Document:

Alkaline Water Company Inc.: Exhibit 10.54 - Filed by newsfilecorp.com

	THE ALKALINE WATER COMPANY INC. 
	 
	SUBSCRIPTION AGREEMENT 
	(UNITS –US$0.33 PER UNIT) 
	 
	INSTRUCTIONS TO PURCHASER 

	1. 	
      All purchasers must complete all of the information in
      the boxes on page 2 and sign where indicated with an “X”.

	 	 
	2. 	
      If you are a “U.S. Purchaser”, as defined in the
      “Accredited Investor Questionnaire”, you must complete and sign the
      “Accredited Investor Questionnaire” that starts on page 9.

	 	 
	3. 	
      Certified check or bank draft should be made payable to
      The Alkaline Water Company Inc. For wire instructions, contact Richard A.
      Wright at ricky@wtfcpa.com.

- 2 - 

THE ALKALINE WATER COMPANY INC. 

SUBSCRIPTION AGREEMENT 

The undersigned (the “Subscriber”) hereby irrevocably
subscribes for and agrees to purchase from The Alkaline Water Company Inc. (the
“Company”) that number of units of the Company (each, a “Unit”) as
is set out below at a price of US$0.33 per Unit. Each Unit is comprised of one
share of common stock of the Company (each, a “Share”) and one-half of
one share purchase warrant (each whole warrant, a “Warrant”). Each
Warrant will entitle the holder thereof to acquire one Share (each, a
“Warrant Share”) at a price of US$0.50 per Warrant Share until 5:00 p.m.
(Mountain time) on the date of expiration of the Warrant, which is 24 months
following the Closing Date (as defined herein). The Subscriber agrees to be
bound by the terms and conditions set forth in the attached “Terms and
Conditions of Subscription for Units”. 

	Subscriber Information 	 
	 	Units to be Purchased 	  
	  	  	 	Number of
      Units:                                                                                                                                       
      
	  	 
    	 	x US$0.33 	 
    
	(Name of Subscriber)
    	  	 	  	=

	  	  	 	  	  
	  	  	 	Aggregate Subscription Price:
      US$                                                                                                        
      
	X 	 
    	 	                 
                         
                   (the “Subscription
      Amount”) 
	(Signature
      of Subscriber – if the Subscriber is an Individual) 	 	 
    	  
	  	  	 	  	  
	X 	 
    	 	 
    	  
	(Signature
      of Authorized Signatory – if the Subscriber is not an Individual) 	 	Please complete if purchasing as agent or trustee for a
      principal (beneficial 
	  	  	 	purchaser) (a “Disclosed Principal”) and not purchasing as
      trustee or agent 
	  	  	 	for accounts fully managed by it. 	 
    
	(Name and
      Title of Authorized Signatory – if the Subscriber is not an 	 	  	 
    
	Individual) 	  	 	 
    	  
	  	  	 	(Name of Disclosed Principal) 	 
    
	 
    	  	 	  	  
	(SSN or
      other Tax Identification Number of the Subscriber) 	 	 
    	  
	  	  	 	(Address of Disclosed Principal) 	 
    
	 
    	  	 	  	  
	(Subscriber’s Address, including city and state of residence)
	 	 
    	  
	  	  	 	  	  
	 
    	  	 	  	  
	  	  	 	(SSN or other Tax Identification Number of Disclosed Principal)
    
	 
    	  	 	  	  
	(Telephone Number) 	(Email Address) 	 	 
    	  
	  	  	 	  	  
	Register the Shares and Warrants as set forth
      below: 	 	Deliver the Shares and Warrants as set forth
      below: 
	 
    	  	 	  	  
	(Name to Appear on
      Share and Warrant Certificate) 	  	 	(Name) 	 
    
	  	  	 	  	  
	  	 
    	 	(Address) 	 
    
	(Address, including
      Postal Code) 	  	 	 
    	  
	 
    	  	 	  	  
	  	  	 	(Contact Name) 	(Telephone Number) 
	 
    	  	 	  	  
	 
    	  	 	  	  
	Number
      and kind of securities of the Company held, directly or 	 	  	  
	indirectly, or over which control or direction is exercised
      by the 	 	  	  
	Subscriber, if
      any: 	  	 	  	  
	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 

ACCEPTANCE: The Company hereby accepts the subscription as set
forth above on the terms and conditions contained in this Subscription
Agreement. 

