BHBW Release Form

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) (v1.0)

Please note that in terms of section 69 of the Protection of Personal Information Act, 2013 (Act No. 4 of 2013) (the Act), the processing of your personal information as a data subject for the purpose of direct marketing by means of any form of electronic communication, including automatic calling machines, facsimile machines, SMSs or e-mail is prohibited unless your written consent to the processing is given.

Select consent type:*

Release Form (for the processing of personal information)Direct Marketing ConsentBoth Release Form and Direct Marketing Consent

I hereby consent and authorize BHBW South Africa Proprietary Limited (“BHBW”) and any of its subsidiaries, suppliers, consultants and affiliated companies to use, reproduce and/or publish photographs and/or videos that may pertain to me alternatively containing any of my personal information. I further consent to the reproduction and/or publishing of any testimonials provided by me. I understand and confirm that these photographs, videos and testimonials may be used in various publications, trade publications, public affair releases, employee portals, corporate videos, recruitment materials, product updates, promotions, marketing, demonstration events or for other related endeavours as required by BHBW, including BHBW’s website at www.bhbwholdings.co.za, any websites of a BHBW principal or BHBW dealer as well as BHBW’s social media pages. I confirm that the consent contained in this document is freely given and I have not been induced in any way into doing so. I indemnify and release BHBW and its employees from any and all liability which may arise from the use of any personal information referred to in this form. I further confirm and agree that BHBW may use any of my personal information contained in this form alternatively make reference to me for purposes of promoting BHBW alternatively any of its associated brands. I further confirm that if I am providing this consent on behalf of a juristic entity, I am authorised to do so. I confirm that all consent provided in this form is perpetual in nature and may only be withdrawn by my specific written request to BHBW’s Deputy Information Officer (DIO) Taryn Macintosh at tmacintosh@bhbw.co.za.

Kindly confirm*

Yes, I do give consentNo, I do not give consent

I confirm that I consent to communication via the following form of communication:*

E-MailSMSWhatsAppOther - Please Specify

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Full Name*

First NameLast Name

Date*

Date

I further confirm that clicking “submit” on this form constitutes my acceptance and confirmation of same.