I consent to my data being processed for the purpose of responding to my inquiry and in accordance with the *Roche Privacy Policy & Privacy Notice for Pharmacovigilance*

F. Hoffmann-La Roche Ltd ("Roche") will keep a record of the personal data that you provide for the purpose of responding to your inquiry, to follow up on such requests, to maintain the information in the Roche medical information database for reference and to comply with our legal and regulatory recording and reporting obligations. The retention time of data is in accordance with respective laws and regulations. By including personal data of another data subject in the form, you represent the lawfulness of processing of such personal data. The Roche Privacy Policy provides further detailed information about your rights and how Roche processes personal data.