Confirmation and Disclosure Form

PLEASE COMPLETE, SIGN AND As a condition of my employment with GBT India Pvt. Ltd. or one of its subsidiaries (the
DATE THIS AGREEMENT “Company”), I _____________________________(insert name)confirm that I have
FORM. received the Company’s code of conduct (the “Code”). I further confirm that I have read
the Code, understand it and agree to abide by it.
Further I confirm that I have completed My Code training.
PLEASE CIRCLE YOUR JOB
BAND BELOW: I understand that it is also my duty to report any violations of the code by myself or other
20 25 28 30 employees so that the Company can take appropriate action. I am aware that the
35 40 45 50 company provides various channels for reporting Code violations, such as Ethics helpline.
60 70 80 90 99 I confirm that I will disclose to the Corporate Secretary any outside position, investments,
business dealings, or other matters which the code requires me to disclose, including any
existing or potential conflicts of interest between my personal dealings or interests and those of
7-DIGIT EMPLOYEE NUMBER the Company, as defined in the Code, and any directorships, officerships or other postions I may
hold in commercial firms or organizations other than the company or one of its subsidiaries.
PLEASE NOTE: THIS FORM (In the space below, you must list such positions whether or not they represent a conflict of
CANNOT BE PROCESSED interest or have been previously disclosed, even if you serve at the request of or with permission
WITHOUT THIS NUMBER of the Company. There is no need to list positions held in charitable or community
organizations whose activities do not conflict with the interest of the Company and which do
not impose excessive demands on your time.)

I understand that I must promptly update these disclosures made pursuant to the code for new
matters that arise in the future.
I acknowledge that neither this Confirmation nor the Code is meant to supersede the regular
terms and conditions of employment with the Company or to constitute a contract of
employment.

Signature

Please Clearly Print your name below:

First Middle Initial Last

Relationships with Accounting Firms

All employees must check one or more of the boxes below:
GBT India external auditors are required to confirm their independence from GBT India pursuant to regulatory requirements. We
jointly seek to ensure proper compliance. Please check one or more of the box(es) below:
o I was a partner, principal, shareholder or employee of PricewaterhouseCoopers or any of its affiliated firms.
o I have a close family member (e.g., spouse, domestic partner, parent, dependent, nondependent child or sibling)
employed by PricewaterhouseCoopers or any of its affiliated firms.
o I have not been employed within the last three years by, nor do I have a close family member who is an employee of
PricewaterhouseCoopers or any of its affiliated firms.
NHG/V10.10.2017 4
GBT Internal