Letter of Authorization SCH .pdf


Nom original: Letter of Authorization - SCH.pdf
Titre: Microsoft Word - Letter of Authorization - SCH
Auteur: sanjayrawat

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Confidentialité: fichier public


Aperçu du document


Letter of Authorization
I hereby authorize the Supreme Council of Health , Qatar or DataFlow , its authorized affiliates, agents and
subsidiaries acting on its behalf to verify information , documentation and back ground verification presented on my
application form including but not limiting to education , employment and licenses.
I hereby grand the authority for the bearer of this letter, with immediate effect, to release all necessary information to
the Supreme Council of Health , Qatar or DataFlow, its authorized affiliates agents and subsidiaries.
This information / documentation may contain but is not limited to grades, dates of attendance, grade point average,
degree/ diploma certification, employment title, employment tenure, license attained, status of the license, place of
issue and any other information deemed necessary to conduct the verification of the information / documentation
provided.
I hereby release all persons or entities requesting or supplying such information from any liability arising from such
disclosure. I am willing that a photocopy of this authorization be accepted with the same authority as the original. I
further understand and acknowledge that this Information Release From will remain valid for a period of two years
following its completion.

Personal Details:
(In BLOCK letters)
Full Name

: ____________________________________________________________________________
(Last / Surname)

(First Name)

(Middle Name)

Passport / Identity Card Number: _________________________

_________________
Signature

_________________________
Date (dd/mm/yy)


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