Authrization Form to Pickup Herbalife Products

Date FROM

, , . TO M/s HERBALIFE INTERNATIONAL INDIA PRIVATE LTD.,

, . Sirs, SUB:AUTHORIZATION - TO PICK UP PRODUCTS I, (Name) (HRBL ID No.) am an Independent Associate of Herbalife International India Private Ltd., (Herbalife) I hereby authorize Mr. / Ms. (Name), whose specimen signature is attested herein below to pick up the products ordered by me vide my Order   Number. dated on my behalf, within 5 days from the date of Invoice/NTS of above mentioned order#. The above said authorized person shall be carrying his/her proof of identification i.e., photo ID and producing the same before the concerned official/s of Herbalife, as I am unable to pick up the said products this time, due to unavoidable circumstances. I hereby confirm that the signature of my above mentioned authorized person shall have the binding effect to the extent that the said products have been received by me personally. This arrangement shall be completely at my own responsibility and risk and Herbalife shall not be responsible and liable in this regard, under any circumstances whatsoever. Accordingly, I shall not have any claims against Herbalife at any time, whatsoever.

Specimen Signature of Mr. / Ms.

Attested by Attested  by Associate Signature of Mr./Ms. of Mr./Ms.

Thank you Yours truly

Associate Signature of Mr./Ms.  NAME  NAME -

.