Dear Healthcare Professional,

Roche Singapore ("Roche") Pte Ltd is committed to deliver innovative pharmaceutical products and related services to healthcare professionals and to the community.

In order to provide with the services outlined in our Privacy Policy, e.g. to respond to your requests or inquiries, to complete a transaction or to personalize your experience, we would like to collect some of your personal information including but not limited to name, address, e-mail address, and telephone number ("Your Data").

We would therefore be grateful if you would please complete your details and confirm your agreement to your data being managed in accordance with our Privacy Policy and applicable law of Singapore and for the purposes specified above.