Consent to Provide Personal Information

 

 

 

○ Name:

○ Birthday:

○ Cell Phone:

○ Address:

 

 

The person above agrees that Gyeongsangnam-do and ○○ City/County may collect   personal information for the following purposes in accordance with the provisions of Article 15, Clause 1 to 2 of the 「Personal Information Protection Act 」

 

 

➀ Recipient

Gyeongsangnam-do, ○○ City / County

② Purpose of Use

Operation of business for One Month Trip to Gyeongnam (○○ City County)

③ Information to be provided

Name, gender, birthday, address, contact information, account number

④ Period for Retention and Use of Personal Information

For 1 year from the date of filling in the consent form

⑤ Consent to unique identification and processing of sensitive information

□ Agree            □ Disagree

⑥ You have the right to refuse the consent to provide personal information, and there may be disadvantage (such as exclusion from being accepted) should you refuse to the consent.

 

 

                                          2025.   .   .

 

                                      Name:            (Sign or affix chop)

 

  To ○○ Mayor·County Governor

 

  【Instruction for how to enter personal information data if agreed】

① Enter the name of the person or organization, to whom the personal information is being provided.

② Enter the recipient’s purpose for use of the personal information.

③ Enter all the items of personal information to be provided.

④ Enter the recipient’s period for retention and use of the personal information.

⑤ Confirm the fact that you have the right to refuse the consent, and that you have been notified of the disadvantage following the refusal of the consent.