Consent Form

Need us to open a case with a federal government agency on your behalf? Fill out the form below to give us permission to work on your behalf!

Please note that if you need help with an immigration issue we have specific consent form linked in the main menu.

Our office may only assist constituents of Richmond Centre–Marpole – to ensure you are a resident of Richmond Centre–Marpole please verify your postal code here.

Full Name:

First Name*

Last Name*

Address:

Mailing Address*

City*

Postal Code*

Date of Birth:

Day

Month

Year

Contact Information:

E-mail

Phone*

Issue*

Comments

Consent:

I hereby request that the office of Chak Au, Member of Parliament, assist me with the issue stated above.

For this purpose I authorize the office of the Member of Parliament Chak Au and/or his representatives to consult the necessary government departments or agencies on my behalf and for the government department/agency to release any and all information in my file to the Member of Parliament and his staff. MP Au and his representatives may use and share with government officials any and all personal information and documentation, including correspondence, which I have provided to him or his representatives to the extent necessary in their efforts to assist me.

I agree