ADMINISTRATIVE SERVICES AGREEMENT

BETWEEN

AND

The Employer hereby contracts with Promedent to reimburse medical and/or dental expenses that qualify as medical expenses under subsection 118.2(2) of the Income Tax Act, and are incurred by eligible partners or employees.

The Employer is responsible to ensure expenses are eligible and within an individual's annual limit. Any unused entitlements or excess expenses cannot be carried forward or back to other years.

The Employer will hold harmless Promedent, its Directors and employees, who accept no responsibility or liability for any damages, penalties or assessments of income tax to the Employer or to its employees that may arise from entering into the Promedent PHSP, a "cost-plus" Private Health Services Plan.

The employer authorizes Promedent to communication with the company and its employees via email and/or phone

The Employer authorizes Promedent to notify the Financial Institution to electronic funds transfer (hereinafter called "EFT") a one-time registration fee of $150.00 plus GST/HST (as applicable by province) (GST# 89758 4314 RT0001).

The Employer authorizes Promedent to notify the Financial Institution to EFT the variable amount of an approved claim, plus a claim fee, and issue an EFT to the employee. The claim fee for EFT is currently $60 (claims totaling between $2,000 to $25,000 will incur a base fee of $60 plus 2% on amounts above $2,000. Claims over $25,000 will have a base fee of $750 plus 4% on amounts exceeding $25,000), or $100 for manual cheques (claims between $2,000 and $25,000 will incur a base fee of $100 plus 3% on amounts above $2000). Claims totalling $25,000+ will be subject to audit and will incur a base fee of $790 plus 4% on amounts exceeding $25,000, plus tax. All fees are subject to GST/HST as applicable by province. Promedent reserves the right to change this fee in the future, and either party may cancel, in writing, this authorization at any time.

Withdrawal amount an EFT may not exceed each time $______________ from my (our) account.

* Promedent shall obtain due authorization from me/us in accordance with Rule H1 for each PAD that Promedent issues against me/us.

Pre-Authorized Debit Details

Authorization: I/We acknowledge that this PAD Agreement is provided for the benefit of Promedent, as the payee, and is provided in consideration of Vancouver City Savings Credit Union agreeing to process debits against the Account (designated above) with my/our financial institution (or any other financial institution I/we may authorize at any time) in accordance with CPA rules.

I/we confirm that we have authority under the terms of my/our Account agreement to authorize this debit arrangement.

By signing this PAD Agreement, I/we acknowledge having received and read a copy of this PAD Agreement, including the terms contained herein; I/we acknowledge that I/we understand the terms of this PAD Agreement; and I/we agree to be bound by the terms of this PAD Agreement. I/we authorize at any time in the Transaction Date period indicated above, for PADs to be drawn on my/our Account according to this PAD Agreement.

I/We warrant and guarantee that the person(s) whose signature(s) are required to sign on the Account have signed this PAD Agreement.

Confirmation and Pre-notifications: Promedent will, at least 10 calendar days before the due date of the first PAD, provide me/us a confirmation in accordance with Rule H1.

For variable amount PADs, after the first PAD, Promedent will provide me/us with 10 days’ prior written notice specifying the amount and date of the next PAD before the due date of the variable amount PAD, unless an exception under Rule H1 applies.

Cancellation of PAD Agreement: I/we acknowledge that I/we may revoke, change or cancel my/our authorization under this PAD Agreement at any time in writing to Promedent. I/we understand and accept that this notification must be provided to Promedent at the contact information indicated below at least 30 calendar days before the next debit is scheduled.

Upon providing a notice of cancellation or revocation of authority, Promedent will cease issuing in accordance with Rule H1.

To obtain a sample cancellation form, or for more information about my/our right to cancel this PAD Agreement, I/we acknowledge that I/we can contact my/our financial institution or visit www.payments.ca.

Recourse/Reimbursement: I/we acknowledge that I/we have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.payments.ca.

Claim period for the employer shall be .