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Servier conscent

AUTHORISATION TO USE

THE IMAGE, THE STATEMENT AND INTERVIEW OF A PERSON

AND/OR THE IMAGE OF AN OWNED PROPERTY

I, in agreement of this document,

hereby authorize LES LABORATOIRES SERVIER, a simplified joint stock company having a share capital of 37.364.812 Euros registered under number 085 480 796 at the Nanterre Companies and Business register whose registered office is situated at 50 rue Carnot, 92284 Suresnes Cedex, France (hereafter called SERVIER) and/or any legal entity within the Servier Group to exclusively use, reproduce, publish, broadcast, adapt, distribute, represent:

☒ My image recorded on the following media:

Video taken during the creation of the content of the podcast project from 17th April to the 31st of                                                                                                                                                                                                            May 2025, for Servier to collect and process my questions.

☒ My verbally expressed words (questions, interview, opinion, comments, testimonial, etc.) during the creation of the content of the podcast project from 17th April to 31st May 2025, for Servier to collect and process my questions.

☒ My first name

☒ My last name

☒ My country

hereinafter called the Content, within the framework of:

☒ internal activities of SERVIER or its Affiliates

☒ external activities of SERVIER or its Affiliates  

for the purposes of:

☒ information

☒ awareness, including disease awareness, patient testimony

☒ communication, including Corporate communication of SERVIER

I agree for the Content to be used, reproduced, published, broadcasted, adapted, distributed and represented:

  • on various media physical or dematerialized and notably printing, photographic, electronic, digital and/or audiovisual multimedia (disk, CD, DVD, hard disk, films, videos, digital media (including magnetic), memory card, USB flash drive, websites and social networks/media, sharing web platforms;
  • by various means known or unknown at the present time, including printing, drawing, photography, and any graphic, plastic or digital arts process;
  • and i) by various mechanical, optical, cinematographic, electronic, magnetic, analog or digital processes such as the Internet (including Intranet, Extranet, blogs, cloud computing, mobile applications, social networks) and ii) by any distribution channel including but not limited to cable, satellite, digital, analog, radio broadcasting  or computer networks, such as the Internet, cloud computing, mobile applications, social networks and iii) any other process for the telecommunication of sound, images, documents, data and messages of any type whatsoever, known or unknown to this day.

I acknowledge that any arrangements, modifications, translation, sub-titles, developments or adaptations of the Content may be made for communication needs, including those which may be necessary for technical purposes without distorting said Content. This includes the right to translate, to synchronize voice and lips via AI.

In all cases, the use of the Content shall comply with the regulatory and ethical guidance rules applicable to the pharmaceutical industry.

I agree that the Content may be temporarily entrusted to a service provider appointed by SERVIER or by any legal entity within the Servier Group to produce a medium, document or content within the framework of the uses listed above.

For non Servier employees, said authorization is given free of charge and worldwide for a period of 5 years from the signature of the authorization.

I am informed that any use of the Content for any other purpose than mentioned above should be previously sent to me for approval.

I am informed that for the performance of this agreement, SERVIER, as data controller, processes personal data (first name, last name, address, email, image, voice). The collection of this personal data is required for the performance of the agreement, for the purposes of the processing mentioned above.

I own a right of access, rectification and erasure of my personal data, a right to restriction of processing and a right to data portability. I may exercise these rights by sending an email to the data protection officer of SERVIER at the following mail address [email protected]. Also, I may lodge a complaint with the supervisory authority concerned if SERVIER does not answer to my request. I hereby acknowledge that these rights may not apply due to local law and regulations related to data privacy in the country where this agreement is performed.

I am informed that SERVIER will retain the personal data for the period of execution of the  authorization given, and then after upon termination for the relevant statutory limitation period. The personal data will be communicated to all employees and attendants of SERVIER and its Affiliates who are duly authorized to process this personal data, as well as SERVIER’s processors and business partners on a need-to-know basis. Some of these recipients may be located outside the European Economic Area (EEA). When such party is located outside the EEA, in countries which do not have an adequate level of protection of personal data as defined by the European Commission, appropriate contractual guarantees such as the European Commission’s Standard Contractual Clauses, or any other equivalent alternative mechanism, are implemented.

I agree that the interpretation and performance of this agreement shall be subjected exclusively to French law. Any dispute concerning the interpretation or performance of this authorization and consent to use said Content shall be submitted to the exclusive jurisdiction of the Paris courts (92000).