Please use this form to notify a personal data breach to IMY. If you are not able to answer all the questions at this stage, you may provide supplementary information later on but it is important that we receive the information without undue delay. Fields marked with an asterisk (*) must be filled in before submitting the application.
When you have filled in the form, press "send". We will confirm that we have received your notification and you will then be able to download a copy of it.