4/7/2021 On-Line Application for PLMAT of Pamantasan ng Lungsod ng Maynila

PLM Admission Form 1 (2020)

PLM Application Form

Pamantasan ng Lungsod ng Maynila

University of the City of Manila
Intramuros, Manila Paste 1.5 X
1.5 ID Picture
PLM Application Form Here

APPLICANT ID: 202125519

PERSONAL INFORMATION:
FULL NAME: Ma. Angela Gabriel Regala
First Name Middle Name Last Name Extension Name
ADDRESS: 1869 Sulu St. Sta. Cruz - Barangay 341 SANTA CRUZ , CITY OF MANILA
PROVINCE: NCR, CITY OF MANILA, FIRST DISTRICT (Not a Province)
REGION: NATIONAL CAPITAL REGION (NCR)
BIRTH DATE: Apr 06, 2002 BIRTH PLACE: GMA, Cavite GENDER: F
CONTACT NO: 09062676120 EMAIL-ADDRESS: gela.regala.143@gmail.com

FAMILY INFORMATION:
Particulars Father Mother
Full Name Ruben Nolasco Regala Felomina Marcelino Gabriel
Address None 1869 Sulu St. Sta. Cruz Manila
Contact No. 0 0
Occupation None (passed away) House Wife
Family Monthly Income: Less than PHP 10,481 Less than PHP 10,481

SCHOOL INFORMATION:
LRN : 136618070350
STRAND TVL
School Name Universidad de Manila
School Address NCR, CITY OF MANILA, FIRST DISTRICT (Not a Province)
School Email Address admin@udm.edu.ph
General Weighted Average (GWA) Grade 11: 89.00
Program Choice 1: Bachelor of Science in Architecture
Program Choice 2: Bachelor of Science in Information Technology
Program Choice 3: Bachelor of Secondary Education major in English

DATA PRIVACY CONSENT FORM

The Pamantasan ng Lungsod ng Maynila (PLM) and its duly authorized representatives are
duty-bound and obligated under Republic Act No. 10173 (Data Privacy Act of 2012) and its
Implementing Rules and Regulations (IRR), and other data privacy rules, to protect the personal
and sensitive personal information that PLM collects, possesses, and retains upon your
enrollment and during your stay in the University.

Personal and sensitive personal information includes any information about your identity,
academics, or any document containing your identity. This includes, but is not limited to, your
name, address, landline/mobile number, email address, names of your parents or guardians,
date of birth, academic information such as grades and attendance, and other information
necessary for basic administration and instruction. By consenting to this Data Privacy Consent
Form, you agree that:

https://web1.plm.edu.ph/crs/admission/print_app_form.php 1/
1. You authorize the University to collect, retain and process information relating to your PLMAT
application for purposes of admission to the University and for your subsequent enrollment
should you eventually qualify to be admitted in PLM. PLM shall also collect, retain and process
your personal and sensitive personal information to pursue its legitimate interests as an
educational and government institution.

2. You expressly authorize PLM to verify, validate and authenticate the information and
documents that you submitted with relevant government and non-government sources and third
parties, for purposes of your admission, enrollment, and other legitimate transactions in PLM.

3. You authorize PLM to share your personal and sensitive personal information with its affiliated
or partner organizations as part of its contractual obligations, or with government agencies such
as, but not exclusive to, the Commission on Higher Education (CHED), UniFAST, and the City
Government of Manila, pursuant to law or legal processes.

4. You understand that photocopies or electronic copies of the personal documents that you
submitted in relation to your application for admission will either be returned to you or properly
disposed of by PLM if you are not accepted for admission or should you decide not to pursue
your application. On the other hand, once accepted and upon enrollment, you will submit the
originals of the needed documents to the Office of the University Registrar.

5. If the University has determined that you qualify for the Social Amelioration Program (SAP) of
the City of Manila under City Ordinance No. 8568, you further authorize PLM and the City
Government of Manila, their agents, representatives and/or outsourced service providers, to:

a) collect, process, update or disclose personal information about you, and to obtain
information about your personal
and academic records, for the purpose of availing the services of the Land Bank of the
Philippines (LBP), or any
necessary third party, for the monthly monetary allowance program of the City Government
of Manila; and

b) establish, confirm, review or update your record with the said LBP or necessary third party,
provided that the same
is for a legitimate purpose, and to use, submit, or issue the same to comply with reporting
obligations under
applicable laws, rules and regulations.

For this purpose, you agree to hold the City Government of Manila and PLM and the
persons or entities from whom
they may obtain, or with whom they may disclose or verify your personal information, free
and harmless from any
liability arising from the use of any such information.

6. You confirm that you are aware that under the Data Privacy Act, you have (a) the right to
withdraw the consent hereby given or to object to the processing of your personal information
provided there is no other legal ground or overriding legitimate interest for the processing
thereof; (b) the right to reasonable access; (c) the right to rectification; and (d) the right to
erasure or blocking of your personal information; subject, however to the conditions for the
legitimate exercise of the said rights under the Data Privacy Act and its IRR, and subject further
to the right of PLM to disqualify you from admission or enrollment to PLM or from availing of any
transaction or benefit to which you may be entitled under the laws or other rules and
regulations, should you withdraw your consent or request the removal of your personal
information.

Signature Over Printed Name of

Applicant Date

Signature Over Printed Name of

Guardian Date