Undertaking/Declaration of Intent

I, ______________________________, __________________ of legal age and of sound mind, hereby declare that:
Full Name Nationality

1. I am an employee of Henkel Asia Pacific Centre (hereinafter referred to as the “Company”)

2. I am physically fit to join Movement: Moving More for our Mental Health 2024 and participate in
recreational activities.
3. I will join the Company’s Movement: Moving More for our Mental Health Activity to be held at
Ayala Triangle, Makati on May 19, 2024, from 7AM to 9AM.
4. I shall act responsibly during the said event. I further agree to be personally liable for any damage,
harm, or injury that I may cause due to negligence.
5. During the event, I shall willingly follow all rules and regulations formulated by the Company
governing our discipline, safety and proper enjoyment.
6. In the absence of fault or negligence on the part of the Company, I hold the Company free and
clear from any and all liability arising from incidents or accidents involving myself and my respective
dependents that may result to injury, death, or damage to myself or to any other participant of the
event, or to third parties.
7. Should any change in my personal circumstances occur, which may affect or tend to affect my
capacity to participate in the said event, I shall immediately inform my department representative so
that the Company may take the matter under advisement.
8. I have read and fully understood all the preceding declarations and undertaking with full and
complete knowledge of the import and intent of this document and of my rights under the law,
before signing this document.
9. I am voluntarily executing this Undertaking/Declaration to attest to the truth of the foregoing
statements in support of my decision to join the Company Summer Activity and for whatever legal
purpose this document may serve.

___________________________________ _________________________ ____________________

Signature over Printed Name Department Date