	THE ALKALINE WATER COMPANY INC. 	_________________________, 2016

	Per: 	 
		Authorized Signatory

TERMS AND CONDITIONS OF SUBSCRIPTION FOR UNITS 

	1. 	
      Subscription

1.1          
On the basis of the representations and warranties and subject to the terms and
conditions set forth herein, the undersigned (the “Subscriber”) hereby
irrevocably subscribes for and agrees to purchase such number of Units as is set
forth on page 2 of this subscription agreement (the “Agreement”) at a
price of US$0.33 per Unit for the Subscription Amount, as set forth
on page 2 of the Agreement, which is tendered herewith (such subscription and
agreement to purchase being the “Subscription”). 

1.2          
Each Unit will consist of one Share and one-half of one Warrant. Each Warrant
will entitle the holder thereof to purchase one Warrant Share, as presently
constituted, for a period of 24 months commencing from the Closing Date at an
exercise price of US$0.50 per Warrant Share. The Units, Shares, Warrants and
Warrant Shares are referred to herein as the “Securities”. 

1.3          
The Company hereby agrees to sell the Units to the Subscriber on the basis of
the representations and warranties and subject to the terms and conditions set
forth in this Agreement. Subject to the terms of this Agreement, this Agreement
will be effective upon its acceptance by the Company.

1.4          
The Subscriber acknowledges that the Subscriber has received the prospectus (the
“Prospectus”) describing the offering (the “Offering”) of the
Units by the Company as filed with the United States Securities and Exchange
Commission. 

1.5          
Unless otherwise provided, all dollar amounts referred to in this Agreement are
in lawful money of the United States. 

	2. 	
      Payment

2.1          
The Subscription Amount must accompany this Subscription and shall be paid by
certified cheque or bank draft drawn on a bank in the United States reasonably
acceptable to the Company, and made payable and delivered to the Company.
Alternatively, the Subscription Amount may be wired to the Company or its
lawyers pursuant to wiring instructions provided by the Company or its lawyers.
If the funds are wired to the Company’s lawyers, the Subscriber authorizes such
lawyers to immediately deliver the funds to the Company upon receipt of the
funds from the Subscriber. The Subscriber authorizes the Company to treat the
Subscription Amount as an interest free loan until the closing of the Offering
(the “Closing”). 

2.2          
The Subscriber acknowledges and agrees that this Agreement, the Subscription
Amount and any other documents delivered in connection herewith will be held on
behalf of the Company. In the event that this Agreement is not accepted by the
Company for whatever reason, which the Company expressly reserves the right to
do, the Subscription Amount (without interest thereon) and any other documents
delivered in connection herewith will be returned to the Subscriber at the
address of the Subscriber as set forth on page 2 of this Agreement. 

	3. 	
      Documents Required from
  Subscriber

3.1          
The Subscriber must complete, sign and return to the Company the following
documents: 

	 	(a) 	
      an executed copy of this Agreement; and

	 	 	 
	 	(b) 	
      if the Subscriber is a U.S. Purchaser (as defined in
      Exhibit A), an Accredited Investor Questionnaire (the
      “Questionnaire”) attached as Exhibit “A”
hereto.

3.2          
The Subscriber shall complete, sign and return to the Company as soon as
possible, on request by the Company, any additional documents, questionnaires,
notices and undertakings as may be required by any regulatory authorities and
applicable law. 

- 4 - 

3.3          
Both parties to this Agreement acknowledge and agree that Clark Wilson LLP has
acted as counsel only to the Company and is not protecting the rights and
interests of the Subscriber. The Subscriber acknowledges and agrees that the
Company and Clark Wilson LLP have given the Subscriber the opportunity to seek,
and have recommended that the Subscriber obtain, independent legal advice with
respect to the subject matter of this Agreement and, further, the Subscriber
hereby represents and warrants to the Company and Clark Wilson LLP that the
Subscriber has sought independent legal advice or waives such advice.

	4. 	
      Conditions and
Closing

4.1          
The Closing shall occur on a date to be determined by the Company in its sole
discretion (the “Closing Date”), provided that the Closing Date is on or
prior to May 6, 2016. The Company may, at its discretion, elect to close the
Offering in one or more closings, in which event the Company may agree with one
or more subscribers (including the Subscriber to this Agreement) to complete
delivery of the Shares and Warrants to such subscriber(s) against payment
therefor at any time on or prior to the Closing Date. 

