STATEMENT OF UNDERSTANDING AND AUTHORITY TO DEDUCT

I, _____________________________, from the ________________________(Department/Site),

understand that in accordance with my Employment Contract with Teleperformance (the Company), I am
required to submit all the pre-employment requirements as stated therein within thirty (30) days from
the execution of the said Contract.

I understand and acknowledge that my failure to submit the pre-employment requirements may
expose the Company to possible penalties and financial damage as may be meted by third parties,
including but not limited to government agencies. I assume all the risks and accept personal responsibility
for whatever damage that my failure to submit my pre-employment requirements may cause the
Company.

In such case and in order to pay the amount of penalties and/or damages contemplated by this
Statement of Understanding and Authority to Deduct, I hereby authorize the Company to deduct the said
amount from my salary until completely paid out, without need of any further written authority from
me, my heirs or my successors-in-interest.

Should I leave the Company or my employment therefrom be terminated for whatever reason
before I fully pay my debt, I hereby authorize the Company to deduct from my final pay any remaining
unpaid portion of the said amount without need for any further written authority from me, my heirs or
successors-in-interest.

I also hereby understand and agree that, notwithstanding this Undertaking, the Company may
exercise whatever administrative and legal rights and remedies it may have for the collection of this debt
including my separation from the company for negligence and the filing of an appropriate civil or criminal
action before the courts.

By affixing my signature below, I am expressing that I have fully read and understood the terms
and conditions of this Statement of Understanding and Consent Form and I am voluntarily entering into
this Agreement by giving my consent to the provisions herein without force or undue influence exerted
on me by any person or entity and I am fully aware of the legal and other ramifications of such fully
informed decision.

_____________________________________

(Printed name and signature)

Witnessed by:

________________________________ ________________________________