Head Office, Hal Far, P.O. Box 47,
Birzebbugia, Malta
Tel: 21654940
E-mail: www.etc.gov.mt
Applikazzjoni għaŜ-Ŝamma ta’ isem fir-Reāistru ta’ Persuni b’DiŜabilità
1. Isem u Kunjom :
2. Indirizz :
Nru. tat-Telefown: _________________________
3.
Numru taë-êertifikat ta’ Reāistrazzjoni ____________________________________
4. Data meta jiskadi ë-êertifkat ta’ Reāistrazzjoni _______________________________
5.
Impieg preŜenti _______________________________________________________
6. l-isem u indirizz tal-prinëipal ______________________________________________
_____________________________________________________________________
Jien qed napplika biex ismi jinŜamm fir-Reāistru ta’ Persuni b’DiŜabilità
Qed nehmeŜ ma’ din l-applikazzjoni kopja tal-Karta tal-identità jew ëertifikat tat-twelid u ë-ëertifikat mediku
riëenti*. Inkompli niddikjara li l-informazzjoni ta’ hawn fuq hi vera u qed napplika biex ismi jinzamm firReāistru ta’ Persuni b’DiŜabilità.
Qed napplika sabiex id-dettalji tiegħi jinŜammu fir-Reāistru ta’ Persuni b’DiŜabilità u naqbel u nagħti lkunsens biex id-data personali tiegħi (li tinkludi data personali sensittiva) tināabar u tiāi proëessata millKorporazzjoni għax-Xogħol u t-Taħriā għal dan il-għan. Jien għandi d-dritt li nara, nibdel u fejn applikabbli
nħassar kull data personali li tikkonëerna lili.
Dan il-kunsens qed jingħata bil-kundizzjoni u bil-fehma li l-ETC tosserva l-provedimenti relevanti kollha
tal-Liāi dwar il-Privatezza tad-Data u kull regolamenti li jinħarāu minnha.
Kull data personali mgħoddija fil-futur lill-ETC għal dan l-istess għan hija suāāetta għall-istess Liāi.
Data:______________________
Firma jew marka tal-applikant:______________________
Numru tad-Dokument tal-Identità ____________________________
Xhud tal- Marka biss __________________________________
Indirizz tax-xhud ________________________________________________________________________
Numru tad-Dokument tal-Identità _________________________
* Certifikat mediku ricenti mahrug minn tabib, izda persuni li jbatu minn mard mentali tali`certifikat ghandu
jinhareg minn psikjatra jew rapport minghand psikologu .
Avviz Legali 156 ta’ 1995; Registrazjoni u Appell dwar Persuni b’Dizabilita’.
Head Office, Hal Far, P.O. Box 47,
Birzebbugia, Malta
Tel: 21654940
E-mail: www.etc.gov.mt
Application for retention of name in Register for Persons with Disability.
1. Name and Surname::
2. Address:
Tel No______________
3. Number of Certificate of Registration ____________________________________
4. Date of Expiry of Certificate of Registration ___________________________________
5. Present Occupation _____________________________________________________
6. Name and address of employer ____________________________________________
_____________________________________________________________________
I apply for my name to be retained in the Register of Persons with Disability.
I here attach a copy of my identification card or birth certificate and a recent medical certificate*. I further
declare that the above mentioned information is true and correct, and that I am applying for my name to be
retained in the Register of Persons with Disability.
I am hereby submitting my application to have my details retained into the Register for Persons with
Disability and agree and explicitly consent to have my personal data (including sensitive personal data)
collected and processed by the Employment and Training Corporation (ETC) for such purpose. As a data
subject I have the right to access, rectify, and where applicable, erase any personal data concerning
myself.
This consent is being granted on the condition and understanding that ETC will comply with all the
relevant provisions of the Data Protection Act and any regulations issued there under.
Any personal data disclosed to ETC for the same purpose on any future occasion shall be subject to the
same Data Protection Act.
Date: _______________________
Applicant’s signature or mark: _____________________
I.D. Number ______________________
Witness to mark only ____________________________
Address of witness ____________________________________________________
ID Number
______________________________
* Recent Medical certificate issued by a General Practitioner, but persons suffering from a mental illness such a
certification has to be issued by a psychiatrist or psychologist’s report.
Legal Notice 156 of 1995; Registration and Appeal of Persons with Disability.