Letter of Acknowledgement and Consent for Collection, Use, and Disclosure of Personal Data

MEDEZE Group Public Company Limited will collect and use your personal data for the benefit of providing services
to you. In order to use such personal data in accordance with the Personal Data Protection Act B.E. 2562, we are required
to receive your written consent. MEDEZE will use your personal data for only purposes that you give consent.

Please mark in the Consent column as follows;

Personal Data Purpose Consent

Full name, address, phone To evaluate the quality of the products and services which you Consent
number, and e-mail, spouse’s may use, to consider benefits under the contract specified, to collect
data (if any), national ID card or the service fees and/or other liabilities (if any), as well as renewals,
passport, and health information. changes, amendments, and cancellation of the contract.

Full name, address, phone To provide you the information of our latest products and services Consent
number, and e-mail including marketing data analysis. Do not Consent

To inform you the promotional and marketing content of our products Consent
and services, to advice and provide the information on relevant Do not Consent
matters including yours and your family’s healthcare, rewarding
or beneficial programs in non-profit activities and events which
you may wish to attend, thus, MEDEZE will provide your personal
data to our Marketing Department or affiliated companies.

To provide contents related to investment relations, public relations, Consent

communication, and various activities by building confidence and Do not Consent
understanding in the company's business and affiliated companies;
and MEDEZE will provide your personal data to investor relations
firms.

If you wish to withdraw the consent or suspect any unauthorized use of your personal data,
please contact us at +66 (0) 9 1599 9999 or e-mail info@medezegroup.com at any time.

By giving consent to MEDEZE for the purposes stated above, I have read and understood the personal data protection policy
in MEDEZE's Privacy Notice, and aware that giving or not giving consent does not affect the consideration of the contract or
the provision of MEDEZE's services to me. In addition, I acknowledge that I can easily withdraw my consent at any time through
the channels specified by the MEDEZE.

Client/consenter
( )
____/____/________

QF-43-02-42,R02 Issued date 01 OCT 2022