I understand that the personal data of myself will be processed by IOM for registering my expression of interest in the IOM counselling for Assisted Voluntary Return and Reintegration, so that I can be contacted by IOM for provision of counselling to myself and/or dependents. I hereby authorize IOM and any authorized person or entity acting on behalf of IOM to collect, use, disclose and dispose of the personal data provided in this form. I acknowledge, for myself and for any person for whom I have the right to do so as well as for relevant heirs and estate, that IOM will not be held liable for any damage caused, directly or indirectly, to me or any such person in connection with IOM assistance that derives from circumstances outside the control of IOM. I declare that the information I have provided is true and correct to the best of my knowledge. I understand that if I make a false statement in signing this form, the assistance provided by IOM can be terminated at any time.