MPOS Withdrawal Concern Form

MPOS WITHDRAWAL / OTHER CONCERNS Form

Merchant Name

Please upload: ACKNOWLEDGEMENT FORM/ Bills Statement paid via MPOS (MANDATORY)

Please upload: CUSTOMER'S VALID ID (MANDATORY)

Please upload: TRANSACTION RECEIPT MPOS (MANDATORY) Picture

I hereby give my full consent to iPROCESS LIAISON AND CONSULTANCY OPC and to Third Party to collect, use, store, process, and share my personal and sensitive information, in accordance with the Data Privacy Act of 2012 (RA 10173), for legitimate business, operational, legal, compliance, and communication purposes. I understand that my data will be handled with strict confidentiality and will only be retained for as long as necessary to fulfill the declared purposes or as required by law. I am aware of my rights as a data subject, including the right to access, correct, and withdraw my personal data, and I acknowledge that I have been informed of these rights and the contact details of the Data Protection Officer at dataprivacy@iprocessph.com.