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1. Parties: Identification of the data subject (person giving consent) and the organization requesting consent, including full names, identification numbers, and contact details
2. Background: Brief context explaining why the information release is needed and the relationship between the parties
3. Definitions: Clear definitions of key terms used in the form, including 'Personal Data', 'Sensitive Personal Data', 'Processing', and other relevant terms as defined in the PDPA
4. Information to be Released: Specific description of the personal data/information to be disclosed, categorized clearly and precisely
5. Purpose of Disclosure: Clear statement of the specific purpose(s) for which the information will be used
6. Recipients of Information: Identification of who will receive the information, including any third parties
7. Duration of Consent: Specification of how long the consent remains valid
8. Rights of the Data Subject: Statement of the data subject's rights under PDPA, including right to withdraw consent
9. Declaration and Signature: Formal declaration of consent and space for signature, date, and witness details
1. Special Category Data Consent: Additional explicit consent section for sensitive personal data such as health information, religious beliefs, or biometric data
2. International Transfer Consent: Required when personal data may be transferred outside Malaysia
3. Emergency Contact Authorization: Optional section for authorizing release of information to emergency contacts
4. Specific Legal Requirements: Additional sections required for specific sectors (e.g., financial services, healthcare)
5. Third Party Authorization: When consent is given by a legally authorized representative rather than the data subject
6. Withdrawal Procedure: Detailed procedure for withdrawing consent, if more detailed explanation is needed
1. Schedule A - Details of Personal Information: Detailed list of specific personal information to be released, categorized by type
2. Schedule B - Authorized Recipients: Complete list of all authorized recipients of the information, including contact details
3. Schedule C - Processing Activities: Detailed description of how the information will be processed, stored, and handled
4. Appendix 1 - Privacy Notice: Copy of the organization's privacy notice or relevant excerpts
5. Appendix 2 - Withdrawal Form: Template form for withdrawing consent in the future
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