Kindly take a few moments to complete this form as it will help us to get in touch with you in the unlikely event that contact tracing is required. All employees are required to complete this form prior to entering the MINI facility.

* Required

Temperature *

Department*:

ID Number*:

Dealership Location*:

Employee's Last name *:

Employee's First name *:

Employee's Contact no. *:

Have you experience any signs and symptoms (fever, chills, sore throat, runny rose, cough, shortness of breath) prior to your visit to our facility?*

Do you have any contact or exposed to someone who has a suspected / probable / positive case of covid-19?*:

If yes, when is the last date of contact/exposure?

What is your relationship with this person?

Do you live in the same home?*:

Do you or anyone in the household have any of the abovementioned signs or symptoms or pending covid-19 test results?*:

HEREBY CONFIRM THAT ALL STATEMENTS ARE TRUE AND COMPLETE*.

"By signing this form/document, I hereby acknowledge that British United Automobiles Inc., including its parent company, affiliates, subsidiaries, and related companies, as well as their respective officers, directors, shareholders, employees, agents, and other parties with which they do business (hereinafter collectively referred to as "Company"), may use and process all personal information that I have voluntarily and knowingly provided, including those that may be sensitive or confidential as may be disclosed by me, in any transaction or activity related to the Company for the purpose herein stated specifically for public health and safety purposes. Use and processing of Personal Information includes collection, recording, listing, systematization, accumulation, storage, updating, extraction, transfer, anonymization, blocking, deletion, destruction, whether through electronic means or otherwise.

I hereby release and forever discharge the Company, including its parent company, affiliates, subsidiaries, and related companies, as well as their respective officers, directors, shareholders, employees, agents, and other parties with which they do business, in their official corporate capacities as well as in their individual personal capacities, from any and all sums of money, or any other obligations, privilege, emolument, entitlement, and benefit arising from any and all incident, directly or indirectly related to, the use and processing of all personal and sensitive information. I likewise categorically declare that I do not have and will not institute any claim or cause of action in relation to the use and processing of personal and sensitive information by the Company.