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    MandaVax Opt-Out

    Uploaded by

    Catherine Higino
    This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

    Copyright:

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

    MandaVax Opt-Out

    Uploaded by

    Catherine Higino
    209 views1 page
    This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

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    © © All Rights Reserved

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    This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

    Copyright:

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

    MandaVax Opt-Out

    Uploaded by

    Catherine Higino
    This document is an opt-out form for MandaVax, a vaccination registration program. It requests the person's name, address, and reason for opting out of MandaVax. By signing the form, the person acknowledges they are voluntarily opting out, which will delete their personal data from MandaVax's database as allowed by law. A privacy statement notes any personal data provided will only be used to process the opt-out request and ensure privacy and security of the data.

    Copyright:

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

    OPT-OUT FORM
    Name ______________________________________________ Household Code: ___________
    Address ____________________________________________ Date _____________________

    Reason for Opting-Out from MandaVax:

    I am fully aware of the importance of registration with the MandaVax prior to vaccination. I hereby
    express my decision to opt-out from the MandaVax which will result in the erasure or deletion of my
    unique QR Code and personal data in the database, subject to the limitation by law. My decision to opt-
    out is being made voluntarily without any force, coercion or intimidation.

    _____________________________
    (Signature over printed name)

    PRIVACY STATEMENT: Any or all personal data you provided will only be used to process any your request
    to opt-out from the MandaVax. This includes contacting you should there be need for clarifications or
    additional information. All collected data will be kept secure and confidential, unless otherwise authorized by
    law. They will be disposed of as soon as the purpose for their use has been achieved. Only aggregate or
    anonymized data shall be subject to further processing. We respect your rights under the Data Privacy Act.
    Should you wish to be clarified on how we are processing of your personal data, or have questions or
    clarifications relative to privacy and data protection, you may contact us at dpo@mandaluyong.gov.ph.

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