	5. 	
      Acknowledgements and Agreements of
      Subscriber

5.1          
The Subscriber acknowledges and agrees that: 

	 	(a) 	
      the decision to acquire the Securities will not be based
      upon any oral representation as to fact or otherwise made by or on behalf
      of the Company and such decision will be based entirely upon a review of
      the Prospectus;

	 	 	 
	 	(b) 	
      there are risks associated with an investment in the
      Securities;

	 	 	 
	 	(c) 	
      all of the information which the Subscriber has provided
      to the Company is correct and complete as of the date this Agreement is
      signed, and if there should be any change in such information prior to
      this Agreement being executed by the Company, the Subscriber will
      immediately provide the Company with such information;

	 	 	 
	 	(d) 	
      the Company is entitled to rely on the representations
      and warranties of the Subscriber contained in this Agreement and, if
      applicable, the Questionnaire and the Subscriber will hold harmless the
      Company from any loss or damage it or they may suffer as a result of the
      Subscriber’s failure to correctly complete this Agreement or, if
      applicable, the Questionnaire;

	 	 	 
	 	(e) 	
      the Subscriber will indemnify and hold harmless the
      Company and, where applicable, its directors, officers, employees, agents,
      advisors and shareholders, from and against any and all loss, liability,
      claim, damage and expense whatsoever (including, but not limited to, any
      and all fees, costs and expenses whatsoever reasonably incurred in
      investigating, preparing or defending against any claim, lawsuit,
      administrative proceeding or investigation whether commenced or
      threatened) arising out of or based upon any representation or warranty of
      the Subscriber contained in this Agreement, if applicable, the
      Questionnaire or in any document furnished by the Subscriber to the
      Company in connection herewith being untrue in any material respect or any
      breach or failure by the Subscriber to comply with any covenant or
      agreement made by the Subscriber to the Company in connection
      therewith;

	 	 	 
	 	(f) 	
      the Subscriber has been advised to consult the
      Subscriber’s own legal, tax and other advisors with respect to the merits
      and risks of an investment in the Securities and with respect to
      applicable resale restrictions, and it is solely responsible (and the
      Company is not in any way responsible) for compliance
  with:

	 	(i) 	
      any applicable laws of the jurisdiction in which the
      Subscriber is resident in connection with the distribution of the
      Securities hereunder, and

	 	 	 
	 	(ii) 	
      applicable resale
restrictions;

- 5 - 

	 	(g) 	
      the Company will refuse to register the transfer any of
      the Securities not made pursuant to an effective registration statement
      under the 1933 Act or pursuant to an available exemption from the
      registration requirements of the 1933 Act and in each case in accordance
      with applicable securities laws;

	 	 	 
	 	(h) 	
      no securities commission or similar regulatory authority
      has reviewed or passed on the merits of any of the Securities;

	 	 	 
	 	(i) 	
      there is no government or other insurance covering any of
      the Securities;

	 	 	 
	 	(j) 	
      by execution hereof, the Subscriber has waived the need
      for the Company to communicate its acceptance of the purchase of the Units
      pursuant to this Agreement; and

	 	 	 
	 	(k) 	
      this Agreement is not enforceable by the Subscriber
      unless it has been accepted by the Company, and the Subscriber
      acknowledges and agrees that the Company reserves the right to reject any
      Subscription for any reason whatsoever.

	6. 	
      Representations, Warranties and Covenants of the
      Subscriber

6.1          
The Subscriber hereby represents and warrants to and covenants with the Company
(which representations, warranties and covenants shall survive the Closing)
that: 

	 	(a) 	
      unless the Subscriber has completed Exhibit “A”, the
      Subscriber is not a U.S. Person;

	 	 	 
	 	(b) 	
      the Subscriber is resident in the jurisdiction shown as
      the “Subscriber’s Address” on page 2 of this Agreement;

	 	 	 
	 	(c) 	
      if the Subscriber is resident outside of the United
      States:

	 	(i) 	
      the Subscriber is knowledgeable of, or has been
      independently advised as to, the applicable securities laws having
      application in the jurisdiction in which the Subscriber is resident (the
      “International Jurisdiction”) which would apply to the offer and
      sale of the Securities,

