< Consent to Collection / Use of Personal Information>

Purpose of Collection / Use of Personal Information

Personal identification of an applicant, proceeding and managing the process of the 3rd
Youth Forum on SDG Implementation

Items of Personal Information subject to Collection

Personally Identifiable Information: Name, Date of Birth, Address, Occupation, Mobile
Phone Number, E-mail Address

Personal Information Retention / Use Period

Personal Information as above will be retained and used from the date of agreement on the
collection and use until 3 years after the 3rd Youth Forum on SDG Implementation.

I agree to the collection/use of my personal information related

to the domestic travel insurance application
□ I Agree □ I Disagree

I have answered the above questions sincerely and provided information regarding the
collection/use of personal information for insurance application and I consent to submit
the information to the organizers of the 3rd Youth forum on SDG Implementation.

Date: 2019/10/16 Name: Juraev Sardor

(Signature)