DR. FILEMON C.

AGUILAR MEMORIAL COLLEGE OF LAS PIÑAS

Golden Gate Subdivision, Talon III, Las Piñas City * Tel. No. 403-1985

DATA PRIVACY CONSENT FORM

The undersigned, enrollee of the DR. FILEMON C. AGUILAR MEMORIAL
COLLEGE OF LAS PIÑAS - MAIN CAMPUS, has given permission to the Office of
the College Registrar staff, in charge of the college admission/enrollment in the
collection; lawful use, and disclosure of my personal information which may include my
student number, name, contact information, course, birth date, civil status, and academic
performance (e.g. number of units enrolled, subject/s with grade/s obtained) and other
details. I further confirm that the OCR and other appropriate offices in the College are
authorized to provide the above information to legitimate officers/institutions requesting
specific information in relation to my enrollment within the specified academic period.
This consent enables the OCR to comply with R.A. 10173, otherwise known as the Data
Privacy Act of 2012. I certify that the information given is true and correct. I consent to
the processing of my personal and sensitive personal information contained in this form
and in documents submitted for my free college application for the purpose of enabling
the DFCAMCLP Main Campus including all the offices and relevant constituent of the
College to verify my identity, prevent fraud, process my application, determine whether I
am qualified to avail of free college admission or other similar financial or other
assistance. I further expressly agree that the College Registrar and administrators from
other offices may directly obtain all my relevant student records whether in electronic or
paper based format in order to verify the information contained in my application for the
purpose of determining my eligibility for the free college admission or other financial
assistance with the assurance that the College will require such parties to observe strict
compliance with the Philippine Data Privacy Act and other related laws and issuances
when they process my personal and sensitive personal information. I understand that the
DFCAMCLP - Main Campus are authorized to process my personal and sensitive
personal information without need of my consent pursuant to the relevant portions of
Sections 4, 12and 13 of the Philippine Data Privacy Act.

_______________________________
Jennifer Sabio Rubica ________________________
August 25, 2021
Signature over Printed Name Date

/annabel2021