CUSTOMER APPLICATION FORM

DECLARATION FOR AUTHORIZED SIGNATORY

I/We,

S. No Name of Partners/ Directors/ Member of Managing Committee

1.
2.
3.

hereby affirms and declares that the following person/s whose name/s and signature/s appear below
is/are the authorized signatory/ies of ________________________________________(Name of
Company), and may make cement purchases/accomplish Sales Order/s and submit the same to Eagle
Cement Corporation.

S. Name of Authorized Designation Signature Date Signed Place Signed

No. Signatory/ies
1.
2.
3.

This authorization is valid until terminated by us through a written advice received by Eagle Cement
Corporation to become effective thirty (30) days from receipt.

Signatures
S. No Name of Partners/ Directors/ Member Designation Signature
of Managing Committee
1.
2.
3.
 DECLARATION

By submitting this filled-up Application Form, the Customer is fully aware that ECC may receive
and have access to Personal Information and Data of the employees and personnel of the
Customer. The Customer hereby consents that ECC, its employees, personnel and
representatives will acquire, collect, store, use, process, share and distribute such Personal
Information to the extent and in such a manner as is necessary for the purpose of evaluating the
Application Form and the information contained therein. ECC shall (i) keep and maintain all such
Personal Information in strict confidence and with utmost care to avoid unauthorized access, use
or disclosure; and (ii) comply with all Data Privacy laws and applicable regulations. If the Personal
Information ceases to be required or necessary for purposes of the Application Form or under
any subsequent agreement between the parties, ECC shall promptly delete, destroy, remove or
otherwise dispose of all copies of such Personal Information that are in its possession or control,
as requested or as may be necessary.