Hereby by submitting this form you (hereinafter “Applicant”, “Subject of Personal Data”) grant PHARMAPARK LLC (Bldg. 1, 8 Nauchny proezd, 117246, Moscow, Russia) (hereinafter “Company”) your consent to process your personal data including surname, given names, electronic mail address, cell phone number, address and other information pertaining to you as the Subject of Personal Data and stated in the filled-out “Adverse Event Report” form (hereinafter “Personal Data”).
By giving this consent you confirm that you act of your own free will and volition and in your own interest. Personal data provided by you are processed for performing functions, responsibilities and required actions related to pharmacovigilance and imposed on the Company by April 12, 2010 Federal Law No. 61-FZ “On Medicine Circulation” (article 64, part 4) as well as for possible further communication with you and providing necessary information; your consent shall remain in effect throughout the term of the Company retaining the Applicant’s Personal Data established by legislation of the Russian Federation unless you withdraw it at an earlier date.
The Company shall process the Applicant’s Personal Data in strict compliance with PHARMAPARK LLC Personal Data Processing and Protection Policy. This consent applies to any actions in relation to Personal data that are required or desirable for achieving the above purpose including without limitation collection, classification, accumulation, correction (update), use, dissemination (including transfer), depersonalization, blocking, destruction, removal as well as any other actions in relation to the Applicant’s Personal data in accordance with applicable legislation. According to provisions of July 27, 2006 Federal Law No. 152-FZ “On Personal Data” PHARMAPARK LLC, as a personal data processor, shall ensure confidentiality of Personal Data and prevent their disclosure to third parties without your consent unless required by federal laws.