PETRONAS DECLARATION & INDEMNITY FORM FOR GIFT CARD REPLACEMENT To: The Manager of Card Operations, Customer Experience Department, PETRONAS Dagangan Berhad (hereafter known as PDB) In consideration of PDB processing the request for Gift Card replacement, |, (Name) of (NRIC*) _ (Residential Address) -~ (Contact Number) _. and (Email Address) _. — with the Gift Card number _ and the available balance of RM in the card, hereby declare that the card is belong to me and agree to indemnify PDB and save it harmless from any suits, actions, damages, liability, expenses, fees, including attorney fee, costs and judgments that may be asserted against PDB by another party who claims and proves that the card is belonged to him or her. PDB reserves our right to take legal action against you for falsely claim for the Gift Card replacement. *l agree to abide by the Personal Data Protection Act 2010, which can be viewed at www.mymesra.com.my/pdpa.” Name & Signature of the Gift Card Holder In the presence of a witness: (Signature) Name NRIC Address Date *This document must be supported with a copy of the signatory’s NRIC For Internal Use Verified by: Approved by: Name & Designation: Name & Designation’ Date Date: