Dear valued Member,
By completing this online request, you provide your consent to process your
and your dependant’s personal information for purposes as set out below.
While your consent is voluntary, it is a requirement for you to register
for and receive the COVID-19 vaccination at one of our vaccination sites.
Momentum Metropolitan will protect your personal information and will
adhere to the Protection of Personal Information Act, 2013 when processing
your personal information.
Your personal information will be processed for the purpose of registering
you and your dependants for a vaccination appointment at one of the
designated Momentum Metropolitan sites (currently Durban, Cape Town,
Qheberha, Sandton and Centurion) and will be shared with the staff on site
in order to assist you.
The National Department of Health (NDoH) has developed an Electronic
Vaccine Data System (EVDS) to support the COVID-19 vaccination rollout. You
are required to register on the EVDS site and provide the relevant
information for this purpose.
Your information will be shared with EVDS to support the COVID-19
vaccination rollout in South Africa. The EVDS will be used to capture
COVID-19 vaccination events digitally and provide data to the NDoH data
analytics platform to monitor and report on.
1. I authorise and give consent to Momentum Metropolitan to collect, store,
collate, process, share and further process my personal information,
including health information, and that of my dependants, for purposes of
registration for the vaccine.
2. If I have consented to the disclosure of my personal information,
Momentum Metropolitan may further process my personal information in
accordance with applicable privacy and data protection legislation and
provide it to any natural or juristic person (which could include a
company, corporation, state, or agency of a state, association, trust or
partnership) or if a contractual relationship exists between Momentum
Metropolitan and their service providers which requires them to do so.
3. I authorise and consent to my personal information and my dependants’
personal information, including demographic data and geographical data, and
where applicable, being shared with authorised third parties such as the
National Department of Health and healthcare providers, provided that it
complies with applicable privacy and data protection legislation.
4. Momentum Metropolitan ensures that your personal information is
safeguarded against the risk of loss or damage and against the unauthorised
or unlawful access.
I give permission for my and my dependant’s information to be shared for
the intended purposes of receiving the COVID 19 vaccine to be administered
to the person/s on my medical scheme membership and for a record of the
vaccination to be entered into the EDVS system for care co-ordination and
to monitor nationwide vaccination coverage. Further, I agree that the
information provided is true and correct.
For information on the National Department of Health’s EVDS system, please
click on the link below:
South African COVID 19 Vaccination Programme Registration