	 	 	 
	 	(ii) 	
      the Subscriber is purchasing the Securities pursuant to
      exemptions from prospectus or equivalent requirements under applicable
      securities laws of the International Jurisdiction or, if such is not
      applicable, the Subscriber is permitted to purchase the Securities under
      applicable securities laws of the International Jurisdiction without the
      need to rely on any exemptions,

	 	 	 
	 	(iii) 	
      the applicable securities laws of the International
      Jurisdiction do not require the Company to make any filings or seek any
      approvals of any kind from any securities regulator of any kind in the
      International Jurisdiction in connection with the offer, issue, sale or
      resale of any of the Securities,

	 	 	 
	 	(iv) 	
      the purchase of the Securities by the Subscriber does not
      trigger:

	 	A. 	
      any obligation to prepare and file a prospectus or
      similar document, or any other report with respect to such purchase in the
      International Jurisdiction, or

	 	 	 
	 	B. 	
      any continuous disclosure reporting obligation of the
      Company in the International Jurisdiction, and

	 	(v) 	
      the Subscriber will, if requested by the Company, deliver
      to the Company a certificate or opinion of local counsel from the
      International Jurisdiction which will confirm
the matters referred to in subparagraphs (ii), (iii) and (iv) above
to the satisfaction of the Company, acting reasonably; 

- 6 - 

	 	(d) 	
      the Subscriber has the legal capacity and competence to
      enter into and execute this Agreement and to take all actions required
      pursuant hereto and, if the Subscriber is a corporate entity, it is duly
      incorporated and validly subsisting under the laws of its jurisdiction of
      incorporation and all necessary approvals by its directors, shareholders
      and others have been obtained to authorize execution and performance of
      this Agreement on behalf of the Subscriber;

	 	 	 
	 	(e) 	
      the entering into of this Agreement and the transactions
      contemplated hereby do not result in the violation of any of the terms and
      provisions of any law applicable to, or the constating documents of, the
      Subscriber or of any agreement, written or oral, to which the Subscriber
      may be a party or by which the Subscriber is or may be bound;

	 	 	 
	 	(f) 	
      the Subscriber has duly executed and delivered this
      Agreement and it constitutes a valid and binding agreement of the
      Subscriber enforceable against the Subscriber;

	 	 	 
	 	(g) 	
      the Subscriber has received and carefully read this
      Agreement and the Prospectus;

	 	 	 
	 	(h) 	
      the Subscriber is aware that an investment in the Company
      is speculative and involves certain risks (including those risks disclosed
      in the Prospectus), including the possible loss of the entire
      investment;

	 	 	 
	 	(i) 	
      the Subscriber understands and agrees that the Company
      and others will rely upon the truth and accuracy of the acknowledgements,
      representations, warranties, covenants and agreements contained in this
      Agreement and, if applicable, the Questionnaire and agrees that if any of
      such acknowledgements, representations and agreements are no longer
      accurate or have been breached, the Subscriber shall promptly notify the
      Company;

	 	 	 
	 	(j) 	
      the Subscriber is not an underwriter of, or dealer in,
      the Securities, nor is the Subscriber participating, pursuant to a
      contractual agreement or otherwise, in the distribution of the
      Securities;

	 	 	 
	 	(k) 	
      the Subscriber understands and agrees that there may be
      material tax consequences to the Subscriber of an acquisition or
      disposition of the Securities. The Company gives no opinion and makes no
      representation with respect to the tax consequences to the Subscriber
      under federal, state, local or foreign tax law of the Subscriber’s
      acquisition or disposition of the Securities;

	 	 	 
	 	(l) 	
      no person has made to the Subscriber any written or oral
      representations:

	 	(i) 	
      that any person will resell or repurchase any of the
      Securities,

	 	 	 
	 	(ii) 	
      that any person will refund the purchase price of any of
      the Securities, or

	 	 	 
	 	(iii) 	
      as to the future price or value of any of the Securities,
      or

	 	 	 
	 	(iv) 	
      that any of the Securities will be listed and posted for
      trading on any stock exchange or automated dealer quotation system or that
      application has been made to list and post any of the Securities on any
      stock exchange or automated dealer quotation system, except that certain
      market makers make market in the Company’s shares of common stock on the
      OTCQB marketplace operated by the OTC Markets Group,
and

	 	(m) 	
      the Subscriber acknowledges and agrees that the Company
      shall not consider the Subscriber’s Subscription for acceptance unless the
      Subscriber provides to the Company, along with an executed copy of this
      Agreement:

- 7 - 

	 	(i) 	
      if the Subscriber is a U.S. Purchaser (as defined in
      Exhibit “A”), fully completed and executed Questionnaire in the form
      attached hereto as Exhibit “A”; and

	 	 	 
	 	(ii) 	
      such other supporting documentation that the Company or
      its legal counsel may request to establish the Subscriber’s qualification
      as a qualified investor.

