Contact form
for using the test track for connected and automated driving inHamburg
Please fill and sign the form and send it to the TAVF coordination centre:
moin@tavf.hamburg

1. Your company/organisation

Name of the company/organisation

Department

Street + number

ZIP cityCountry

2. Contact data

First nameLast name

Phone

Email

Please note the information related to data privacy on page 3.

3. Short description of the use case
Focus of the trials/technology (e. g. communication vehicle-to-infrastructure via ITS-G5, localisation via Galileo,
environment detection via laser scanners etc.):

Problem, solution approach:

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Benefit/added value for the city of Hamburg with respect to the strategic objectives ”Improvement of traffic
safety“, “Reduction of environmental impacts”, “Efficiency of the overall system”, ”Adequate, securetransmission of information“ and “Promoting innovation“:

Risks of implementing the application:

Further partners involved:

4. Test track use
Period:Number of vehicles in moving traffic:
Required segments of the test track (e. g. intersection, pedestrian traffic light, or bike way):

Required functions/information on the test track (e. g. signal phases or digital maps):

Additional hardware/infrastructure facilities required which are currently not in place and which need to beprovided by the city of Hamburg or with support of special subsidies, respectively:

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5. Data privacy☐ No data in terms of the EU General Data Protection Regulation (GDPR) will be collected.

☐ Data in terms of the EU General Data Protection Regulation will be collected, which are listed da follows:A privacy concept for the processing of personal data
☐ will be developed☐ is already available

Information related to Art. 13 of the European General Data Protection
Regulation (GDPR)
1. Data protection declaration
The data protection declaration of the ITS mobility e.V.,
being assigned as TAVF coordination centre, can befound on www.tavf.hamburg/privacy.html
2. Consent
By signing this application form, the applicant consents
to the processing of his personal data for the purpose ofhandling the application.
3. Responsible authority and purpose of dataprocessing
As responsible authority, theITS mobility e.V.
Hermann-Blenk-Straße 1838108 Braunschweig
Germany
Phone: +49 531 231721-0
Email: info@its-mobility.de
Website: www.its-mobility.de
Value added tax identification number (VAT-ID) related
to § 27a Umsatzsteuergesetz: DE 267055141
Register court: Amtsgericht Braunschweig
Register number: VR 200598,
being assigned as TAVF coordination centre, processes
and uses the personal data from the application form
(first name, last name, phone, email) solely for thepurpose of assessing the application, clarifying open
questions and contact the applicant with respect to thedecision making and further progress.

Place, date

4. Receiver of the dataAs far as required for the assessment of the application,
the TAVF coordination centre transmits the personal
data to the test track operators:
1. Freie und Hansestadt Hamburg,Behörde für Verkehr und Mobilitätswende
Alter Steinweg 4, 20459 Hamburg, Germany
2. Freie und Hansestadt Hamburg,
Landesbetrieb Straßen, Brücken und Gewässer,
Sachsenfeld 3-5, 20097 Hamburg, Germany
A further transfer to third parties, with except of theprocessors named in the data protection declaration, as
well as the use of the data for advertising purposes, does
not take place.
5. Duration of the data storing
The data will be stored as long as the application isprocessed. After finalisation of the assessment, thepersonal data will be deleted.
6. Rights of the applicant
The applicant a) is entitled to obtain information of the
responsible authority about whether concerned personal
data are processed; if this is the case, then the applicant
has the right of information about these personal data(Art. 15 GDPR), b) has the right of rectification in case of
personal data wrongly gathered (Art. 16 GDPR), c) has aright to erasure of the personal data (Art. 17 GDPR), tolimitation of processing (Art. 18 GDPR), of appeal toa supervisory authority (Art. 77 GDPR) and to data
portability (Art 20 GDPR).

Signature

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