subject rights, please visit our Roche Privacy Policy at https://www.roche.com/privacy_policy.htm

If you are a CA resident, you may have additional data subject rights, which are summarized here https://www.roche.com/ccpa-privacy-notice.htm

If you do not wish use this form, you may submit your DSR by reaching out using the following alternate options:

Call us at : 800-975-7105 (available only during regular business hours Pacific Time)
email us at : uspriv@roche.com

Section 1 : Identification

First Name *

Last Name *

Are you making this request on your own or another's behalf (if on behalf of another, include information about your relationship to the data subject about whom the records relate and describe your relationship to the data subject) *

Please provide at least one form of contact information (i.e., email, telephone number, or residential address) *

We will use this information to request additional documentation to verify or clarify your request. We may also use this information for preliminary identification and verification of your records in our systems (depending on the nature of your request). For this reason, it is recommended that you provide the contact information that we are most likely to have on file to help us confirm your identity and fulfill your request.

Are you a California Resident? *

Yes

No, but I am a US resident (name the state or territory of your residence below)

No, I am not a CA or US resident (name the country of your residence below)

If you selected "No" above, please provide additional details below

Section 2 : Request Details

Please provide details about your request

How are / were you associated with Roche / Genentech ? *

Please select one or more of the following options that reflect your association with the company:

Health Care Professional

Customer ( other than a patient or study participant )

Patient

Study Subject or Participant

Legal Representative (Caregiver/Parent(s) to a minor/Guardian/Power of Attorney)

Job Applicant

Employee (current or former)

Contractor / Consultant

Contingent Worker

Business Partner

Supplier / Vendor

Users / Visitors of Public Roche Digital Services / Websites / Channels

On-Site or Campus Visitor

Other:

Required

What type of request are you making? *

Please select one or more of the following options: Note that Roche may be limited in the extent to which it can fulfill some types of requests. If you are requesting that we erase your personal data, we will need to contact you to confirm your request.

Access to or copies of your personal data

Correct, amend, or rectify your personal data

Erase your personal data

"Port" your personal data

Know the 3rd parties with whom and how often your personal data has been or is shared, and why

Know the categories of personal data Roche/Genentech is collecting and/or processing of yours, and why

Object to or restrict Roche/Genentech processing your personal data (be sure to include additional information below about how you would like to restrict such activities)

Object to or restrict Roche/Genentech sharing your personal data

Direct the way Roche/Genentech communicates with you

Withdraw your consent

Other:

Required

Please describe your request, including as much specific information about your request as possible (including the relevant time period(s), type(s) of records or information impacted, detailed description of your relationship with Roche/Genentech, etc.). *

Please be sure to indicate how you think Roche / Genentech stores / processes your personal data, as this information will help us fulfill your request more quickly. If we need more details to understand your relationship with Roche / Genentech or the nature of your request, we will contact you via the contact information you shared above.

If you are requesting access, copies or an accounting of information, how would you like your request to be fulfilled? *

We will do our best to accommodate your request, but may be limited in the formats in which we can respond.

Email, with attachments

Mail (consider the security of this format, especially if the response includes sensitive information)

Does not apply

Other:

Submit

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