Data privacy consent form

The Data Privacy Consent Form is used to obtain an individual's consent for the collection, use, and disclosure of their personal data.

Time to complete

2 minutes

Eligibility

Any individual who wants to avail the services of a company that collects, uses, or discloses personal data must fill out a data privacy consent form.

Not the Template you are looking for?
Request new template
Not the Template you are looking for?
Request new template

Questions for Data privacy consent form

1.

I consent to the collection of my personal data by the Data Controller for the purposes of:

The answer should be a multiple choice:
  1. Carrying out marketing and market research activities
  2. Communicating with me
  3. Providing me with information about products and services
  4. Carrying out customer satisfaction surveys
  5. Tailoring products and services to better meet my needs
  6. Managing my account with the Data Controller
  7. Processing transactions
  8. Complying with legal and regulatory requirements
2.

I understand that the organization will be collecting, using, and disclosing my personal data for the following purposes: a. To provide me with products and/or services that I have requested; b. For marketing and promotional purposes; c. For the purposes of conducting market research and/or customer satisfaction surveys; d. To contact me in relation to matters pertaining to the products and/or services that I have requested; and e. For any other purpose which I may have consented to.

The answer should be a single choice:
  1. Yes
  2. No
3.

I have read and understood the Data Controller’s Privacy Policy. I understand that I may withdraw my consent at any time by contacting the Data Controller.

The answer should be a single choice:
  1. Yes
  2. No
4.

Name

The answer should be a text input.
5.

Signature

The answer should be a signature.
6.

Date

The answer should be a date input.
7.

Address

The answer should be a text input.
8.

Email address

The answer should be an email input.
9.

I consent to the collection, use, and disclosure of my personal data by the organization.

The answer should be a single choice:
  1. Yes
  2. No

Similar Ideas

  • Privacy Policy Consent Form
  • Terms of Service Consent Form
  • Cookie Consent Form
  • Marketing Consent Form
  • Third-Party Consent Form

Here are some FAQs and additional information
on
Data privacy consent form

What is a data privacy consent form?

A data privacy consent form is a form that individuals must sign in order to consent to the collection, use, and disclosure of their personal data.

What information do I need to include in a data privacy consent form?

A data privacy consent form must include the specific purposes for which the data will be used, and the individual must sign the form in order to give consent.

Can I use a data privacy consent form for my website?

Yes, you can use a data privacy consent form for your website. However, you should make sure that the form is prominently displayed on your website so that individuals can easily find it and consent to the collection of their personal data.

Want to use this template?

Loved by people at home
and at work

“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Data privacy consent form

1000+ Templates, 50+ Integrations

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE