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Data Privacy Consent

The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

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Nilda Buzeta Garcia
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605 views1 page

Data Privacy Consent

The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

Uploaded by

Nilda Buzeta Garcia
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

DATA PRIVACY CONSENT

Policy Number/s: _______________________


Name of Insured: _______________________ Name of Policy Owner: ______________________

I allow The Philippine American Life and General Insurance Company (“Company”) to provide me certain
services (“Services”) declared in the document or deed where this Consent form is attached.

I acknowledge and agree to third party processors required by the Company in order to maintain quality, and
deliver efficient and effective Services. I also acknowledge and agree to provide my personal identifiable and
sensitive information to the Company for it to provide said Services.

In line with these, I agree and authorize the Company to collect, record, organize, store, update, transfer, use
for monitoring and/or audit purposes, and to process as necessary, any information pertaining to myself, this
application or insurance policy issued pursuant to it or my existing insurance policies, if any, or any updates
thereof under the following circumstances:

1. To provide the Services I requested as stated in the document or deed where this Consent form is
attached, for the purpose of the policy being issued and administered for benefits provided as stated in the
policy;

2. To acknowledge and agree that medical information will be uploaded to a Medical Information Database
accessible to life insurance companies for the purpose of enhancing risk assessment and preventing fraud.
Once uploaded, all life insurance companies will only have limited access to the said medical information in
order to protect my right to privacy in accordance with law. A copy of Circular Letter No. 2016-54 may be
accessed at the Insurance Commission’s website at www.insurance.gov.ph;

3. To disclose my information to the Company’s affiliations (including but not limited to any of its
subsidiaries/affiliates in the Asia Pacific Region), its Brokers, Agents, and their employees and staff and to
accredited/affiliated third parties or independent/non-affiliated third parties, whether local or foreign. In this
regard, the Company employs security systems designed to protect my information against unauthorized
access;

4. In order to improve the quality of service the Company provides, the Company may use such information
in the design and communication of its customer programs, marketing campaigns and offers;

5. To allow this Consent to remain valid from its execution and until 10 years after the termination of my
policy, or at such time that I submit to the Company a written revocation/cancellation of such Consent,
whichever is earlier; I agree that my information will be deleted/destroyed after this period.

I hereby acknowledge and warrant that I have acquired the consent of all parties pertinent to this transaction to
disclose their information for the proper administration and provision of services requested from this transaction.
I hereby hold free and harmless and undertake to indemnify the Company for any complaint, suit, damages and
the like which any party may file or claim against the Company in relation to this acknowledgement and warranty.

_____________________________ ___________________________________
Signature of Insured and Date Signature of Policy Owner and Date

Note: The Company may not fully provide the services required unless consent to all conditions above have been
granted.

For further information on how we process and protect your data, please visit our website, www.philamlife.com

QR-CGCO-DPC/REVISION 0/SEPTEMBER 2017 PHILAM CUSTOMER CONFIDENTIAL

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