BACKGROUND REVIEW DISCLOSURE AND AUTHORISATION FORM

BACKGROUND REVIEW DISCLOSURE

In the interest of maintaining the safety and security of our staff, clients and property, the Company will
engage a third party professional firm to conduct a background review on any of our current staff and / or
candidates (as applicable), where a background review report will be prepared. The said report will be the
property of the Company.

The Company's respect for the right to privacy of personal information is paramount. It is in alignment
with our belief that an individual has all the rights to their personal information and the disclosure of it. As
such, the background reviews will NOT be conducted without first notifying you beforehand.

The scope of the background reviewing may include, but not limited to, identity verification; educational
verification; previous employment verification; reference checks and criminal history record.

AUTHORISATION
I, ...................................................................................................................................................................................................................... ,
NRIC / PASSPORT NO. : .......................................................................................................... hereby consent and authorise
123RF Technology Sdn Bhd and its appointed professional bodies, agents and representatives to conduct a
comprehensive background review on me through a background check report to be generated in order to
assess my employment, promotion, reassignment and / or retention as a staff in the Company.

I certify that, to the best of my knowledge, all personal information on this form and resume / employment
application / any supporting documents provided by me are true and correct. I acknowledge and
understand that my employment will be refused or my employment will be terminated with immediate
effect without recourse (as applicable), in the event of any false statement / declaration /
misrepresentation / concealment of fact made by me.

I understand that a copy of this authorisation form shall have the same force and effect as the original
authorisation form. The foregoing authorisation shall continue in full force until revoked by me in writing. I
understand that the information collected pursuant to this form is solely for the purpose stated in this
form, and the appointed third party professional firm and the Company will not use the said information for
any other purposes.

The following information is required by agencies and other entities for identification purposes only when
such checks are required to be performed.

Birthdate DD/MM/YEAR | …..................................................

This will not affect hiring decision.

Current Address | ….........................................................................................................................................................

…........................................................................................................................................................

Mobile Phone Number | …..................................................

Signature
….......................................................

Date DD/MM/YEAR |

HR/MY/v2-18NOV2015 Page 1 of 1