The Consent To Release Information Form is a crucial document used in Belgium when one party needs to share personal information about an individual with another party, requiring explicit consent under both Belgian law and GDPR. This document is essential for compliance with the Belgian Data Protection Act and EU data protection regulations, particularly in situations involving sensitive personal data or professional confidentiality. The form serves as a legal record of informed consent, detailing 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 information sharing must be carefully documented and controlled. The document includes specific provisions required by Belgian law regarding data subject rights, consent withdrawal procedures, and data protection measures.
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1. Data Subject Information: Full identification details of the person whose information will be released (name, address, contact details, and any relevant ID numbers)
2. Information Holder Details: Identity and contact information of the organization/person currently holding the information
3. Recipient Details: Identity and contact information of the person(s) or organization(s) to whom the information will be released
4. Information to be Released: Specific and detailed description of the information authorized for release
5. Purpose of Release: Clear statement of the specific purpose(s) for which the information will be used
6. Duration of Consent: Specific timeframe for which the consent is valid
7. Data Subject Rights: Statement of rights under GDPR including right to withdraw consent, right to access, and right to erasure
8. Declaration and Signature: Formal declaration of consent and space for signature, date, and witness if required
1. Special Categories of Data: Additional specific consent sections for sensitive data categories under GDPR (health, biometric, genetic data etc.) - include when such data is involved
2. Third Party Processing: Details of any third-party data processors - include when data will be processed by parties other than the direct recipient
3. International Transfer: Specific provisions for international data transfers - include when data will be transferred outside the EU/EEA
4. Emergency Contact Authorization: Authorization for emergency contacts to access information - include in medical or emergency-related contexts
5. Professional Secrecy Waiver: Specific waiver of professional secrecy obligations - include when information is covered by professional secrecy laws
1. Detailed Information List: Itemized list of specific documents or information to be released
2. Authorized Recipients List: Detailed list of all authorized recipients and their contact information when multiple recipients are involved
3. Processing Activities Description: Detailed description of how the information will be processed, stored, and protected by the recipient
4. Privacy Notice: Detailed privacy notice explaining how the data will be handled in accordance with GDPR requirements
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