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Authorization of Disclosure

Based on the commercially sensitive nature of my existing (or prospective) position with the LOM Group of Companies, I hereby authorize the LOM Group or its agents to conduct such reasonable due diligence on my background as the LOM Group sees appropriate; and I hereby authorize third parties requested by the LOM Group or its agents to disclose information for this purpose. Please provide the following for the purposes of disclosure.

I understand that falsification, misrepresentation or omission of any information whatsoever supplied to the LOM Group of Companies may prejudice my application of employment or constitute grounds for immediate dismissal.

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