Data Privacy Statement and Informed Consent
By signing this consent form, I grant my free, voluntary, and unconditional consent to the collection and processing of all personal data (as identified in this form) to the members of the UP Diliman Research Ethics Board, by whatever means in accordance with
Republic Act (R.A.) 10173, otherwise known as the "Data Privacy Act of 2012" of the Republic of the Philippines, including its Implementing Rules and Regulations (IRR) as well as all other guidelines and issuances by the National Privacy Commission (NPC).
I understand that my “Personal Data” means any information, whether recorded in a material form or not, (a) from which the identity of an individual is apparent or can be reasonably and directly ascertained by the entity holding the information, or when put together with other information would directly and certainly identify an individual, (b) about an individual’s race, ethnic origin, marital status, age, color, gender, health, education and religious and/or political affiliations, and (c) issued by government agencies peculiar to an individual which includes, but not limited to, social security numbers and licenses.
Personal Data that will be collected in this Google Form are:
- Title (i.e. Mr., Ms., Dr., Atty., Engr., etc.)
- Full name
- Email Address
- Age Range
- Affiliation
- Category (i.e. faculty, REPS, admin staff, student)
- Position/Designation
- Affiliation
For this particular Google Form, I understand that the UPD REB will collect, process, and will keep my Personal Data in strict confidence, and that the collection and processing of all Personal Data may be used solely for UPD REB-related functions such as but not limited to:
- Conduct thorough reviews of research proposals involving the collection, processing, or storage of personal data to ensure compliance with ethical standards and regulations
- Develop and update policies and guidelines related to the ethical conduct of research involving personal data
- Monitor ongoing research or UPD REB related-activities to ensure compliance with approved protocols and ethical standards
- Provide training and educational programs to faculty, REPS, admin staff, and students on research ethics and the responsible conduct of research
- Foster dialogue and collaboration with the UP Diliman community and key stakeholders to promote ethical research practices and protect participant's rights
At the same time, I agree that the Personal Data shall be retained by UPD Research Ethics Board for as long as necessary for the fulfillment of any of the aforementioned Purposes, and shall continue to be retained until the end of my employment in UP Diliman notwithstanding the termination of any of the above Purposes.
I hereby acknowledge that I have been provided with the written notification below on my rights as a Data Subject in accordance with the Data Privacy Act of 2012, to with:
i. to be informed whether Personal Data is being or has been processed.
ii. to require UPD Research Ethics Board to correct any Personal Data relating to the Data Subject which is inaccurate;
iii. to object to the processing of the Personal Data in case of changes or amendments to the Personal Data supplied or declared to the Data Subject;
iv. to access the Personal Data;
v. to suspend, withdraw or order the blocking, removal or destruction of the Data Subject's Personal Data from UPD Research Ethics Board's information database system.
I acknowledge, further, that if I was to exercise any of the Rights enumerated above, UPD Research Ethics Board reserves its right to re-evaluate and/or terminate its Business with me as well as any of the Purposes for which the Personal Data has been collected and processed. If in any case I decide to submit a written cancellation of being a Data Subject, the UPD Research Ethics Board will immediately delete my Personal Data from their database. The improper use of the information in this form (online, offline, or printed) will be subjected to appropriate actions under the Data Privacy Act of 2012.
I have read and understood the above and hereby consent to, agree on, accept and acknowledge these terms of consent for myself by signing below.
