DSC HSM2955 Guia De Instalacion página 6

4. Consent Form
CONSENT WITH PROVIDING PERSONAL DATA / SENSITIVE PERSONAL DATA Data Sub-
1
ject
First name: _____________________ Last name: ______________________________
Residing at: ___________________________________________________ I hereby grant an informed con-
sent to allow _______________________________ and its affiliates (hereinafter the "Company") to pro-
cess my personal data [ ]
consent with the data being transferred to third parties and abroad, if that is necessary for the Com-
pany to fulfill of the purpose of data collection as described below, in accordance with applicable
data privacy laws.
Personal Data collected: __________________________ (include specific data fields)
Sensitive Personal Data collected: __________________ (include specific data fields)
The data is collected for the purpose of ________________________________________________________
_____________________________________________________________________________________________
_______ (describe in reasonable detail)
I have been informed about my rights related to the processing of personal data and about other
conditions related to the processing of personal data and to the method of its processing and
accessing. I certify that all the personal data is accurate and true and provided voluntarily. I have
been informed about my right to access and check my personal data processed by the Company
upon request sent to ____________________________________________________. I am aware I can with-
draw this consent in writing at any time.
CONTENT AND PURPOSE OF THIS CONSENT EXPLAINED BY
Full name: _____________________________________________________________
Signature: ______________________________________________________________
Contact detail: __________________________________________________________
To learn more about the Data Controller's privacy practices visit/email:
Date: ________________________________
Data subject signature: ____________________________
1
Data Subject is the person to whom the personal data relates to.
2
Personal data is any information relating to an identified or identifiable individual, such as name, email or other addresses, phone
number, ID numbers, employment data (such as salary or evaluations), mother's maiden name, credit card number or credit inform-
ation etc.
3
Sensitive personal data is personal data consisting of information as to the racial or ethnic origin of the individual, their political
opinions, religious beliefs, physical or mental health or condition, sexual life etc.
2
/ sensitive personal data [ ]
3
for the purpose specified below. I also
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