Sample Form

Full Name

Country

Address

Gender

Male Female Other Prefer Not To Disclose

Date of Birth

Proof of Status

Proof of Address

Confirmation of Information Accuracy

By submitting this form, I confirm that all information provided is accurate and true to the best of my knowledge (see conditions below)

Acceptance of Terms and Conditions

By submitting this form, you acknowledge and agree to the following terms and conditions:

Data Use and Privacy: You consent to the collection, use, and sharing of the personal information provided in this form as described in our Privacy Policy. This may include necessary communications related to the services requested through this form.
Accuracy of Information: You certify that all information provided in this form is accurate, complete, and up-to-date to the best of your knowledge. You agree to update such information as necessary to maintain its accuracy.
Compliance with Policies: You agree to comply with all applicable laws and regulations, as well as any additional policies and guidelines provided in connection with the service or product requested through this form.
Amendments to Terms: [Organization Name] reserves the right to amend these terms and conditions at any time. Your continued use of the service following any changes signifies your agreement to be bound by the revised terms and conditions.
Governing Law: This agreement shall be governed by the laws of the Province of Alberta and applicable federal laws of Canada.

Consent and Acknowledgment

By checking the box, you:

Acknowledge that you have read, understood, and agree to be bound by the above terms and conditions.
Consent to the data practices described in the Privacy Policy.

Indigenous Empowerment through Digital Connectivity