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Consent And Declaration Form
"I need a Consent and Declaration Form for my medical research study in Singapore, which will involve collecting sensitive health data from participants over 65 years old starting from March 2025, with specific provisions for withdrawal of consent."
1. Personal Information: Details of the person giving consent/making declaration including name, identification number, contact details
2. Purpose Statement: Clear explanation of why consent is being sought and how the information/consent will be used
3. Scope of Consent: Specific details of what is being consented to, including any limitations or conditions
4. Declaration Statements: Specific statements being declared as true, with each statement clearly numbered and detailed
5. Acknowledgment: Confirmation that the person understands and voluntarily provides consent, including PDPA acknowledgments
6. Signature Block: Space for signature, date, and witness details if required, including electronic signature provisions
1. Withdrawal of Consent: Process and conditions for withdrawing consent, applicable for ongoing consent relationships
2. Third Party Authorization: Authorization section for cases where a third party needs to act on behalf of the declarant
3. Witness Section: Additional section for witness details and signature when witnessing is required
4. Parent/Guardian Consent: Additional consent section for cases involving minors or persons lacking capacity
1. List of Authorized Activities: Detailed schedule listing specific activities, uses, or disclosures being consented to
2. Supporting Documents: Schedule listing required supporting documents and declarations
3. Terms and Conditions: Detailed terms and conditions applicable to the consent and declaration
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