AUTHORIZED PERSONS

AUTHORIZED PERSONS
Name and Surname Residential address Phone number Email address Signature of the Authorized Person
I the below undersigned,
hereby declare that all details given above are true and accurate.
Full Name*
Signature
Date*
Date Format: DD slash MM slash YYYY
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Name and Surname	Residential address	Phone number	Email address	Signature of the Authorized Person

I the below undersigned,