LOGO

<Company Name>

DECLARATION IN REFERENCE TO ACCEPTANCE OF POLICY AND PROCEDURES

I hereby acknowledge that I have been oriented on all HR policies, rules and regulations mentioned in
the HR policy manual. I understand and agree that these policies, procedures govern various aspects
related to my role and employment with <Company Name>

I have clearly understood all policies, procedures and associated terms, conditions. I hereby declare that
I would continue to follow, abide by all policies and procedures explained to me and the ones
mentioned in the HR policy manual with full honesty and good faith. I understand that I should consult
my supervisor or HR POC if I have any questions about the information contained in the HR policy
manual. I hereby acknowledge and agree that company may initiate disciplinary actions against
employees who are found violating company policies, procedures, code of conduct which may also lead
to termination of employment.

I also understand that this HR policy manual supersedes all previously issued handbooks, policy manuals.
From time to time, the company may change, modify, suspend, or cancel at any time, any terms
contained herein, in whole or in part, without having to consult with or obtain agreement from the
employee. The Company also reserves the right to make decisions involving employment as needed in
order to conduct its operations in a manner that is beneficial to the employees and the Company and
which complies with all relevant legislations. Since the information, policies, and benefits described in
the HR policy manual are subjected to change, I acknowledge that revisions to the HR policy manual
would be binding to me. All such changes will be communicated through official notices.

I promise to hold high, company’s business interest, corporate values and governing principles while
performing my duties. I would faithfully abide by all rules, regulation, policies and procedures related to
my role and employment with <Company Name>.

Employee Name:

Signature:

Date: Place: