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I represent and warrant that I have the authority to provide the information submitted in this form (including information in any attachments) to FUJIFILM Business Innovation Philippines Corp., and I give my consent for such information to be stored, used and/or disclosed by FUJIFILM Business Innovation Philippines Corp. for the purpose of investigating and/or responding to my inquiry/request. I acknowledge that I have read, understood and/or have been duly informed of the terms and conditions pertaining to the data privacy practices of FUJIFILM Business Innovation as reflected in the FUJIFILM Business Innovation Data Privacy Policy at https://www-fbph.fujifilm.com/en/Privacy-Policy and I hereby express my full conformity thereto.

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