HEALTH DECLARATION

I hereby declare and state that to the best of my knowledge and basis last conducted medical tests and consultations:
1.  I am physically and mentally fit for carrying out the job offer that I am accepting.
2. I have in the past been diagnosed only for the following ailments / disease/ physical condition mentioned in the table
below (State NA for Not Applicable).
Ailments / disease/ physical condition Yes / No Comments
High / low blood pressure-Pls specify type in comments -if yes
Any Hearing/Visual disability -Pls specify type in comments -if yes
Diabetes (medication/insulin dependent)
High Cholesterol
Any form of physical disability, deficiency or challenge
Any Ailments/Disease/Physical condition other than mentioned above (is specified below):
_______________________________________________________________________________________________
_______________________________________________________________________________________________,
3. I am currently only under the following regular medications
1. _____________________________________________________________________________________________,
2.______________________________________________________________________________________________
3.______________________________________________________________________ (State NA for Not
Applicable).
4. I also state that the above mentioned ailments / disease/ physical condition is a lifestyle management condition and well
within control and does not affect my day to day physical and mental fitness required for carrying out the job offer that I
am accepting. (State NA for Not Applicable). - _____.
5. I understand that clearing the medicals is a mandatory prerequisite for my employment with Vodafone Idea Limited.
6. I understand that due to the prevailing COVID 19 Pandemic, I am not subjected to the medical tests by Vodafone Idea
Limited due to risk of COVID 19 exposure.
7. I undertake unconditionally to undergo appropriate medical examination as per company standards and direction as and
when the company advises in future.
8. I further state that I have not been diagnosed for any other ailments / disease/ physical condition other than what has
been declared above by self.
9. I hereby indemnify the company against all and any claims or liabilities arising out of any ailments / disease/ physical
condition that is within my knowledge and willfully not disclosed by self.
C2 – Vodafone Idea Internal
10. Any other Voluntary Declaration
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

11. I also understand and accept that in the event of any ailments / disease/ physical condition that impairs my mental or
physical fitness that is within my knowledge and willfully not disclosed by self to Vodafone Idea Limited, Vodafone Idea
Limited is well within their right to Terminate my contract of employment with immediate effect upon gaining knowledge
of my willfully undisclosed ailments / disease/ physical condition.   

Name in Capital Letters: ____________________

Full Signature:____________________________
Date & Place:_____________________________

C2 – Vodafone Idea Internal