Date: 02 Nov 2026

To,
Cipla Limited,
Peninsula Business Park,
Ganpatrao Kadam Marg,
Lower Parel,
Mumbai 400 013.

Purpose: Consent to participate in the campaign conducted by Cipla Limited for spreading awareness towards Pediatric Asthma.

I hereby grant my consent to participate in the campaign conducted by Cipla Limited (‘CIPLA’) for spreading awareness and education through templatised video. I also hereby provide my consent to CIPLA to further record and use my name & city of practice audio/video byte (‘Recording’) wherein I share my views on the Subject.

I hereby acknowledge and agree that CIPLA will be entitled to edit, arrange, adapt, or translate the Recording either in whole or in part for the purposes of making it available on CIPLA’s or any of its affiliate’s websites and/or on digital and social media platforms / internal communications. I further understand that my Recording may either appear alongside other recordings or used independently for purposes as defined in the subject line.

I understand that any materials provided by CIPLA to me in relation to the Purpose are only to be used as a reference and all rights, title and interest in such reference materials and presentations shall always lie with Cipla. I will not be entitled to use, exhibit, showcase, broadcast the same for any other purpose and on any other medium other than for the aforementioned Purpose.

I hereby grant my consent to CIPLA, to collect, store, process, protect and use my name, designation, image, registration number, only for the Purpose, as well as my name, email id and phone number for further notice and intimation to me, arising out of and relating to the use of the Recording for achieving the Purpose. Name, image, registration number, email id and phone number collectively referred to as (‘Personal Information’).

I understand that CIPLA will require to share the photos / name / video recording with certain third-party vendors for editing and broadcasting the same and that CIPLA will be responsible and liable for protecting my Personal Information against misuse by such third-party service providers under applicable laws.

I am aware of and shall always abide by all the applicable laws governing medical professionals. CIPLA shall not be responsible or liable in case of any violation of applicable laws and/or any third-party rights in this regard and I take complete responsibility of the same. I confirm that any views expressed, suggestions given or any information shared on the Subject by me are my own and based on my understanding and expertise of the Subject.

I further acknowledge that my participation is voluntary and is not subject to any terms and conditions, commercial or otherwise and that the use of my photos / Recording will only be in accordance with the consent provided by me herein. I confirm that I shall not mention or refer to a particular pharmaceutical product or medical device or personal identifiable information of any patient.

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Privacy Notice

(Please read this Privacy Notice carefully before signing the Consent Letter)

Introduction. Cipla Limited including its affiliates or subsidiaries (hereafter referred to as “Cipla”, “we”, “our” or “us”) respects your privacy and is committed to protecting your Personal Data. In this Privacy Notice “You” or “Your” refers to Data Principal whose Personal Data is collected and processed by us.

Purpose of this notice. This Privacy Notice will explain how we will collect and use your Personal Data taken during your interaction with the company or its employees / affiliates (hereinafter referred to as “Engagement”). This notice is also to apprise you of your rights and the grievance mechanism available to you in relation to your Personal Data.

What Data will be collected and how will it be used? On providing the below consent, Cipla or its authorized service providers may collect your personally identifiable data in the due course of your engagement with us in relation to Children’s Day Engagement (referred to as “Program”), including but not limited to your name, age, gender, marital status, email id, mobile number, photo identity proof, address proof, photographs & video clips showcasing you during such engagement (collectively referred to as “Personal Data”), and such would be used for Internal Usage. Cipla may share your Personal Data with third-party service providers for editing the photographs for aesthetic and / or visual purposes and / or for broadcasting or printing the same.

What are your data protection rights? You can request access to the information we process about you at any time. If at any point you believe that the Personal Data that we process, relating to you, is incorrect or not updated, you can request to see this information and have it corrected, restricted, or erased. You also have the right to withdraw your consent at any time.

Grievance mechanism. If you wish to raise a complaint on how we have handled your personal data, including any queries on collection, storage, processing, use, protection, deletion and retention of personal data, details relating to third-party service providers involved, with whom the data is being / will be shared, can be obtained by writing to us at globalprivacy@cipla.com and any grievances or complaints for correction and updating of your personal data can be obtained by writing to ethics@cipla.com.

If you are not satisfied with our response or believe we are not processing your personal data in accordance with the applicable laws, you can raise a complaint with the appropriate authority as prescribed and notified under applicable laws.