6.2          
In this Agreement and the Questionnaire, the term “U.S. Person” shall have the
meaning ascribed thereto in Regulation S promulgated under the 1933 Act and for
the purpose of this Agreement includes any person in the United States. 

	7. 	
      Representations and Warranties will be Relied Upon
      by the Company

7.1          
The Subscriber acknowledges that the representations and warranties contained
herein are made by the Subscriber with the intention that such representations
and warranties may be relied upon by the Company and its legal counsel in
determining the Subscriber’s eligibility to purchase the Securities under
applicable securities laws, or (if applicable) the eligibility of others on
whose behalf the Subscriber is contracting hereunder to purchase the Securities
under applicable securities laws. The Subscriber further agrees that by
accepting delivery of the certificates representing the Securities on the
Closing Date, it will be representing and warranting that the representations
and warranties contained herein are true and correct as at the Closing Date with
the same force and effect as if they had been made by the Subscriber on the
Closing Date and that they will survive the purchase by the Subscriber of the
Securities and will continue in full force and effect notwithstanding any
subsequent disposition by the Subscriber of such Securities. 

	8. 	
      Waiver

8.1          
The Subscriber hereby waives, to the fullest extent permitted by law, any rights
of withdrawal, rescission or compensation for damages to which the Subscriber
might be entitled in connection with the distribution of any of the Securities.

	9. 	
      Collection of Personal
  Information

9.1          
The Subscriber acknowledges and consents to the fact that the Company is
collecting the Subscriber’s personal information for the purpose of fulfilling
this Agreement and completing the Offering. The Subscriber’s personal
information (and, if applicable, the personal information of those on whose
behalf the Subscriber is contracting hereunder) may be disclosed by the Company
to (a) stock exchanges or securities regulatory authorities, (b) the Company’s
registrar and transfer agent, (c) tax authorities and any other governmental
authorities and (d) any of the other parties involved in the Offering, including
legal counsel, and may be included in record books in connection with the
Offering. By executing this Agreement, the Subscriber is deemed to be consenting
to the collection, use and disclosure of the Subscriber’s personal information
(and, if applicable, the personal information of those on whose behalf the
Subscriber is contracting hereunder) for the foregoing purposes, and to the
retention of such personal information for as long as permitted or required by
law or business practice. Notwithstanding that the Subscriber may be purchasing
Securities as agent on behalf of an undisclosed principal, the Subscriber agrees
to provide, on request, particulars as to the identity of such undisclosed
principal as may be required by the Company in order to comply with the
foregoing. 

	10. 	
      Costs

10.1          
The Subscriber acknowledges and agrees that all costs and expenses incurred by
the Subscriber (including any fees and disbursements of any special counsel
retained by the Subscriber) relating to the purchase of the Securities shall be
borne by the Subscriber. 

	11. 	
      Execution of Subscription
  Agreement

11.1          
The Company shall be entitled to rely on delivery by facsimile machine or e-mail
of an executed copy of this Agreement, and acceptance by the Company of such
facsimile or e-mail copy shall be equally effective to create a valid and binding agreement between the Subscriber
and the Company in accordance with the terms hereof. If less than a complete
copy of this Agreement is delivered to the Company at Closing, the Company and
its counsel are entitled to assume that the Subscriber accepts and agrees to all
of the terms and conditions of the pages not delivered at Closing unaltered.
This Agreement may be executed in two or more counterparts, each of which shall
be deemed to be an original and all of which together shall constitute one and
the same Agreement.

- 8 - 

11.2          
The Subscriber hereby authorizes the Company to correct any minor errors in, or
complete any minor information missing from any part of this Agreement and any
other acknowledgements, provisions, forms, certificates or documents executed by
the Subscriber and delivered to the Company in connection with the Subscription.

