(NAME OF BENEFICIARY)

(Address of Beneficiary)
Malaysia

ACKNOWLEDGMENT SLIP

I/We (Name of Recipient / Beneficiary) received a total contribution amounting Ringgit Malaysia
(Two Hundred and Sixty-Five Thousand Only (RM265,000.00) dated (Insert Date) . This is
in reference to the “Anda Pam, Kami Derma” National Raya CSR Campaign 2019.

I/We (Name of Recipient / Beneficiary) undertake to Shell that in connection with such moneys /
in-kind donations, received from Shell that it will comply with all applicable anti-bribery laws.

I/We (Name of Recipient / Beneficiary) represents and warrants to Shell that it has not made and
will not make any payments and has not given or will not give anything of value to officials, officers or
employees of the government or to any agency, department or instrumentality of such government, or to
any other person, in connection with such expenditure which would be inconsistent with or contravene
applicable anti-bribery laws.

Received by : ……………………………………….
(Signature & Company Stamp)

Name : ………………………………………...

Position : ………………………………………...

Date : …………………………………………

Upon receiving the contribution, appreciate if you could acknowledge this slip and send to:

LOH SIYAN

Shell Retail Academy

No.6, Jalan Batu Tiga Lama,
Seksyen U1, Glenmarie,
40150 Shah Alam, Selangor.