Consent to the processing of personal data, authorised by the data subject for dissemination
I,		,	
(full name)	
ID number_____________ issued on___________by______________________________________
address ____________________________________________________________________________________
tel., e-mail _______________________________________________________________________________,
in accordance with Article 10.1 of Federal Law No. 152-FZ of 27.07.2006 On Personal Data, 
give my consent
to the processing of my personal data in the form of dissemination by the Immanuel Kant Baltic Federal University federal state autonomous educational institution of higher education (address: 14 Al. Nevskogo St, Kaliningrad, Russia, 236041, INN 3906019856, OGRN: 1023901002949, the operator’s information resources: https://publish.kantiana.ru/, https://journals.kantiana.ru/, https://balticregion.kantiana.ru/, https://www.spractice.ru/jour/index, https://balticregioneditorial.kantiana.ru, https://vestnik-nature.ru) for the purpose of publishing the Work ___________________________________________________ __________________________________________________ authored/co-authored by me (please underline the applicable), in the journal/collection of papers __________________________________________________ (if applicable, indicate the title) issued by the operator the Immanuel Kant Baltic Federal University federal state autonomous educational institution of higher education (address: 14 Al. Nevskogo St, Kaliningrad, Russia, 236041, INN 3906019856, OGRN: 1023901002949, the operator’s information resources: https://publish.kantiana.ru/, https://journals.kantiana.ru/, https://balticregion.kantiana.ru/, https://www.spractice.ru/jour/index, https://balticregioneditorial.kantiana.ru, https://vestnik-nature.ru).
The categories and a list of my personal data to the processing of which in the form of dissemination I give my consent to are as follows.
Personal data:
- last name, first name, middle/patronymic name;
- place of work (service, study);
- job position;
- degree and academic title;
- e-mail address.
Limitations and restrictions on the processing of the aforementioned personal data (Part 9, Article 10.1 of Federal Law No. 152-FZ of 27.07.2006 On Personal Data) (please tick the applicable):
☐ I do not impose any limitations.
☐ I prohibit the transfer (except for granting access) of this data by the operator to the general public.
☐ I prohibit the processing (except for granting access) of this data by the operator to the general public.
☐ I impose the following conditions on the processing (except granting access) of this data by the general public: ________________________________________________________________________ 
The terms under which the personal data may be transferred by the operator only within its internal network, providing access to the information to strictly designated employees or through the use of information and telecommunications networks, or without transferring the personal data:
 _____________________________________________________________________.
This consent is valid from the day it is signed until the day it is revoked in writing by the signer.

(signature)		(name and initials)	
			
		(date)