Application for Access, Correction, or Consent Withdrawal of Personal Data

Note:

  1. Under the Personal Data Protection Act 2012 (PDPA) as amended up to 1 February 2021, we provide for individual’s autonomy and rights, in accordance thereto, we provide this form for all personal data requests 
  2. Please check the applicable box/es and strike of that which is not applicable
  3. Company means I-Cube Consortium Pte Ltd 
  4. By requesting for your personal data, you are deemed to have provided your consent to contact you for verification of your identity
  5. Company may treat any data or information provided by you in accordance with PDPA
  6. Requests for access or correction may be fulfilled within 30 days from date of receipt of application, subject to the requirements and exemptions of PDPA.
  7. You will be required to verify your identity or proper authentication / authorization for provision of requested data.
  8. Should Company reject an access request, Company should continue to preserve the requested personal data for a reasonable period (minimally 30 days) after rejecting the request.
  9. In the event you submits an application to the PDPC to review company’s rejection of the access request, Company will continue to preserve the requested personal data until PDPC’s review is concluded and any right of the individual to apply for reconsideration and appeal is exhausted.
  10. You may raise objections if dissatisfied with the refusal to correct your personal data. Where no correction is made, company will annotate the correction that was requested but not made in history/activity log/ticket counter.

 

I. APPLICATION FOR 

o ACCESS TO PERSONAL DATA

Information requested for

Type (name, gender, IC, passport, address, telephone number, email id, account number, etc.)

 

Format (text, video, etc.)

 

Date range and time (from – to)

 

o CORRECTION OF PERSONAL DATA

Change of 

Before

After

Type (name, gender, IC, passport, address, telephone number, email id, account number, etc.) – past and present

 

 

Proof of Change (you may attach the same to this form)

 

 

o WITHDRAWAL OF CONSENT

Indicate where your consent was provided to us (you may choose more than one):

Job application

 

Employment / Secondment / Internship

 

Website enquiry

 

Business relationship

 

Others (please specify)

 

COLLECTION OF DATA

For the purposes of fulfilling your request, please indicate where your personal data was collected by us (you may choose more than one):

  1. Visit to office premises

 

  1. Job application

 

  1. Employment / Secondment / Internship

 

  1. Website enquiry

 

  1. Business relationship

 

  1. Others (please specify)

 

Data Provided to:

  1. Person in Charge

 

  1. Department

 

  1. Reference number (if any)

 

II. APPLICANT PARTICULARS

Name

 

Contact phone number

 

Email id

 

Identification number (last 3 numbers and the following letter of the English Alphabet)

 

III. REPRESENTATIVE PARTICULARS (if applicable)

Name

 

Contact phone number

 

Email id

 

Identification number (last 3 numbers and the following letter of the English Alphabet)

 

Letter of authorization with appropriate authentication to the satisfaction of the Company (required)

 

Please complete the form and submit it to:

If in person or by post, to:

 

Data Protection Officer

Company: SOLVECUBE PTE LTD (aka) ICUBE CONSORTIUM PTE LTD 

Address: 30 Cecil Street, #19-08, Prudential Tower, Singapore 049712

If by email, to:

 

dpo@solvecube.com

Please note that these details in Section II will be deleted from our system and records as soon as your request is fulfilled, and there are no limitations or reasons under PDPA for us to retain the same. Information required to recorded and maintained by us under Access & Correction Obligation will be retained.

I confirm that I am the applicant named in this form in relation to my own personal data. I confirm that the information provided herein is true and accurate. I understand that the information that I have provided will be used to confirm my identity and help fulfil my request/s. I further accept that this information may be used for statistical and monitoring purposes.

 

By submitting this form, I confirm that the information stated above is true, complete and accurate to the best of my knowledge and belief.

 

Signature:                              Date: __/__/____ (dd/mm/yyyy)

 

For Official Use:

Fees to be charged for Access requests (mode of payment):

 

Authorised by

 

Signature:                              Date: __/__/____ (dd/mm/yyyy)

 

Acknowledged and accepted by:

 

 

Signature:                              Date: __/__/____ (dd/mm/yyyy)

[Applicant / Authorised Representative]

Reason for Rejection, if any: