Data protection request - Bristol Myers Squibb

Please provide the information requested below to the best of your ability. We may use this information for 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.

*Required Fields

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Who is the request for?

*Are you making the request for yourself or for someone else? Please fill out required fields

*Individual Type Please fill out required fields

*First Name Please fill out required fieldsEnter valid First Name

*Last Name Please fill out required fieldsEnter valid Last Name

*Country Please fill out required fields

*National Identification Number Please fill out required fields Enter valid Identification number

*Mailing Address Please fill out required fieldsEnter valid mailing address

*State/Province of Residence Please fill out required fields

*Please provide at least one of the method of communication below

E-mail

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Phone Number

Please enter a valid phone number Please fill out required fields

Consumer Fax number Please enter a valid fax number

Representative Details

*Please specify your relationship with the individual Please fill out required fields

*Full Name of the Requestor Please fill out required fieldsEnter correct Full Name

Company Name

*E-mail Please fill out required fieldsPlease enter valid email

*Mailing Address Please fill out required fieldsEnter valid mailing address

*Phone Number Please fill out required fieldsPlease enter a valid phone number

Requester Fax NumberPlease enter a valid fax number

*Request Type Please fill out required fields

If you are unable to provide the information in the Required fields above, you will be unable to submit your request through this form. Kindly refer to the Privacy Policy to identify alternate channels to submit a Data Protection/Privacy request

*Describe your request Please fill out required fieldsEnter valid description

Please describe your consumer rights request, including as much specific information about your request as possible. Please provide us any details about your relationship with BMS, that may help us identify or verify you in our systems such as time period(s), identification numbers or enrollment details, etc.

*I certify that I am authorized to submit this request and that the foregoing is true and correct.

By providing your personal information, you agree that BMS may use your information and contact you about your inquiry. Your information will otherwise be governed by our Privacy Policy. This policy may be updated from to time to time and you can view the most current version on this website.

This form is intended for submitting a Consumer/Data Subject Rights request under the Data Protection regulations applicable to the countries available in this form. It is not intended for the reporting of side effects or product complaints associated with the use of prescription drugs. If you, or someone you know, have possibly experienced a side effect or have a product complaint while taking a Bristol Myers Squibb product, please contact us using the numbers provided at http://www.globalbmsmedinfo.com/