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Republic of the Philippines NPC Form 01 -2019 NATIONAL PRIVACY COMMISSION DATA PROTECTION OFFICER REGISTRATION

Republic of the Philippines

NPC Form 01-2019

NATIONAL PRIVACY COMMISSION DATA PROTECTION OFFICER REGISTRATION

Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting documents should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our guidelines posted on our website.

All the information submitted herein shall be used for the purpose stated above and other legitimate interests 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 THE 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

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 (Signature over Printed Name)

Data Protection Officer (Signature over Printed Name)

SUBSCRIBE and SWORN to before me, this issued at

on

Doc. No.

;

Page No.

;

Book No.

;

Series of

;

, who exhibited to me (his/her) Government Issued ID

Notary Public

NPC Form 01 - 2019 Republic of the Philippines NATIONAL PRIVACY COMMISSION DATA PROTECTION OFFICER

NPC Form 01-2019

Republic of the Philippines

NATIONAL PRIVACY COMMISSION DATA PROTECTION OFFICER REGISTRATION

Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting documents should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our guidelines posted on our website.

All the information submitted herein shall be used for the purpose stated above and other legitimate interests 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.

Please choose ALL SECTORS which your organization belongs to.

 

GOVERNMENT

   

INTERNATIONAL ORGANIZATIONS

 
                   
 

Executive Department

   

United Nations Agency

   
   

Department

   

Foreign Embassy in the Philippines

 
   

Bureau

   

Others (please specify)

 
   

Agency

           
   

Office

   

BANKS

   
 

Legislative Department

           
 

Judicial Department

   

Universal Bank

   
   

Supreme Court

   

Commercial Bank

   
   

Court of Appeals

Regional Trial Court

   

Thrift Bank

   
       

Rural Bank

   
   

MTC, MeTC, MTCC, MCTC

 

Cooperative Bank

Others (please specify)

 
 

Constitutional Office

           
           

NON-BANKS

   
 

LOCAL GOVERNMENT UNITS

         
           

Non-Bank with Quasi-Banking Function

 
 

Provincial

   

Non-Stock Savings & Loans Association

 
             
 

City/Municipality

   

Offshore Banking Unit in the Philippines

 
 

Barangay

   

Representative Office in the Philippines

 
           

Pawnshop

   
 

GOVERNMENT-OWNED AND CONTROLLED CORPORATIONS

 

Remittance Center

Commercial Loan Provider

   
               
 

Government Financial Institution

     
 

Trade, Area Development & Tourism

 

Credit Union

   
 

Educational & Cultural

   

Social and Community Lending

 
 

Gaming

   

Leasing Company

   
 

Energy and Materials

   

Currency Exchange

   
 

Agricultural, Fisheries, & Food

 

Other Non-Bank Financial Institution

 
 

Utilities & Communications

   

Others (please specify)

 
 

Healthcare Services

           
 

Others (please specify)

         

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NPC Form 01-2019

INSURANCE AND PRE-NEED PROVIDERS

 

EDUCATION

 
             

Life Insurance

   

State University and College (SUC)

Non-Life Insurance

   

Private University, College and/or Other Institution of Higher

Professional Reinsurer

     

Learning

Insurance Broker

   

Private Secondary Educational Institution

Reinsurance Broker

   

Public Secondary Educational Institution

Mutual Benefit Association

   

Private Elementary Educational Institution

Accredited Actuary

   

Public Elementary Educational Institution

Services Insurance Company

 

Private Primary Educational Institution

Pre-Need & Servicing Company

 

Public Primary Educational Institution

Others (please specify)

 

Other Schools and Training Institution

   

Others (please specify)

HEALTH MAINTENANCE ORGANIZATION

       
       

TELECOMMUNICATIONS

             
       

Telecommunications Network

HEALTH FACILITIES

   

Internet Service Provider

 

Hospital

   

Media Service Provider

 

Birthing Home

   

Cable TV Operator

 

Infirmary

   

Others (please specify)

Social Hygiene Clinic

         

Rural Health Unit

   

BUSINESS PROCESS OUTSOURCING

Drug Abuse Treatment & Rehabilitation Center

     

Barangay Health Station

   

Knowledge Process Outsourcing and Back Office

Diagnostic or Therapeutic Facility

 

Animation

Call Center

 

Specialized Out Patient Facility

Ambulatory Surgical Clinic (ASC)

Custodial Care Facility (e.g., Nursing Home)

 

Software Development

Game Development

 

Others (please specify)

 

Engineering Design

 
   

Medical Transcription

       

Others (please specify)

PHARMACEUTICAL

       
             

Mainline/Brand Developer

   

RETAIL/DIRECT MARKETING

Research & Development

   

Direct Marketing

Retail

 

Generic

Others (please specify)

   
   

Telemarketing

 
       

Supermarket

 

MEDIA AND SOCIAL MEDIA

     
     

Convenience Store

Non-Shop Retail (E-Commerce)

Television Network

   

Radio Broadcasting Station

   

General Merchandise

 

Publishing House

   

Warehouse Store

 

Social Networking Site

   

Service-Related Establishment (e.g., salon)

Mobile Application

   

Rental Place (e.g., sing-along spot)

Others (please specify)

 

Other Establishments Enganged in Retail/Direct Marketing

     

Others (please specify)

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NPC Form 01-2019

               

MANUFACTURING/PRODUCTION

 

TOURISM

   
               
       

Hotels and Accomodations

 
     

Casino Hotel

 

UTILITIES

     

Resort & Spa Resort Hotel

         

Electric Power Company

     

Bed & Breakfast Homestay

Water and Wastewater Services Company

   

Budget Hotel

 

Oil & Gas Company

     

Luxury Hotel

 

Steam and Airconditioning Supply

   

Dorm Hotel

 

Integrated Service Provider (e.g., maintenance, repair, operations)

   

Pension House

 

Others (please specify)

 

Food and Beverage (e.g., restaurant, cafe, fastfood center)

       

Travel Agency, Tour Operator and other Tourist Guide Services

MANPOWER AGENCIES

   

Adventure and Recreation (e.g., camping)

     

Attraction (e.g., historical site, cultural center)

Landbased

           

Seabased/Maritime Manning

   

Events & Conference (e.g., Film/Music Festival Promoter, Cultural Events Promoter)

Others (please specify)

 

Others (please specify)

TRANSPORTATION, STORAGE AND LOGISTICS

 

OTHERS (PLEASE SPECIFY)

Public Utility Vehicles Operator (e.g., bus, jeepney, taxi)

         

Ride-Hailing Operator (e.g., Grab, Angkas)

Cargo Trucking

 

Service Vehicle Operator (e.g., rent-a-car, tourist vehicle, limousines)

Storage

 

Others (please specify)

     

REAL ESTATE

 
   

Agricultural

Commercial (e.g., office, shopping center)

Residential (e.g., condominium, townhouse)

Industrial (e.g., manufacturing building, warehouse)

Cemetery and Columbarium Devt., Selling, Renting, Leasing and

 

Operating

Construction Industry

 

Others (please specify)

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