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RMIT Third Party Consent Form

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ananthasivaraman1992
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50 views1 page

RMIT Third Party Consent Form

Uploaded by

ananthasivaraman1992
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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Third party consent form


RMIT Connect

Students should use this form if they want to give a third party their express consent to interact with RMIT on their behalf in relation to the collection, use or
disclosure of their personal or health information.
Please note that this authority applies to communication initiated by the third party only and applies to the sharing and confirmation of details relating to the
areas for which consent is given. All communications initiated by RMIT will continue to be directly with the student. Only the student can make changes
to their enrolment or personal details. If the information is collected in person, the authorised third party will need to prove their identity before information
will be provided. Identity can be proved by provision of a current Australian driver licence, a Proof of Age Card or a current Australian passport.
RMIT values the privacy of every individual and handles personal and health information in accordance with the privacy principles contained in the Privacy
and Data Protection Act 2014 (Vic), the Health Records Act 2001 (Vic) and other relevant legislation. For more information about privacy and the protection
of personal information, visit the RMIT Privacy webpage rmit.edu.au/about/governance-and-management/governance/privacy.

Student details

First name/s Pragya Family name Sampath

RMIT student number s3909127 Date of birth (DD/MM/YYYY) 13/01/2002

Mailing address pragyasampath1234@gmail.com

Telephone +61474092043 Personal email (optional)

Proof of identity
To protect privacy, this consent will not be accepted as third party authorisation without proof of your identity.
Please attach a certified copy of one of the following documents:
— current Australian driver licence or Proof of Age card
— current Australian passport
— other proof of signature and current address details.

Student consent

I (full name of student) Pragya Sampath

0 authorise no longer authorise change/update the authority of

(name of third party) Anantha Sivaraman to speak with RMIT in relation to my

I enrolment fees other

This consent will remain valid until (specify date) 12.12.25 unless rescinded or amended by me beforehand.

Student signature Date (DD/MM/YYYY)

Third party details – Used by RMIT staff to confirm your identity when making contact with RMIT

First name/s Anantha


Family name Sivaraman Date of birth (DD/MM/YYYY) 25 May 1992
Mailing address ananthasivaraman@gmail.com

Telephone +64211636532 Personal email (optional)

Third party consent


I authorise RMIT University to keep my details on file for the purpose of recording this third party consent and to facilitate confirmation of my identity should
I make contact with RMIT in relation to the above matter/s. I acknowledge that this consent will remain valid until the date specified above, unless otherwise
rescinded or amended beforehand.
For more information on how RMIT manages your personal information, please refer to the RMIT Privacy webpage rmit.edu.au/about/governance-and-
management/governance/privacy.

Third party signature Date (DD/MM/YYYY)

RMIT Connect | Third party consent form 1117 | 1 of 1

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