NPC Form 01-2019

Republic of the Philippines

NATIONAL PRIVACY COMMISSION
DATA PROTECTION OFFICER REGISTRATION

Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting
documents should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our
guidelines posted on our website.
All the information submitted herein shall be used for the purpose stated above and other legitimate interests of NPC as
mandated by law. Information that are matters of public interest may be disclosed to the public. Rest assured that security controls are
implemented to pr otect all the information in this document.

PERSONAL INFORMATION CONTROLLER / PERSONAL INFORMATION PROCESSOR

NAME OF THE ORGANIZATION

WEBSITE (URL) EMAIL ADDRESS

COMPANY ADDRESS CONTACT NO.

HEAD OF THE ORGANIZATION

LAST NAME EMAIL ADDRESS

FIRST NAME CONTACT NO.

MIDDLE INITIAL

OFFICIAL DESIGNATION

DATA PROTECTION OFFICER

LAST NAME EMAIL ADDRESS

FIRST NAME TEL NO.

MIDDLE INITIAL MOBILE NO.

OFFICIAL DESIGNATION DATE OF DESIGNATION AS DPO

SWORN STATEMENT

I declare under oath that this Registration Form is accomplished by Data Protection Officer, and is a true, correct and complete statement and pursuant to the
provision of the pertinent laws, rules and regulations of the Republic of the Philippines. I also authorize the National Privacy Commission to verify/validate the
contents stated herein.

_______________________________________ _______________________________________
Head of Agency Data Protection Officer
(Signature over Printed Name) (Signature over Printed Name)

SUBSCRIBE and SWORN to before me, this ___________________, who exhibited to me (his/her) Government Issued ID No. _________________________
issued at ________________________________ on _____________________________.

Notary Public

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NPC Form 01-2019

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Republic of the Philippines

NATIONAL PRIVACY COMMISSION
DATA PROTECTION OFFICER REGISTRATION
Note: The personal information submitted herein shall be used for your registration with the National Privacy Commission. Supporting documents
should be attached with this form, which shall be validated by the Commission. You may find the list of supporting documents in our guidelines
posted on our website.
All the information submitted herein shall be used for the purpose stated above and other legitimate interests of NPC as mandated by
law. Information that are matters of public interest may be disclosed to the public. Rest assured that security controls are implemented to protect all
the information in this document.

Please choose ALL SECTORS which your organization belongs to.

0 GOVERNMENT 0 INTERNATIONAL ORGANIZATIONS

D Executive Department D United Nations Agency
D Department □ Foreign Embassy in the Philippines
D Bureau D Others (please specify)
□ Agency
D Office □ BANKS
D Legislative Department D Universal Bank
D Judicial Department
D Supreme Court D Commercial Bank
D Court of Appeals □ Thrift Bank
D Rural Bank
D Regional Trial Court
D Cooperative Bank
□ MTC, MeTC, MTCC, MCTC D Others (please specify)
D Constitutional Office

0 LOCAL GOVERNMENT UNITS □ NON-BANKS

D Non-Bank with Quasi-Banking Function
D Provincial D Non-Stock Savings & Loans Association
D City/Municipality D Offshore Banking Unit in the Philippines
D Barangay D Representative Office in the Philippines
□ GOVERNMENT-OWNED AND CONTROLLED CORPORATIONS D Pawnshop
D Remittance Center
D Government Financial Institution D Commercial Loan Provider
D Trade, Area Development & Tourism D Credit Union
D Educational & Cultural D Social and Community Lending
□ Gaming D Leasing Company
D Energy and Materials D Currency Exchange
D Agricultural, Fisheries, & Food D Other Non-Bank Financial Institution
D Utilities & Communications D Others (please specify)
D Healthcare Services
D Others (please specify)

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