Consent Form

The personal data collected on this form may be used for the purposes as in this form. If you wish to receive the following, please tick the appropriate boxes and submit this form to me. You may select more than one box.


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By submitting this form to you, I consent to you to use and /or disclose my personal data as provided in this form with effect from the date of  this form and until such time as I shall inform you in writing of my withdrawal of consent.


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