11th Floor, Double Dragon Plaza Tower 2, EDSA Extension cor.

Macapagal Boulevard, Pasay City

T: (02) 8291-1232/ E: hr@igcph.com

Authorization for Disclosure of Personal Information to a Third Party

I, ______________________________________, ____________ national, of legal age, authorize

Asian Technology Services, Inc. to disclose my personal information to:

Name of Company: ___________________________

For the purpose of: ___________________________

Effective on: ___________________________

I authorize Asian Technology Services, Inc. to disclose the following information:

Date Hired

Designation

Monthly Compensation

Date of Birth

Mobile Number ____________________________

Email Address ____________________________

Home Address ____________________________

Others ____________________________

I am freely giving an informed consent of my personal information to the transmittal of said personal
data to a third party for the purpose mentioned above. I absolutely release Asian Technology Services,
Inc. for any liabilities related to providing the said information.

IN WITNESS WHEREOF, I have hereunto set my hand on this ___ day of ________, ______ at
__________________________.

___________________________
Signature over Printed Name

(for HR use only)

Name of Caller: _________________________

Date of Call: _________________________

__________________________
Signature over Printed Name