Declaration

for appearing on the website and social media

I, the undersigned,

Name: ………………………………………………………………………………

in accordance with Article 6 (1/a) of the GDPR, declare that MIRA Health Ltd (registered office: 1092 Budapest, Ráday Street 37, 5th floor, door 1, company registration number: 01-09-333473), as the Data Controller, will process my personal data as follows:

Data processing statements:

1.) ◻ I consent to the Data Controller taking a photo of me during dietetic counseling/closed webinar.

2.) I consent to the Data Controller using the photo taken of me during dietetic counseling/closed webinar on the following platforms:

◻ Data Controller's website

◻ Facebook

◻ Instagram

◻ LinkedIn

◻ TikTok

◻ Youtube

◻ other:

3.) ◻I consent to the Data Controller recording a video of me during dietetic counseling/closed webinar.

4.) I consent to the Data Controller using the video recorded of me during dietetic counseling/closed webinar on the following platforms:

◻ Data Controller's website

◻ Facebook

◻ Instagram

◻ LinkedIn

◻ TikTok

◻ Youtube

◻ other:

5.) ◻ I have read the Data Processing Information, understood its content.

Date: ………………….., 2024, .............month ..............day

_____________________________

Signature

[1] Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation)