HERBALIFE INTERNATIONAL PHILIPPINES, INC.

26th Floor the Trade and Financial Tower, 32nd street

Corner 7th Avenue, Fort Bonifacio Global City, Taguig,
City 1634, Philippines
(02) 8555-2828 – Member Services
(02) 532547-25 – Member Services Fax
NAME CHANGE REQUEST FORM

Member’s Name: Herbalife Nutrition ID Number:

(Requestor)

Reason for change - please select one (attachments/information required to process request):

Marriage – Please attach copy of legal marriage certificate

Divorce – Please attach copy of divorce decree

Other – Please attach appropriate legal documentation and specify reason for change:

In order to process your request, Herbalife Nutrition requires that you attach a copy of your new social
security card or Individual Taxpayer Identification Number (which reflects the name indicated below) in
addition to the above-required documentation.

Name should appear as (please indicate in capital letters – 50 characters or less):

How would you like your name to appear for recognition purposes (if different than above)?

Privacy Statement:
By signing this form, I acknowledge and consent that Herbalife Nutrition shall collect and process my personal data provided in or with this form for
the purposes of processing my request, fulfilling all legal and contractual requirements, and other business purposes described in its privacy policy
in accordance with the Republic Act No. 10173, otherwise known as the “Data Privacy Act of 2012” (“DPA”), and all regulations, orders, notifications,
and other subsidiary legislation thereunder, and as set forth in its privacy policy located at https://www.herbalife.com.ph/footer-pages/privacy-policy/,
which forms an integral part hereof, as consistent with the DPA. I have read and understood the privacy policy and understand that Herbalife
Nutrition will retain my personal data for as long as necessary for the purposes for which it was collected, or as long as required by law. I consent
that Herbalife International Philippines, Inc. may share my data with Herbalife International of America Inc. and its affiliates, subsidiaries, related
parties, associates, and third parties pursuant to its privacy policy and the Rules of Conduct and Nutrition Club Rules which may be accessed at:
https://www.myherbalife.com/ed/en-PH/pages/DocumentsAndPolicies/policies.html. I have the right to request access to my personal data and to
amend or update inaccurate or incomplete personal information, request deletion of my personal data or request that Herbalife no longer use my
personal data in the manner as set out in the privacy policy. I may email privacy@herbalife.com or call Member Services at (632) 8555-2828 to
make a request. I further understand that if I have concerns about Herbalife’s collection and use of my personal information that Herbalife cannot
resolve to my satisfaction, I have the right to lodge a complaint before the National Privacy Commission.

Member’s Signature Date Telephone Number

DS NAME CHANGE - RP
Revision: 03/11/2021