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    Data Privacy Consent

    Uploaded by

    Nilda Buzeta Garcia
    The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Data Privacy Consent

    Uploaded by

    Nilda Buzeta Garcia
    363 views1 page
    The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

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    The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    363 views1 page

    Data Privacy Consent

    Uploaded by

    Nilda Buzeta Garcia
    The document is a data privacy consent form for an insurance policy. It allows the Philippine American Life and General Insurance Company to collect, store, use, and share the policyholder's personal information as needed to provide services, assess risk, prevent fraud, improve customer programs and marketing, and disclose information to affiliates and third parties. The consent is valid for 10 years after the policy termination or until a written revocation is submitted, whichever comes earlier. The policyholder acknowledges giving consent for their information and that of all relevant parties to the transaction to be used for proper administration of services.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    DATA PRIVACY CONSENT

    Policy Number/s: _______________________


    Name of Insured: _______________________ Name of Policy Owner: ______________________

    I allow The Philippine American Life and General Insurance Company (“Company”) to provide me certain
    services (“Services”) declared in the document or deed where this Consent form is attached.

    I acknowledge and agree to third party processors required by the Company in order to maintain quality, and
    deliver efficient and effective Services. I also acknowledge and agree to provide my personal identifiable and
    sensitive information to the Company for it to provide said Services.

    In line with these, I agree and authorize the Company to collect, record, organize, store, update, transfer, use
    for monitoring and/or audit purposes, and to process as necessary, any information pertaining to myself, this
    application or insurance policy issued pursuant to it or my existing insurance policies, if any, or any updates
    thereof under the following circumstances:

    1. To provide the Services I requested as stated in the document or deed where this Consent form is
    attached, for the purpose of the policy being issued and administered for benefits provided as stated in the
    policy;

    2. To acknowledge and agree that medical information will be uploaded to a Medical Information Database
    accessible to life insurance companies for the purpose of enhancing risk assessment and preventing fraud.
    Once uploaded, all life insurance companies will only have limited access to the said medical information in
    order to protect my right to privacy in accordance with law. A copy of Circular Letter No. 2016-54 may be
    accessed at the Insurance Commission’s website at www.insurance.gov.ph;

    3. To disclose my information to the Company’s affiliations (including but not limited to any of its
    subsidiaries/affiliates in the Asia Pacific Region), its Brokers, Agents, and their employees and staff and to
    accredited/affiliated third parties or independent/non-affiliated third parties, whether local or foreign. In this
    regard, the Company employs security systems designed to protect my information against unauthorized
    access;

    4. In order to improve the quality of service the Company provides, the Company may use such information
    in the design and communication of its customer programs, marketing campaigns and offers;

    5. To allow this Consent to remain valid from its execution and until 10 years after the termination of my
    policy, or at such time that I submit to the Company a written revocation/cancellation of such Consent,
    whichever is earlier; I agree that my information will be deleted/destroyed after this period.

    I hereby acknowledge and warrant that I have acquired the consent of all parties pertinent to this transaction to
    disclose their information for the proper administration and provision of services requested from this transaction.
    I hereby hold free and harmless and undertake to indemnify the Company for any complaint, suit, damages and
    the like which any party may file or claim against the Company in relation to this acknowledgement and warranty.

    _____________________________ ___________________________________
    Signature of Insured and Date Signature of Policy Owner and Date

    Note: The Company may not fully provide the services required unless consent to all conditions above have been
    granted.

    For further information on how we process and protect your data, please visit our website, www.philamlife.com

    QR-CGCO-DPC/REVISION 0/SEPTEMBER 2017 PHILAM CUSTOMER CONFIDENTIAL

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