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Philippine Statistics Authority

The document is a consent form from the Philippine Statistics Authority for participation in the 2020 Census of Population and Housing via an online survey method. It states that by checking the box and signing, participants consent to having their information collected, processed, used and stored by PSA for legitimate statistical purposes according to relevant laws. It also notes that PSA cannot use the information as legal evidence and provides contact information for questions.

Uploaded by

Hedjarah M. Hadji Ameen
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© © All Rights Reserved
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88 views2 pages

Philippine Statistics Authority

The document is a consent form from the Philippine Statistics Authority for participation in the 2020 Census of Population and Housing via an online survey method. It states that by checking the box and signing, participants consent to having their information collected, processed, used and stored by PSA for legitimate statistical purposes according to relevant laws. It also notes that PSA cannot use the information as legal evidence and provides contact information for questions.

Uploaded by

Hedjarah M. Hadji Ameen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines Annex 1 – Consent Form

Philippine Statistics Authority

Accomplishment of the
2020 Census of Population and Housing (CPH) Questionnaire via
Computer-Assisted Web-based Interviewing (CAWI) Technique

CONSENT FORM

TERMS AND AGREEMENT


 You give consent to the Philippine Statistics Authority (PSA) to collect, process, use and
store all information provided for any legitimate purposes pursuant to Republic Act No.
10625 (Philippine Statistical Act of 2013), and Republic Act No. 10173 (Data Privacy Act of
2012) and other statutory acts that may apply;

 You agree that PSA cannot utilize any information as evidence in any legal proceeding;

Kindly put a check mark ( ) below and affix your signature if you agree to all above-stated terms and
agreements;

I agree to all above-stated terms and agreements.

I do not agree to all above-stated terms and agreements.

Attested by:

_________________ _________________
Signature Date

_________________ _________________
Surname, First Name Agency

Please return the accomplished form by email [email protected]/ or


[email protected]. For inquiries, our staff, Melanie S. Mohammad, CPH focal person can
be reached at 0975-928030-73 or 552-32-06.
Republic of the Philippines Annex 2 – Personnel Information for CAWI
Philippine Statistics Authority

Accomplishment of the
2020 Census of Population and Housing (CPH) Questionnaire via
Computer-Assisted Web-based Interviewing (CAWI) Technique

PERSONNEL INFORMATION FOR CAWI

Last Name:
First Name:
Middle Name:
Position/ Official Designation:
Name of Agency:
PSA Board or
Name of Inter-agency
Committee on Statistics
(e.g. Inter-Agency Committee on
Population and Housing Statistics)
Residential Address:

Permanent Address:

Telephone Number/s:
Mobile Number/s:
Email Address/es:

Attested by:

__________________
Surname, First Name
(Signature over printed name)

__________________
Date

Please return the accomplished form by email [email protected]/ or


[email protected]. For inquiries, our staff, Melanie S. Mohammad, CPH focal person can
be reached at 0975-928030-73 or 552-32-06.

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