Consent: personal data permitted for distribution

Consent

to the processing of personal data

permitted for publication by the data subject

(for public disclosure)

I, _____________________________________________________ (full name, phone, e-mail or mailing address of the data subject), in accordance with Article 10.1 of Federal Law No. 152-FZ of 27.07.2006 “On Personal Data”, give my consent to the distribution of personal data subject to processing by the operator, AVS LLC (TIN 9723255222, OGRN 1257700280727, address: 109387, Moscow, Lyublino municipal district, Lyublinskaya St., 42, premises 39/11/3)

for the purpose of _________________________________________________________

________________________________________________________________ (e.g. publication of reviews on the operator’s site, information about employees to clients for orders, etc.)

as follows:

Category of personal data	List of personal data	Permitted for distribution (yes/no)	Conditions and prohibitions
Personal data	Surname
	First name
	Patronymic (if any)
	Year of birth
	Month of birth
	Date of birth
	Place of birth
	Address
	Marital status
	Education
	Occupation
	Social status
	Income

Special categories of personal data	Ethnic origin
	Nationality
	Political views
	Religious beliefs
	Philosophical beliefs
	Health
	Intimate life
	Criminal record information

Biometric personal data	Color digital face image

Information on the operator’s information resources by which public access and other actions with the data subject’s personal data will be performed:

Information resource	Actions with personal data

Conditions on which the personal data may be transferred by the operator only over an internal network available only to certain employees, or using telecommunications networks, or without transfer of the personal data received:

– ____________________________________;

– ____________________________________ (to be completed by the data subject as desired).

This consent is given for a period of _____________________ (fixed period or end date).

“__” ___________ ____ (year)

Data subject:

_____________________ (signature) / ____________________ (full name)