Business Policy Sign-Off Form

BUSINESS POLICY SIGN-OFF FORM

Company Name:

Policy Title:

RECITALS

WHEREAS, the company named above (Company) has established the policy identified as Policy Title for the purpose of setting standards, obligations, and procedures applicable to employees, contractors, and other covered persons; and

WHEREAS, the undersigned Signatory is employed by or engaged with Company and acknowledges receipt of the policy and intends to comply with its terms and any related procedures;

WHEREAS, compliance and acknowledgement are conditions of continued engagement and may be tied to training, certification, or specified payments where provided below.

SCOPE OF WORK / SCOPE OF POLICY APPLICATION

Describe the scope of the policy, who is covered, and any actions required of the Signatory. Include procedural steps, deliverables, or training obligations below:

PAYMENT TERMS (IF APPLICABLE)

Amount payable for training, certification, or administration (enter 0.00 if not applicable):

TERM AND TERMINATION

This acknowledgement and any obligations created hereunder commence on and shall remain in effect until , unless earlier terminated in accordance with this section.

Either party may terminate this acknowledgement for cause upon written notice to the other party describing the basis for termination. Non-compliance with the policy constitutes cause. If no cause exists, termination without cause requires days' prior written notice.

CONFIDENTIALITY

The Signatory acknowledges that, in the course of engagement and in connection with the policy, they may receive or have access to confidential, proprietary, or sensitive information of Company. Signatory shall:

(a) hold such information in strict confidence; (b) use the information solely for purposes authorized by Company; (c) not disclose such information to any third party except as authorized in writing; and (d) take reasonable measures to protect the confidentiality of such information at least as stringent as those used to protect Signatory's own confidential information.

This confidentiality obligation survives termination of this acknowledgement for a period of three (3) years, unless a longer period is required by applicable law.

I acknowledge and agree to the confidentiality obligations set forth above.

GOVERNING LAW

This acknowledgement shall be governed by and construed in accordance with the laws of without regard to conflict-of-law principles. The parties consent to the exclusive jurisdiction and venue of the courts located in that jurisdiction for resolution of disputes.

ENTIRE AGREEMENT

This Form, together with any attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment to this Form must be in writing and signed by authorized representatives of both parties.

ACKNOWLEDGMENT

By signing below, the Signatory confirms receipt of the policy identified above, acknowledges understanding of its terms, agrees to comply with all requirements set forth therein, and acknowledges that violations may result in disciplinary action up to and including termination.

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