TO WHOM IT MAY CONCERN
I, the applicant, hereby authorise the ACT Government to provide details of all traffic and licence history records recorded against me to:
My Representative Name: ANITA NOLAN
Organisation: ELITE SCREENING AUSTRALIA
Postal Address: P.O Box 636, Toowoomba City, QLD 4350
Individual’s Declaration and Warranty
I declare and warrant that:
I am the person referred to in this Authority to Release Information Consent Letter.
All the personal details are my personal details and are true and correct.
I agree for Elite Screening Australia to collect my personal information in accordance with their privacy policy.
I acknowledge and agree to the Elite Screening Australia terms of use.
I authorise Elite Screening Australia to submit my search of record application form to the ACT Government on my behalf