UNIVERSITY OF THE EAST

Philippines

CONSENT FORM FOR ACADEMIC / RECORD VERIFICATION

I, , am fully aware that

University of the East (UE) or its designated representative is duty bound and
obligated under the Data Privacy Act of 2012 to protect all my personal and
sensitive information that it collects, processes, and retains upon my enrolment and
during my stay in the University. I also understand that my personal information
cannot be disclosed without my consent.

In this regard, I am giving my consent / permission in favor of

(Third party verifier)

who is responsible in checking with UE, the veracity and authenticity of the
academic records which I submitted in line with my application for possible
employment OR application for admission at:

(Name of Employer / Institution / School)

In addition, I authorize the University of the East, specifically the

Department of Registration and Records Management, to disclose academic
information concerning the above-request for record verification.

Signed and dated:

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Print name and sign above

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Date