Shell Club15 Plus, Inc. Membership Application Form

Important: Before filling up the webform below with your personal information, please read the following carefully, and confirm that you understand, agree, consent, or certify by marking the corresponding tick boxes for each of the subject headings below:

Please note that the system will not allow you to submit the application form if all the boxes are not properly marked.

On Data Privacy

Shell Club15 Plus (SC15+) is committed to honouring and safeguarding your privacy. We will process the personal information you will provide in accordance with the Data Privacy Act (DPA) of 2012, its implementing rules and regulations and other applicable laws. Should your application not be approved, then all the personal data you supplied will not be stored in our systems and will be deleted immediately. Should your application be approved and you become a member, we will collect, store, and process your personal data, that are necessary for the execution of our club activities, grant of the Good Samaritan Fund, and the provision of services, which are in line with the main objectives of SC15+ and in compliance with the provisions of the DPA. Please be aware that you, as a data subject, can exercise the following rights under the DPA:

• Right to be informed	• Right for erasure or blocking
• Right to object	• Right to file a complaint
• Right to access	• Right to damages
• Right to correct	• Right to data portability

For more information on how you can exercise these rights, please refer to https://privacy.gov.ph/data-subject-rights/

For more information on how your personal information will be processed and the rationale behind the steps involved, please visit the SC15+ Data Privacy Policy at https://shellclub15.com/privacy-policy/

*

I hereby understand and agree to the processing of the personal information I will submit, in accordance to the DPA. I further understand that, as a data subject, that I can exercise the above rights under the DPA.*

On Your Role as a Club Member

As a member of the club you can attend our discussion series, attend club events and socials, vote during the AGMM (for regular members only), and can be qualified for grants under our Good Samaritan Fund.

In return you are highly expected to take the role of an active member, by attending meetings and events of the club regularly, be a volunteer to some of the regular events, respond to surveys accordingly, and in some cases be a member of ad-hoc committees. It is also your duty to inform the Secretariat of any changes in your contact details so that we can communicate with you regularly. Should you not attend any of the several events of the club for a period of 2 consecutive years without any valid reasons, or should you no longer be contactable for a period of 2 years, then we will take it that you are no longer interested to become a member and will take your case to the Board of Trustees for the appropriate action.

*

I hereby understand and agree to the roles that I will take as a club member. *

On Your Current Job or Profession

*

I hereby certify that I am not actively engaged in the manufacturing and/or marketing of petroleum fuels (liquid or gas), lubricants and/or in competition with the Shell Group of Companies, either as a principal, partner or employee.*

On convictions, if any.

*

I hereby certify that I am not convicted of any crime involving moral turpitude.*

Please fill up of the web form below. The system will automatically send the accomplished form in PDF to the Shell Club15 email address for the approval of your application by the Board of Trustees. You will be notified of the status of your application by The Secretariat accordingly.

Last Name*

First Name*

Middle Name*

Nickname*

Date of Birth

(Birthdate) Month*

(Birthdate) Day*

(Birthdate) Year*

Present Address*

Mobile No.*

Email Address*

Civil Status*

Name of Spouse*

Shell Employment Status*

Still with Shell
Retired

When did you join Shell?

(Date Joined Shell) Month*

(Date Joined Shell) Year*

When did you leave Shell?

(Date Left Shell) Month*

(Date Left Shell) Year*

Current/Last Position in Shell*

Current/Last Department in Shell*

Years of Service*

Please enter a number from 1 to 100.

Reason for Application*

Field of Specialization/Profession*

Present Employer/Nature of Business

After you left Shell, did you actively engage in any business in competition with SCiP either as owner, principal, partner or employee (example: Trading, Phoenix, Total, Petron, Caltex, etc.)*

Yes
No

If yes, please provide name of company, start and end dates , and role or position in the company.

Name of Company

Role or Position

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Contact Person in Case of Emergency*

Contact Number in Case of Emergency*

Photo*

Please attach a recent photo of yourself.

On the veracity of the information you provided

*

I hereby certify that the information provided herein are true and correct which may be validated by the Club. I declare that these are voluntarily given by me for the exclusive use of the Shell Club15 Plus, Inc. for the purpose of processing my membership application to the Club. *

On the storage of your personal information

*

I agree that the Club may store my information until such time that I cease to be a member thereof which may be brought about by expulsion, resignation or death. *

On your consent to the sharing of your information

*

I further give my consent to the sharing of the above information by the Club to any of its affiliates, agents, representatives or assigns but only with respect to the furtherance of my membership in the said Club. Other than that, the Club must first obtain my consent before sharing my information to anybody else. *

*

I will abide by the rules of Shell Club15 Plus, Inc.*

Name

This field is for validation purposes and should be left unchanged.

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