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The short answer: leave all three unchecked

This bot needs no privileged gateway intents. If the boxes are ticked when you open the form — they often are by default — untick all three and submit nothing else.
bot.py builds the client with discord.Intents.default(), which excludes all three privileged intents. The structural test harness asserts it on every release:
Requesting an intent you do not use is not free. It slows verification, invites questions you have no screenshots to answer, and grants your process access to data you then have to disclose in your privacy policy and defend in a breach.

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Why each one is unnecessary here

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Server Members Intent

Grants the full member list of every server, and member join/leave events. This bot never enumerates members. Everything it does with a person happens because that person just interacted with it: interaction.user on a slash command, a button, or a modal, all of which Discord supplies without the intent. Role granting uses interaction.user, who is by definition present.

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Presence Intent

Grants every member’s online status, activity and rich presence. Nothing in this bot reads presence. There is no “who is online” feature and no plan for one.

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Message Content Intent

Grants the text of every message in every server it is in. This bot has no prefix commands — only slash commands and component interactions, which deliver their arguments as structured data, not as message text. There is no on_message handler at all. The command_prefix is when_mentioned specifically so discord.py does not warn about the missing intent. A string prefix like "!" makes it log “Privileged message content intent is missing, commands may not work as expected” on every startup — true about prefix commands, irrelevant here, and exactly the kind of warning that teaches operators to ignore warnings.

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Filling in the form

Everything below that heading in the form — the per-intent justification, screenshots, and off-platform storage questions — only applies to intents you request. With none requested, none of it needs answering.

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If you ever do need one

The likeliest candidate is Server Members, if you later add something that acts on people who have not just interacted — bulk role syncing, or granting a role to everyone who bought before a date. You would need to:
  1. Add it in bot.py before the client is constructed. discord.py reads intents when the client is built, so mutating intents afterwards silently does nothing.
  2. Enable it in the Developer Portal under Bot → Privileged Gateway Intents.
  3. Apply through this form once you pass 100 servers, with a screen recording of the feature working.
  4. Update Privacy — the data you collect would have changed, and the policy is a factual description of that.
Below 100 servers you can simply toggle it on in the portal; the application is only required for verification.