Source: AMS Inform Private Limited Version 2010 -1.

DISCLOSURE AND AUTHORIZATION

I ___________________________ ____________authorize the Employer (“Coromandel International Limited”) and AMS

Inform, an India based pre-employment screening agency, and its agents, to retrieve the necessary information and
prepare a pre-employment screening report. I understand and authorize that some or all of my information may be
transmitted electronically and when required maybe transferred across international borders. I understand that AMS
Inform may transmit my personal information to its agents and information sources as necessary through the course of
business and that host country and receiving country privacy laws will be observed if information is transferred across
international borders.

I understand that my background investigations will be based on information that I provide in my Employment
Application, Curriculum Vitae/Resume, Disclosure/Authorization and/or the information requested below (together
called “Source documents”). My Personal information will not be shared with any person, organization or company
other than those entities acting as an authorized agent of AMS Inform for the specific purpose of verifying the
information I provided unless required by law or I specifically authorize. I authorize AMS Inform to obtain, and the
information sources to provide the following types of information

Academic/Education Employment References Criminal History

I understand that a report may be prepared summarizing information from these categories and I authorize educational
institutions, employers, government agencies, credit reporting agencies, companies, corporations and law enforcement
agencies at the international, federal, state, provincial or county level to provide any and all information concerning my
background, If my prior employers and/or references are contacted, the report may include information obtained
through personal interviews regarding my character and general reputation.

I understand that all the information will be held by AMS Inform Private Limited/ AMS Inform Research Services
Private Limited : 301-302 Aditya Kaushambhi Plaza, Sector 14, Kaushambhi, Ghaziabad 201010 UP, India Phone : +91
120 419 7700

I authorize the Employer (“the company”) to procure a background check report about me from AMS Inform Private
Limited/AMS Inform Research Services Private Limited. I am willing that a photocopy of this authorization be accepted
with the same authority as the original.

Signature _________________________ Date: ________________________

Full Name _________________________ Date of Birth : _________________

(dd/mm/yyyy)