VT001 12-05-2020 \VEMBSYS TECHNOVATION PVT. LTD. Date : 2.05.2020 COVID 19 Free declaration |, Karthikeyan A hereby certify, represent as follows: Within the twenty-one (21) days immediately preceding the Date of this Health Declaration Form, 4.1 have not tested positive or presumptively positive with the Coronavirus or heen identified as a potential carrier of the COVID-19 virus or similar communicable illness 2. | have nol experienced any symptoms commonly associated with the Coronavit S. 3. | have not been in direct contact with or the immediate vicinity of any person | knew and/or now know to be carrying the Coronavirus or has been identified as a potential carrier of the Coronavirus. IR- 12.)o5]2020 Signature Date Mr.Karthikeyan A is working as @ senior calibration engineer in the Vembsys Technovation Pvt Ltd. The above declaration given by him is examined and verified. fe sJoase Authorized sigftat Date Address: 217,719A, Arcadia Building, Unitech tower, South City 2, Gurugram, Haryana 122018 Phone : 0124 405 9940 Property of VT Page 1