Confidentiality Pledge (ACT, NSW, NT, QLD, SA, WA)

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Tel: (02) 8853 6200

DEALER AREA

Confidentiality Pledge (ACT, NSW, NT, QLD, SA, WA)

Name *

First

Last

Company *

Date of Birth *

Drivers Licence Number *

As an officer, employee or associate of Guardian, I may have access to personal information. "Personal information" is defined in Privacy and Personal Information Protection (PPIPA) Act. *

I acknowledge

I am bound by the policies and procedures established by Guardian respecting the collection, use, disclosure, protection, alteration, retention and destruction of any personal information to which I may have access. *

I acknowledge

I undertake and agree not to collect, use, disclose, alter, retain or destroy personal information in relation to any unauthorised activity. *

I acknowledge

I further undertake and agree that:

I will treat all personal information to which I have access as strictly confidential; *

I agree

I will limit my access to personal information to that which I am authorised by Guardian to use and that I need to know to carry out my contracted duties; *

I agree

I will not remove any personal information, or any copy of personal information, in any form or medium, from the premises of Guardian Interlock; *

I agree

I will not retain or make unauthorised copies of any personal information, in any form or medium; *

I agree

I will not modify or alter any personal information in any unauthorised manner; *

I agree

I will not disclose any personal information, in any form or medium, to any unauthorised person, organisation or entity; and *

I agree

I will comply with the security safeguards and measures contained in Guardian’s policies. *

I agree

I acknowledge that failure to comply with the undertakings in this Pledge of Confidentiality may result in my being prohibited from contracted services, and in other disciplinary action or in other proceedings against me. *

I acknowledge

Acceptance *

I, the abovementioned person, confirm that by providing this submission I acknowledge that I have read and accepted all conditions outlined in this Confidentiality Form as outlined above and this form was completed by me. I acknowledge that completing this form on behalf of another person is a act of fraud.

Declaration Date *