Claim

User Consent

I,__________,have engaged Tathastu Complete Healthcare Consulting, K 1101, Pragati Savvy Swaraj Phase 2, Off S G Road , Opposite Godrej Garden City,JAGATPUR, AHMEDABAD,Gujarat, 382470, and operating under the brand name “ClaimKar” to undertake preparation of reimbursement claim for [myself/family member having name [.]]. [I am duly authorized to provide sensitive personal data or information, and sign this consent form on behalf, of __________.]

As ClaimKar’s customer, we want you to know that we respect the privacy of your sensitive personal data or information. This consent is being obtained pursuant to the Information Technology Act, 2000, and Rule 5 of the Information Technology (Reasonable security practices and procedures and sensitive personal data or information) Rules, 2011, and is supplemental to ClaimKar’s privacy policy available at: http://localhost/claim/privacy-policy.

 

I understand that:

Having read and understood ClaimKar’s privacy policy available at http://localhost/claim/privacy-policy, and having understood the foregoing, I give my consent to ClaimKar to access and use the sensitive personal data or information provided.

Name: __________
Contact number: __________
Date: __________

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