CONSENT FORM

Dated ..................... of ......................... ,20.......

To: The Manager, Credit Bureau

C/o Cable and Wireless Jamaica Limited, Columbus Communications Jamaica Limited,
Dekal Wireless Limited (hereinafter collectively referred to as “FLOW” or C&W Business)

Re: Disclosure of my/our Credit Information

I/WE THE UNDERSIGNED DO HEREBY CONSENT AS FOLLOWS:

1. To the disclosure of my/our Credit Information to CRIF- NM Assure Limited and any other Credit Bureau licensed under
the Credit Reporting Act, to C&W Business.
2. To the disclosure by C&W Business of my/our Credit Information to CRIF- NM Credit Assure Limited and any other
Credit Bureau licensed under the Credit Reporting Act.
3. To C&W Business providing this signed consent form to Credit Bureau in Jamaica and any other relevant Credit Bureau
(pursuant to item (2) by electronic means.
4. To C&W Business to check my individual Credit Report.

5. This consent shall:

(i) Subsist for the duration of my application for this service and any future service or credit facility
which I/WE may have with C&W Business or apply for and so long as this credit facility or such
future credit facility shall subsist.
(ii) Remain valid and binding during the existence of any credit facility with C&W Business until the
credit facility comes to an end or upon termination of my/our relationship with C&W Business.
(iii) Be applicable to all credit applications which I may make to C&W Business for credit facilities
where I/WE am/are either the Borrower or Guarantor and /or for the purpose of facilitating risk
assessment for the granting of additional credit facilities.
(iv) Be provided to the credit bureau either electronically or manually.

COMPANY/ORGANISATION
Full Name Name

Address Registered Address

Taxpayer Registration No. Taxpayer Registration No.

Date Date

Name & Position

Authorized Signature

Name & Position

Signature /Mark Authorized Signature

I/We, ............................................................................................., hereby sign this Consent of Natural Person of my/our

own free will and volition the same having been read by/to me/us and I/We fully understand the implications of signing.

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Name of Customer Customer’s Signature

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Name of Witness* Signature of Witness

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Name of Customer Customer’s Signature

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Name of Witness* Signature of Witness

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Name of Director Director’s Signature

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Name of Witness* Signature of Witness