(To be printed on Client’s headed notepaper)
Consent for release and publication of Sensitive information/Records
to Relevant Third Parties
I ……………………………… hereby give
…………………………………… (name of Employer) consent to the release
of the Sensitive Information or Records listed below to Alcumus
SafeContractor and for Alcumus SafeContractor to publish it on the
SafeContractor portal.
I agree that my rights concerning access to and publication of my Sensitive
Information or Records have been explained to me, and that I fully understand
how this information relating to me will be used.
Personal Details:
Full name:
Full Address:
Date of Birth:
Post Code:
Telephone No:
Email:
Sensitive Information or Records
1…………………………
2…………………………
3…………………………
4…………………………
5…………………………
6…………………………
7…………………………
8…………………………
9…………………………
10………………………..
Signed …………………………………………
Date ……………………………
This document needs to be completed and returned as part of your information
submission that contains the relevant sensitive information.
Issued July 2016 version 3
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