	12. 	
      Beneficial
Subscribers

12.1          
Whether or not explicitly stated in this Agreement, any acknowledgement,
representation, warranty, covenant or agreement made by the Subscriber in this
Subscription Agreement, including the exhibits hereto, will be treated as if
made by the disclosed beneficial subscriber, if any. 

	13. 	
      Governing Law

13.1          
This Agreement is governed by the laws of the State of Nevada and the federal
laws of the United States applicable therein. The Subscriber, in its personal or
corporate capacity and, if applicable, on behalf of each beneficial purchaser
for whom it is acting, irrevocably attorns to the jurisdiction of the courts of
the State of Arizona. 

	14. 	
      Survival

14.1          
This Agreement, including, without limitation, the representations, warranties
and covenants contained herein, shall survive and continue in full force and
effect and be binding upon the parties hereto notwithstanding the completion of
the purchase of the Securities by the Subscriber pursuant hereto. 

	15. 	
      Severability

15.1          
The invalidity or unenforceability of any particular provision of this Agreement
shall not affect or limit the validity or enforceability of the remaining
provisions of this Agreement. 

	16. 	
      Entire Agreement

16.1          
Except as expressly provided in this Agreement and in the agreements,
instruments and other documents contemplated or provided for herein, this
Agreement contains the entire agreement between the parties with respect to the
sale of the Units and there are no other terms, conditions, representations or
warranties, whether expressed, implied, oral or written, by statute or common
law, by the Company or by anyone else. 

	17. 	
      Notices

17.1          
All notices and other communications hereunder shall be in writing and shall be
deemed to have been duly given if mailed or transmitted by any standard form of
telecommunication. Notices to the Subscriber shall be directed to the address of
the Subscriber set forth on page 2 of this Agreement and notices to the Company
shall be directed to it at 7730 E Greenway Road, Ste. 203, Scottsdale, Arizona
85260, Attention: President. 

- 9 - 

	18. 	
      Counterparts and Electronic
  Means

18.1          
This Agreement may be executed in any number of counterparts, each of which,
when so executed and delivered, shall constitute an original and all of which
together shall constitute one instrument. Delivery of an executed copy of this
Agreement by electronic facsimile transmission or other means of electronic
communication capable of producing a printed copy will be deemed to be
execution and delivery of this Agreement as of the date hereinafter set forth.

- 10 - 

EXHIBIT A 

ACCREDITED INVESTOR QUESTIONNAIRE 

All capitalized terms herein, unless otherwise defined, have
the meanings ascribed thereto in the Subscription Agreement between The Alkaline
Water Company Inc. (the “Company”) and the undersigned Subscriber.

This Questionnaire applies only to persons that are U.S.
Purchasers. A “U.S. Purchaser” is: (a) any U.S. Person, (b) any person
purchasing the Units on behalf of any U.S. Person, (c) any person that receives
or received an offer of the Units while in the United States, or (d) any person
that is in the United States at the time the Subscriber’s buy order was made or
this Agreement was executed or delivered.

The purpose of this Questionnaire is to assure the Company that
the Subscriber will meet the standards imposed by the appropriate exemptions of
applicable state securities laws. The Company will rely on the information
contained in this Questionnaire for the purposes of such determination. This
Questionnaire is not an offer of the Securities or any other securities of the
Company in any state other than those specifically authorized by the Company.

By signing and returning this Questionnaire, the Subscriber
agrees that, if necessary, this Questionnaire may be presented to such parties
as the Company deems appropriate to establish the availability, under applicable
state securities law, of an exemption from registration in connection with the
sale of the Securities hereunder. 

The Subscriber covenants, represents and warrants to the
Company that it satisfies one or more of the categories of “Accredited
Investors”, as defined by Regulation D promulgated under the United States
Securities Act of 1933 (the “1933 Act”), as indicated below: (Please
initial in the space provide those categories, if any, of an “Accredited
Investor” which the Subscriber satisfies) 

          Category
1      An organization described in Section
501(c)(3) of the United States Internal Revenue Code, a corporation, a
Massachusetts or similar business trust or partnership, not formed for the
specific purpose of acquiring the Securities, with total assets in excess of
US$5,000,000; 

