Consent Form

Permission to use Image and/or Testimonial

Dear Sirs:

I/We understand that the Amicorp Group (which term will include and any connected companies forming part of the Amicorp Group of Companies, hereinafter referred to as the “Group”) wishes to use my image and/or testimonial for the purposes set out below.

This letter is to confirm that:

1. I/We grant the Group my/our expressed and unconditional permission/consent to use our corporate logo, brand and/or service mark, contact details/my name, image, films, recordings, contact details and/or testimonial (“Materials”):

1.1 Free of any remuneration, compensation, royalty or charges,
1.2 Throughout the world without any limitation of territory,
1.3 For any of its commercial or non-commercial purposes publicly on participating websites, in all and any media (digital or print materials including, without limitation, in the Group’s printed publications, presentations, promotional materials, and website, whether now existing or hereafter created), in the advertising or communications of the Group’s services or its corporate responsibility actions, advertisement, communications and promotions of Goals 4 Kids 2015 Tournament (“Specified Purposes”), and
1.4 in its original format or edited or altered in any way which the Group deems appropriate.

2. I/We do not object to the Group and irrevocably consent to the Group:

2.1 Storing copies of the Materials and/or endorsement for the Specified Purposes; and

2.2 Transferring the Materials to a destination outside the country where my workplace/ our office is located.

3. This agreement and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims) shall be governed by and construed in accordance with the law applicable in Curaçao . I irrevocably agree that the competent courts of the city of Curaçao shall have exclusive jurisdiction to settle any dispute or claim that arises out of or in connection with this agreement or its subject matter or formation (including non-contractual disputes or claims).
We hereby forever release and discharge the Group, and its respective members, officers, employees, customers and representatives from any and all claims, demands, actions, liabilities and damages whatsoever arising out of or attributable to, in whole or in part, the use of the Materials.