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Data Registration Form

This document is a registration form for a Data Processing System and appointment of a Data Protection Officer (DPO) with the National Privacy Commission of the Philippines. It requests information such as the organization name, website, address, contact details for the head of the organization and DPO. The head of the organization and DPO must sign sworn statements that the information provided is true and complete. Once validated, the NPC will provide an access code via email and SMS to continue the online registration process.

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alyssanuqui
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620 views

Data Registration Form

This document is a registration form for a Data Processing System and appointment of a Data Protection Officer (DPO) with the National Privacy Commission of the Philippines. It requests information such as the organization name, website, address, contact details for the head of the organization and DPO. The head of the organization and DPO must sign sworn statements that the information provided is true and complete. Once validated, the NPC will provide an access code via email and SMS to continue the online registration process.

Uploaded by

alyssanuqui
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

National Privacy Commission


REGISTRATION OF DATA PROCESSING SYSTEM
DATA PROTECTION OFFICER – DPO

Note: The personal information submitted herein shall be used for the initial phase of the Data Processing System Online Registration and supporting documents should be
attached along with this form. Once this form has been validated by the NPC, you will be given an access code via email and SMS to continue with your registration with the online
system. You may find the list of supporting documents in our guidelines forwarded to you via email and posted in our website.
All the information submitted herein shall be used for the purpose stated above and other legitimate interest of NPC as mandated by law. Information that are matters of public
interest may be disclosed to the public. Rest assured that security controls are implemented to protect all the information in this document.

PERSONAL INFORMATION CONTROLLER / PERSONAL INFORMATION PROCESSOR


NAME OF ORGANIZATION

WEBSITE (URL) EMAIL ADDRESS

COMPANY ADDRESS CONTACT NO.

HEAD OF THE ORGANIZATION


LAST NAME EMAIL ADDRESS

FIRST NAME CONTACT NO.

MIDDLE INITIAL

OFFICIAL DESIGNATION

DATA PROTECTION OFFICER


LAST NAME EMAIL ADDRESS

FIRST NAME TEL. NO.

MIDDLE INITIAL MOBILE. NO.

OFFICIAL DESIGNATION DATE OF DESIGNATION AS DPO

SWORN STATEMENT

I declare under oath that this Registration Form is accomplished by Data Protection Officer, and is a true, correct and complete statement and pursuant to the
provision of the pertinent laws, rules and regulations of the Republic of the Philippines. I also authorize the National Privacy Commission to verify/validate the
contents stated herein.

_______________________________________ _______________________________________
Head of Agency Data Protection Officer
(Signature over Printed Name) (Signature over Printed Name)

SUBSCRIBE and SWORN to before me, this ___________________, who exhibited to me (his/her) Government Issued ID No. _________________________
issued at ________________________________ on _____________________________.

Notary Public
Doc. No. ;
Page No. ;
Book No. ;
Series of ;

*** TO BE FILLED UP BY NPC-COMPLIANCE AND MONITORING DIVISION ***


NPC ACCESS CODE APPROVED BY (SIGNATURE OVER PRINTED NAME)

DATE GIVEN (MM/DD/YYYY)

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