Accenture Consent Form

CONSENT
I, Ramiro, Ma. Carlota A., of legal age, hereby declare without compulsion and
out of my own free will, the following:
a) I have been informed that as part of my employment in Accenture, Inc.

(Accenture), I will be enrolled in Accenture‟s Health Maintenance Organization
(HMO) program with its provider, Maxicare Healthcare Corporation. This will
allow me to avail of health-related services (Benefits and Services) that are
covered under the Agreement between Accenture and Maxicare Healthcare
Corporation.
b) I understand that I may be asked to provide Personal Information1, including my

Sensitive Personal Information2 (Collectively “PII”) to complete my HMO
enrollment. In addition, I have been made aware that this PII, may be collected,
used, processed or shared with the Maxicare Healthcare Corporation for the
following purposes:
i. Provision of the Benefits and Services under the Agreement between

Accenture and Maxicare Healthcare Corporation;
ii. Anonymized profiling or historical statistical analysis for Accenture‟s
benefit, and for providing advice or information covering Maxicare
Healthcare Corporation„s products or services to effectively administer or
manage the Accenture account, enhance customer services to, or to
communicate with Accenture for purposes of performing its obligations
under the Agreement in accordance with acceptable and lawful data
processing principles. I have been made aware that this PII may be used
by Accenture for such other legitimate purposes in furtherance of
Accenture‟s interests, including but not limited to, performance evaluation,
data analytics, management & market research, and automated
processing systems. Accenture may also hold, retain and use this PII for a
period reasonably necessary to complete the purposes I have agreed to
herein.
c) I understand that the processing activities enumerated above will be carried out
in accordance with applicable data privacy laws and Accenture‟s Policy 90,
which together regulate the way in which Accenture collects and uses personal
data and my rights to access and correct my data. A copy of Policy 90 is
available on request and should I have concerns, I can reach out to the following
Accenture Points of Contact:
Miscen L. Desiderio-Dime, Director of Legal Services, Regulatory & Compliance

Operations
Higino Jason A. Justo, GDN Counsel
Cynthia G. Sagmit, Manager for Employee Relations
1
Personal information refers to any information, whether recorded in a material form or not, from which the
identity of an individual is apparent or can be reasonably and directly ascertained by the entity holding the
information, or when put together with other information would directly and certainly identify an individual
2
Sensitive Personal Information refers to personal information:
1. About an individual’s race, ethnic origin, marital status, age, color, and religious, philosophical or political
affiliations;
2. About an individual’s health, education, genetic or sexual life of a person, or to any proceeding for any offense
committed or alleged to have been committed by such individual, the disposal of such proceedings, or the
sentence of any court in such proceedings;
3. Issued by government agencies peculiar to an individual which includes, but is not limited to, social security
numbers, previous or current health records, licenses or its denials, suspension or revocation, and tax returns; and
4. Specifically established by an executive order or an act of Congress to be kept classified.
Accenture Confidential
d) I hereby give my consent to the processing and sharing of my PII and the
storage of which for a time reasonably necessary to carry out the activities as
described in the foregoing paragraphs.
e) Further, should I elect to enroll dependent/s, I warrant that I have secured

his/her/their consent for the purposes enumerated above, prior to providing
his/her/their PII to Accenture.
I declare the afore-mentioned statements as my own and hereby confirm the same, this
December 20, 2022.
Ramiro. Ma. Carlota A.

Signature over printed name
Accenture Confidential

Accenture Consent Form

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CONSENT

a) I have been informed that as part of my employment in Accenture, Inc.

b) I understand that I may be asked to provide Personal Information1, including my

i. Provision of the Benefits and Services under the Agreement between

Miscen L. Desiderio-Dime, Director of Legal Services, Regulatory & Compliance

e) Further, should I elect to enroll dependent/s, I warrant that I have secured

Ramiro. Ma. Carlota A.

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