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Letter of Authorization
I hereby authorize the Dubai Health Authority or DataFlow Group, 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 grant the authority for the bearer of this letter, with immediate effect, to release all necessary information to Dubai Health Authority or DataFlow Group, 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 Form will remain valid for a period of two years following its completion.
(in BLOCK letters)
Full Name : GOROSPE JOAN ALYSSA SALEM
(Last / Surname) (First Name) (Middle Name)
Passport / Identity Card Number: EB3759694
Signature Date (dd/mm/yyyy)