Personal Data Collection & Use Consent

This consent form explains what personal data the Organization collects, why, how long it is kept, and your rights. Granular consent options below let you accept some uses while declining others.

Section 1 — Data Subject Information

Full name:

National ID / passport number (optional):

Email:

Phone:

Section 2 — Data Controller

Organization name:

Contact for data protection inquiries (email):

Section 3 — Purposes of Collection (granular consent)

Check each purpose you consent to. You may decline any purpose and still receive the core service.

Service delivery — process my data to provide the service I requested.

Account management — use my data to maintain my account, billing, and support history.

Marketing — send me promotional emails about products and offers.

Analytics — analyze aggregated usage to improve the service.

Third-party sharing — share my data with the partners listed below for the stated purposes.

List third parties and the purpose for sharing (if applicable):

Section 4 — Special Category Data

Some data (health, biometric, religious belief, sexual orientation, criminal record) requires explicit additional consent. List any special category data the Organization will process, and why:

I explicitly consent to the processing of the special category data described above.

Section 5 — Retention & Your Rights

Retention period (months from end of service):

You have the right to access, correct, or delete your data, to restrict or object to processing, to data portability, and to withdraw consent at any time without affecting the lawfulness of past processing. Contact the data protection contact above to exercise these rights.

I have been informed of my data subject rights.

Section 6 — Signature

I have read and understood this consent form.

I consent to electronic signatures having the same legal effect as handwritten signatures.

Data subject — printed name:

Date:

Optional — upload a copy of identification or supporting document:

This template is provided for reference only. Data protection law varies by jurisdiction (GDPR, PDPA, CCPA, etc.). Consult qualified counsel before relying on this document.