Annexure – XIV

(Undertaking on Medical Fitness & Responsibility towards untoward incident on Contractor’s Letter Head)

To Date: .

The Head – HSE

Vedanta Limited
Lanjigarh, Kalahandi

Sub: Undertaking on Medical Fitness and Responsibility towards untoward incident

We hereby undertake that the persons (in the attached list for temporary pass) are medically fit for work and
we shall be held responsible for any untoward incident taking place during the execution of the work by these
persons at site or any in-disciplinary action done by these person at the premises of Vedanta Limited, Lanjigarh.

Yours Faithfully

Authorized Signature of the Contractor with Seal.

Name:
Designation

Personal Declaration:
I declare that I am physically & mentally fit to work and I have no past health record which prevents/ advises
me not to work in any industry. I am agreeing with the above undertaking given by my employee.
Name of the Persons Signature of the Persons