|   Signatures of the Consenting Party/s: 1: ………………………… Date: …… / …… / ……   2: ………………………… Date: …… / …… / …… 3: ………………………… Date: …… / …… / ……   4: ………………………… Date: …… / …… / ……   Date Signed: …… / …… / ……   Once signed, return this form to the Agent. Address: …………………………………………………………………………………………………………… Phone:    (…).…….…………………………………………. Mobile: ……..…………………………………… Email:     ……………………………………………….…………………………………………………………..   Note: The Consenting Party/s may update details of the communication methods provided herein or terminate such consent by the provision of written notice to the Agent. |