Date

Katherine Anne V. Molina

Regional Vice President for Membership
NFJPIA-R4

Dear Mr./ Ms. Surname,

Greetings!
In compliance with the Republic Act 10173 or the Data Privacy Act of 2012, any information
from our local chapters are not sent to other entities such as suppliers, sponsors or partner
schools without our authorization.
The supplier for the membership cards is name of supplier.
The list of sponsor firms are the following:
 Ernst & Young | Sycip Gorres & Velayo, Co.
 KPMG | R.G Manabat & Co.
 Price Waterhouse Coopers | Isla Lipana & Co.
 Deloitte | Navarro Amper & Co.
 Reyes Tacandong & Co.
 Grant Thornton | Punongbayan & Araullo, Co.

The partner schools may depend on the event and is a local chapter duly recognized by
NFJPIA-R4
During our membership week, we informed our members regarding this. We made them sign as
an approval of their authorization. Thus, as a representative of our members, we authorize the
regional council to send their information, as well.
Attached herewith is the DATA PRIVACY CONSENT AGREEMENT and MEMBER CONSENT
that should be kept by the LC Membership Officer and should be submitted to the regional council
when needed.

Thank you.

Respectively yours,

SIGNATURE
LOCAL CHAPTER REPRESENTATIVE
Position, Local Chapter
 DATA PRIVACY CONSENT AGREEMENT

NFJPIA, NFJPIA-R4 and Sacred Heart College, Lucena recognize their responsibilities under
the Republic Act No. 10173 (Act), also known as the Data Privacy Act of 2012, with respect to the
data they collect, record, organize, update, use, consolidate or destruct from our members.

The personal data obtained from this Membership Form is entered and stored by the Regional
Vice President for Membership within secured drive and will only be accessed by the authorized
personnel of NFJPIA, NFJPIA-R4 and Sacred Heart College, Lucena.

NFJPIA, NFJPIA-R4 and Sacred Heart College, Lucena have instituted appropriate
organizational, technical and physical security measures to ensure the protection of the members’
personal data.

Furthermore, the information collected and stored from our members shall only be used for the
following purposes:
1. Processing and reporting of documents related to the membership, (e.g., Membership
Report).
2. Announcements / promotions of events, programs, and other activities organized by NFJPIA,
NFJPIA-R4 and Sacred Heart College, Lucena.
3. Activities pertaining to establishing relations with sponsors and alumni.

NFJPIA, NFJPIA-R4 and Sacred Heart College, Lucena shall not disclose the member’s
personal information without their consent and shall retain this information over a period of ten
years for the effective implementation and management of the organization.

MEMBER CONSENT

I have read the Data Privacy Statement of NFJPIA, NFJPIA-R4 and Sacred Heart College,
Lucena and express my consent for NFJPIA, NFJPIA-R4 and Sacred Heart College, Lucena to
collect, record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or
destruct my personal data as part of my information.

I hereby affirm my right to be informed, object to processing, access and rectify, suspend or
withdraw my personal data, and be indemnified in case of damages pursuant to the provisions of
the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding
Implementing Rules and Regulations.

_____________________________ _________________
Signature over printed name Date