Pamantasan ng Lungsod ng Maynila

(University of the City of Manila)

Intramuros, Manila

DATA PRIVACY CONSENT FORM

FOR THE SOCIAL AMELIORATION PROGRAM OF THE CITY OF MANILA

I hereby authorize the City Government of Manila and the Pamantasan ng Lungsod ng Maynila (PLM),
their agents, representatives and/or outsourced service providers, to –
[1] collect, process, update or disclose personal information about me, and to obtain information
about my personal and academic records, in accordance with the Data Privacy Act, its
Implementing Rules and Regulations (IRR), and other pertinent privacy laws, rules and
regulations, including those promulgated by the University, for the purpose of availing the
services of G-Xchange, Inc. for the monthly monetary allowance program of the City
Government of Manila under City Ordinance No. 8658; and
[2] to establish, confirm, review or update my record with G-Xchange, Inc. provided that the
same is for a legitimate purpose, and to use, submit, or issue the same to comply with
reporting obligations under applicable laws, rules and regulations.
I agree to hold the City Government of Manila and PLM and the persons or entities from whom they
may obtain, or with whom they may disclose or verify, my personal information free and harmless
from any liability arising from the use of any such information.
I confirm that I am aware that under the Data Privacy Act, I have (a) the right to withdraw the consent
hereby given or to object to the processing of my personal information provided there is no other
legal ground or overriding legitimate interest for the processing thereof; (b) the right to reasonable
access; (c) the right to rectification; and (d) the right to erasure or blocking of my personal information
subject, however to the conditions for the legitimate exercise of the said rights under the Data Privacy
Act and its IRR, and subject further to the right of PLM to disqualify me from availing of my benefits
under City Ordinance No. 8568, should I withdraw my consent or request the removal of my personal
information.
Printed Name of Student:

Signature of Student:
Date:

Conforme:

Printed Name of Parent/s or Guardian:

Signature of Parent/s or Guardian:

Date:
For complete reference on the Data Privacy Act,
you may access the National Privacy Commission Website
at https://www.privacy.gov.ph/data-privacy-act