Covid-19 Vaccination Status Declaration

If there is any change to the vaccination status from your initial declaration until you join us, you may send an
updated declaration to recruitment.singapore@xe08.ey.com.

Q1 Which of the following describes the progress of your Covid-19 vaccination?

Fully vaccinated (by Singapore’s Ministry of Health’s definition) – more than 14 days after completing
vaccination regimen (2nd dose).

Fully vaccinated (2 doses and 14 days had passed) <skip Q3>

Vaccination booked/in progress <skip Q3>
Yet to book any vaccination appointment <skip Q2>

Q2 When will/did you receive your 2nd dose of Covid-19 vaccines?

Please input date <30/09/2021>:
Q3 Are you medically ineligible for Covid-19 Vaccination?
For “Yes”, refer to footnote and attach supporting document in your email reply
*Yes
No

*Medically Ineligible for COVID-19 Vaccines

If you are medically ineligible for COVID-19 vaccines, you are required to obtain a ^VDS Concession (link) by
visiting any General Practitioner (GP) clinic, or public or private healthcare institution to be certified as
medically ineligible. Concession is subjected to meeting the criteria articulated in Annex B. Please attached
this certificate as your supporting document.
Declaration

By submitting this Form, I hereby declare that all information given in this declaration is true, correct,
complete and had understood and agreed to the above.

You also agree that EY and other member firms of the EY network may, collect, use and disclose your personal
data as provided in the questionnaire for the following purposes in accordance with the Personal Data
Protection Act 2012 and Personal Data Protection Act 2012 and EY Data Privacy
Statement (https://www.ey.com/en_gl/privacy-statement ).

This information will be kept strictly confidential and will be used to manage operational excellence.

Full Name: Ochedikwu Jonah Onche

Signature: Date: 20-05-2022