Rubicon Project

Data Subject/Consumer Access Request – Identity Verification Form

  • I, the undersigned individual, do hereby swear, certify, and attest that:

    1. I am a citizen and/or resident of

  • 2. Please complete for the access you are requesting:

    Mobile Phone:
    I own and operate one or more mobile devices with the following Device Identifier(s) (as that term is used in Rubicon Project’s Data Subject Rights Notice):


  • Browser:
    I own and operate a device on which is stored at least one cookie labeled either “khaos” or “ruid”, set by the rubiconproject.com domain, which contains the following string(s) of text:

  • Drop files here or
    Accepted file types: jpg, jpeg, png, Max. file size: 2 MB, Max. files: 5.
      Limit of 5 files. Maximum file size: 2MB each.


    • 3. I have the authority under relevant laws, rules, and regulations, to submit a subject access request for personal data associated with the above-listed identifiers; and

      4. I am not requesting this information for any fraudulent, criminal, malicious, or otherwise unlawful purpose.

      I declare under penalty of perjury that the foregoing is true and correct.


      Data Subject/Consumer:

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