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DECLARATION CUM UNDERTAKING

Date: 23/12 /2022

To,
The HR Manager
Cimpress India Private Limited (“Company”)
(Ahmedabad/Bengaluru/Mumbai) Office

I, Nirav Makwana, Employee ID: 10117256 hereby declare that the Electricity is in the name
of Family Member - LAXMIBEN BAGHABHAI MAKWANA who is my Grand Mother and we are
living with her. Please find the below details of the Electricity for your reference:

Name of Electricity: PASCHIM GUJARAT VIJ COMPANY LIMITED


Address on Bill (Present Residence Address of Employee):
BLOCK NO. C 2988
KALIBID BHAGAVTI PARK.
BHAVNAGAR
Gujarat

Bill Date: 03-12-2022


Bill Due Date: 13-12-2022
Bill Amount: 5705.22
Payment made by: (employee): Nirav Makwana

As per the company’s norms, I am claiming the Electricity Expenses to enable me to work effectively
from home.

I agree and undertake to indemnify the Company against any loss, damage, proceeding which the
Company might suffer due to any changes to the above-mentioned facts and any wrong submission
made by me.

In case you have any queries in relation to the above, you may contact me at 8141300390 or
nirav.makwana@cimpress.com

Regards,

Nirav Makwana

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