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Submit Application

Please fill out the form below to initiate the application process. Please make sure that you are authorized to do so on behalf of the organization you represent. 

Verification

Once your application is received, the EPiHC Secretariat will verify the submitted information and contact you for any clarifications. 

Signatory

Once verified, the organization will become an EPiHC signatory and will gain access to resources and support offered by such signatory status. 

Signatory Application

Please fill out the form below.

Company

Covered Businesses

If your entire company or organization is adopting EPiHC, please check the "All" button.

Otherwise, please describe the business lines that are adopting EPiHC (e.g., "The Company and each of its subsidiaries, except Subsidiary X" or "Only the company's subsidiaries in Region Y").

Region
Type

Authorized Person

Please provide your name and contact details.

By providing your name and contact details, you are confirming that you are authorized to submit this Signatory Application on behalf of the company or organization listed above and that you are authorized to execute any and all writings and agreements and to take any other action on behalf of the company or organization listed above, in accordance with the Signatory Letter below.

Please provide the name, title, email and phone number of additional individuals who are authorized to act on behalf of the company/organization.

Below you will be creating a user account with your email and proving a password. This will allow you to create and edit your Signatory account in the future.

Contact Person

If the contact person for EPiHC is different than the authorized person, please provide details below.

This email will become a user name for your online Signatory account.
Please create a password to set up your online Signatory account.

Final Review and Submission

Please carefully review the EPiHC Signatory Letter and EPiHC Governing Provisions prior to accepting the terms of the EPiHC Signatory Letter. Should you have any questions, please contact epihcteam@ifc.org.

Ethical Principles in Health Care Signatory Letter

The company or organization listed above (the “Signatory”) is pleased to affirm, effective as of today, its adoption of the Ethical Principles in Health Care (“EPIHC” or the “Principles”) with respect to the Covered Businesses listed above. Terms not defined in this letter have the meanings set forth in the Governing Provisions of the Principles (the “Governing Provisions”).

In connection with the affirmation of the Principles, the Signatory hereby affirms that so long as it remains a Signatory to the Principles it will accept the requirements and limitations that may be established from time to time in accordance with the Governing Provisions.

The Signatory represents, warrants and undertakes that neither it nor any of its Affiliates (as defined below)islistedordesignatedonanyofthelistscurrentlypromulgatedbytheUnitedNationsSecurity Council or its committees pursuant to any resolution issued under Chapter VII of the United Nations Charter or on the World Bank Listing of Ineligible Firms & Individuals. In the event that it (or any of its Affiliates) is listed or designated in the future on any such list, the Signatory agrees to promptly notify theSecretariatofsuchoccurrence.TheSignatoryunderstandsthatitsstatusasaSignatoryissubject to (among other things) compliance with the conditions set forth in this paragraph, and that its Signatory status may be revoked, suspended or terminated for any violation of or failure to comply with such requirements. For purposes hereof, “Affiliate” shall mean any individual, entity or other enterprise or organization controlling, controlled by, or under common control with the Signatory.

The Signatory acknowledges and agrees that for so long as IFC hosts the Secretariat, IFC may access information provided by the Signatories or Advisory Board to the Secretariat and (a) use such information in its investment and advisory operations, including in relation to the possible provision of services by IFC to a Signatory and (b) use the name and logo of the Signatory for publicity or otherwise, in accordance with IFC’s internal policies, procedures and practices.

The Signatory acknowledges and agrees that Signatory status is not an endorsement or verification of its alignment with the Principles by the Secretariat, the Advisory Board, International Finance Corporation (“IFC”) or any member of the World Bank Group (the “WBG”), and that none of the Secretariat, the Advisory Board, IFC or any member of the WBG is providing any legal or investment advice in connection with the Principles. In addition, none of the Secretariat, the Advisory Board, IFC or any member of the WBG is responsible for, or shall be held liable in connection with, any act, omission or disclosure by any Signatory or otherwise in respect of the Principles. The Signatory hereby designates the person(s) listed as Authorized Person(s) above (each, an “Authorized Person”) as its authorized representative(s) of the Signatory with respect to the Principles.

The Signatory confirms and undertakes that each such Authorized Person is authorized (without power of substitution except as expressly provided in the General Provisions) to execute any and all writings and agreements and to take any other action, in each case, on behalf of the Signatory, in relation to the Principles or the General Provisions, as s/he may reasonably deem necessary or appropriate from time to time.

By clicking I Agree, on behalf of the Company indicated above (the "Company"), I acknowledge that I have read the terms of the EPiHC Governing Provisions and the EPiHC Signatory Letter, and I hereby agree to the terms of the EPiHC Signatory Letter. I acknowledge that the EPiHC Secretariat may run background checks on the Company, including checks against any of the lists currently promulgated by the United Nations Security Council or its committees pursuant to any resolution issued under Chapter VII of the United Nations Charter or against the World Bank Listing of Ineligible Firms & Individuals ("Background Checks"). I acknowledge that becoming a Signatory is subject to the EPiHC Secretariat’s satisfaction with the results of such Background Checks. I acknowledge that the EPiHC Secretariat will send a written notice to the email or physical address listed above confirming or denying the application for the Company to become a Signatory and that, until the Company receives confirmation from the EPiHC Secretariat that the Company is a Signatory, the Company shall not use EPiHC’s name or logo or otherwise hold itself out to be a Signatory.
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