Legal Personal Data Form

LEGAL PERSONAL DATA FORM

This Legal Personal Data Form (the "Form") is made effective as of Effective Date: by and between Data Subject: residing at (the "Data Subject") and Requesting Party: with primary address (the "Requesting Party").

RECITALS

WHEREAS, the Data Subject possesses certain personal data and related information that may be necessary for the Requesting Party to perform business, legal or administrative functions; and

WHEREAS, the Requesting Party has requested access to specified categories of the Data Subject's personal data for the limited purposes described in this Form and agrees to process such data in accordance with the terms set forth herein; and

WHEREAS, the Data Subject is willing to provide the requested personal data subject to the representations, assurances and restrictions contained in this Form.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, the following terms shall have the meanings set forth below: "Personal Data" means any information relating to an identified or identifiable natural person provided by the Data Subject under this Form; "Processing" means any operation performed upon Personal Data including collection, recording, organization, storage, alteration, retrieval, disclosure or erasure; "Purpose" means the specific, limited reasons for which the Requesting Party is authorized to Process Personal Data as set forth in Section 3.

2. PERSONAL DATA TO BE PROVIDED

The Data Subject hereby discloses and the Requesting Party may collect the following categories of Personal Data. The Data Subject must indicate which categories are being provided by selecting the applicable boxes and, where requested, supplying additional detail.

3. PURPOSE AND SCOPE OF PROCESSING

The Requesting Party is authorized to Process the Personal Data solely for the following Purpose(s). Processing beyond the scope specified below is prohibited without prior written consent from the Data Subject.

4. REPRESENTATIONS, WARRANTIES AND CONSENT

The Data Subject represents and warrants that the Personal Data supplied is accurate to the best of the Data Subject's knowledge and that the Data Subject has the authority to provide the Personal Data for the Purpose set forth herein. The Data Subject expressly consents to the collection, use and disclosure of the Personal Data as described in this Form.

5. DATA SECURITY AND CONFIDENTIALITY

The Requesting Party agrees to implement and maintain appropriate technical, administrative and organizational measures to protect Personal Data against unauthorized or unlawful Processing and against accidental loss, destruction or damage. The Requesting Party shall limit access to Personal Data to those employees, agents or contractors who have a legitimate need to know and who are bound by confidentiality obligations at least as protective as those set forth in this Form.

In the event of a confirmed data breach affecting the Personal Data, the Requesting Party shall notify the Data Subject without undue delay and shall provide reasonable cooperation and remediation measures required to mitigate harm.

6. RETENTION, DELETION AND RETURN

Personal Data shall be retained only for the period necessary to fulfil the Purpose or as required by applicable law. Upon expiration of the retention period, completion of the Purpose, or earlier lawful request by the Data Subject, the Requesting Party shall securely delete or return the Personal Data to the Data Subject, and shall certify such deletion or return upon request.

7. NOTICES

All notices, requests, consents and other communications required or permitted under this Form shall be in writing and sent to the addresses provided below. A notice is effective upon receipt.

8. LIABILITY; REMEDIES

Each party acknowledges that monetary damages may be an inadequate remedy for a breach of the confidentiality or data security obligations in this Form and that equitable relief may be appropriate in addition to any other remedies available at law or in equity. The Requesting Party shall be liable for direct damages caused by its negligent or willful breach of this Form; liability for indirect, special, incidental or consequential damages is disclaimed to the extent permitted by law.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the state or jurisdiction specified by the Requesting Party at the time of execution below. This Form constitutes the entire agreement between the parties with respect to the collection, use and disclosure of the Personal Data and supersedes all prior agreements and communications, whether oral or written, on such subject. If any provision of this Form is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

10. AMENDMENT; WAIVER; COUNTERPARTS

No amendment to this Form shall be effective unless made in writing and signed by both parties. Failure or delay by either party to exercise any right shall not constitute a waiver. This Form may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

11. CERTIFICATION

By signing below, the Data Subject certifies that the Personal Data provided is true and accurate to the best of the Data Subject's knowledge and that the Data Subject has read and understands the terms of this Form. The Requesting Party certifies that it will only Process the Personal Data in strict conformity with this Form.

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