POPI Form 4

Application for the consent of a data subject for the processing of personal information for the purpose of direct marketing in terms of section 69(2) of the Protection of Personal Information act, 2013 (Act No. 4 of 2013) Regulations relating to the protection of personal information, 2018 [Regulation 6] To:

Staycold International (Pty) Ltd), 1 Kakie Strachan Road, Parys, FS 8595

Your Company

Address

Phone Number

Fax Number

Email

Name, address and contact details of responsible party
Full Name

Position

I am authorised to provide this information
By checking this box I am digitally signing this form
Date

PART B

herby

give my consent

To receive direct marketing from Staycold International (Pty) Ltd in relation to their products and services as well as general information and special offers by means of electronic communication. Signed at

this

Signature

By checking this box I am digitally signing this form