Professional Documents
Culture Documents
PSA Death Certificate
PSA Death Certificate
Middle Name
PRIVACY NOTICE
Sex Date of Death 1. I declare that I am the document owner/duly-authorized representative of the document
☐ Male owner whose Information appears in this application form. I further declare that I am fully
aware that the above data shall be used for application of copy issuance/authentication/
☐ Female Month Day Year
certification of civil registry document.
Place of Death _________________________________________________
City/Municipality and Province (Country if died abroad) 2. I give my consent to the processing of the above information subject to the exemptions
Last Name
provided by the Data Privacy Act and other applicable laws and regulations.
Father’s
Name
3. I trust that the above information shall remain confidential and shall only be retained for as
First Name (include JR., SR., II, III, IV, etc., if applicable) long as necessary for the fulfillment of the declared, specified, and legitimate purpose, or
when the processing is relevant to such purpose, strictly in accordance with PSA’s records
Middle Name retention policy.
4. I further affirm that all the statements/information that appear in this application form are
Mother’s Last Name (before marriage) true, correct, and complete to the best of my knowledge and belief.
Maiden
Name
First Name Conforme: