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I hereby declare that the information given above are correct, true and complete to the best of my knowledge. I understand that deliberate and unintentional misinformation or omission to declare required information can be penalized in accordance with law.

I hereby voluntarily and freely consent to the collection and sharing of the above personal information only in relation to the DLSMC COVID-19 internal protocols and that of existing guidelines or policy provided for by law and proper authorities.