LOCAL GOVERNMENT UNIT OF POLANCO

MUTYA SA POLANCO 2024

OFFICIAL APPLICATION
CONSENT
FORM

THE LOCAL GOVERNMENT UNIT OF POLANCO is committed to giving you a fair opportunity to
participate in the Mutya sa Polanco 2024 Pageant while implementing safeguards to protect
your privacy and keep your personal data safe and secure.

Data Protection

LGU Polanco shall implement reasonable and appropriate organizational, physical, and
technical security measures for the protection of your Personal Information. The security
measures shall aim to maintain the availability, integrity, and confidentiality of the Personal
Information against any accidental or unlawful destruction, alteration, and disclosure, as well
as against any other unlawful processing.

Confidentiality

LGU Polanco’s employees who are granted access to your Personal Information shall operate
and hold the same under strict confidentiality.

Your Rights as Data Subject

Under the DPA, you are entitled to the following rights: (a) right to be informed; (b) right to
access; (c) right to object; (d) right to erasure and blocking; (e) right to rectify; (f) right to file
a complaint; (g) right to damages; and (h) right to data portability.

By affixing you signature below, you represent and warrant that:

i. All data that you will provide or have provided are true and correct to the best of your
knowledge, freely and voluntarily given for purposes of allowing LGU Polanco to
determine your eligibility to join the Mutya sa Polanco 2024 Pageant,

ii. You categorically and explicitly authorize LGU Polanco, its employees and duly
authorized representatives, including its event organizers to keep, store, use, access
and process all information that you will provide or have provided in this Official
Application Form.

iii. You likewise categorically and explicitly understand, acknowledge, and accept, that
LGU Polanco may store and share your personal information with its sponsors and
partners, for purposes of providing you marketing and/or promotional information on
the products and services they are offering, helping to create, develop, deliver, and
improve their products and services, opening prospective employment opportunities
for you, and such other uses consistent with the foregoing purposes and the Data
Privacy Act of 2012, via SMS, voice call, e- mail, and other similar means of
communication. LGU Polanco may also disclose your personal information to the
relevant authorities if required by law or legal process.

iv. You fully understand and confirm that signing this document means giving your
consent and that you do so freely, knowingly, voluntarily, willingly and under no
duress, and that your application for entry into the Mutya sa Polanco 2024 Pageant as a
prospective candidate will not be processed or entertained without first affixing your
signature below.

Applicant’s Signature over Printed Name Date

(Please fill out this Application Form in your own handwriting and submit to our staff.)

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I. PERSONAL INFORMATION

FULL NAME NICKNAME

PEN NAME/STAGE NAME/PSEUDONYM SEX
PRESENT ADDRESS House No./Unit No./Condominium Street

Barangay City/Municipality Province

AGENCY/BARANGAY/SCHOOL
(If more than one address within the last five (5) years, including foreign addresses, kindly indicate the same
below as well as length of stay and inclusive dates. Attach a separate sheet if necessary)
ADDRESS LENGTH OF STAY INCLUSIVE DATES

1.

2.

CONTACT DETAILS
LANDLINE MOBILE EMAIL
I can most easily be reached/contacted through:

AGE
PLACE OF BIRTH DATE OF BIRTH mm / dd / yyyy

PARTICIPATION IN OTHER BEAUTY PAGEANTS

BEAUTY CONTEST/ORGANIZER TITLE WON DATE

EDUCATION
YEAR GRADUATED
SCHOOL/UNIVERSITY ADDRESS DEGREE/LEVEL

HIGHEST EDUCATIONAL ATTAINMENT

LANGUAGES/DIALECTS SPOKEN

OTHER PERSONAL INFORMATION

HOBBIES

SPORTS ACTIVITIES

TALENTS/SKILLS

HANDLER

FAMILY BACKGROUND

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 NAME OCCUPATION ADDRESS CONTACT NO/S.

