By signing below and submitting this form you:

• reasonably believe that you will be eligible to participate in the action;
• warrant that;
  • the information you have provided is true and correct; and
  • you will not sign-up or register using any false or misleading details;
• hereby execute and agree to be bound by and comply with the terms of the;
  • Retainer Agreement
  and consent to us entering the information you have provided to us into those documents
• have been given the opportunity to obtain independent legal advice as to the nature and effect of the Retainer Agreement, and you agree to be bound and comply with the terms of our Retainer Agreement.;
  • after obtaining, and in reliance on such independent legal advice; or
  • having elected not to obtain independent legal advice; and
    • you have read and understood the nature and effect of our Retainer; and
    • you do not require any explanation or advice in relation to those documents;
• consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and
• consent to receive further communications from us regarding any continued participation in the action.