EUROPEAN COMMISSION

JOINT RESEARCH CENTRE

Directorate A - Science Policy Coordination

Communication

Authorisation to use personal data on the JRC website

I hereby authorise the JRC to collect, process and publish my personal data, as specified below, on
any restricted or public web pages maintained by the JRC. This includes storing my personal data in
a file system or database for this purpose.

My personal data will be available on JRC web pages for a maximum duration of 4 years starting
from filling the present form or until I notify in writing my wish to change or withdraw it. The maximum
duration can be extended by having me sign an updated form.

The purpose is to provide contact details in relation with a specific activity or event or to
communicate on my achievements or contributions to JRC activities.
I am aware that my authorised personal data can be consulted by anyone having access to the JRC
websites using the Internet or any other dedicated network.
As this processing collects and further processes personal data, Regulation (EC) 45/2001 of the
European Parliament and of the Council of 18 December 2000 on the protection of individuals with
regard to the processing of personal data by the Community institutions and bodies and on the free
movement of such data is applicable.
This processing of personnel data is under the responsibility of the Head of Unit JRC.A.6
Communication acting as Controller. My authorised personal data are processed according to Art.5d
of the Regulation (EC) 45/2001 (the data subject has unambiguously given his or her consent).
The related Privacy statement is available on the website of the Data Protection Officer of the
European Commission: http://ec.europa.eu/dataprotectionofficer/ (see Register, notification DPO-
712).

Declaration

□ I give my unambiguous consent to the use of my personal data on JRC

websites, as specified hereafter (delete if not appropriate): First name - Last
name – Title – Function – work Email address – work mail address – work
phone number – work fax number – Personal or group picture – personal bio
and CV – Photo of me - Signature
□ I do not give my consent to the use of my personal data on JRC websites

□ I withdraw my consent to the use of my personal data on JRC websites

Name / Surname

Personal Number (if applicable)

Date

Signature

Commission européenne, B-1049 Bruxelles / Europese Commissie, B-1049 Brussel - Belgium. Telephone: (32-2) 297 21 27