Employee Share Application Form

Employee Share Application Form

Complete this form to apply to acquire shares under the Company's Employee Share Plan. Submission of this application does not constitute acceptance; all awards or purchases are subject to the terms of the applicable plan, the approval of the plan administrator or committee, and compliance with applicable law.

Personal Information

Date of Birth:   Nationality:

Position Information

Employment History (Most Recent First)

Education

References (Professional)

Share Application Details

Type of Offer: Employee Share Purchase Plan Share Award / Grant Stock Option

Total Purchase Amount: $   Current Holdings (Company Shares):

Cash / Bank Transfer Payroll Deduction Stock Swap / Surrender

Vesting, Restrictions & Conditions

I acknowledge that any shares acquired pursuant to this application will be subject to the terms of the Company's Employee Share Plan, any applicable award agreement, and the Company's shareholder agreement, including vesting schedules, transfer restrictions, forfeiture provisions and any right of repurchase. Acceptance of this application is subject to approval by the plan administrator or compensation committee and to compliance with applicable securities laws.

I agree to be bound by all terms and conditions of the plan and any award or purchase agreement.

Tax, Withholding & Payment Authorization

I understand that the Company may withhold from my compensation or require other forms of payment to satisfy any tax withholding or other statutory obligations arising from the acquisition or vesting of shares. I authorize the Company to deduct such amounts from my wages and to take any other actions it deems necessary to satisfy tax obligations in connection with the issuance of shares.

U.S. Tax Resident: Yes No

Declarations, Representations & Warranties

By submitting this application I represent and warrant that:

1. I am an eligible employee under the terms of the applicable plan and have the legal capacity to enter into this application;
2. The information provided in this application is true, complete and correct to the best of my knowledge; I have not omitted material information;
3. I am not subject to any legal restriction or contract that would prevent me from acquiring or holding the shares requested;
4. I understand that shares acquired may be subject to lock-up, transfer restrictions, forfeiture and other limitations set forth in plan documents and applicable law;
5. I understand that acceptance is subject to corporate approvals and compliance with securities laws, and that the Company may refuse or adjust awards or purchases at its discretion.

Applicant Certification & Authorizations

I certify that all information provided in this application is true and complete. I authorize the Company and its agents to verify any information, including contacting previous employers, references and educational institutions, and to conduct employment and background checks as permitted by law. I consent to the collection, use and disclosure of personal information for the purposes of administering this application and any resulting award or purchase, including compliance with tax and securities laws.

I acknowledge that submission of this application does not guarantee that shares will be issued and that any issuance will be governed by the plan documents and a separate award or purchase agreement which I must accept. I further acknowledge that the Company may require additional documentation prior to any issuance, and may impose conditions or limitations as necessary to comply with law.

Applicant Authorization to Contact Previous Employers and Conduct Background Checks: I authorize the Company to contact previous employers and to conduct employment, reference and background checks.

At-Will Employment & Equal Opportunity

Submission of this application does not alter the at-will nature of employment, if applicable. Employment remains at-will and may be terminated by either the Company or the employee at any time, subject to applicable law.

The Company is an equal opportunity employer. Employment and participation in benefit or compensation plans, including share programs, will be administered without unlawful discrimination.

Acknowledgment

I have read and understand this application, and I certify that I am authorized to provide the information herein. I acknowledge that false statements made in this application may result in disciplinary action, including denial of the application, rescission of any award, or termination of employment.

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