TO WHOM IT MAY CONCERN
I, the applicant, hereby authorise the QLD Department of Transport and Main Roads 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 release of information application form to the QLD Transport Department on my behalf