VOICE OF SPECIALLY ABLED PEOPLE (VOSAP)

Subsidy Program – United States

Beneficiary Consent and Self-Declaration Form

About Voice of Specially Abled People:

Voice of Specially Abled People Inc(VOSAP or Voice of SAP) is a USA based 501(c)(3) Non-profit organisation, focused on empowering specially Abled people with assistive devices, scholarships and other enablement programs by providing financial assistance.

About This Form:

This application form collects your information so VOSAP can verify your eligibility, process your application, and provide approval for VOSAP subsidy for assistive technology products for you. Please read each section carefully. Your agreement by accepting this electronically by clicking the “I Agree” button is legally binding under U.S. federal and California state law. You may contact us at any time with questions.

Questions? Contact us: privacy@voiceofsap.org | Voice of Specially Abled People Inc., 22734 Stagg St, West Hills, CA 91304

1. PROGRAM STRUCTURE AND ROLE OF VOSAP

1.1. You are applying to the VOSAP Assistive Technology Subsidy Program. Submission of this application is solely for the purpose of determining eligibility for subsidy assistance and does not constitute a purchase agreement, product order, or device delivery commitment by VOSAP.

1.2. If your application is approved, VOSAP will notify you and the relevant Assistive Technology Partner (“AT Partner”), who will supply the assistive device directly to you.

1.3. All responsibilities relating to product quality, functionality, defects, installation, training, support services, warranties, and after-sales service rest solely with the AT Partner supplying the device.

1.4. Any financial contribution required from the beneficiary or funding partner is paid directly to the AT Partner. VOSAP does not collect, hold, process, or retain beneficiary payments and does not act as a seller, distributor, reseller, or financial intermediary.

1.5. VOSAP’s role is limited to eligibility verification, program coordination, and facilitation of access to assistive technology solutions.

1.6. VOSAP does not act as a payment processor, escrow agent, marketplace, reseller, or financial intermediary for assistive devices.

1.7. Assistive devices are supplied by independent third-party AT Partners of VOSAP. VOSAP does not manufacture, design, distribute, or control such devices and makes no representations regarding device safety, fitness for purpose, or regulatory approvals. Beneficiaries should consult the AT Partner for product specifications, safety instructions, and warranty terms.

1.8. Any purchase, warranty, service, or support agreement relating to the assistive device shall be governed by the terms and conditions provided by the respective AT Partner.

2. WHO CAN APPLY

2.1. To apply for VOSAP's Assistive Technology Program, you must satisfy one of the following eligibility criteria:

2.1.1 Option A - Adult Applicant - I am 18 years of age or older, of sound mind, and entering into this agreement on my own behalf.

2.1.2 Option B - Parent or Legal Guardian - I am the lawful parent or legal guardian of a person with a disability who requires a guardian. I am acting with full legal authority on their behalf.

I confirm that:

I am 18 years of age or older and entering this agreement on my own behalf.

OR

I am the lawful parent or legal guardian of the applicant and have legal authority to act on their behalf.

3. YOUR APPLICATION INFORMATION

3.1. Please ensure the following information in your application is accurate and complete. You will have confirmed these details during the online application process. Details such as: Full Legal Name; Email Address; Phone Number; State of Residence; Proof of Disability Provided; Photograph Provided (if applicable);

3.2. Why we ask: Each piece of information has a specific legal purpose. Your name, email, and phone are needed to contact you and verify your identity. Your proof of disability is required to confirm eligibility. Your photograph, if provided, may be used for identity verification and, with your separate consent in Section 4, for VOSAP communications. Full details are in Section 3.

3.3. Data Minimization Commitment: VOSAP collects only the minimum personal information necessary to verify your eligibility, process your application, and deliver assistive technology. Each category of information is used solely for the specific purposes described above and will not be used for any incompatible secondary purposes without your additional consent.

3.4. For more detailed information about how VOSAP collects, uses, stores, and protects your personal information, please review our full Privacy Policy available at our website. By submitting this application, you acknowledge that you have had the opportunity to review our Privacy Policy.

4. HOW WE USE YOUR INFORMATION (DATA PRIVACY CONSENT)

4.1. The following explains exactly what information we collect, why, and your rights under U.S. law. This section constitutes a legally valid notice and consent under the California Consumer Privacy Act / California Privacy Rights Act (CCPA/CPRA), applicable state privacy laws, and the Americans with Disabilities Act (ADA). VOSAP is a nonprofit organization and is not a healthcare provider, health plan, or covered entity under HIPAA. While VOSAP implements reasonable safeguards to protect medical documentation, HIPAA does not apply to this program.

