PERSONAL DATA CONSENT FORM

In order to enable your access to and use of the PSPhere service offerings and features on http://pspherehome.dkshpsp.com.sg (the “Site”), and subsequently to continue performing the contractual agreements entered between you and DKSH Singapore Pte Ltd. (“DKSH”), DKSH may need to disclose the personal data of the individual(s) named above to our affiliates, group companies, subsidiaries and other authorized third parties. The third parties we disclose the personal data to may include but not limited to (1) governmental, supervisory and regulatory bodies such as the Banks, the Ministry of Public Health and Medical Councils; (2) our business partners such as healthcare service providers, pharmaceutical companies and medical device companies; and/or (3) agents and/or outsourcing vendors (collectively, “External Parties”). These External Parties may locate, store, maintain and/or process the personal data within or outside of Thailand.

We are required to obtain your consent when collecting the personal data, unless exempted under Personal Data Protection Acts(the “PDPA”). Specifically, we are also required to obtain your explicit consent when we collect sensitive personal data, unless exempted under the PDPA.

DKSH’s latest Privacy Policy can be accessed here http://pspherehome.dkshpsp.com.sg.

DECLARATION OF CONSENT

By agreeing to this this form, I am declaring that I have read, understood and agreed to terms of the Privacy Policy http://pspherehome.dkshpsp.com.sg, and I hereby expressly consent to and authorize DKSH:

1. To request for and to obtain all the personal data required for the purpose of enabling my access to and my use of the PSPhere platform on the Site and all other purposes which are required in relation to my contractual arrangements with DKSH;

2. To disclose the personal data of the aforementioned individual(s) to the External Parties;

3. To anonymize my personal data for further processing; and/or

4. To collect and process the sensitive personal data of the aforementioned individual(s) (where applicable).

By signing this form, I represent and warrant that all personal data that I have provided are all true, up-to-date and accurate, and that I have read and understood all of the above provisions. Should there be any changes to any of the personal data, I shall notify DKSH immediately.

SIGNATURE

DATE