BSM Crew Service Centre Philippines, Inc.

Human Resource Department

DATA PRIVACY ACT - CONSENT FORM

1. In compliance with the Data Privacy Act of 2012 BSM Crew Service Centre Philippines Inc. (“BSM
CSC”) seeks your consent to collect your personal data i.e.:
a. Name
b. address
c. contact numbers
d. mailing and email addresses
e. other personal data like health and medical records from the company doctor or seafarer’s
doctor submitted to BSM CSC, passport, seaman’s book, etc.
2. Your personal data will be:
a. Used to maintain the HR Personal Information files.
b. Disclosed to BSM CSC’s principals and affiliated organisations where necessary (“Purposes”).
3. BSM Crew Service Centre Philippines Inc. will use your personal data to provide information for:
a. HMO
b. Insurance
c. PEME
d. Government Mandated Agencies (SSS/PagIbig/Philhealth/BIR/POEA/DOLE, ETC.)
e. Activities such as:
 Upcoming events
 Seminars/Trainings
 Workshops/Team buildings/Conferences
 And training programs organized and conducted by BSM Crew Service Centre Philippines
Inc. and its principals and affiliated organizations which may be relevant to you
(“Services”).
f. Flag state Authorities and embassies
4. Allowing BSM Crew Service Centre Philippines Inc. to access my personal information details in
the POEA e-Registration records.
5. BSM Crew Service Centre Philippines Inc. respects your privacy and assures that your personal
data will be kept securely in accordance with Data Privacy Act of 2012.
6. I hereby give my acknowledgement and consent to BSM Crew Service Centre Philippines Inc. to
use my personal data for the aforesaid Purposes, Required Information and Services. I further
agree to indemnify BSM Crew Service Centre Philippines Inc. against any financial penalties
imposed by the National Privacy Commission or any court of law in the Philippines as a direct or
indirect result of my failure to inform BSM Crew Service Centre Philippines Inc. of my prior or
subsequent registration with other organizations and manning agencies.
7. I agree that my consent will remain in place until my withdrawal by officially notifying BSM Crew
Service Centre Philippines Inc. in writing.

Name : _RODEL T. JULIAN__

Government Issued ID No. : _CRN-0111-4138296-1__
Contact No. : _09211745755_
Email : _rodeljulian_tasyo@yahoo.com_
Signature : ___________________________
Date : __march 23,2022__

DPA.REV 01.100518.agv