The Basic Intake Form serves as a fundamental document for initial client engagement across various sectors in Nigeria. It is designed to collect essential information from new clients while ensuring compliance with the Nigeria Data Protection Regulation (NDPR) 2019 and other relevant Nigerian laws. This document should be used at the first point of contact with new clients or when updating existing client information. The Basic Intake Form includes sections for personal information, contact details, consent declarations, and service-specific requirements, with optional modules that can be activated based on the specific service context. It is structured to protect both the service provider and client while ensuring transparent data collection practices and clear documentation of the client-provider relationship.
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1. Personal Information: Basic client details including full name, date of birth, nationality, and contact information
2. Contact Details: Comprehensive contact information including physical address, email, phone numbers, and preferred contact method
3. Identification Details: Government-issued ID information, type of ID provided, and ID number
4. Emergency Contact Information: Details of person(s) to contact in case of emergency
5. Data Protection Notice: Statement on how personal information will be collected, used, and protected in compliance with NDPR
6. Consent Declaration: Client's explicit consent for data collection and processing
7. Signature and Date: Space for client signature and date of completion
1. Medical Information: Optional section for collecting relevant medical history or conditions when required for specific services
2. Employment Details: Optional section for collecting employment status and information when relevant to service provision
3. Financial Information: Optional section for collecting banking or payment details when required for billing purposes
4. Service-Specific Requirements: Optional section for collecting information specific to particular services being sought
5. Guardian Information: Optional section for cases involving minors or individuals requiring legal guardianship
1. Schedule A - Required Documents Checklist: List of additional documents required to be submitted with the intake form
2. Schedule B - Terms and Conditions: Detailed terms and conditions regarding the use and processing of provided information
3. Schedule C - Privacy Policy: Detailed privacy policy and data protection measures in compliance with NDPR
4. Appendix 1 - Service-Specific Forms: Additional forms specific to particular services being requested
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