Acknowledgement of Contractor by HPDocuments


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									Independent Contractor Acknowledgement

                          This is a statement by a contractor or vendor stating
                          his/her acknowledgment of obligations to adhere to
                          client's policies and procedures, code of conduct
                          and the status of the contractor of an independent
                          contractor and not of an employee of the client.

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The undersigned certifies that he/she a duly authorized independent contractor or vendor
(“Contractor”). Contractor certifies that Contractor has received and reviewed Company and its
affiliates, Code of Conduct and Ethics (“Code”) and fully understands the requirements set forth
in the Code.

Contractor certifies and acknowledges that Contractor shall act in full accordance with all
applicable Company policies and procedures in addition to statutory laws and regulations. These
policies and procedures include Company’s commitment to conduct its business in compliance
with the highest ethical standards.

Contractor’s failure to comply with the policies and procedures set forth in Company’s Code, or
failure to report violations of these policies and procedures may result in immediate termination
of Company’s agreements with Contractor.

Contractor understands that Contractor has an obligation to conduct business within the
guidelines of the Code of Conduct that prohibit actual or potential conflicts of interests.
Contractors acknowledge that: (check one)

□ I do not have a conflict of interest
□ I may have a potential conflict of interest (explain below)

Further Contractor acknowledges that Contractor shall comply with all applicable laws, by-laws,
ordinances, regulations, statutes, proclamations, orders and rules, and with the lawful
requirements of the relevant authorities as may be in any way related to the services. This
compliance shall be extended to any new or changed law, by-law, ordinance, regulation,
proclamation, order rule or lawful requirement as may be in any way related to the Services

Contractor acknowledges that in providing the services the Contractor acts as an independent
contractor and not as an employee, partner or agent of the Company and the Contractor shall
have no authority to act for or to bind the Company in any manner whatsoever other than as
expressly contemplated by this Contract. Contractor acknowledges and agrees that the Contractor

a)     not entitled to payment of salary, holiday pay, sick pay, severance pay, long service leave
or any other entitlement an employee has in respect of his or her employer;

b) solely responsible for all payments in relation to any taxes such as but not limited to income
tax, pay-roll tax, sales tax or any other payments as may be imposed on in respect of contractors
under the law of United States of America or other jurisdictions;

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c) solely responsible for providing superannuation, sickness benefits and work cover or their
counterparts in other jurisdictions;

d) solely responsible for ensuring compliance with all relevant federal, state and local with
respect to provision of the services.

Name of Contractor: ________________________________________________
Signed: __________________________________________________________
Print Name: ______________________________________________________
Title: ____________________________________________________________
Date: ___________________________________________________________

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