To Whom This May Concern:
AUTHORISATION TO REQUEST INFORMATION:
I, the undersigned:
Identity Number:
Telephone Number:
Hereby authorize MAFORI INSURANCE BROKERS, FSP License Number 51562 to obtain any information on my behalf regarding my assurance and/or investment portfolio, and any of my employee benefits, from any life office, short term insurer, retirement fund, medical aid or other financial institution directly, or by using the services of The Financial Services Exchange (Pty) Ltd., trading as Astute.
I hereby give consent to any financial institution or employer in possession of information regarding my insurance / assurance, investment and employee benefits portfolio to release that information upon request directly to the person who is in terms of this document authorized to request it, or the authorized person via Astute. For this purpose, I confirm that the authorized person is acting on my behalf and/or my interest. It was explained to me, and I understand, that this consent may possibly have a restricting influence on my constitutional right to privacy.
This authorization shall remain valid for 12 months (365 calendar days) from the date of my signature.
