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Consent to the Processing of Personal Data

Interactive form

    I, the undersigned, am aware and consent to the fact that Poradna pro integraci, z.ú. (Counselling Centre for Integration), based at Opletalova 921/6, 110 00 Praha 1 - Nové Město, ID No.: 673 62 621, registered in the Register of Institutions lodged with the Municipal Court in Prague, Section U, File No. 139 (“PPI”), processes my personal data within the scope specified in this form, as well as other personal data that I provide to PPI, in order to enable it to provide quality services, to protect my important interests and also to enable PPI to comply with its obligations under the law and protect its legitimate interests and also protect an important public interest constituting the provision of integration services.

    I grant this consent for the duration for which PPI provides me with social services or services under the project, and subsequently for a period of 10 years after the provision of such services ceases. I may revoke my consent to the processing of personal data free of charge at any time by writing to PPI. I am aware that revoking my consent could restrict or prevent PPI from providing me with social services or services under the project.

    In the event of any change to my personal data provided to PPI, I undertake to inform PPI of such changes without undue delay to ensure that the personal data processed by PPI is up to date and accurate.

    I declare that I have been duly informed of my right to access, correct or delete my personal data, or to restrict the processing of my personal data, my right to file an objection against the processing of my personal data, as well as my right to the portability of my personal data, and that I may exercise these rights with PPI as the processor of my personal data. I have also been informed of my right to file a complaint with the Office for Personal Data Protection. I have read the additional information about how such rights may be exercised, as well as other details relating to the processing of my personal data by PPI, in the Information about Clients’ Rights in Connection with the Processing of personal data, available at the PPI website.

    Surname

    First and Second name

    Gender

    Date of birth

    A person under 15 years of age

    If you are under 15, fill the contact details of the legal representative

    Identification card number

    Sample documents in PDF

    specimen

    Current address in the Czech Republic

    Residence status

    Nationality

    Telephone

    Contact phone number to Czech Republic

    Email address

    I consent to receiving information about PPI activities sent to the above email address.

    Additional information about the client

    e.g. family members

    Copy of ID

    scan or take photos of you ID

    I declare that I have been informed of:

    • the basic information about the social service or service under the project that will be provided to me, and

    • the other rules of cooperation – the option and method used to file a complaint concerning the quality of the social service or the manner in which it is provided, the procedure and reasons for terminating the provision of the service and the procedure to follow in urgent or emergency situations.

    I also declare that I have been informed that the above information and rules are available in writing in an accessible place at the PPI premises. These rules are available in Czech, Russian, Vietnamese and English.

    I declare that all the above information has been provided to me in a language that I understand, and that I have understood it.

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