VIE consent form

I (name)
Date of Birth

Day Month Year
Date
Of (address)
Part A: storing and processing data

I authorise Voices in Exile (ViE) to store and process my personal data in a confidential manner in any database or in electronic or paper files. 'Data' may include names, addresses, details of family members, income, immigration history, national insurance and/or any other information that the worker may feel appropriate and reasonable to collect in order to proceed with my case. ViE will process this data for the purpose of providing advice to me, contacting me to let me know about services or events that may be of interest to me/my family, and for abiding by its monitoring and analysis procedures (for example internal audits and audits by external regulatory bodies such as OISC and funders

I understand that it will be kept for a minimum of 7 years after my last contact with ViE and may

then be destroyed, unless I request my data to be destroyed before this time. I understand thatI

have the right to see the personal data ViE holds on me, but ViE will require notice to arrange this. I understand that I can withdraw this consent at any time.

I have been given a copy of ViE's Privacy Notice and I understand that ViE's Data Protection Policy is available on request.
Signed

Clear
Date

Day Month Year
Date
Enabling, advocating, accompanying & supporting those seeking asylum, refugees & those with no recourse to public funds Company Limited by Guarantee and Registered Charity Number 1130363 OISC reference number: N201800021
Part B: obtaining and disclosing data
I authorise any ViE worker to obtain and disclose relevant information on my behalf from the following organisations in order to progress my case. I understand that ViE will only obtain/disclose data in order to get the best possible outcomes for me and it may make it difficult (or impossible) for ViE workers to progress my case or support me to access services unless they can obtain/disclose data from the organisations listed below. I understand that the ViE worker will advise me further as to which organisations might be essential to progressing my case.

Home Office Government agencies (e.g. Department for Work and Pensions, Job Centre) HMRC Local authorities and social services Accommodation providers and housing trusts Voluntary sector organisations/charities/refuges Solicitors/immigration advisers/barristers School and education providers Police/ACRO criminal records office NHS trusts, doctors, health practitioners Local member of Parliament
I understand that ViE will only obtain and disclose my data if it is in my best interests and will keep

me informed of disclosures that are made on my behalf. I understand that I can withdraw this consent at any time by notifying ViE.
Signed

Clear
Date

Day Month Year
Date
NB: Adults cannot sign on behalf of another adult and children who are 13 years or over must sign their own form (unless there are issues of capacity It is not possible to consent by silence or acquiescence, so do not provide any advice to a person until they (or their parent if required) have signed this form.

Enabling, advocating, accompanying & supporting those seeking asylum, refugees & those with no recourse to public funds Company Limited by Guarantee and Registered Charity Number 1130363

OISC reference number: N201800021
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm