Consent Form – Breakthrough Energy Solutions Canada

I acknowledge, as an authorized representative of the Applying Organization (herein referred to as

the Applicant), that in submitting this project application to Breakthrough Energy Solutions
Canada, that I agree to the following:

 If this application advances to the semi-finalist stage, NRCan can share the application
package and any other supplemental information obtained as part of the review process
(herein referred to as the Full Project Proposal) with representatives of Breakthrough
Energy Ventures (“BEV”);
 BEV may use the information contained in the Full Project Proposal to participate in the
final selection of the Breakthrough Energy Solutions Canada Cohort of companies;
 If the Applicant becomes a participant of the Breakthrough Energy Solutions Cohort, BEV
may also use the information contained in the Full Project Proposal to evaluate potential
BEV investments in relation to the project presented;
 If the Applicant becomes a participant of the Breakthrough Energy Solutions Cohort,
NRCan may share the Applicant’s company information with representatives of BEV, who
can use this information to participate in the Annual Accelerator Sessions to further
evaluate potential BEV investments in the Applicant’s company; and BEV may also use
such information to provide annual reviews and feedback to the Applicant; and
 The Applicant expressly acknowledges that BEV and its representatives, investors and
affiliates (collectively, the “BEV Entities”) evaluate and invest in numerous companies,
some of which may be deemed competitive with the Applicant’s current or anticipated
business, and the Applicant agrees that, to the fullest extent permitted under applicable
law, the Applicant hereby waives, and the BEV Entities shall not be liable to the Applicant
for, any claim arising out of or based upon the NRCan funding program, this application
or agreement, or any investment by any BEV Entities in any entity competitive with the
Applicant.

Accordingly, the Applicant hereby authorizes NRCan to disclose such information in confidence
to BEV and its representatives for such purposes.

Project Title _________________________________________________

Applicant’s Authorized Representative _________________________________________________

Printed Name, Title, Organization Name

________________________________________________

Signature

___________________________________________________

Date