In accordance with RA 10173 or Data Privacy Act of 2012, I consent to the following terms and conditions on the collection, use, processing and disclosure of my personal data: I am aware that the office has collected and stored my personal data upon accomplishment of this form. These data include my full name, contact details like addresses, and landline/mobile numbers. I express my consent for the Tagum Cooperative to collect, store my personal information. I hereby affirm my right to be informed, object to processing, access, and rectify and to suspend or withdraw my personal data pursuant to the provisions of the RA 10173 and its implementing rules and regulations. By clicking the Next button below, I warrant that I have read, understood all of the above provisions, and agreed with its full implementation.

I declare that the information that I have provided above is to my best knowledge and is accurate. I understand that action may be taken against me for any willful and/or malicious reports made by me which I know to be false.