Financial Information Disclosure Consent Form

I hereby authorize the disclosure and sharing of my financial information as specified below. I understand the purpose and scope of this authorization, and my rights regarding this consent.

Personal Details

Full Name Email Address Financial Institution Account Number

Purpose of Disclosure

Information to be Disclosed

• Account balance
• Transaction history
• Income details
• Other (please specify):

Recipient(s) of Information

Consent Validity Period

From To