Hong Kong Vaccination Requirement at Workplace - Declaration Form

Fax number

Legal First Name

Legal Last Name

Personal Email Address

Please enter your email address that was used to liaise with UBS recruiter

Position Applied For

Application ID

Example: 123456BR

Candidate Reference Number

7 digits found in email upon job application submission

GPN(Optional)

Applicable for existing UBS employees only

I declare that my vaccination status, as at the date of submission of this form, is as follows:

Completed at least the first dose of COVID-19 vaccine*
Not vaccinated (certified as medically ineligible for vaccination)*
Not vaccinated (for other reasons; Optional - please feel free to share reason(s) in the comments box below)

Additional comments(Optional)

Notes: *You are required to present proof of COVID-19 vaccine or a medical exemption certificate issued by a registered Hong Kong healthcare practitioner upon request before entering the workplace, and comply with other applicable anti-epidemic measures as may be amended from time to time.

Privacy disclaimer – Hong Kong Vaccination Requirement at Workplace - Declaration

This communication is issued by UBS AG Hong Kong Branch ("UBS" or "We").

In the context of the Hong Kong Covid Safe Management Measures, we collect and process the following personal information: Your vaccinations status and additional comments you wish to share ("Personal Data").

We collect and process your Personal Data for the purpose of compliance & risk management, specifically to perform our duties to mitigate health risks at the workplace (the "Purpose").

Only a limited number of UBS personnel within the UBS Human Resources Team will have access to individual responses on a need-to-know basis.

Your Personal Data may be shared with and processed by UBS Group companies. If Data is transferred abroad, it may no longer be protected by your local laws (e.g., data protection laws may not necessarily provide an equivalent or comparable level of protection, when compared to the rights provided under laws that apply to your relationship with UBS) and may fall under foreign regulations that allow the Data to be passed to relevant local authorities or other third parties.

We will retain your Personal Data for as long as required to fulfil the Purpose.

For more information about how UBS processes your data including how we protect your data, your rights in respect of your data and contact details of the Data Protection Officer, please refer to our privacy notice.

If you have any questions about the processing of your personal data, please contact your HR Advisor or for data protection specific questions the Data Protection Office at dpo-apac@ubs.com.

Confirmation

Confirmation
By accepting the terms set out in this disclaimer, you consent to the processing of your Personal Data as set out above.