Get Aducated Student Computer Loan Program

in Partnership with ACER Academy

Data Privacy Notice

I hereby authorize ADAMSON UNIVERSITY to collect and process the data for the purpose of loan
documentation. I understand that my personal information is protected by RA 10173, Data Privacy Act of
2012 and its Implementing Rules and Regulation. I hereby declare that all information provided by me are
true and accurate.

ADAMSON UNIVERSITY shall retain the data collected for a period of one year or until loan has been
settled. All documents will be kept in a secured storage. After such time, ADAMSON UNIVERSITY shall
dispose the documents by shredding.

Name of Student: Student No.:

Course and Year Level: Student’s Contact No.:

Parent’s or Guardian’s Name: Parent’s or Guardian’s Contact No.:

Parent’s or Guardian’s Residential Address: Parent’s or Guardian’s Valid ID & No.

Vendor:

Unit to be purchased: Selling Price:

Amount of Loan:

________________________________________ _______________________________________

Name and Signature of Student Name and Signature of Parent/Guardian

NOTE: Please send application to pcloanprogram@adamson.edu.ph