Kindly take a few moments to complete this form as it will help us to get in touch with you in the unlikely event that contact tracing is required. All employees are required to complete this form prior to entering the MINI facility. Information collected will be kept safely and any personal information will not be disclosed unless as required by law or with the employee’s express consent. It will be kept safely and any personal information will not be disclosed unless as required by law or with the customer’s express consent.
* Required
Person to Visit *
Customer's Last name *
Customer's First name *
Customers complete address *
Contact cumber (Preferably mobile phone) *
Do you have a history of travel within 14 days?*
If yes, when and where?
Have you experience any respiratory symptoms (sore throat, runny rose, cough, shortness of breath) prior to your visit to our facility?*
Have you experienced any fever or chills prior to your visit to our facility?*
If yes,please specify the maximum temperature
Do you have any contact or exposed to someone who has suppected / probable / positive case of covid-19?*
If yes,when is the last date of contact/exposure?
Do you or anyone in the household have any of the above mentioned signs or symptoms or pending covid-19 test results?*
"By signing this form/document, I hereby acknowledge that British United Automobiles Inc., including its parent company, affiliates, subsidiaries, and related companies, as well as their respective officers, directors, shareholders, employees, agents, and other parties with which they do business (hereinafter collectively referred to as “Company”), may use and process all personal information that I have voluntarily and knowingly provided, including those that may be sensitive or confidential as may be disclosed by me, in any transaction or activity related to the Company for the purpose herein stated specifically for public health and safety purposes. Use and processing of Personal Information includes collection, recording, listing, systematization, accumulation, storage, updating, extraction, transfer, anonymization, blocking, deletion, destruction, whether through electronic means or otherwise.
I hereby release and forever discharge the Company, including its parent company, affiliates, subsidiaries, and related companies, as well as their respective officers, directors, shareholders, employees, agents, and other parties with which they do business, in their official corporate capacities as well as in their individual personal capacities, from any and all sums of money, or any other obligations, privilege, emolument, entitlement, and benefit arising from any and all incident, directly or indirectly related to, the use and processing of all personal and sensitive information. I likewise categorically declare that I do not have and will not institute any claim or cause of action in relation to the use and processing of personal and sensitive information by the Company.
