Personal Credential Verification

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Personal Credential Verification

Permission and Indemnity Declaration

(A) COMPANY DETAILS (“The Company”)

To be completed by Company Agent – PLEASE PRINT

Company Name:	Financial Services Board	Email:	Mandlenkosi.hendricks@fsb.co.za
Branch Name:	CIS Department	Phone:	(012) 428 8089
Agent Name:	Mandla Hendricks	Fax:	(012) 346 6533

(B) CHECKS REQUIRED

Criminal by Name/ID	x		ID Number Validation		ID Number Verification	x
Qualification	x		Drivers License		Professional Drivers Permit
Employment Reference	x		Employment Register	x	Fraud Listing	x
Passport			Citizenship		Permanent Residence
Address Register			Deed Search		Sequestration
Directorship Search			Trade List
Credit TransUnion	x	** Reason Code Required! Please select a Reason Code from the list below
Credit Experian	x	** Reason Code Required! Please select a Reason Code from the list below

**	1. Employment in a position that requires trust and honesty and entails the handling of cash or finances…………….	x
	2. Verifying educational qualifications and employment ………………………………	x
	3. Fraud detection and fraud prevention services ………………………………	x

(C) PERSONAL INFORMATION

Surname:
Full First Names:
Maiden Name:		Date of Birth:

Primary ID No:

2^nd ID / Passport:

Res. Address:
		Code:

(D) QUALIFICATION INFORMATION

To be completed by Candidate – PLEASE PRINT

	(1)	(2)	(3)
Qualification:
Institution/School:
City / Address:
Date Obtained:
Student No:
Certificate No:
Exam No:

(E) INDEMNITY DECLARATION

To be completed by Candidate – SIGN and DATE

I hereby authorize the Company’s duly authorized verification agent, Managed Integrity Evaluation (Pty) Ltd (“MIE”), to forward any personal information as well as any information that I have provided in support of my application to verification information suppliers acting on behalf of MIE (including but not limited to the South African Police Services, the Government of the RSA, and any educational, training, credit bureau and fraud prevention organizations) for the purpose of verifying my personal credentials and records.

Authorized credential verification types include, but are not limited to, educational qualifications, professional membership, employment history, employment references, consumer credit, criminal record, drivers’ license, and fraud prevention checks.

I authorize Kroll’s verification information suppliers to furnish information regarding my credentials, whether claimed or not, to MIE and the Company. I unconditionally indemnify MIE and its verification information suppliers against any liability that may result from furnishing information in this regard.

I understand that it is a condition of MIE verification information suppliers that this information is furnished by them solely for the purposes of my proposed / continuation of employment via the offices of the Company and that any information that is furnished to the Company and MIE will be disclosed to me before a decision is made on my continued employment or application for employment.

				/		/
	CANDIDATE SIGNATURE		DD		MM		CCYY

As the enquiring Agent of the Company, and in the case that this form instructs MIE to provide consumer credit information, I hereby state that I understand the provisions of the National Credit Act (34 of 2005), section 70(2)(g), and the Regulations made in terms of the Act, section 18(4) and (5).

				/		/
	AGENT SIGNATURE		DD		MM		CCYY

All signatories to this document agree that MIE will NOT be held liable for the content, factual correctness or accuracy of any Supplier Data supplied to Kroll for the Company by Kroll’s suppliers. The Company and the Candidate hereby indemnifies and holds Kroll harmless against any loss arising from neglect or damage in procuring, communicating or failing to communicate information to the Company

Personal Credential Verification

Criminal by Name/ID

ID Number Verification

Professional Drivers Permit

Fraud Listing

Permanent Residence

Credit TransUnion

x

Credit Experian

x