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DPA Consent Form - Sample

This document is a consent form for sharing personal information between BDO Insurance Brokers, Inc. and its affiliates. It allows BDOI to collect, process, store, and share a customer's personal data with affiliates and third parties for legitimate purposes like risk management, fraud prevention, and marketing. A customer's information may be shared for 5 years after transactions conclude or as required by law. Customers can access, update, or withdraw consent for use of their data by contacting BDOI's Data Protection Officer.

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531 views1 page

DPA Consent Form - Sample

This document is a consent form for sharing personal information between BDO Insurance Brokers, Inc. and its affiliates. It allows BDOI to collect, process, store, and share a customer's personal data with affiliates and third parties for legitimate purposes like risk management, fraud prevention, and marketing. A customer's information may be shared for 5 years after transactions conclude or as required by law. Customers can access, update, or withdraw consent for use of their data by contacting BDOI's Data Protection Officer.

Uploaded by

Joan Baltazar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DATA PRIVACY ACT

Consent Form

This is to grant consent on the general use and sharing of information obtained from me in the course of any Transaction 1, between me and BDO
Insurance Brokers, Inc. (BDOI), its parent and affiliates and their respective representatives and agents ( collectively, the “BDOI Group”) and/or
any of BDOI’s accredited insurers or from third parties. I acknowledge and agree that any member of the BDOI Group and its accredited insurers
may share these data between them and such data may constitute my personal or sensitive personal information (which includes without
limitation, my name, address, gender, age, marital status, contact details, birthday, SSS/GSIS, TIN, education, employment information, financial
information, medical information, spouse details, preferences, behavior, and other information classified as “personal data,” “personal
information,” or “sensitive personal information” under the Data Privacy Act), as well as information relating to my accounts, transactions and
communications with any member of the BDOI Group.

Said data may be collected, processed, stored, updated, or disclosed by any member of the BDOI Group and BDOI’s accredited insurers and
shared between and among them or to third parties (i) for legitimate purposes including but not limited to credit and risk management, know
your customer (KYC) checks, prevention and detection of fraud or crime, system or product development and planning, cross-selling, direct
marketing, profiling, complaints management, insurance, audit and administrative purposes, and relationship management, (ii) to provide
services to me or implement transactions which I request, allow, or authorize, and, (iii) to comply with BDOI Group’s internal policies and BDOI
Group’s reporting obligations to comply with (a) Applicable Law2, and internal policies or procedures, or (b) any demand and/or requests from
Government Authorities3 for purposes of reporting, regulatory trade reporting, disclosure or other obligations under Applicable Law.

My consent authorizes members of the BDOI Group and BDOI accredited insurers to process, collect, use, store, or disclose my information
between them and to other members, to Governmental Authorities, and to third parties4, as may be necessary.

My information may continue to be collected, stored, processed and/or shared between and among members of the BDOI Group and BDOI
accredited insurers for five (5) years from the conclusion of my Transactions with them and any of their members or until the expiration of the
retention limits set by Applicable Law, whichever comes later.

I do understand that BDOI and its accredited insurers are committed to ensuring the confidentiality of my information under Republic Act No.
1405 or the “Bank Secrecy Law,” Republic Act No. 8791 or the “General Banking Law of 2000,” and Republic Act No. 6426 or “The Foreign
Currency Deposit Act” subject to Applicable Law, and will exert reasonable efforts to protect against unauthorized use or disclosure.

Further, I understand that I may access, update, or correct certain personal information, or withdraw consent to the use of any of my information
as set out in this letter at any given time by communicating with the BDOI Data Protection Officer at 45/F BDO Corporate Center Ortigas, 12 ADB
Avenue, Ortigas Center, Mandaluyong City 1550, (02) 702-6000 local 56746 and data_protection_officer_bdoinsurance@bdo.com.ph. I
recognize that I may file complaints with and/or seek assistance from the National Privacy Commission.

I hereby acknowledge that this record supplements but does not supersede nor replace any other consent I may have previously provided to
BDOI or any of its accredited insurers. This form is to be construed in accordance with Philippine Law.

1
Transaction means any transaction, business, or other form of contractual or commercial relationship
2
Applicable Law refers to any statute, law, constitution, regulation, rule, ordinance, order, decree, directive, guideline, policy, requirement, or other governmental
restriction or any similar form of decision of, or determination of any of the foregoing by, any national, regional or local government or political subdivision, commission,
authority, tribunal, agency or entity of the Republic of the Philippines or a foreign country, as may be applicable.
3
Governmental Authority means the government of the Republic of the Philippines or a foreign country, as may be applicable, or any political subdivision thereof, and any
entity exercising executive, legislative, judicial, regulatory, or administrative functions of or pertaining to the government.
4
Refers to any third party (local or overseas):
o Who acquires or will acquire the rights and obligations of any member of the BDOI Group or of the BDOI accredited insurer;
o Who is in negotiations with any member of the BDOI Group in connection with the possible sale, acquisition or restructuring of any member of the BDOI Group;
o Who processes information, transactions, services, or accounts, on behalf of the BDOI Group (including but not limited to courier agencies; telecommunication
information technology companies; payment, payroll, collection, training, and storage agencies; entities providing customer support, and other similar entities); or
o Who requires the information for market research, product and business analysis, audit and administrative purposes, or for marketing or advertising activities
undertaken by the BDOI Group.

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