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MandaVax Opt-Out

This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

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Catherine Higino
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219 views1 page

MandaVax Opt-Out

This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

Uploaded by

Catherine Higino
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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MandaVax

OPT-OUT FORM
Name ______________________________________________ Household Code: ___________
Address ____________________________________________ Date _____________________

Reason for Opting-Out from MandaVax:

I am fully aware of the importance of registration with the MandaVax prior to vaccination. I hereby
express my decision to opt-out from the MandaVax which will result in the erasure or deletion of my
unique QR Code and personal data in the database, subject to the limitation by law. My decision to opt-
out is being made voluntarily without any force, coercion or intimidation.

_____________________________
(Signature over printed name)

PRIVACY STATEMENT: Any or all personal data you provided will only be used to process any your request
to opt-out from the MandaVax. This includes contacting you should there be need for clarifications or
additional information. All collected data will be kept secure and confidential, unless otherwise authorized by
law. They will be disposed of as soon as the purpose for their use has been achieved. Only aggregate or
anonymized data shall be subject to further processing. We respect your rights under the Data Privacy Act.
Should you wish to be clarified on how we are processing of your personal data, or have questions or
clarifications relative to privacy and data protection, you may contact us at dpo@mandaluyong.gov.ph.

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