*Privacy Collection Statement: Merck Sharp & Dohme (New Zealand) Limited (“MSD”) will collect, record and use your first name, last name, email, phone number, city and other Personal Information (please note some of this information maybe personal sensitive information) (“Personal Information”) by way of this form, for the purpose of processing your request for a visit or online meeting with an MSD representative. We may conduct data analytics on the Personal Information you provide, including to help us improve our services and customise information for you. If you choose not to provide us with your Personal Information, we may not be able to fulfil these purposes. We will keep your Personal Information for only as long as is necessary to carry out the purposes described above (unless we are required or permitted by law to hold the information for a longer period). We may disclose your Personal Information to organisations who assist us and our affiliated companies (which may be located in other countries including the United States, United Kingdom, Singapore, South America, Poland, China or India). If you would like to know more about our privacy policy, including how to access and seek correction of the Personal Information MSD holds about you, how to complain about a breach of the New Zealand Privacy Principles, and how MSD handles such complaints, please go to https://www.msdprivacy.com/nz/en/ or contact our Privacy Officer at: MSD, PO Box 99-851, Newmarket, Auckland 1149, T +64 9 523 6000, E msd_privacy_office@msd.com.