Consent and Indemnity Form - RefCheck

1 Consent and Indemnity FormCOMPANYINFORMATION COMPANY Company NameConsultant NameEmail AddressPhone NumberCANDIDATE PERSONALINFORMATIONS urnameFull First NameMaiden SurnameDate Of BirthSA ID NumberPassportEmail AddressContact NumberPhysical AddressInitialLexis RefCheck Consent & Indemnity FormI Pg 1 CANDIDATE SELF-DISCLOSUREC riminalRecord CheckHave you ever been criminally charged?YesNoIf yes, detail of charge / conviction AcademicQualificationsQualificationsInst itutionCityYear CompletedStudent MediaCurrentEmployerPrevious EmployerFacebookURLT witter HandleLinkedIn 005 676 CONSENTTO PROCESS PERSONAL INFORMATIONI hereby: consenttotheCompany,itsdulyauthorisedage nt,LexisNexisRiskManagement(LNRM)anditsd ataproviderstoprocessmypersonalinformati onandconductbackgroundverificationchecks includingbutnotlimitedto;credit,criminal ,qualifications,employmentreferences,fra udprevention,IDverification,FAIS comprehensive,professionalassociations,d river slicenceandsocialmedia; understandthatallpersonalinformationisdi sclosedinconfidenceandwillbekeptconfiden tialinasecuremannerbytheCompanyandLNRM; authorisethecommunicationoftheresultsoft hebackgroundcheckstotheCompanyandLNRMwho ,inturn,willkeepacopyonrecord,aspercompa nypolicy.

2 Consenttothisindemnityformbeingusedfromt imetotimeforcontinuedverificationpurpose sforthedurationofmyengagementwiththeComp any; authorizeLNRM toreceiveandstoremypersonalinformationfo rcurrent,futureorcontinuedverificationpu rposes(whetherfortheCompanyorforotherleg itimatepurposes); confirmthatIhavebeeninformedfullyofthepu rposesofthebackgroundchecksandthatmycons entisgivenvoluntarilywithoutcoercionandt hatImayrequestacopyofthisconsentformtore tainformyownpurposes; declarethat,tothebestofmyknowledgeandbel ief,alloftheinformationprovidedinconnect ionwiththisapplicationisfullandcorrectan duptodate;and am aware that: anyinformationfurnishedtotheCompanywillb edisclosedtomeuponrequestandthatImaydisp uteanyinformationintherecordasprescribed intheProtectionofPersonalInformationAct4 of2013ortheNationalCreditAct34of2005(NCA ); theCompanyisresponsibleforverifyingtheac curacyofinformationfurnishedbytheSouthAf ricanPoliceService; wheremypersonalhistoryrequiresbackground checkstobecarriedoutinothercountrieswher eIhaveworked,studiedorresided,mydatamayb etransferredtoandprocessedintheothercoun tries,wherethedataprotectionlawsmaynotbe asstrict; inprocessingmypersonalinformation,theCom panyorLNRM mayhaveaccesstopersonalinformationofmine thatissensitive,includinginformationabou tcriminalbehaviourrelatedtothecommission oforallegedcommissionofoffencesandmycred ithistory; ; theCompanyorLNRM maycontactmeandmyrefereesbytelephone,ema il,orpostforthepurposessetoutabove; verificationrequestsformpartofthebackgro undscreeningprocess.

3 Requestsforcreditinformationwillonlybeco nductedundertheregulationsoftheNCAanddat aobtainedfromtheFinancialSectorConductAu thorityservesonlyforthepurposesofdetermi ningthefitnessandproprietaryasenvisagedi ntheFinancialAdvisoryandIntermediaryServ icesAct37of2002; requestsforconsumercreditinformationwill beprovidedforthebelowprescribedpurposeso nly:oconsideringmeforemploymentinapositi onthatrequireshonestyindealingwithcashan d/orfinances(asperrelevantjobdescription );ofrauddetectionandfraudpreventionservi ces; forthepurposeofcriminalbackgroundchecks, ,whereavailable; thepurposeofbackgroundscreening,includin ganysocialmediachecks,isforconsideration oftheresultsbytheCompanyaspartofmyapplic ationand/ormysuitabilityforemployment; thesocialmediainformationthatmaybecovere dinthebackgroundchecksincludesallsocialm ediaaccountsofwhichIamamemberoruser, ,theCompany,refereesinmyCVand/orthedatap rovidersshallnotincurliability, ,LNRM andtheCompanywillnotbeheldliableforrelyi ngonanyinaccurate, (Place)OnDD/MM/YYYY(Date)Applicant/Guard ianNameConsultantNameApplicant/GuardianS ignatureConsultantSignatureLexis RefCheck Consent & Indemnity FormI Pg2