TAKING THE VACCINE IS VOLUNTARY; AMDOCS IS NOT BE RESPONSIBLE FOR ANY OUTCOME

WAIVER
I, the undersigned, of legal age, hereby state and attest to the following:

1. I understand that, to help curb the spread of the 2019 Coronavirus Disease (COVID-19), Amdocs
Philippines, Inc. (the “Company”) will be providing its employees and their dependents access to a
COVID-19 vaccine (“Subject Vaccine”) at no cost (the “Vaccination Program”) as a benefit.

2. I affirm that, after conducting my own research about the Subject Vaccine, I voluntarily and
knowingly request to be inoculated with the Subject Vaccine under the schedule to be set by the
Company by a third-party health facility/physician that will administer the Subject Vaccine. In this regard, I
fully understand that the Company does not warrant the efficacy and/or safety of the use and
administration of the vaccine, and I will assume all risks attendant to my inoculation of the Subject
Vaccine. I am not aware of any health consideration that prevents me from receiving the Subject Vaccine.

3. I consent to the collection, storing, and processing of any and all information required for
participation in the Vaccination Program and to administer the Subject Vaccine to me by the Company or
any of its authorized representatives, as well as to the disclosure of any information contained herein to
the government, health professionals, and other relevant third parties pursuant to applicable laws and
regulations, including data privacy law and regulations and all those enacted and issued in light of the
current COVID-19 pandemic.

4. I hereby release, remise, discharge and hold free and harmless the Company, its affiliates, parent
company, and each of their respective successors-in-interest, stockholders, officers, directors, agents or
employees, past or present , from any and all claims, causes of action of any kind or nature, liabilities, sum of
money, damages, and demands whatsoever arising wholly, partially, directly or indirectly, from my inoculation
of the vaccine under the Vaccination Program (the “Liabilities”), which in law or in equity I, my heirs,
successors or assigns, ever had, now have, or which I, my heirs, successors or assigns hereafter may have
by reason of any matter, cause or thing whatsoever, the intention hereof being completely and absolutely to
release such persons from any and all Liabilities.

5. I fully understand that the act of releasing the Company from any and all Liabilities is consistent
with law particularly, Section 8 of Republic Act No. 11525, otherwise known as the COVID-19 Vaccination
Program Act of 2021, which provides that employees, manufacturers, volunteers, and representatives of
duly authorized private entities who are duly authorized to carry out a COVID-19 Vaccination Program
shall be immune from suit and liability under Philippine laws with respect to all claims related to, or
resulting from the administration or use of a COVID-19 vaccine, save for an act amounting to willful
misconduct or gross negligence solely attributable to the Company and manufacturer of the Subject
Vaccine.

6. I undertake that neither I nor my heirs or assigns will institute or participate in any action against the
Company or any of the aforesaid persons, by reason of my inoculation of the Subject Vaccine.

I have read and fully understood this document and have affixed my signature hereunder voluntarily and
freely.

___________________________________
Signature

Print Name: _____________________

Address: ________________________
Date: ____________________________