MEDICAL UNDERTAKING MARYAM ALBEWKAR Age 17, Soa Daughter of Sunil Alenka, do hereby declare tha: watt areqularbesis HH Geet sutter from any sisease. condition or eal ptoblemn ad on ta), Which needs MeaIeatio® on IV ARYAN ALBENKAR do heraby daciare tat tte fom a) b) 2) land need to take following medicines: 3) 3 6n a Fegulat basis, which are presctibed by Dr 31 Thaie enclosed herewith the attested photocopy of last / recent prescription. 4) further dectace that. Lhave not concealed any material information pertaining to my medical candition anc medication ‘thereo!. Incase of any deterioration in ry health arising nut of non-diseiaeure of my sediical condition, | declare that | will be Aisbl forthe same and SIU shall have ne liabity this regard S| further deciare that: | have not been allergic to any subistance, medicine or climatic condition 33-on today oR Thave been allergic: a) b) a 4 further deste that. il inform to the campus Medial Oficer of Symbiosis Centre of Health Care (SCHC) SOQuA al my Imecigal Gonditons and sty change io my mackcal condition and / 1 ay Resin problems those would Ores, age | yor Symbiosis 7 hereby willingly offer my consent ta Symbiosis ta Utlize my heath data fo analysis / research purpose #1 As per details submitted by me to SIU J Institute, | hereby confirm that, my blood gfoup isd we ‘understand that the conficentialty wall be duly maintained, Name of the Candidate: ARAN ALBENKAR Signature: Date; 25-Sep-2022 Place: Hague