Republic of the Philippines DOCUMENT CONTROL

BAGUIO WATER DISTRICT Document Name Data Consent

ISO 9001:2015 Certified Document No. DSC_2020-F1
DATA SUBJECT CONSENT FORM Effectivity Date: November 2020
Revision No. 00

Name of Data Subject:

(Last Name) (First Name) (Middle Initial)

Purpose (eg. employment application, attendance to training/seminar by personnel from other

agencies, etc.)

_________________________________________________________________________________

a. I consent to allow my personal data be collected/processed for the above specific and legitimate
purpose;
b. I understand that my personal information will be processed in a manner that ensures
appropriate privacy and security safeguards; and
c. I hereby affirm my right to be informed, object to processing, access and rectify, suspend and
withdraw my personal information and be indemnified in case of damages pursuant to the
provisions of Republic Act No. 10173 (Data Privacy Act of 2012) and its Implementing Rules and
Regulations.

Data Subject signature over printed name Date signed

No. 003 Utility Road, Brgy. Marcoville, 2600 Baguio City, Philippines
Tel/s (074) 442-6539; 442-4228; 442-4929; 442-6463; 442-4940; 442-4008
Telefax: (074) 444-7246; 444-7245; 442-3456; 442-4858; 444-5364
Email: baguiowaterdistrictgmo@gmail.com