Authority to Release Information Form - Jun 2021

This form is used to authorize the release of personal information by individuals. This form is typically used when individuals want to grant permission for organizations or agencies to access and disclose their personal information. The form requires the individual to provide their personal details, specify the information to be released, and indicate the purpose of the release. Once filled out, the form should be submitted to the relevant organizations or agencies as specified.

Individuals authorizing the release of their personal information should fill in this form.

The completed Authority to Release Information Form should be submitted to the relevant organizations or agencies.