COVID-19 Self-Assessment Declaration

COVID-19 Procedure Self-Assessment Declaration for Return to Work

Name:ANISUR RAHMAN Employer :FRIENDS INTERNATIONAL SDN BHD

These questions are to be answered by every individual before returning to work at IQ, TRX, Kuala Lumpur.

1. Do you currently have any of the following symptom(s)?

☐ Fever ☐ Dry cough ☐ Body aches ☐ Headache
☐ Sore throat ☐ Runny nose ☐ Tiredness ☐ Shortness of breath
☐ None of the above

2. Have you have had any fever or sickness in the last 14 days?
☐ Yes ☐ No

3. Have you been in contact with a confirmed Covid-19 patient in the last 14 days?
☐ Yes ☐ No

4. In the past 14 days, have you been in close contact with anyone who has been placed in self-isolation or mandatory
quarantine as required by government authorities / whose ability to attend work or associate with the public has been
restricted by a government authority?
☐ Yes ☐ No

5. Have you been outside your city of residence in the past 14 days?
☐ Yes ☐ No

If yes, please indicate area(s) travelled to:

6. Have you been outside your country of immediate residence in the past 14 days?
☐ Yes ☐ No

If yes, please indicate the country(s):

7. Do you live in an area where a spike in Covid-19 cases has occurred within the past 14 days?
☐ Yes ☐ No

ANISUR 13.09.2021 MD JALAL

Signature over Printed Name Date Manager

The information I provided above are true and correct and I acknowledge that I can be held liable for any inaccuracy therein.

I give my permission for this data to be held by JLL. I understand that the data shall only be used internally by JLL to determine my possible exposure to COVID-
19 (if any) and for contact tracing purposes. As part of the government-mandated SOP, temperature will be taken at least once a day and recorded. Records will
be kept for a minimum of 3 months. This will also apply for information obtained from screening of Covid-19 symptoms on a daily basis. JLL may also collect and
record any data that is required by the government from time to time. The data will not be used by JLL for purposes not allowed by law or shared with 3rd
parties, except as otherwise required by regulations.

For more information on how JLL processes and manages your personal information, please view our relevant privacy policies and privacy statements available
from www.jll.com.

Saya mengaku bahawasanya segala maklumat yang saya telah berikan adalah benar dan betul dan jika didapati bahawa ianya tidak benar, saya bertangunggjawab
atas kesilapan saya. Saya memberi kebenaran untuk maklumat ini disimpan oleh JLL dan saya faham bahawa maklumat ini akan digunakan oleh JLL sahaja bagi
memastikan kemungkinan saya dijankit COVID-19, dan juga untuk tujuan penjejakan hubungan-hubungan saya. Sebagai salah satu daripada SOP kerajaan, suhu
badan akan diambil sekurang-kurangnya satu kali sehari dan akan direkod. Rekod akan disimpan sekurang-kurangnya untuk 3 bulan. Ini juga termasuk maklumat
yang diterima dari saringan symptom Covid-19 yang akan dibuat setiap hari. JLL mungkin juga akan mengumpul dan menyimpan maklumat lain yang dikehendaki
oleh kerajaaan dari semasa ke semasa. Maklumat ini tidak akan digunakan oleh JLL untuk diberikan atau dipinjam kepada mana-mana pihak mengikut undang-
undang kecuali yang dimandatkan oleh kerajaan. Jika anda menginginkan maklumat lanjut tentang bagaimana JLL memproses dan menyimpan maklumat peribadi
anda, sila layari laman web kami www.jll.com dan baca dasar-dasar sulit dan kenyataan-kenyataan sulit kami.