GENERAL CONSENT FORM

I, [ Name of data subject ], understand that, in coordination with the German Federal Foreign Office, the
International Organization for Migration (hereinafter, “IOM”) is processing hazard application for former employees
of German Organizations in Afghanistan. This involved the collection of personal information to be shared with
Section 510 of the German Federal Foreign Office and the German Organization in Afghanistan I claim to have been
employed by for the purposes of verifying my identity and employment history.

I understand that verification will occur by cross-checking with the German Organization in Afghanistan that I claim
to have worked for, using my name, last name, job ID, date of birth, place of employment, job title, and period of
employment.

I also hereby authorize the and any authorized person or entity acting on behalf of IOM to collect, use, disclose,
dispose of and otherwise process my personal data as follows (full name, job ID; date of birth / age; place of birth;
place of residence; place of employment; period of employment; employed as; breaks in period of employment;
contact information; father’s full name & age; mother’s full name & age; all requested information about reported
treat; all requested information about personal and family life; all requested information about parents’ and/or
siblings’ surroundings; all requested information related to the next steps of the procedure; and any additional
information volunteered) and, where applicable, the personal data of my dependents [Name of child/family
members] for the following purposes:

PURPOSES DESCRIPTION CONSENT

Specified and defined prior
to data collection
(a) Original specified purpose
To be filled in by data controllers/interviewers YES NO
For the purposes of verifying that I was employed by a German
organization in Afghanistan over the period claimed and, in the
position, stated in my application, as well as for the
Government of Germany or IOM to contact me about my Threat
Notification as required

I agree that my personal data may be disclosed to the following third parties for the above purpose(s):

NAME OF THIRD PARTY CONSENT

(e) Authorized IOM Staff
(f) Authorized third parties
To be filled in by data controllers/interviewers YES NO
IOM Afghanistan project staff assigned to the Threat
Notification project funded by the German Federal Foreign
Office (GFFO)
Section 510 of the German Federal Foreign Office (GFFO)
German Organization in Afghanistan that I claim to have worked
for

Data subject’s declaration of informed consent:

1. I have been informed about the specified purposes for which my personal data will be collected, used,
disclosed and otherwise processed as described above.
2. I understand that I may make requests concerning my personal data including access, modification and
deletion, by contacting IOM at iomkabulgeap@iom.int or iommazargeap@iom.int):
3. I understand that withdrawal of my consent may result in IOM being unable to provide me with a service
for my benefit.
4. I declare that the information I have provided is true and correct to the best of my knowledge.
5. I hereby release, discharge and agree to hold harmless IOM, its officers, employees and agents from any
liability or damage caused, directly or indirectly, to me, my family or relatives in connection with this
authorization by virtue of the use or disclosure of my personal data for the specified purpose(s) as described
above.
6. I understand the contents of this informed consent form after:
(a) Having read the above clauses: YES/NO
(b) The above clauses have been translated or read to me: YES/NO
7. I voluntarily make this declaration and freely consent to the collection and processing of my personal data
by IOM.

……………………………………… …………………………………………….
Signed at (place) on (date)

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Interpreter’s signature Data subject’s signature or mark
(or parent/guardian/proxy)

……………………………………….
IOM staff signature