OPTICAL BENEFIT FORM - C.F. Sharp Group

1 TO: Executive OPTICAL Inc. Love your Eyes . Branch: _____. For additional inquiries: OPTICAL BENEFIT FORM. Name of Employee Company/ Position Direct Superior Residence Maximum Purchase Limit No maximum limit Contact Details/ Email Address Name of Dependent Form valid until (7 days from date of issuance). Authorize signatory Name and Position Name and Position Availment should only be in all EO Branches Items availed through Branch Referral System will be at 20% discount for any House Brand items. Prescriptive Lenses / CEG, Sunglasses ( House Brands). CONDITIONS: Discount not applicable to contact lenses, accessories and solution BENEFIT is transferable to dependents Not in conjunction with any EO promotions DISCLAIMER: OPTICAL branch availments shall be at 20% Discount on Suggested Retail Price (SRP) payable within sixty days (90) days from the transaction.

2 This voucher /. OPTICAL form can't be combined with any other promotions of Executive OPTICAL , Inc. PAALALA: Ang lahat na kukuning House Brand frames at sunglasses ay may 20% Discount mula sa Suggested Retail Price (SRP) at babayaran sa loob ng anim na pung araw (60) araw. Ang voucher o OPTICAL form na ito ay hindi maaaring gamitin para sa ibang promosyon ng Executive OPTICAL . EO Corporate Accounts Department Help desk: EO Corporate Accounts Department Telefax: 02-374-78-53. AUTHORITY TO DEDUCT. I have understood and accepted the above conditions and disclaimer. I hereby authorize the COMPANY to deduct the total amount of _____ (Php_____) for the Products or services purchased via deferred payment scheme; and In the event that I resign, retire, be terminated or has gone on Absence Without Official Leave (AWOL), or is otherwise separated from the COMPANY, the COMPANY shall immediately deduct the total amount or any balance due to the EXECUTIVE OPTICAL INC.

3 From the remaining balance of my payroll, separation, or retirement pay. Employee's Conforme: EO Representative Witness: Form Issued by: _____ _____ Sharp Group of Companies Signature over printed name/Date Signature over printed name/Dat