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I, declare that I or my representative or my legal heir or my legal guardian or my parent hereby give my informed consent to German Remedies Pharmaceuticals Private Limited (“GRPPL”) for using my personal information including but not limited to name, address, phone number, e-mail address, location, other personal information and/ or sensitive personal information etc. to enhance their products, services, website and for marketing and promotion activities. I have also read, understood and hereby acknowledge to have accepted the Privacy Policy and Cookie Policy associated with the use of services offered by GRPPL. I confirm that all the personal information provided by me is provided voluntarily, is true and correct. I understand that my personal information will be used for Named Patient Purchased Program purposes by GRPPL and that I shall receive no compensation for such use of personal information. I hereby release GRPPL from any and all claims arising out of the use of such personal information provided by me. I understand that GRPPL follows the applicable data protection laws and will not disclose my personal information to any third party and will keep it protected to the best of their abilities.

To place an order, please keep the below documents/details available:

• • 2 ID proofs along with PAN card details along with attested scanned copies
• • Valid doctor prescription scanned copy
• • Doctor’s MCI number
• • Doctor’s mobile number

Post order documents:

• • Authority Letter
• • Doctor Consent Letter
• • Drug Utilization Letter