Fill online: Employee consent for specific processing, with withdrawal

Try the first few blanks free and watch the document fill in on the right. Pay, and the whole document opens here to finish and download in Word and PDF.

0 of 116 blanks filled

Leave a blank empty and it stays highlighted in your document, to fill by hand. Your answers are saved in this browser only.

Try the first 5 blanks free. After payment the whole document opens here: every blank, and clean Word and PDF downloads.

Your details

Name of the Company

Fills 2 places in the document.

Version number of the consent form

Name of the employee (1)

Employee code (1)

Designation and department of the employee

Version number of the privacy notice

Date the privacy notice was received

English / Hindi / Other language

Link or HR portal path for withdrawal of consent

Name or designation of the grievance officer

E-mail address of the grievance officer

Name of the background verification agency

I authorise / I do not authorise

Designation for which the criminal record check is required

Reason the role needs a criminal record check, e.g. custody of cash or client funds, access to children, privileged systems access

Designation of the persons who see the result

One

I consent / I do not consent

Designation for which the credit check is required

Reason the role needs a credit check, e.g. authority to sign cheques or approve payments

Fingerprint / face

Locations of the biometric attendance devices

The device only / the Company's attendance server / the provider's server

Areas to which biometric access applies

Alternative attendance method, e.g. access card and PIN

Name of the insurance broker

Name of the group insurer

Name of the TPA

Name of the clinic or wellness provider

Designation authorised to approve a content review

Name of the IT acceptable use policy

Name of the mobile device management software

Alternative to a personal device, e.g. a Company device or webmail access only

Name of the field force application

Alternative method of recording visits, e.g. a visit report signed by the client

Name of the productivity analytics tool

Does / does not

Telephone lines or systems on which calls are recorded

The Company's website, social media pages, brochures, recruitment advertisements, client proposals and press releases

Fifteen

Twelve

Language in which the form was explained

Name of the employee (2)

Date of the consent

Name and designation of the HR officer

Date the consent was received

Employee code (2)

Withdrawn / Not withdrawn (1)

Withdrawn / Not withdrawn (2)

Withdrawn / Not withdrawn (3)

Withdrawn / Not withdrawn (4)

Withdrawn / Not withdrawn (5)

Withdrawn / Not withdrawn (6)

Withdrawn / Not withdrawn (7)

Withdrawn / Not withdrawn (8)

Withdrawn / Not withdrawn (9)

Withdrawn / Not withdrawn (10)

Withdrawn / Not withdrawn (11)

Withdrawn / Not withdrawn (12)

Reason, if the employee wishes to give one

Date of the withdrawal

Withdrawal received and acknowledged to the: Done on

Withdrawal received and acknowledged to the: By

Processing stopped in Company systems: Done on

Processing stopped in Company systems: By

Data Processors instructed to stop and to: Done on

Data Processors instructed to stop and to: By

Data erased, or retained only where a law: Done on

Data erased, or retained only where a law: By

Alternative arrangement put in place, where: Done on

Alternative arrangement put in place, where: By

Written confirmation sent to the employee: Done on

Written confirmation sent to the employee: By

Seven

Employee code, row 1

Section, row 1

Given / Refused (1)

Date, row 1

Version of the notice, row 1

Withdrawn on, row 1

Action completed on, row 1

Processors informed on, row 1

Employee code, row 2

Section, row 2

Given / Refused (2)

Date, row 2

Version of the notice, row 2

Withdrawn on, row 2

Action completed on, row 2

Processors informed on, row 2

Employee code, row 3

Section, row 3

Given / Refused (3)

Date, row 3

Version of the notice, row 3

Withdrawn on, row 3

Action completed on, row 3

Processors informed on, row 3

Employee code, row 4

Section, row 4

Given / Refused (4)

Date, row 4

Version of the notice, row 4

Withdrawn on, row 4

Action completed on, row 4

Processors informed on, row 4

Employee code, row 5

Section, row 5

Given / Refused (5)

Date, row 5

Version of the notice, row 5

Withdrawn on, row 5

Action completed on, row 5

Processors informed on, row 5

When to ask for consent. Processing for the purposes of employment, including safeguarding the employer from loss or liability and providing a benefit the employee asks for, is a legitimate use under s.7(i) and needs no consent; do not ask for consent to processing the Company will carry on regardless, because a consent that cannot be refused is not free and its withdrawal would leave the Company with nothing to rely on. This form takes consent only for processing that goes beyond that, or where the person who holds the record (a university, a previous employer) needs the employee's authority to release it. Each consent is separate and optional, with nothing pre-selected (s.6(1): free, specific, informed, unconditional and unambiguous, by a clear affirmative action). Give the employee the privacy notice first, and offer this form in English or a language of the Eighth Schedule (s.6(3)). Until the SPDI Rules 2011 cease to apply, they require consent in writing before collecting biometric, health and financial data (rule 5(1)), which Sections 2 and 3 below provide for biometric and health data, and the acknowledgement to the privacy notice provides for bank details. Keep the signed form, with the version of the notice given, as the record of consent: the burden of proving consent is on the Company (s.6(10), from 13.05.2027).

[Name of the Company] · Employee consent form · Version [Version number of the consent form]

CONSENT FOR SPECIFIC PROCESSING OF PERSONAL DATA

Part A. Particulars

Particulars	Entry
Name	[Name of the employee]
Employee code or application reference	[Employee code]
Designation and department	[Designation and department of the employee]
Privacy notice received	Version [Version number of the privacy notice], on [Date the privacy notice was received]
Language of this form	[English / Hindi / Other language]

The rest of this format (49 more paragraphs and tables) opens here after payment, to fill in the same way.

₹199 + GST, for the finished document, Word and PDF

The short sample is the opening of the document with your details, marked SAMPLE.

A drafted format for your use. It is not legal advice; for a complex matter, consult a professional. About this format