DSWD-SB-GF-073 | REV 00 | 04 MAR 2022

DATA PRIVACY CONSENT

(FOR APPLICANT/ DESIGNATED REPRESENTATIVE OF DSWD - REGULATORY SERVICES)

In compliance with the Data Privacy Act (DPA) of 2012, and its Implementing Rules
and Regulations (IRR) effective since September 8, 2016, I allow the Department of
Social Welfare and Development (DSWD) to enter and store my personal data within
the Department’s authorized storage system and will only be accessed by the DSWD
authorized personnel. The DSWD has instituted appropriate organizational, technical
and physical security measures to ensure the protection of personal data.

Furthermore, the information collected and stored in the portal shall only be used for
the following purposes:

1. Processing and reporting of documents related to the conduct of regulatory

activities (i.e., registration. licensing, accreditation of SWDAs and/or service
providers), under certain conditions as required by law.
2. Announcements or promotions of programs, projects, and other activities
organized by the Department and its partners.
3. Activities pertaining to establishing relations with DSWD stakeholders.

I understand that I am given certain rights under the Data Privacy Act, including the
right to object to processing of my data, the right to access my data, the right to
correct any inaccurate data, and the right to erasure or blocking of data. For more
information on these rights, and for requests to review the Data, to withdraw consent
to the use of the Data for any of the purpose stated above, and/or to correct or
update the Data, I am to contact the Standards Bureau Data Privacy Compliance
Officer at sb@dswd.gov.ph.

Signed this _____ day of ____________ 20___ at _______________________.

Riza T. De Leon RSW

Signature over Printed Name

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DSWD Field Office XI, R. Magsaysay Avenue Cor. D. Suazo Street, Davao City, Philippines 8000
Website: http://www.dswd.gov.ph Tel Nos.: (082) 227 1964 / (082) 227 8746 / (082) 227 1435 Telefax: (082) 226 2857