FATHER

MOTHER
GUARDIAN
(if any)
If Parents are separated, who has legal custody (if Applicant is a minor):

Is the separation of the Parents legally documented? (YES or NO)

BODY MEASUREMENTS AND INFORMATION

Height Weight Shoe Size (Heels)

Bust Waist Hips

PERSONAL REFERENCES
(Provide at least three (3) reference who are NOT your
relatives)
NAME ADDRESS CONTACT NO/S.

1.

2.

3.

Reason/s for applying for or wanting to join the Mutya sa Polanco 2024:

Other interesting personal information (if any):

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II. CERTIFICATION AND WARRANTY OF INFORMATION/STATEMENTS

1. I certify that all of the following information/data and/or matters indicated in this Application
Form and such documents attached hereto are true, and that there are no false statements,
misrepresentations or omissions herein. Any such false statements, misrepresentations or
omissions will be sufficient ground for LGU Polanco to reject this application, without
prejudice to any other legal remedies LGU Polanco may be entitled to under the premises.

2. I further certify that:

a. I am at least 18 years old;

b. I am neither married, nor have I ever been married; I have never sought the annulment
of my marriage or the declaration of nullity thereof; I have never been, nor am I
presently, pregnant. I have neither given birth to a child nor am I a parent;

c. I am of good moral character;

d. I am of Polancohanon roots;

e. I was born with the anatomy of a female and that I have not consented to and/or
underwent any surgical, medical and/or cosmetic procedure to transform myself into a
biological female.

3. I hereby authorize LGU Polanco to verify the truth of all my assertions herein and the
genuineness/validity of all the documents I have submitted, thereby waiving for these purposes
the provisions of all laws, rules, and regulations, local or foreign, relating to the privacy or
confidentiality of the matters hereunder.

4. I warrant that the documents I have submitted are public documents in my possession or
which came into my possession legally and/or are public documents attested to by the
officer/s having the legal custody of the records, and that, where applicable, the entries
therein were made in the regular performance of an official duty, and that I will hold LGU
Polanco free and harmless from any breach of this Warranty.

III. UNDERSTANDING OF CONDITIONS

1. I understand that I am applying as a candidate in the Mutya sa Polanco 2024 Pageant and
that the requirements and/or limitations with regard to age, residency, and citizenship may
vary, subject to the requirements of different international pageants, and that accordingly,
my qualifications are further subject thereto.

2. I am aware that LGU Polanco, in its sole discretion, may require me to submit additional and
sufficient proof of age, residency, citizenship, and other documentation/information
regarding my qualifications. Should I be required to do so, I undertake to provide LGU
Polanco with such requested documentation/information, and failing to comply within the
period to submit, as determined by the LGU, I understand that my application will not be
considered complete and submitted.

3. I understand that I have to pass the screening and meet all the requirements and
qualifications of LGU Polanco before I can qualify as a candidate in the Mutya sa Polanco
2024 Pageant. I further understand that the basic requirements relate to information
obtained from me as contained in this Official Application Form.

4. In considering my application to be a candidate in the Pageant, I understand that personal

achievements, intelligence, beauty, physical fitness, personal style and charisma, among
other criteria, shall also be considered. I agree that all issues relating to my eligibility as an
applicant shall be determined solely by the LGU and that I shall abide by its determination,
which shall be final and non-appealable.

5. In filling out and signing this Official Application Form, I further understand that LGU Polanco
is under no obligation to accept me as a candidate. My acceptance as an official candidate
shall commence only when I am formally and specifically notified thereof by the LGU.

6. If I am chosen as an official candidate, this Official Application Form shall be considered part
and parcel of the Official Entry Form/Contract which I shall be required to sign.

7. I understand that in signing this Official Application Form, I have accepted the sole
discretion of LGU Polanco to accept or reject me as a candidate in the Mutya sa Polanco
2024 Pageant and that the decision of the LGU on this application is final and non-
appealable.

8. I finally certify that I have read this Official Application Form carefully, that I have
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understood the same, and that no promises or representations were made to induce me to
sign this Official Application Form.

Applicant’s Signature over Printed Date

Name

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