Relatives Declaration Form -2

Employee Relatives Declaration Form I understand that working with relatives in the same department / area where they can influence each others work can potentially create conflict of interest and hence needs prior approval of Human Resources Department. In view of the above, I hereby confirm that:

o

I DO NOT have any relatives working in Samba Financial Group;

o

I DO HAVE relatives working in Samba Financial Group (give details below);

Name of Relative(s)

Relationshi p

Working Dept. / Unit

Note: Relative included in definition is Spouse, Children, Parents, Brothers & Sisters, Cousin, Parent-in-Law, Brother/Sister-in-Law Uncle, Aunt

I also confirm that in future if any of my relative joins Samba, I will make Human Resources Department aware of this in writing.

Name

Signature

Department

Cadre & Business Title

Location

Date