Simple Letter Agreement - Stem Cell Information

The PROVIDER, RECIPIENT and RECIPIENT SCIENTIST must sign both copies of this letter and return both signed copiesto the PROVIDER. The PROVIDER will then send the MATERIAL.PROVIDER INFORMATION and AUTHORIZED SIGNATUREProvider Organization: ES Cell International Pte LtdAddress: P.O Box 6492, St. Kilda Rd. Central, Melbourne 8008, AustraliaName of Authorized Official: __________________________________Title of Authorized Official: ___________________________________Signature of Authorized Official: _______________________________Date: ________________RECIPIENT INFORMATION and AUTHORIZED SIGNATURERecipient Scientist: ___________________________________________Recipient Organization: ________________________________________Address: ___________________________________________________Name of Authorized Official: ____________________________________Title of Authorized Official: ____________________________________Signature of Authorized Official: _______________________________Date: ________________CERTIFICATIONCertification of Recipient Scientist: I have read and understood the conditions outlined in this Agreement and I agree to abideby them in the receipt and use of the MATERIAL.Recipient Scientist: ___________________________________________Date: _______________ES Cell International Pte Ltd 2

Schedule 1This Request must be completed and signed by the Investigator and an authorised representative of the Institution with whichthe Investigator is affiliated.Name and Title of Investigator:Name of Institution:Postal Address:Shipping Address:Telephone:Facsimile:Email:Materials Requested :Brief Statement of Proposed ResearchES Cell International Pte Ltd 3