4.2. Information We Collect and Why - The following categories of personal information are collected, together with the purpose of collection and the legal basis:

4.2.1. Full Name - To identify the applicant; address and ship the device; maintain program records. Legal basis: Contractual necessity; CCPA § 1798.100.

4.2.2. Email Address - To send application status updates, program notifications, and required legal notices.

4.2.3. Phone Number - To send application updates via SMS or Call. You expressly consent to automated SMS per Section 3.3 below.

4.2.4. Proof of Disability - To verify eligibility for assistive technology under program criteria. Classified as Sensitive Personal Information. Accessed only by authorized VOSAP staff.

4.3. Your Phone Number and SMS Communications (TCPA Consent) - By providing your mobile phone number in this application, you expressly consent to receive automated SMS text messages from Voice of Specially Abled People (VOSAP) at the number you provide.

4.3.1. Types of Messages You Will Receive:

4.3.1.1. Messages (Required for Application Processing): Application status updates (approval, denial, processing status), Device delivery and tracking notifications

4.3.1.2. Program Communications : Follow-up communications regarding your assistive device, Program satisfaction surveys, Impact assessment requests

4.3.2. How to Opt Out:

4.3.2.1. You may opt out of Program Communications at any time by: Replying STOP, Emailing privacy@voiceofsap.org , Any other reasonable method of communication.

4.3.2.2. We will process your opt-out request within ten (10) business days and send you a confirmation message.

4.3.2.3. This consent is provided under the Telephone Consumer Protection Act (TCPA), 47 U.S.C. § 227, and applicable FCC regulations including the April 2025 Opt-Out Rule. VOSAP will not use your phone number for telemarketing, fundraising solicitations, or any purpose unrelated to your assistive technology application without your separate express written consent.

4.3.2.4. Please understand that some communication for auditing purposes will still be done and that provide explicit consent and agreement to comply with that

4.4. Sensitive Information - Your Proof of Disability

4.4.1. Your proof of disability is classified as Sensitive Personal Information under California law (CPRA § 1798.121). VOSAP treats this information with heightened protections:

4.4.1.1. It will be used only to verify your eligibility for the Assistive Technology Program.

4.4.1.2. It will not be sold, shared for advertising, or disclosed to any third party except as strictly required to deliver your device or as required by law.

4.4.1.3. It will be accessible only to authorized VOSAP staff on a need-to-know basis.

4.4.1.4. It will be retained for five (5) years after your application is processed, then securely deleted, unless a longer period is required by law.

4.4.1.5. You have the right to request deletion of this information subject to applicable legal retention obligations.

4.4.2. Acceptable Proof of Disability: VOSAP accepts the following documentation:

4.4.2.1. Documentation from a licensed healthcare provider (physician, psychologist, or other qualified professional).

4.4.2.2. Government-issued disability certification (e.g., Social Security Administration disability determination letter, VA disability rating).

4.4.2.3. Educational records indicating disability accommodations (e.g., Individualized Education Program (IEP) or Section 504 Plan).

4.4.3. Data Security: All disability documentation is stored in encrypted format on secure servers with role-based access controls. Only authorized VOSAP staff with a legitimate need-to-know may access this information.

4.5. Data Retention Periods

4.5.1 VOSAP retains your personal information for the following periods:

4.5.1.1. Name, email, phone: Duration of program participation plus three (3) years. Legal basis: CCPA; program records.

4.5.1.2. Proof of disability: five (5) years post-application. Legal basis: CPRA § 1798.121; program compliance.

4.5.1.3. Application records (denied applications): two (2) years post-denial. Legal basis: Program records; fraud prevention.

4.5.1.4. Photograph: Duration of consent; deleted upon withdrawal (unless required for audit). Legal basis: CCPA; right-of-publicity law.

4.5.1.5. Program / device records: seven (7) years post-distribution. Legal basis: IRS; donor audit requirements.

4.5.1.6. Backup / residual copies: Up to ninety (90) days after deletion. Residual copies in backup systems are automatically purged through routine backup rotation cycles and are not accessible for operational purposes after deletion from primary systems.

5. PHOTOGRAPH AND MEDIA USE CONSENT

5.1. This section is separate from Section 3. It governs whether VOSAP may use your photograph or likeness for communications and fundraising. This consent is entirely optional and will NOT affect your eligibility for the Assistive Technology Program if you decline.

