Pauls Homemade Ice Cream

Consent Form

I/We, the undersigned,

Full names of natural person / full registered name of juristic person(Required)

First Last

Hereby give my/our consent for the processing (use) of my/our personal information by Paul’s Homemade Proprietary Limited trading as Paul’s Homemade Ice Cream, for the purposes of carrying out the following (TICK APPROPRIATE BOX):

Opening an account as a wholesaler and applying for credit

Applying for employment

Other

Please Specify if other

This consent specifically includes the right to obtain and utilise my/our personal information as requested and required for purposes of giving effect to the above. This consent is furnished on condition that my/our personal information shall be used and processed in accordance with the Protection of Personal Information Act.

SIGNED AT

Date(Required)

Signature (who warrants that he/she is duly authorised to sign this consent form)