To,

The Centre In-Charge,

Ipsaa Holdings Pvt Ltd,

_____________________________ (Center)

______________________________(City)

Dear Madam,

Declaration Cum Indemnity

We ___________________________(name)are parents of Ms/ Master______________________________. We shall be

sending/dropping our child at your center w.e.f ______________________for Day care.

In this connection we hereby declare that neither the child nor any of our family members nor
servants/maids/drivers coming to our residence or attending the child are suffering from Covid-19
or any other contagious virus and have any recent (Less than one month) history of Covid-19
infection.

We further undertake that we shall not send/drop our child at the center if we get information that
anyone in our family or servants/maids/drivers have been infected and shall always keep
Aarogaya Setu app duly updated and installed in our mobiles and shall show the latest status
everyday before leaving and picking-up our child from the daycare premises.

We also undertake to indemnify Ipsaa Holdings Pvt Ltd if someone suffers/is infected/ because of
the infection of our child in future.

We further undertake that in case the child is infected by any ailment/infection, we shall not hold
ipsaa Holdings Pvt. Ltd responsible for any claims.

Yours Sincerely

Parent's Signature