5.2. If I provide a photograph, I understand it may be used for:

5.2.1. Identity verification during the application review process.

5.2.2. VOSAP's website, social media, donor presentations, and press materials to highlight the impact of the program on people with disabilities.

5.2.3. Annual reports and grant applications to support VOSAP's mission.

5.3. I further understand that:

5.3.1. I waive any right to royalties or financial compensation for the use of my photograph or likeness by VOSAP.

5.3.2. VOSAP will not use my photograph for advertising products or services unrelated to its nonprofit mission.

5.3.3. I may withdraw this media consent at any time by emailing privacy@voiceofsap.org. Withdrawal does not affect prior uses and auditing as well.

5.4. Biometric & Photograph Notice

5.4.1. VOSAP does not use facial recognition technology, biometric scanning, or automated facial geometry analysis. If you submit a photograph, it will be reviewed manually for identity verification, auditing and marketing purposes only and will not be converted into biometric identifiers or biometric information. If applicable state law requires additional disclosures or written consent regarding biometric data, VOSAP will provide such disclosures and obtain required consent before collecting or processing biometric identifiers.

6. YOUR PRIVACY RIGHTS UNDER U.S. LAW

6.1. As an applicant for VOSAP's US program, you have the following rights under the California Consumer Privacy Act / California Privacy Rights Act (CCPA/CPRA) and applicable state law. These rights apply regardless of which state you reside in, as VOSAP is a California-based organization.

6.1.1. Right to Know: Ask us what personal information we have collected about you, where it came from, and how we use it.

6.1.2. Right to Delete: Request that we delete your personal information. We will do so unless we are legally required to keep it (e.g., for tax, audit, or legal compliance).

6.1.3. Right to Correct: Ask us to correct any inaccurate personal information we hold.

6.1.4. Right to Limit Sensitive Data Use: Direct us to use your disability-related information only for delivering the assistive device program, nothing else.

6.1.5. Right to Opt-Out of Sale: VOSAP does not sell your personal information. This right is included for full CCPA compliance.

6.1.6. Right to Non-Discrimination: VOSAP will never deny you services, charge you a different price, or treat you differently because you exercised any of these rights.

6.1.7. Right to Withdraw Consent: You may withdraw your consent at any time by contacting privacy@voiceofsap.org. Withdrawal applies to optional processing only and does not require VOSAP to delete records needed for legal compliance or audit.

6.1.8. Right to Data Portability: Request a copy of your personal information in a portable, commonly used, machine-readable format that allows you to transmit the data to another entity without hindrance.

6.1.9. Right to Know Data Sources: Ask us to disclose the categories of sources from which your personal information was collected, if we obtained information about you from third parties.

6.1.10. Right to Opt-Out of Automated Decision-Making: If VOSAP uses automated systems that produce legal or similarly significant effects on your eligibility determination, you may request human review of such decisions or opt out of solely automated processing.

6.2. To exercise any of these rights, contact: privacy@voiceofsap.org. We will respond within forty - five (45) days. VOSAP may extend this period by an additional forty - five (45) days when reasonably necessary, and will notify you of any extension and the reason for the delay. Responses are provided free of charge.

7. ASSISTIVE DEVICE OBLIGATIONS

7.1. By accepting an assistive device provided through the VOSAP Assistive Technology Program by an authorized Assistive Technology Partner (“AT Partner”), you agree to the following:

7.1.1. Use of the Device

7.1.1.1. The device is provided exclusively for your personal use (or the use of the minor/ward on whose behalf you are applying) to support mobility, education, livelihood, or general daily activities.

7.1.1.2. You may not sell, rent, mortgage, pledge, transfer, or give away the device to any other person or entity.

7.1.1.3. If the device is not used within three (3) months of delivery, VOSAP may issue a formal notice. If unused for an additional month after that notice, VOSAP reserves the right to reclaim the device.

7.1.2. Software and Digital Accounts (If Applicable) - If your assistive technology includes software licenses, digital subscriptions, or user accounts:

7.1.2.1. You are responsible for maintaining the confidentiality of any login credentials provided.

7.1.2.2. You may not share, transfer, or sublicense any software or digital accounts to others.

7.1.2.3. Software licenses remain the property of the respective licensors; VOSAP grants you only a limited right to use such software for personal assistive purposes.

7.1.2.4. Upon termination of your participation in the program or at VOSAP's request, you agree to cease using and, if technically feasible, return or delete any software or digital accounts provided.

