The document is a consent form signed by Demo Test on July 30, 2015. It authorizes any medical provider or insurer to share Demo Test's complete medical records with Travel Healthcare Insurance Solutions Inc. / guard.me International Insurance for administering claims. All information will be kept confidential and not released to other parties. Email will only be used for insurance inquiries unless Demo Test initiates contact. A photocopy or fax of the form is as valid as the original.