“By signing the present form you consent, in accordance with the Data Protection Legislation, that the personal data that you provide in this form will be included in a personal data filing system controlled by Linical Spain, S.L.U. (Linical), with corporate address at Calle Las Norias 92, 2ª planta. Puerta B. Edificio Nuestra Señora del Pilar, 28221 Majadahonda, Madrid with the purpose of managing clinical trial and for contacting you in future clinical trials in which Linical is involved on behalf of its Sponsors. For this same purposes, Linical may transfer your personal data to the entities which are part of its group of companies see at.

Moreover, by signing this form you represent that you have obtained the consent from any individual whose personal data is disclosed by you in this form.

You may exercise your rights of access, rectification, cancellation and objection by means of sending a written notification, including a photocopy of your identity card or passport, to Linical in the above stated address.”