PD122rA Opt Out form

Opt-out Notice Company

This document is an opt-out notice under Regulation 32 paragraph (9) of the Conduct of Employment Agencies and
Employment Businesses Regulations 2003 as amended (the Conduct Regulations) and is:

FROM
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*(See Footnote 1)

of (the Consultant Company)
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*(See Footnote 2)

TO LA International Computer Consultants Limited (company no. 01633646), whose registered office is at
International House, Festival Way, Stoke on Trent, Staffordshire, ST1 5UB, whether acting as an employment
agency or employment business (LA International)

DATE
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RE
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*(See Footnote 3)

1 The Consultant Company hereby consents to LA International informing the following persons prior to the introduction
or supply of the Consultant Company/ Consultant to such persons (or at any time) that the Consultant Company has
given notice:

the hirer (the First Hirer) and any intermediary to which LA International first introduces or supplies the Consultant
Company and the person who will be supplied to carry out the work (the Consultant) for a position or assignment
(the First Engagement); and

the First Hirer, any other hirer (each a Subsequent Hirer) or any intermediary to which LA International may
subsequently introduce or supply the Consultant Company and the Consultant for a position or assignment (each a
Subsequent Engagement).


2 This opt-out notice is given in respect of the following (subject to the notes set out in the Opt Out Notes attached to this
notice):

the Consultant Company freely agrees that paragraphs (1) to (8) of Regulation 32 of the Conduct Regulations
should not apply in respect of the First Engagement or any Subsequent Engagement; and

the Consultant Company has read, understands and agrees to be bound by the terms of this Opt Out notification.
In particular, the Consultant Company understands that by signing this Opt Out notification, the Consultant
Company agrees that the provisions of the Conduct Regulations 2003 shall not apply.


Signed for and on behalf of )
The Consultant Company ) ---------------------------------------------------------------------------------------------------------


*Footnotes:
1 Insert full Limited Company or Management Company Registered Name in the space provided directly above.
2 Insert full Limited Company or Management Company Registered Address in the space provided directly above.
3 Insert full Contractor name in the space provided directly above.