CONSENT FORM

Complete Name:
Address:
Government issued ID:

Subscriber's Declaration
1. I hereby confirm that the foregoing information is true and correct, that supporting
documents attached hereto are genuine and authentic, and that I voluntarily
submitted said information and documents for the purpose of SIM registration.

2. I give you permission to disclose any information contained in the application to

accredited direct seller’s, PTEs, and NTC.

By checking the box, I agree to the collection and use of the data that I have
provided through this registration. I understand that the collection and use of this
data, which may include personal information and sensitive personal information,
shall be in accordance with the Data Privacy Act of 2012.

Sign over printed name

Date: