COLGATE- PALMOLIVE (INDIA)

LIMITED
MODEL RELEASE / CONSENT FORM

Program: Keep India Smiling (KIS) Foundational Scholarship Program

Through NGO/IP: ShikshaDaan and Buddy4Study

Regarding: Photoshoot / Video/Using both or either / Other requirements

Taken by ShikshaDaan and Buddy4Study On

__________30/12/2021___________________________

I Mr./Ms. Naman S/O / D/O DINESH KUMAR hereby

consent to the irrevocable worldwide use of my photographs/videos/footage/Testimonials taken
with respect to the KIS Foundational Scholarship Program by Colgate-Palmolive (India) Limited /
its affiliates ("C-P") in its advertising material across any media including without limitation,
product packaging, print (posters, banners, magazines, newspapers), company reports,
publications, television, Digital, internal communications, communication to the shareholders,
press shoot, promotional or education materials, POP or Internet at large including but not
limited to social media networking websites like Facebook, Twitter, etc.(“advertising material”)
without restriction as to frequency and duration of use.

I confirm that I had not modelled for any competitive oral care products. I relinquish and give C-
P all rights / interests in and to the Image/Visuals/ and acknowledge that the Image may be
modified or edited suitably by C-P in its advertising material.

I understand that my participation is strictly voluntary and that I will not be compensated for the
same / that I have been sufficiently compensated for the same.

I, for myself, hold C-P, its affiliates, officers, employees, directors harmless from all losses,
injury, damages, rights, claims and actions of any kind which may occur directly or indirectly in
connection with the image / referenced photo shoot.

I certify I have the full right to grant this consent. I understand that in consideration for this
consent, C-P may use the footage itself or authorize ShikshaDaan, Buddy4Study and/or other
affiliates in the manner described above.

Name : Naman Signature Naman

 COLGATE- PALMOLIVE (INDIA)
LIMITED

MODEL RELEASE / CONSENT FORM

I hereby declare that the information provided by me, on my Keep India Smiling (KIS)
Foundational Scholarship Program application form is correct, to the best of my knowledge. I
acknowledge that the terms and conditions in application form are understood by me clearly. I
commit to share my progress at required frequency and utilize the Mentorship Program to the
fullest to help build my capabilities and confidence as and when I am expected to go through it,
while keeping focus on my regular academics. I have clearly understood that C-P has all the
right to fix / change scholarship amount, category and duration and I will use the amount strictly
for “said” purpose and submit required documents/evidence.

I understand that if the information provided by me is found to be incorrect, I shall be liable to

refund the entire amount awarded to me by ShikshaDaan Foundation under the Keep India
Smiling (KIS) Foundational Scholarship Program. I acknowledge that ShikshaDaan Foundation
reserves the right to discontinue this Scholarship at any time without any prior notice to me due
to any false information / breach of above conditions and shall not be held liable for any
consequences thereof.

I have read and understood this consent and release clearly.

Date 30/12/2021

Name Naman

S/D/Guardian/of ________Dinesh Kumar___________________________________

Address: Bichpuri, near railway station, Agra , UP