MEDICAL FITNESS - SELF DECLARATION

I __________________________________________________ hereby declare that I am medically fit and do not suffer from
any serious illness or infection or any terminal or infectious disease at the time of my appointment/employment with the
Company. I am conscious and aware that any incorrect/false or misleading information or suppression of information or
material omission of information about any of the MEDICAL condition may make me ineligible for employment and I would
be liable to be terminated or my appointment in the Company / letter of appointment would be called back and that at the
sole discretion of the Company, the Company may be free to initiate disciplinary action against me, if need be, as deemed fit
by the Company. I hereby authorize Indian School finance Company Private Limited to use this undertaking and also authorize
Indian School finance Company Private Limited to use the information contained herein for all purposes including contesting or
denying any claim or allegations against any authority in the name of and using my health condition. This authority can also be used
by Indian School finance Company Private Limited to deny or refuse any claim or allegations which I or my family members or legal
heirs or dependents may make against Indian School finance Company Private Limited or its officials.

Name (Mr./Mrs./Ms) :

Date of Birth : Age (in years) : Gender :

1. Height :
___________
2. Weight :
___________
3. Identification mark :
a) _________________________________

b) _________________________________
4. Whether wearing spectacle? :
______________
If so, what is the power :
______________
For how long you have been using :
______________
5. Blood Group :
______________
6. Do you have any existing injury or pre-existing injury : Yes/No

7. Any sickness suffered needing : Yes/No

rest/recuperation/treatment for above 15 days at a time,
so far? (If yes, provide details of the sickness)
Declaration

I, ………………………………………………………………, do hereby solemnly affirm that the information provided herein above by me is true and
correct in every respect and complete to the best of my knowledge and no information concerning my past or present state of
health has been withheld or concealed.

I, hereby declare that I am medically fit and do not suffer from any serious illness or infection or any terminal or infectious disease at
the time of my appointment/employment with the Company.

I hereby agree and also undertake to undergo any health assessment or medical examination by a medical practitioner, as and when
called upon or prescribed by the Company, if deemed necessary by the Company at any point of time before or after my
appointment and during the tenure of my appointment in the Company.

I am conscious and aware that any incorrect/false or misleading information or suppression of information or material omission of
information about any of the question mentioned herein may make me ineligible for employment or if employed I would be liable to
be terminated or my appointment in the Company / letter of appointment would be called back and that at the sole discretion of
the Company, the Company may be free to initiate disciplinary action against me, if need be, as deemed fit by the Company.

Signature : ______________________

Date : __________________________

1|Page Medical Fitness - Self-Declaration