In compliance with the Data Privacy Act of 2012 and its Implementing Rules and Regulations, I allow the University of the Philippines Mindanao to use all the information on this form for the purposes of processing this request and other relevant preparations related to the said request.

I also agree that the data collected hereof will be retained up to one (1) year from filing of request and will be destroyed/deleted after this period. Further, I acknowledge and warrant that I hold free and harmless and indemnify the University of the Philippines Mindanao and all its administrators and employees from any complaint, suit or damages which any party may file or claim in relation to my consent.

You can proceed to the next page by giving your consent to collect your personal information in the succeeding pages.