7.1.2.5. VOSAP is not responsible for third-party software functionality, updates, or discontinuation.

7.1.3. Cooperation and Follow-Up

7.1.3.1. You agree to cooperate with VOSAP's impact assessment team and share progress updates, photographs, and feedback as reasonably requested via email, phone, or messaging apps.

7.1.3.2. You agree to allow VOSAP representatives to follow up to confirm the device is functioning as intended.

7.1.4. Release and Limitation of Liability

7.1.4.1. The assistive device is provided "as-is" without warranties of any kind. To the extent permitted by law, you release and hold harmless Voice of Specially Abled People Inc., its donors, volunteers, officers, directors, and agents from claims arising out of your use of the assistive device, except for claims arising from VOSAP's gross negligence, willful misconduct, or fraud. This release does not apply to claims that cannot be waived under applicable law, including California Civil Code § 1668. VOSAP's total liability, if any, shall not exceed the greater of the device's fair market value or USD $500. If you are a California resident, you waive California Civil Code § 1542, which provides that a general release does not extend to unknown claims.

7.1.4.2. Any claims relating to product defects, malfunction, safety issues, warranty claims, training, maintenance, or device performance must be directed solely to the AT Partner supplying the device.

8. ELECTRONIC SIGNATURE, GOVERNING LAW, AND FINAL AGREEMENT

8.1. Electronic Signature (E-SIGN Act Disclosure) - By clicking "I AGREE" below, you agree to sign this form electronically. Your electronic signature has the same legal effect as a handwritten signature under the Electronic Signatures in Global and National Commerce Act (E-SIGN Act), 15 U.S.C. § 7001, and the Uniform Electronic Transactions Act (UETA) as adopted in your state. You confirm that you: (a) have the ability to access and retain electronic records; (b) consent to conduct this transaction electronically; and (c) have had the opportunity to print or save a copy of this form before agreeing. To withdraw your consent to electronic transactions, contact privacy@voiceofsap.org.

8.2. Governing Law and Dispute Resolution - This form and any dispute arising from it shall be governed by the laws of the State of California, without regard to conflict of law principles. Any dispute shall first be attempted to be resolved informally by contacting privacy@voiceofsap.org. If unresolved, disputes shall be submitted to binding arbitration in Los Angeles County, California under the American Arbitration Association rules. Either party may seek emergency equitable relief in any court of competent jurisdiction. Nothing in this form prevents you from exercising any mandatory consumer protection rights available under your state's laws.

8.3. Accuracy of Information - By agreeing to this form, you represent and warrant that all information provided in your application is true, complete, and accurate to the best of your knowledge. You understand thatproviding false or misleading information may result in disqualification from the program, reclamation of any device provided, and may constitute fraud under applicable law.

8.4. Grievance Contact - VOSAP Grievance (United States Operations):

8.4.1. Name : Nimish Sevak

8.4.2. Email: Grievance@voiceofsap.org

8.4.3. Organization: Voice of Specially Abled People Inc., 22734 Stagg St, West Hills, CA 91304

8.4.4. Grievances will be acknowledged within forty-eight (48) hours and resolved within thirty (30) days.

8.5. Accessibility Accommodations - This form is available in alternative accessible formats through userway plugin on the website, including large print, screen-reader compatible versions, and audio format. If you require accommodations to complete this application due to your disability, please contact: privacy@voiceofsap.org. VOSAP is committed to ensuring equal access to our programs for all individuals with disabilities in accordance with the Americans with Disabilities Act (ADA). Note: For applicants unable to complete or sign this form electronically due to a disability, VOSAP will provide a physical (paper) copy upon request. Please contact: Email: privacy@voiceofsap.org.

8.6. Final Declaration - By clicking "I AGREE", I solemnly declare and confirm that:

8.6.1. I have read (or had read to me in a language I understand) and fully understand every section of this form.

8.6.2. All information I have provided in my application is true, accurate, and complete.

8.6.3. I meet the eligibility requirements stated in Section 1.

8.6.4. I declare that my total household income from all sources is below USD $75,000.00 per year. I understand that VOSAP reserves the right to request documentation of income eligibility.

8.6.5. I voluntarily, freely, and without coercion give my informed, specific, and unambiguous consent to all items I have checked above.

8.6.6. I understand this is a legally binding agreement under U.S. federal and California state law.

8.6.7. I understand that VOSAP is purely a subsidy facilitation mechanism, and that all product and service responsibilities lie with VOSAP's AT partner and myself.