LOCKOUT DISCLAIMER

Job Number:

To whom it may concern.

do hereby request and authorise a representative of the Company to provide one of the following services:

Entry/Access only - no keys to be cut Entry/Access as well as provide keys without changing the locks Entry/Access as well as provide completely new keys

To the premises listed below, which are OWNED / CO-OWNED / RENTED by myself:

I require this emergency service because:

I have locked my keys inside My Partner/Spouse/Co-Owner/Co-Director, etc has taken my keys I have lost my keys I left my keys for this property elsewhere Eviction or property seizure Other

I assure the Company that they are acting lawfully by providing me entry to this property, stating categorically that I am legally entitled and empowered to seek entry to this property.

I also state the action of my entry is in no way deceitful or fraudulent and does not infringe upon the rights of any other person or the property’s security, and such action does not in any way break the law.

I personally accept full and total responsibility for any liability and damages arising as a result of my entry if, in the events following, it is found that by asking the Company to provide me entry, I may have infringed on the rights of any other person in any way.

I make no claims against the Company and leave them free of and indemnify them against any future claims without prejudice or reservation.

I confirm my identity via photo ID proof given:

Type of identification used:Number:

Contact Telephone Number:Alternative:

Right to enter verified by:

I approve this authority of my own free will:

Customer Signature:

Sign with finger/stylus

Dated:

Witness Signature:

Witness signature

Witness name:

Dated:

Privacy Notice: The information collected on this form is used for verifying identity, confirming authority to enter the premises, recording the service provided, and emailing a copy of this disclaimer to Armstrong Smarter Security. This information may be retained for job records, invoicing, legal, and dispute resolution purposes. By submitting this form, you confirm the details provided are accurate and you consent to the form details and signatures being sent electronically.