COMPLAINT FORM

The purpose of the Data Privacy Act of 2012 is to protect the privacy of individuals with respect to personal
information about themselves held by an organization and provide individuals with a right of access to that
information.

Instructions: Use this form to submit a privacy complaint. A privacy complaint can be submitted when you
believe that an organization mishandles personal information or not answered your request for access to
your personal information. When you complain to this Office of the DPO, you are asking us to review and
address the issues raised in your complaint. Digido will respond to this complaint in fifteen (15) days from
receipt. We will inform you immediately if Digido require more time to respond to your compliant.

The personal information provided on this form is protected under the provisions of RA 10173 and its IRR.

Are you making this complaint on your own behalf?

YES NO

Are you making this complaint on behalf of another individual?

YES (If Yes, attach authorization document) NO

This Form is to be sent by email to the Data Protection Officer of Digido at the following email address:
dpo@digido.ph

CONTACT INFORMATION

Name (Last, First): ______________________________________________________________

Telephone number: _____________________________________________________________
Email Address: _________________________________________________________________
Home Address: _________________________________________________________________
Business Name and Address: ______________________________________________________

Please submit a photocopy of your government issued IDs or passport to verify your identity.

Please indicate your preferred means of contact where our response will be sent by ticking the box below.

Home Address Business Address Email Address

Please state a description of your complaint, including as much detail as possible to help Digido investigate
and resolve the matter such as:
a. Nature of the data concerned, Name of Officer/Employee (and his/her unit or department) by
whom the personal data was collected;
b. Details of the complaint;
c. Time frame over which the suspected wrongdoing occurred
d. Attach documentary evidence in support of the complaint

DESCRIPTION OF COMPLAINT:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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In order to help us identify systems that may contain information about you, please check the boxes below
that describe your relationship with Digido:

□ Job applicant
□ Former employee or contractor
□ Employee of Digido
 □ Individual- Customer of Digido
□ Employee family member, dependent, beneficiary or emergency contact
□ Employee of Digido Client or business partner
□ Employee of an Digido supplier or vendor

Other – please describe:

_____________________________________________________________________________________
_______________________________________________________________________
______________________________________________________________________________

If your information may be under another name, please provide that name and reason for the change:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

The information collected in this form is intended to enable our Data Protection Officer to respond to your
Complaint. They will be archived after the Complaint has been treated for (5) five years and then deleted.
For any question related to this Complaint/Request Form, please send your request at the following email:

_____________________________________________________________________________________

I CERTIFY THAT THE INFORMATION GIVEN ON THIS FORM & THE DOCUMENTS ATTACHED HERETO, TO THE
BEST OF MY KNOWLEDGE, IS TRUE AND COMPLETE

First and Last Name (print)

Signature

Date