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 Working Dept. / Unit

p

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