Letter of Undertaking

Please complete this form to confirm your transport requirements for fertility materials. This serves as a formal acknowledgement of the risks and terms involved in the logistics process.

I/We understand the purpose of this Letter of Undertaking and agree to proceed.*

This form is a mandatory requirement before transport scheduling can be finalised.

Patient Details

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PARTNER 1

Full Name *

Date of Birth *

NRIC / Passport Number *

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PARTNER 2

Full Name

Date of Birth

NRIC / Passport Number

Transport Details

Material Type

Number of Vials

Origin Clinic *

Destination Clinic *

Legal Declaration & Risk Acknowledgement

I/We, the undersigned, hereby confirm that I/we have been fully informed of the risks associated with the transfer and/or transportation of the gamete(s) and/or embryo(s). I/We acknowledge and agree that such transfer and/or transportation is undertaken at my/our sole risk, cost, and expense, and I/we irrevocably waive any right to claim against Cryolink for any loss and/or damage arising therefrom.

I/We specifically acknowledge the risk that the gamete(s) and/or embryo(s) may not survive the thawing process and confirm that no claim shall be made in respect of such outcome.

I/We further undertake to make payment in accordance with the invoice issued for permit processing and transportation costs.

I/We accept the applicable cancellation terms, including that:

only 50% of fees paid will be refunded for cancellations made at least seven (7) days prior to embarkation; and
no refund shall be payable for cancellations made within seven (7) days of embarkation.

I/We have read and understood the above declaration thoroughly.*

I/We acknowledge and accept the stated risks and conditions of service.*

Signatures

Upload an image of each partner's signature. These will appear on the Letter of Undertaking PDF. PNG, JPEG, or WebP; maximum 3 MB per file.*

How to upload your signature

Sign on plain white paper using a dark pen.
Take a clear photo in good lighting (no shadows).
Crop closely around the signature area.
Upload as PNG, JPG, or WebP (max 3 MB).

Tip: Keep your phone parallel to the paper so the signature looks straight and sharp on the PDF.

Partner 1 signature *

Partner 2 signature

Contact & Submission

Telephone Number *

Email Address *

Date of Submission *