CONSENT FORM TO PROCESS PERSONAL INFORMATION
EMPLOYEE
1. I, the undersigned, Employee of ________ _________________, a company incorporated in
Malaysia and having its registered address at XXXXX Lumpur Sentral, 50470 Kuala Lumpur
(“the Company”) hereby grant my:
(i) consent for the Company to collect, use, process, record, hold, store, share and/or
disclose (“process”) any and all of my Personal Data (defined hereunder), which is in the
possession and/or control of the Company, for the performance of my employment
contract with the Company and for any other lawful purpose.
(ii) express consent for the Company to disclose or obtain my medical records, including
details of my medical claims, which are in the possession or control of the Company to,
or obtain such records from:
the appointed health care manager/provider appointed by the Company from time
to time to which disclosure is to be made;
the insurance company appointed by the Company from time to time to provide
health care insurance to which disclosure is to be made; and
panel clinics/hospitals appointed by the Company from time to time to which
disclosure is to be made,
The purpose or need for such disclosure is for the Company to provide me with
insurance and medical benefits under my employment contract with the Company.
(iii) consent for the Company to process my Personal Data and express consent for the
Company to process my Sensitive Personal Data (defined below) for the following
reasons:
to perform my contract with the Company including for the Company to submit my
Personal Data to the Company’s contractors, sub-contractors, employers, clients,
potential clients, partners, potential partners and professional advisors;
compliance with any contractual, legal and/or regulatory obligations to which the
Company is subject to under the law or under contract with any third parties, in
addition to any obligation imposed under my contract with the Company;
for strategic alliances, surveys, appreciations, loyalty and engagements programmes,
marketing and promotional purposes for all businesses and developments by the
Company; or
for the administration of justice or exercise of any functions conferred on any person
or party by or under any law.
The purpose or need for such disclosure is for the performance of my employment
contract with the Company.
2. I confirm that I have read and understood this statement regarding the processing of my
Personal Data and Sensitive Personal Data.
3. For the purpose of securing consent to process my children’s medical records, I undertake
to inform the Company upon any of them reaching the age of 18 and becoming entitled to
the insurance and medical benefits pursuant to Clause 2.9 of the Employee Handbook
(explained below under Definitions).
4. I may withdraw my consent provided herein at any time except to the extent that action has
been taken by the Company relying on my consent provided herein. Unless expressly
withdrawn earlier, this consent expires upon the expiry of my employment with the
Company.
……………………………………………….
Name :
Employee No. :
Date :
Definitions
"Personal Data" means any personal information you have provided to us or available to us due to your
contract with us, i.e. name, Identity Card /Passport No., address, email, telephone numbers, picture and
information about your transactions with the Company such as property purchasing, salary etc.
"Sensitive Personal Data" means any of your personal information related to your physical or mental
health or condition, your political opinions, your religious beliefs or other beliefs of a similar nature, the
commission or alleged commission by you of any offence or any other personal data as determined by
law.
"Company" includes its holding company, subsidiary and related corporations defined under the
Companies Act 1965.
“Child” defined under Clause 2.9 of the Employee Handbook means “Employees’ children, natural,
legally adopted or step children, who are dependants/unmarried and below the age of 18 or up to age
23 for children who are pursuing full tertiary education (up to first degree) and disabled children
(including mentally challenged children) who are not gainfully employed, irrespective of age.
Stepchildren are deemed as dependent if they are living under the guardianship of the employee.
Details of the dependent children must be notified to the Company.”
“Spouse” under Clause 2.10 of the Employee Handbook calrifies that “For a male employee who has
more than one (1) legal wife, only one (1) legal wife will be included.”
SPOUSE – In reference to Clause 2.10 of the Employee Handbook
I, the undersigned, spouse of the above Employee, hereby grant my express consent for the
Company to disclose or obtain my medical records, including details of my medical claims,
which are in the possession or control of the Company to, or obtain such records from:
the appointed health care manager/provider appointed by the Company from time to time,
to which disclosure is to be made;
the insurance company appointed by the Company from time to time to provide health care
insurance, to which disclosure is to be made; and
panel clinics/hospitals appointed by the Company from time to time, to which disclosure is
to be made.
The purpose or need for such disclosure is for the Company to provide me with insurance and
medical benefits under the Employee’s contract with the Company.
……………………………………………….
Name :
NRIC No. :
Date :
Employee Name :
Definitions
"Personal Data" means any personal information you have provided to us or available to us due to your
contract with us, i.e. name, Identity Card /Passport No., address, email, telephone numbers, picture and
information about your transactions with the Company such as property purchasing, salary etc.
"Sensitive Personal Data" means any of your personal information related to your physical or mental
health or condition, your political opinions, your religious beliefs or other beliefs of a similar nature, the
commission or alleged commission by you of any offence or any other personal data as determined by
law.
"Company" includes its holding company, subsidiary and related corporations defined under the
Companies Act 1965.
“Spouse” under Clause 2.10 of the Employee Handbook clarifies that “For a male employee who has
more than one (1) legal wife, only one (1) legal wife will be included.”
CHILD - In reference to Clause 2.9 of the Employee Handbook
I, the undersigned, child of the above Employee, have reached 18 years old as at the date of
this Consent Form, hereby grant my express consent for the Company to disclose or obtain my
medical records, including details of my medical claims, which are in the possession or control
of the Company to, or obtain such records from:
the appointed health care manager/provider appointed by the Company from time to time,
to which disclosure is to be made;
the insurance company appointed by the Company from time to time, to provide health
care insurance to which disclosure is to be made; and
panel clinics/hospitals appointed by the Company from time to time to which disclosure is
to be made.
The purpose or need for such disclosure is for the Company to provide me with insurance and
medical benefits under the Employee’s contract with the Company.
……………………………………………….
Name :
NRIC No. :
Date :
Employee Name :
Definitions
"Personal Data" means any personal information you have provided to us or available to us due to your
contract with us, i.e. name, Identity Card /Passport No., address, email, telephone numbers, picture and
information about your transactions with the Company such as property purchasing, salary etc.
"Sensitive Personal Data" means any of your personal information related to your physical or mental
health or condition, your political opinions, your religious beliefs or other beliefs of a similar nature, the
commission or alleged commission by you of any offence or any other personal data as determined by
law.
"Company" includes its holding company, subsidiary and related corporations defined under the
Companies Act 1965.
“Child” defined under Clause 2.9 of the Employee Handbook means “Employees’ children, natural,
legally adopted or step children, who are dependants/unmarried and below the age of 18 or up to age
23 for children who are pursuing full tertiary education (up to first degree) and disabled children
(including mentally challenged children) who are not gainfully employed, irrespective of age.
Stepchildren are deemed as dependent if they are living under the guardianship of the employee.
Details of the dependent children must be notified to the Company.”
