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Form A

1. I consent and authorize China Bridge (Malaysia) Sdn Bhd (Visa Centre) to collect,
use, transfer, disclose and/or retain my information (including but not limited to
personal data) in compliance with Personal Data Protection Act 2010 for the
purposes stated in the Privacy Notice issued by Visa Centre (a copy of
which is available at the premises of Visa Centre as well as its website at

2. I hereby declare that I have read,understood and agreed to be subjected to

Visa Centres Privacy Notice and I understand that the Privacy Notice may be
modified or updated by Visa Centre from time to time and is aware that I shall visit
Visa Centres website at for the updated version.

3. I consent for Visa Centre to disclose my personal data to any third parties,
including but not limited to the parties listed out in the Privacy Notice and/or any of
their respective agents and/or servants, whether located within or outside Malaysia
for the purposes stated in the Privacy Notice.

4. I expressly give consent to Visa Centre to process my sensitive personal data

including but not limited to my medical and/or criminal records.

5. I acknowledge that in the event of any potential, proposed or actual corporate

restructuring exercise (including without limitation any sale of business, disposal,
acquisition, merger or reorganisation involving Visa Centre or the assets of Visa
Centre to another party), my personal data may be required to be disclosed and/or
transferred to the other party as part of such corporate restructuring exercise.
I hereby acknowledge that such disclosure and/or transfer may occur and hereby
permit Visa Centre to release my personal data to the other party, its advisers and

6. In circumstances where I may have provided personal data relating to others (e.g
family, spouse, emergency contact persons, etc), I represent and warrant that I have
had their consent or are otherwise entitled to provide their information to Visa
Centre. I shall indemnify Visa Centre in the event Visa Centre suffers any loss or
damage as a result of my failure to comply with the same.

Visa Centre - PDPA - version180416 Page 1 of 1