Pamantasan ng Lungsod ng Maynila

(University of the City of Manila)

Intramuros, Manila

DATA PRIVACY CONSENT FORM

TERMS OF AGREEMENT FOR APPLICANTS FOR ADMISSION

I, __________________________________ , am fully aware that Pamantasan ng Lungsod ng Maynila (PLM) or any of its
duly authorized representative, is duty bound and obligated under Republic Act 10173 (Data Privacy Act of 2012) and its
Implementing Rules and Regulations, and other data privacy rules, to protect all my personal and sensitive personal
information that it collects, processes, and retains upon my enrolment and during my stay in the University.

Personal or sensitive personal information includes any information about my identity, academics, or any document
containing my identity. This includes, but is not limited to, my name, address, landline/mobile numbers, email address,
names of my parents or guardians, date of birth, academic information such as grades and attendance, and other
information necessary for basic administration and instruction.

I understand that by applying for admission in PLM, I authorize the University to collect and process information relating
to my application and to be used by PLM to pursue its legitimate interests as an educational institution. I am also fully
aware that PLM may share such information to its affiliated or partner organizations as part of its contractual obligations,
or with government agencies pursuant to law or legal processes.
I also understand that the photocopies of my personal documents that I will submit in relation to my admission application
will be properly disposed by the University if I am not accepted or if I decide not to pursue my application. On the other
hand, once accepted and upon enrollment, I will submit the original copy of the needed personal documents at the Office
of the University Registrar (OUR).

Printed Name of Student-Applicant: _______________________________________

Signature of Student-Applicant: ___________________________________________
Date: _________________________

Conforme:
Printed Name of Parent/s or Guardian: _____________________________________
Signature of Parent/s or Guardian: ________________________________________
Date: _________________________

Note:

Kindly submit this Data Privacy Consent Form together with the accomplished Application Form and other requirements to the
Admissions Office.

For complete reference on the Data Privacy Act, you may access the National Privacy Commission Website at
https://www.privacy.gov.ph/data-privacy-act