Self-Declaration Form for COVID-19 Vaccination

I, Onkar Ashok Pawar, have taken 2 dose of COVID-19 vaccination and by sharing my
vaccination certificate I give IndiaMART InterMESH Limited my consent and right to store and
save the data related to my COVID-19 vaccination.

I assure that the above information shared by me is correct and in the event of any
misrepresentation of facts coming to light, the company reserves its right to take any action as
deemed fit.

Thanking you,

Yours Truly

Signature & Date: 25/02/2022