APPLICATION FROM A DATA SUBJECT GRANTING CONSENT FOR THE PROCESSING OF PERSONAL

INFORMATION FOR THE PURPOSE OF DIRECT MARKETING IN TERMS OFSECTION 69(2) OF THE
PROTECTION OF PERSONAL INFORMATION ACT (POPIA) NO.4 OF 2013

[Regulation 6]

PART A:

TO :__________________________________________________________________________________________

EMAIL: _______________________________________________________________________________________

FROM:

1) CCMA National Office Deputy Information Officer (DIO) for queries related to information housed at the National Office
Annah Mokgadinyane
Executive: Governance and Strategy
Commission For Conciliation Mediation and Arbitration
011 377 6650
mediarelations@ccma.org.za or communications@ccma.org.za

2) CCMA National Office Deputy Information Officer (DIO) for queries related to information hiused across the CCMA’s Provincial
Offices
Marius Kotze
NCS: Dispute Resolution
Commission For Conciliation Mediation and Arbitration
011 377 6650
info@ccma.org.za or popia@ccma.org.za

PART B:

I, ____________________________________________________________________________________________
(full names of data subject) hereby give my consent to receive direct marketing of the below listed products/services to be
marketed by means of electronic communication:

- CCMA Quarterly Newsletter

- CCMA Reports (Annual report/ Annual Performance Plans)
- Invitations
- Surveys
- Media Alerts
- Notices
- Training & Outreach interventions

SPECIFY METHOD OF PREFERRED COMMUNICATION:

E – mail Mobile Application; CCMAConnect CCMA Website

Disclaimer: In compliance with the Protection of Personal Information Act (POPIA), please note that the CCMA treats personal information disseminated through the completion of this
form as private and confidential. The CCMA will not disclose your personal information to any external organisations or parties without your express authorization, unless authorised to
do so by law. Therefore, by completing this form you are granting the CCMA the authorization to use your information for its organisational data management processes.
 For any direct queries related to POPIA, please email the CCMA’s designated POPIA email address on popia@ccma.org.za

OTHER METHODS – SPECIFY:______________________________________________________________________

Signed at .......................................... this ...................... day of ...........................20………...

………………………………
Signature of data subject

Disclaimer: In compliance with the Protection of Personal Information Act (POPIA), please note that the CCMA treats personal information disseminated through the completion of this
form as private and confidential. The CCMA will not disclose your personal information to any external organisations or parties without your express authorization, unless authorised to
do so by law. Therefore, by completing this form you are granting the CCMA the authorization to use your information for its organisational data management processes.