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I HEREBY CERTIFY that the information provided in this form is complete, true and correct to the best of my knowledge. FURTHER, I HEREBY ACKNOWLEDGE that I have read and understood the DHF Privacy Notice and agree there to as well. I give my consent to DHF to collect, use and process the information provided for mutual benefit. I understand that my consent does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under the Data Privacy Act of 2012 and other applicable laws.

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