THE PROTECTION OF PERSONAL INFORMATION ACT 4 OF 2013 (POPIA)

With the signing of this form, I/We hereby grant my/our voluntary consent to the use, processing, collection and/or disclosure of my/our personal information in accordance with the Protection of Personal Information Act 4 of 2013.

I/We furthermore agree that my/our personal information may be used for lawful and reasonable purposes in as far as LIVING WITH CANCER (the responsible party) requires to use this information in the performance of its duties.

LIVING WITH CANCER is hereby granted my/our express consent to the utilisation of my/our personal information (inclusive of my/our pathology reports) to assist the South African National Cancer Registry (NCR) and other medical institutes / pharmaceutical companies for the purposes of better decision making as regards oncology medication and spend OR for any other relevant purposes LIVING WITH CANCER deems fit.

I/We fully understand that for the abovementioned reasons my/our personal information may at any time be disclosed to any third party for LIVING WITH CANCER to perform its duty.

I/We understand that, according to the aforementioned Act, there may be instances where my/our express consent is not required to process personal information, such as when the information is related to litigation or is publicly available.

Further details or queries on this document can be directed to: admin@livingwithcancersa.co.za