WP E-Signature by Approve Me - Sign Documents Using WordPress -

Submission to Inquiry

Name of Inquiry *

Title or Rank *

Given Names *

Surname *

Post-nominals (if applicable)

Street Number and Name *

Suburb *

Postcode *

State *

Email Address: *

Primary Contact Number *

Secondary Contact Number

Is the Submission on behalf of an organisation? If yes, please provide details:

Provide a summary of your submission:

✔

✔ I also consent to the Defence Honours and Awards Appeals Tribunal:

using information contained in my submission to conduct research;
providing a copy of my submission to a person or organisation considered by the Tribunal to be appropriate; and
providing a copy of my submission to a person or organisation the subject of adverse comment in the submission;
using content in my submission in its report to Government.

The Tribunal will decide which person or organisation is appropriate, and this may include:

✔ I declare that the information I have provided is correct.

Name

Date

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

23 October, 2020 9:52 am AEST

Submission to Inquiry Uploaded by Defence Defence Honours Tribunal - DHA.Tribunal@defence.gov.au IP 110.175.137.214