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SCHEDULE 6

AUTHORIZATION FOR RELEASE OF INFORMATION, AND RELEASE AND HOLD HARMLESS PMI FROM LIABILITY

I authorize Philip Morris Products SA and/or its agents as defined below (the “Company”) to: collect, process, and verify certain individually identifiable information about me (“personal data”), including education, employment/work history, and credit history, contact personal references, and search criminal history record information pertaining to me, as well as any business (Partnership, Sole Proprietor) concerns I am connected to and/or receive an investigative consumer report which can include credit standing, credit capacity, character, and/or general reputation. Also, I acknowledge and confirm that I am capable of understanding communications provided in English.

I understand that this may include personal data for the purposes of applicable legal principles (which may include national data protection legislation and/or other applicable laws) and do hereby consent to risk assessment. The Company will use personal data to evaluate the accuracy of information submitted and to evaluate professional qualifications, experience, trustworthiness, and character and assess my or my company’s capability and suitability to perform vendor services. As part of this process, I understand my personal data may be transferred outside the country of my residence (and/or, if inside the European Union, to outside the European Union), for which I give my consent. Security and access to my personal data will be given only to those who need such access for the purposes specified or where required by law, and will be kept confidential.

I have read and understand this authorization for release of information, and I authorize the background investigation which could include consumer report/investigative consumer report and verification. I authorize persons, schools, current and former employers, and other organizations and agencies to provide the Company with any information that is requested, and I hereby release and hold harmless all of the persons and agencies providing such information from any and all claims and damages connected with their release of information. I agree that any copy of this document is as valid as the original.

I further agree to forever release, discharge, and hold harmless the Company, its agents, directors, employees, subsidiaries, affiliates, and representatives from any claims, damages, losses, liabilities, costs, and expenses (including attorney and legal fees), or any other charge or complaint filed, arising from the retrieving, reporting, and using the information referred to above.


I HAVE CAREFULLY READ, FULLY UNDERSTAND, AND VOLUNTARILY SIGN THE ABOVE AUTHORIZATION, RELEASE AND HOLD HARMLESS PROVISIONS. I UNDERSTAND THAT THIS IS A BINDING LEGAL DOCUMENT AND SIGN IT KNOWING THAT I ASSUME ALL RISK AND RESPONSIBILITY ASSOCIATED WITH THE INFORMATION BEING RELEASED, REPORTED, AND USED.

Date: xDatex

Name: xNamex

Signature: xSigx

Date of birth: xDobx

Identification number: xIDx