CONSENT FORM: ABC PRODUCT
Please Read & Confirm these data protection regulations
Jubilee Health Insurance Ltd (” Jubilee Health/The Company/We/us”) respects the privacy and protects the personal and sensitive personal data of its prospective and existing clients and complies with the Data Protection Act, 2019 and the Data Protection Regulations. The personal and sensitive data requested will be used for the provision of quotations, administration of, and/or other services relating to the ABC product, you are seeking to place with Jubilee Health and partners.
All the information you have provided on this application (and any additional supporting pages) will only be used for lawful purposes and treated in accordance with the requirement of the Data Protection Act and its Regulations. Your personal/sensitive personal data will be shared with the contracted third-party service providers (Data Processors and Sub-Processors) for the purpose of providing services related specifically to the service you are seeking or have in place with us. We may also be required to provide this information to Regulators, the Government or any other institution or organization, for lawful or statutory purposes.
Personal and Sensitive Personal Data may be transferred outside Kenya through cross border transfer of data, and in line with this, further consent is hereby sought from you for this purpose. Appropriate data protection safeguards will be put in place regarding the data transferred. Cross border transfer of personal and sensitive data refers to the transfer of such data outside Kenya for the performance or conclusion of a contract; implementation of pre-contractual measures at a data subject’s request; or for any matter of public interest, or the establishment, exercise or defence of a legal claim, or the purpose of compelling legitimate interests pursued by the Data Controller or Data Processor which do not override the interests, rights and freedoms of the data subject. The transfer of data cross border may also occur in circumstances Jubilee Health utilizes the services of a third-party service provider regarding the storage of personal data.
Under the conditions defined by the Data Protection Act 2019 and Data Protection Regulations, you have the right to:
- Access your personal data and information on the processing (processing purposes, categories of personal data concerned, recipients to whom your personal data has been or will be communicated and the retention period. To find out how long we will keep your data, please refer to our Privacy Notice at jubileeinsurance.com/ke/privacy/
- Access, rectification and/or have your personal data erased.
- Receive the personal data provided to Jubilee Health in a structured, commonly used and legible format; This shall be done free of charge by writing to the Data Protection Officer at: Jubilee Health Insurance Limited, Jubilee House, Wabera Street, Nairobi, Kenya, or by e-mailing email@example.com
- Oppose, for legitimate reasons, the processing and use of your personal data.
- Request us to transfer your personal data to another Data Controller.
- Lodge a complaint with us at firstname.lastname@example.org
- At any time, change your personal data and revoke your consent for the retention. You have the right to appoint a third party to whom your data may be communicated to after your death. You agree to inform the third party of their appointment.
- Withdraw your consent to the processing activities at any time which may affect the services we provide to you or may stop us from being able to assist you. We reserve the right to not send you or delete your personal data in some circumstances – if we do, we will write to you setting out the reasons why, as detailed in Regulation 12(4) (b) and Regulation 12 (4) (e) of the Data Protection (General) Regulations, 2021.
We request your explicit consent for the processing of your personal and sensitive personal data as outlined above. Without this consent Jubilee Health will not be in a position to handle your data or provide the services you are seeking.
The consent below requires filling by the policy holder or prospective member of the ABC Program. This consent will be valid for the entire duration of the program. Please note that it may be changed or revoked at any time. In instances where the program is for provision of personal and sensitive data of a dependent(s) i.e., spouse, child, sibling or parents, the consent you signed will be deemed specific on their behalf.
A parent or guardian should complete the consent for any member that is under the age of eighteen (18).