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Consent To Release Information Form for Indonesia

Consent To Release Information Form Template for Indonesia

This document serves as a formal authorization mechanism under Indonesian law, particularly compliant with Law No. 27 of 2022 on Personal Data Protection (UU PDP), for the release of specified personal information from one party to another. It includes comprehensive details about the information to be shared, the purpose of sharing, the duration of consent, and the rights of the data subject. The form incorporates necessary safeguards and compliance elements required by Indonesian data protection regulations, ensuring legal validity while protecting the interests of all parties involved in the information exchange process.

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What is a Consent To Release Information Form?

The Consent To Release Information Form is a crucial document used in Indonesia when personal data needs to be shared between parties, ensuring compliance with Law No. 27 of 2022 on Personal Data Protection (UU PDP) and related regulations. This document is essential in situations where organizations need explicit permission to access, use, or share an individual's personal information. The form serves as a legal record of informed consent and typically includes detailed specifications about what information can be shared, with whom, for what purpose, and for how long. It's particularly important in regulated sectors such as healthcare, financial services, and education, where sensitive personal data is routinely processed. The document must incorporate specific elements required by Indonesian law, including clear statements of data subject rights and provisions for withdrawal of consent.

What sections should be included in a Consent To Release Information Form?

1. Information Provider Details: Full identification of the individual providing consent, including name, ID number, contact details, and address

2. Information Recipient Details: Full identification of the organization/entity receiving authorization to access the information

3. Scope of Information: Detailed description of the specific information authorized for release, clearly itemized and defined

4. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information will be used

5. Duration of Consent: Specific timeframe for which the consent remains valid

6. Rights of the Information Provider: Statement of rights under UU PDP including right to withdraw consent, access data, and request corrections

7. Authorization Statement: Formal declaration of consent and confirmation of understanding

8. Signature Block: Space for dated signatures of all relevant parties, including witnesses if required

What sections are optional to include in a Consent To Release Information Form?

1. Special Category Data Consent: Additional specific consent for sensitive personal data (health, financial, religious beliefs etc.) when applicable

2. Third Party Disclosure: Authorization for subsequent sharing with specified third parties, if relevant

3. Electronic Communication Consent: Specific consent for electronic transmission of information when applicable

4. Translator Certification: Required when the form is presented in multiple languages or when the information provider is not fluent in the language of the form

5. Parent/Guardian Authorization: Required when the information subject is a minor or legally incapacitated person

What schedules should be included in a Consent To Release Information Form?

1. Schedule A - Detailed Information List: Itemized list of specific information/documents authorized for release

2. Schedule B - Authorized Recipients List: Detailed list of all authorized recipients when multiple parties are involved

3. Schedule C - Processing Activities: Detailed description of how the information will be processed, stored, and protected by the recipient

4. Appendix 1 - Identity Verification Documents: Copies or details of identity documents used to verify the information provider

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

Indonesia

Publisher

Ƶ

Document Type

Authorization Form

Cost

Free to use
Relevant legal definitions
























Clauses




















Relevant Industries

Healthcare

Financial Services

Education

Human Resources

Insurance

Legal Services

Real Estate

Banking

Telecommunications

Government Services

Social Services

Employment Services

Relevant Teams

Legal

Compliance

Human Resources

Data Protection

Information Security

Risk Management

Operations

Administrative Services

Customer Service

Medical Records

Information Technology

Relevant Roles

Data Protection Officer

Compliance Manager

Legal Counsel

HR Manager

Privacy Officer

Information Security Officer

Risk Manager

Operations Manager

Medical Records Administrator

Customer Service Manager

Administrative Officer

Company Secretary

Recruitment Manager

Financial Advisor

Healthcare Administrator

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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