NPC Form 01-2019

Republic of the Philippines

NATIONAL PRIVACY COMMISSION
DATA PROTECTION OFFICER REGISTRATION
Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting
documents should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our
guidelines posted on our website.
All the information submitted herein shall be used for the purpose stated above and other legitimate interests of NPC as
mandated by law. Information that are matters of public interest may be disclosed to the public. Rest assured that security controls are
implemented to pr otect all the information in this document.

PERSONAL INFORMATION CONTROLLER / PERSONAL INFORMATION PROCESSOR

NAME OF THE ORGANIZATION

WEBSITE (URL) EMAIL ADDRESS

COMPANY ADDRESS CONTACT NO.

HEAD OF THE ORGANIZATION

LAST NAME EMAIL ADDRESS

FIRST NAME CONTACT NO.

MIDDLE INITIAL

OFFICIAL DESIGNATION

DATA PROTECTION OFFICER

LAST NAME EMAIL ADDRESS

FIRST NAME TEL NO.

MIDDLE INITIAL MOBILE NO.

OFFICIAL DESIGNATION DATE OF DESIGNATION AS DPO

SWORN STATEMENT

I declare under oath that this Registration Form is accomplished by Data Protection Officer, and is a true, correct and complete statement and pursuant to the
provision of the pertinent laws, rules and regulations of the Republic of the Philippines. I also authorize the National Privacy Commission to verify/validate the
contents stated herein.

_______________________________________ _______________________________________
Head of Agency Data Protection Officer
(Signature over Printed Name) (Signature over Printed Name)

SUBSCRIBE and SWORN to before me, this ___________________, who exhibited to me (his/her) Government Issued ID No. _________________________
issued at ________________________________ on _____________________________.

Notary Public

Doc. No. ;
Page No. ;
Book No. ;
Series of ;

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 NPC Form 01-2019

Republic of the Philippines

NATIONAL PRIVACY COMMISSION
DATA PROTECTION OFFICER REGISTRATION
Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting
documents should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our
guidelines posted on our website.
All the information submitted herein shall be used for the purpose stated above and other legitimate interests of NPC as
mandated by law. Information that are matters of public interest may be disclosed to the public. Rest assured that security controls are
implemented to pr otect all the information in this document.

Please choose ALL SECTORS which your organization belongs to.

GOVERNMENT INTERNATIONAL ORGANIZATIONS

Executive Department United Nations Agency
Department Foreign Embassy in the Philippines
Bureau Others (please specify)
Agency
Office BANKS
Legislative Department
Universal Bank
Judicial Department
Commercial Bank
Supreme Court
Thrift Bank
Court of Appeals
Rural Bank
Regional Trial Court
Cooperative Bank
MTC, MeTC, MTCC, MCTC
Others (please specify)
Constitutional Office

NON-BANKS
LOCAL GOVERNMENT UNITS
Non-Bank with Quasi-Banking Function
Provincial
Non-Stock Savings & Loans Association
City/Municipality
Offshore Banking Unit in the Philippines
Barangay
Representative Office in the Philippines
Pawnshop
GOVERNMENT-OWNED AND CONTROLLED CORPORATIONS Remittance Center
Government Financial Institution Commercial Loan Provider
Trade, Area Development & Tourism Credit Union
Educational & Cultural Social and Community Lending
Gaming Leasing Company
Energy and Materials Currency Exchange
Agricultural, Fisheries, & Food Other Non-Bank Financial Institution
Utilities & Communications Others (please specify)
Healthcare Services
Others (please specify)

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 NPC Form 01-2019

INSURANCE AND PRE-NEED PROVIDERS EDUCATION

Life Insurance State University and College (SUC)
Non-Life Insurance Private University, College and/or Other Institution of Higher
Professional Reinsurer Learning
Insurance Broker Private Secondary Educational Institution
Reinsurance Broker Public Secondary Educational Institution
Mutual Benefit Association Private Elementary Educational Institution
Accredited Actuary Public Elementary Educational Institution
Services Insurance Company Private Primary Educational Institution
Pre-Need & Servicing Company Public Primary Educational Institution
Other Schools and Training Institution
Others (please specify)
Others (please specify)

HEALTH MAINTENANCE ORGANIZATION

TELECOMMUNICATIONS
Telecommunications Network
HEALTH FACILITIES Internet Service Provider
Hospital Media Service Provider
Birthing Home Cable TV Operator
Infirmary Others (please specify)
Social Hygiene Clinic
Rural Health Unit BUSINESS PROCESS OUTSOURCING
Drug Abuse Treatment & Rehabilitation Center
Knowledge Process Outsourcing and Back Office
Barangay Health Station
Animation
Diagnostic or Therapeutic Facility
Call Center
Specialized Out Patient Facility
Software Development
Ambulatory Surgical Clinic (ASC)
Game Development
Custodial Care Facility (e.g., Nursing Home)
Engineering Design
Others (please specify)
Medical Transcription
Others (please specify)
PHARMACEUTICAL
Mainline/Brand Developer RETAIL/DIRECT MARKETING
Research & Development
Direct Marketing
Generic
Retail
Others (please specify)
Telemarketing
Supermarket
MEDIA AND SOCIAL MEDIA Convenience Store
Television Network Non-Shop Retail (E-Commerce)
Radio Broadcasting Station General Merchandise
Publishing House Warehouse Store
Social Networking Site Service-Related Establishment (e.g., salon)
Mobile Application Rental Place (e.g., sing-along spot)
Others (please specify) Other Establishments Enganged in Retail/Direct Marketing
Others (please specify)

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 NPC Form 01-2019

MANUFACTURING/PRODUCTION TOURISM
Hotels and Accomodations
Casino Hotel
UTILITIES Resort & Spa Resort Hotel
Electric Power Company Bed & Breakfast Homestay
Water and Wastewater Services Company Budget Hotel
Oil & Gas Company Luxury Hotel
Steam and Airconditioning Supply Dorm Hotel
Integrated Service Provider (e.g., maintenance, repair, operations) Pension House
Others (please specify) Food and Beverage (e.g., restaurant, cafe, fastfood center)
Travel Agency, Tour Operator and other Tourist Guide Services
MANPOWER AGENCIES Adventure and Recreation (e.g., camping)
Attraction (e.g., historical site, cultural center)
Landbased
Events & Conference (e.g., Film/Music Festival Promoter,
Seabased/Maritime Manning Cultural Events Promoter)
Others (please specify)
Others (please specify)

TRANSPORTATION, STORAGE AND LOGISTICS OTHERS (PLEASE SPECIFY)

Public Utility Vehicles Operator (e.g., bus, jeepney, taxi)
Ride-Hailing Operator (e.g., Grab, Angkas)
Cargo Trucking
Service Vehicle Operator (e.g., rent-a-car, tourist vehicle, limousines)
Storage
Others (please specify)

REAL ESTATE
Agricultural
Commercial (e.g., office, shopping center)
Residential (e.g., condominium, townhouse)
Industrial (e.g., manufacturing building, warehouse)
Cemetery and Columbarium Devt., Selling, Renting, Leasing and
Operating
Construction Industry
Others (please specify)

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