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Declaration With Regard To Medical Fitness:: Vamsi Talachintala T.Vamsi Witness: (Name & Address)

Vamsi Talachintala declares that he is medically fit for employment with Virtusa Consulting Services. He does not have any communicable diseases or symptoms of viral infections. He has not traveled in the last 2 months to countries affected by COVID-19 or showed any symptoms if he did travel. His family and contacts have also not traveled to affected areas or shown any symptoms. He agrees to notify the company immediately if any symptoms develop and leave work to prevent spreading infection. He acknowledges punitive action if this declaration is found untrue.

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67 views2 pages

Declaration With Regard To Medical Fitness:: Vamsi Talachintala T.Vamsi Witness: (Name & Address)

Vamsi Talachintala declares that he is medically fit for employment with Virtusa Consulting Services. He does not have any communicable diseases or symptoms of viral infections. He has not traveled in the last 2 months to countries affected by COVID-19 or showed any symptoms if he did travel. His family and contacts have also not traveled to affected areas or shown any symptoms. He agrees to notify the company immediately if any symptoms develop and leave work to prevent spreading infection. He acknowledges punitive action if this declaration is found untrue.

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Sensitivity: Internal Use Only

DECLARATION WITH REGARD TO MEDICAL FITNESS

I, _Vamsi Talachintala_ hereby declare that I am completely fit for the employment with Virtusa Consulting
Services Private Ltd (the company).
 
I neither have any communicable disease nor have any symptoms of bacterial or viral infections which may
be contagious.
 
I acknowledge that I have not travelled in the last 2 months to any of the countries/locations/ suspect Areas
which may have possible impact of COVID-19 (Or) I had travelled to such countries/locations/suspect places
but not reported with any of the symptoms and completed the recommended observation period, with no
such symptoms, till the date of declaration.
 
I also acknowledge that my family members /friends/ relatives/ neighbors/ with whom I had interacted in
the last 1 month had no travel history to COVID -19 affected countries after 1 st Jan 2020 and neither of
them have symptoms of possible suspect of COVID -19 or any other contagious disease.
 
Hereby I agree to undertake that I shall take all adequate measures and in case of exhibiting any such
infection symptoms / conditions, I shall notify immediately to the company and leave the workplace
instantly keeping the consideration of care and health of the other employees and further I agree that if my
declaration is found to be untrue at any stage during the employment with the company I shall be liable for
punitive action.

                                                                                            Name & Signature : Vamsi Talachintala

Signature : T.Vamsi

Witness:
(Name & Address)
Sensitivity: Internal Use Only

Annexure: Countries with maximum reported laboratory-confirmed COVID-19 cases and deaths. Data as of
13 March 2020* by WHO.

China Italy
Japan Spain
Singapor
e France
Australia Germany
Malaysia UK
Philippin Netherlan
es d
Thailand Sweden
Iran Denmark
Qatar Austria
Bahrain Belgium
UAE Norway
USA Canada

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