KONSULTAMD FOR SG APPLICATION FORM

Company Name: ____________________________________________ Contact Number: _______________________

Authorized Representative Name: ______________________________________________
Authorized Representative Email Address: ______________________________________
Mobile Number: _____________________ Business Industry: _______________________
Name of After-sales Contact Person: ____________________________________________________
Email Address of After-sales Contact Person: ____________________________________________
Mobile Number: _____________________

KonsultaMD Subscription
Monthly Recurring Fee (MRF): NA
Quantity: 1 KonsultaMD for 6 months

By completing this form and the attached list of employees to be enrolled in the KonsultaMD Service, Customer hereby
confirms the accuracy and completion of the information given and warrants that the consent of the persons whose names
appear in the list have been obtained for the collection and processing of their personal data for the purpose of their enrolment to
the KonsultaMD service.

Customer further confirms that the KonsultaMD Service shall be provided to its enrolled employees subject to the following
terms and conditions:

TERMS AND CONDITIONS GOVERNING SUBSCRIPTION TO KONSULTAMD:

1. DESCRIPTION OF SERVICE
Service shall mean subscription to KONSULTAMD which is a 24/7 health hotline service manned by skilled and licensed
Filipino doctors who provide medical assessment and information, including basic healthcare and advice on permissible
medication over the phone.

2. OWNERSHIP
2.1 KONSULTAMD and any copyrights, trademarks, patents, trade secrets, intellectual property rights and other proprietary
rights in and to the Service are owned by Globe’s licensor and/or its Suppliers, and Customer obtains no right, title or
interest therein. Should the Service or the operation thereof become, or in Globe’s opinion is likely to become, the subject
of a claim of infringement, Globe may (i) procure for Customer the right to continue using the Service, (ii) replace or
modify the same so that it becomes non-infringing; or (iii) terminate this Agreement upon written notice in which event,
Customer will not be liable for pre-termination charges.

3. AFTER-SALES SUPPORT
For all billing and account-related support, Customer may email mybusiness.solutions@globe.com.ph Mondays to
Fridays, 8:00 a.m. to 5:00 p.m.

4. BILLING AND PAYMENT

Upon activation of enrollment to the KonsultaMD Service. Globe shall notify customer that its enrolled employees may
already avail of the Service. Billing shall commence upon such activation. The monthly recurring fee stated in the
Statement of Account (SOA) must be paid by the customer on or before the due date stated in the SOA. Globe has the
option to suspend the Service if the customer fails to pay the amount due, on or before the due date.

5. FORCE MAJEURE
Globe shall not be considered to be in default if its failure to perform any obligation hereunder is caused solely by
supervening conditions beyond Globe’s reasonable control, including, but not limited to, natural calamities, civil
commotion, strikes, labor disputes, fires, terrorist acts, or governmental demands or requirements; provided that any such
performance shall be completed as soon as commercially reasonable following the termination of any such supervening
conditions.
6. WARRANTY DISCLAIMER
6.1 KONSULTAMD is furnished on an "as is", as-available basis. Globe does not warrant that the Service will be
uninterrupted or error-free. All warranties of any type not expressly stated in the Agreement, express or implied, including
the warranties of merchantability and fitness for a particular purpose are expressly disclaimed.

Innove Communications, Inc. is a wholly owned subsidiary of Globe Telecom, Inc.

6.2 Globe shall not be liable for any loss, injury, claim, liability, or damage of any kind
resulting in any way from: (a) any errors in or omissions from the Service, (b) the
unavailability or interruption of the Service, (c) Customer’s use of the Service
(regardless of whether Customer received assistance from Globe or its licensor in
using the Service, or (d) Customer’s use of any equipment in connection with the
Service.

7. LIMITATION OF LIABILITY
7.1 In no event shall Globe and/or its Suppliers be liable for any consequential, incidental, indirect, special or punitive
damages whatsoever (including without limitation, damages for loss of profits, loss of use, business interruption, loss of
data or other pecuniary loss), in connection with this agreement, whether based upon contract, tort or any other legal
theory, including negligence, even if Globe has been advised of the possibility of such damages.
7.2 In no event shall Globe’s liability to Customer arising out of this Agreement exceed the total amount of fees actually paid
by Customer to Globe, or an amount equivalent to one year MSF, whichever is lower.

8. TERMINATION
8.1 Either party may terminate the subscription to the Service by providing written notice.
8.2 The termination shall take effect after the cutoff date of the then current billing period provided that Customer sends a
written notice to GLOBE at least 10 business days prior to the cutoff date.

9. ASSIGNMENT
Customer shall not assign or transfer his/her subscription to the Service without the prior written consent of Globe.

10. TERMS OF USE OF SERVICE

The terms and conditions published in https://www.konsulta.md/conditions governs the use of the Service by the enrolled
end-users of the Customer.

Conforme

___________________________________
Authorized Representative Name
Date of Signing:

List of employees to be enrolled in the KonsultaMD Service

Employee ID for Mobile No. Email Address First Name Last Name Gender
verification upon that will be
callout used for
KonsultaMD
subscription
1.)
2.)
3.)
4.)
5.)
6.)
Customer may change the list of Covered Employees. The change will take effect after the cutoff date provided that a written
notice of the change is given to Globe at least 10 business days prior to the cutoff date.

Innove Communications, Inc. is a wholly owned subsidiary of Globe Telecom, Inc.