Financial Wellbeing Services – Participant Consent

Financial Wellbeing Services – Participant Consent
Participant's Full Name:

First NameLast Name
Participant's Date of Birth:

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant's Contact Number:
I, the undersigned, authorise COVEY to:

· Access and review my financial information as provided by me or my authorised representatives.

· Liaise with relevant third parties on my behalf for the purpose of providing financial wellbeing support.

· Provide me with tailored advice, budgeting assistance, and referrals to other support services where appropriate.

This mandate is limited to activities directly related to my financial wellbeing plan and does not authorise the provider to make financial transactions or commitments in my name without my explicit written consent.

This mandate will remain in effect no longer than is necessary for the specific purpose for which it was collected. All personal information will be handled in accordance with applicable data protection laws. I understand I have the right to request access to, correction of, or deletion of my personal data.

By signing below, I confirm that I have read and understood this mandate and that the information I have provided is accurate.
Participant's Full Name:

First NameLast Name
Type a question
Date:

MonthDayYear
Date
Should be Empty: