Data breach

Data breach

Company data

Describe the data breach 

Describe in full detail the cause and (possible) results of the data breach for the personal data protection.

Contact person 

When did you detect the breach?

When did the breach occur?

Describe the group of people whose personal data is affected by the breach

More than one possible answer.



What is the nature of the breach?

 More than one possible answer.

How many people’s data has been affected? 

Report a minimum and maximum number.

What type of personal data is involved?

Types of personal information are:

  • Name, address, city data
  • Telephone numbers
  • Email addresses or other addresses for electronic communication
  • Authorisation or identification data (e.g. login, password, customer number)
  • Financial data (e.g. bank account number, credit card number)
  • Social security number
  • Passport copy or copy of other id documents
  • Gender, birth date and/or age  
  • Special/sensitive information (medical data etc.)
  • Other data (please describe).

Has the personal data been encrypted, hashed or otherwise rendered incomprehensible or inaccessible to unauthorised parties?

Describe the situation. When rendered incomprehensible, please describe how this was done.

Does the data breach concern personal data of European Union citizens apart from the Dutch?

 Make your choice:



What technical and/or organisational measures has your company implemented?

What measures has your company implemented to tackle the breach and to prevent further breaches?