Test Consent Form - Share The Cost Global

Client Details

Client's Name *

Client's Email

Date of Birth

Contact Number *

Street Address *

City

ZIP / Postal Code

Country

Authorisation

I hereby authorise Share The Cost Global to act on my behalf

Consent GivenYesNo

Reason for Third-Party Authority

Why you are giving third-party authority to act on your behalf?

Reason

Details of Authorised Third Party

Name

Relationship To Client

Contact Number *

Scope of Authorisation

Client Declaration

I affirm that the information provided on this form is accurate and that I have the authority to grant this permission. I understand that this authorisation allows Share The Cost Global to act on my behalf for the matters specified above. I acknowledge that I can revoke this authorisation at any time by providing written notice to Share The Cost Global

Client's Full Name

Client Signature

Date

Authorised Third Party Signature

Date

Share The Cost Global is committed to protecting your privacy. All information provided through this form will be handled with the strictest confidentiality and used solely for the purposes specified. Your personal information will not be disclosed to any unauthorised parties without your explicit consent, except as required by law.YesNoGive Consent