Participating Agency Questionnaire

Your hosted service provider

Hosted service organisation name

Organisation name (as it appears on the New Zealand Companies Register or Charities Register)

Registration number:

Please provide information detailing the nature of the organisation's business, including core services

If "Other" please explain

Is the organisation listed as a Participating Agency in the EIV Act 2012?

Yes

No

If "yes" which class applies (or is the organisation individually named)?

Besides full name and date of birth, is there a business requirement for place of birth and/or gender to also be provided?

Yes

No

If yes, please advise which attribute(s) and explain the need for the additional attribute(s)

Does the organisation have an established Privacy Policy or provisions in place to comply with the Privacy Act 2020?

Yes

No

If "Yes", briefly describe the policies. (Evidence may be requested)

Has the organisation been found in breach of the Privacy Act 1993/ Privacy Act 2020 within the past 5 years?

Yes

No

If "yes", please provide details of the incident(s): when it occurred, what happened and the decision or outcome of the investigation.

What policies or practices have been put in place to prevent similar incidents from occurring in the future

Are you aware of any risks in authorising the organisation to use RealMe? e.g.has the organisation been, or is it currently the subject of investigation into the conduct of the organisation or its directors/partners/owners?

Yes

No

Please provide contact details for follow up

Name

Role

Date

Email address

Phone number