APPLICATION FORM

DISCLAIMER

In compliance with Republic Act No. 10173, otherwise known as the Data Privacy Act of 2012 (the “Data Privacy Act”), its implementing rules and regulations and relevant issuance of the National Privacy Commission of the Philippines, Netify Communications Corporation wishes to secure your consent for Netify to obtain, collect, store, retain, receive, transmit, derive or otherwise process or have access to your personal information (as defined under Data Privacy Act).

By signifying your consent to the Terms and Conditions of this agreement, you likewise giving your consent to the processing of your personal information for the purposes provided under this agreement.

I affirm and say, THAT:

1. The information given in this form is true, complete, and accurate. I am fully aware that I can be held criminally and administratively liable for any misdeclaration, or intentional omission made herein, pursuant to Republic Act No. 10173 or the “Data Privacy Act of 2012” and the applicable laws and regulations.

2. I authorize Netify to collect and to process the data indicated herein for the purpose of my Netify Service application. I understand that my personal information is protected by R.A 10173, Data Privacy Act of 2012 to provide truthful information. And that the disclosure and sharing shall only be upon my consent, or as required by law, with relevant private or public persons, offices, or entities.

Please read Privacy Policy.