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ANNEX C: INTERVIEW CONSENT FORM TEMPLATE INTERVIEW CONSENT FORM DFA Social Media Campaign: “The Global Filipino” The Office of Strategic Communications and Research of the Department of Foreign Affairs (DFA OSCR), through the Philippine Embassy in New Zealand , wishes to use for promotional purposes your photographs/video and interview answers for the social media campaign “The Global Filipino”. ‘These photos/video and interview responses may appear on the following official social media accounts of the DFA: Facebook: www.facebook.com/dfaphi Twitter : www.twitter.com/DFAPHL Instagram: www.instagram.com/dfaphl Information other than the photos/video and quotes collected from the interview will not be published on the abovementioned social media accounts of the DFA. Nevertheless, please take note that the photolvideo, and quote/s uploaded on the Department's Facebook, Twitter, and Instagram accounts can be seen throughout the world, not just in the Philippines. Conditions of use: ‘+ DFA OSCR will not use your photos/video and interview answers for any other purposes than those already mentioned. ‘+ Except for the name of the interviewee and his/her city or town of residence, DFA OSCR will not include other personal details of the interviewee (e.g., exact home and office address, contact numbers) in the social media posts for the campaian. '* Copyright of photos/video taken by the Philippine Embassy in New Zealand will remain with DFA OSCR. (Note: If the interviewee is below 18 years old, this form must be filled out by the interviewee's parent or legal guardian.) DO YOU GIVE US PERMISSION TO USE YOUR PHOTOSIVIDEO AND QUOTES FOR THE DFA’S SOCIAL MEDIA CAMPAIGN “THE GLOBAL FILIPINO"? YES No Name of interviewee (or parent/guardian of the interviewee): (if applicable) Name of parent/guardian of the interviewee: Signature: Dat (or of the interviewee’s parentiguardian)