NATIONAL

TEACHERS COLLEGE


DATA PRIVACY CONSENT FORM

Republic Act No. 10173 or the Data Privacy Act of 2012 (DPA) “to protect the
fundamental human right to privacy of communication while ensuring free flow of
information to promote innovation and growth [and] the [State’s] inherent obligation to
ensure that personal information in information and communications systems in
government and in the private sector are secured and protected”.

I, ___________________________________________, understand that I am being

asked to participate in a survey/questionnaire activity that part of research study entitled,
CASH TO CASHLESS: THE PROS AND CONS OF ADOPTING CASHLESS
TRANSPORTATION TO THE COMMUTERS IN MANILA CITY. It is my understanding
that this survey/questionnaire has been designed to gather data and information that
could help on the said study.

I understand that my participation in this survey/questionnaire is completely voluntary and

that I am free to decline to participate.

I also understand that any information I provide will be treated with the utmost
confidentiality and will be used strictly for academic purposes and obligated under
Republic Act No. 10173 or the Data Privacy Act of 2012 (DPA).

I hereby consent to the processing of the personal data that I have provided and declare
my agreement with the data protection regulations in the data privacy statement above.

_____________________________
(Respondent’s Name and Signature)