          Category
2      A natural person whose individual net
worth, or joint net worth with that person’s spouse, exceeds US$1,000,000. For
purposes of this Category 2, "net worth" means the excess of total assets at
fair market value (including personal and real property, but excluding the
estimated fair market value of a person's primary home) over total liabilities.
Total liabilities excludes any mortgage on the primary home in an amount of up
to the home's estimated fair market value as long as the mortgage was incurred
more than 60 days before the Securities are acquired, but includes (i) any
mortgage amount in excess of the home's fair market value and (ii) any mortgage
amount that was borrowed during the 60-day period before the date of the
acquisition of Securities for the purpose of investing in the Securities; 

          Category
3      A natural person who had an individual
income in excess of US$200,000 in each of the two most recent years or joint
income with that person’s spouse in excess of US$300,000 in each of those years
and has a reasonable expectation of reaching the same income level in the
current year; 

____ Category
4      A “bank” as defined under Section (3)(a)(2)
of the 1933 Act or savings and loan association or other institution as defined
in Section 3(a)(5)(A) of the 1933 Act acting in its individual or fiduciary
capacity; a broker dealer registered pursuant to Section 15 of the Securities
Exchange Act of 1934 (United States); an insurance company as defined in
Section 2(13) of the 1933 Act; an investment company registered under the
Investment Company Act of 1940 (United States) or a business development
company as defined in Section 2(a)(48) of such Act; a Small Business Investment
Company licensed by the U.S. Small Business Administration under Section 301(c)
or (d) of the Small Business Investment Act of 1958 (United States); a
plan with total assets in excess of US$5,000,000 established and maintained by a
state, a political subdivision thereof, or an agency or instrumentality of a
state or a political subdivision thereof, for the benefit of its employees; an
employee benefit plan within the meaning of the Employee Retirement Income
Security Act of 1974 (United States) whose investment decisions are made by
a plan fiduciary, as defined in Section 3(21) of such Act, which is either a bank,
savings and loan association, insurance company or registered investment
adviser, or if the employee benefit plan has total assets in excess of
US$5,000,000, or, if a self-directed plan, whose investment decisions are made
solely by persons that are accredited investors; 

- 11 - 

____ Category
5           A private
business development company as defined in Section 202(a)(22) of the
Investment Advisers Act of 1940 (United States); 

          Category
6           A director or
executive officer of the Company; 

____ Category
7          A trust with total
assets in excess of US$5,000,000, not formed for the specific purpose of
acquiring the Securities, whose purchase is directed by a sophisticated person
as described in Rule 506(b)(2)(ii) under the 1933 Act; 

____ Category
8          An entity in which all
of the equity owners satisfy the requirements of one or more of the foregoing
categories; 

Note that the Subscriber claiming to satisfy one of the above
categories of Accredited Investor may be required to supply the Company with a
balance sheet, prior years’ federal income tax returns or other appropriate
documentation to verify and substantiate the Subscriber’s status as an
Accredited Investor. 

If the Subscriber is an entity which initialled Category 8 in
reliance upon the Accredited Investor categories above, state the name, address,
total personal income from all sources for the previous calendar year, and the
net worth (exclusive of home, home furnishings and personal automobiles) for
each equity owner of the said entity:

	 
	 

The Subscriber hereby certifies that the information contained
in this Questionnaire is complete and accurate and the Subscriber will notify
the Company promptly of any change in any such information. If this
Questionnaire is being completed on behalf of a corporation, partnership, trust
or estate, the person executing on behalf of the Subscriber represents that it
has the authority to execute and deliver this Questionnaire on behalf of such
entity. 

IN WITNESS WHEREOF, the undersigned has executed this
Questionnaire as of the ____ day of ________________, 2016. 

	 	Print or
      Type Name of Entity 
	 	 
	 	Signature of Authorized Signatory 
	 	 
	 	Type of Entitya1027executiveannualbonu

Exhibit 10.2.7   Executive Annual Bonus Plan            PLAN OVERVIEW        The Executive Annual Bonus Plan (the Annual Plan) is designed to reward superior calendar‐year performance for the    senior executive officers of Employers Mutual Casualty Company (“the Company”).  The Annual Plan helps EMC attract    and retain high caliber senior executives.  The Annual Plan provides compensatory motivation to achieve specified    targets to incent senior executive officers to continually strive for optimal results. The following organization goals are    the foundation for the Annual Plan:         Underwriting profitability     Strengthening and protecting surplus     Premium growth        GENERAL PLAN STRUCTURE        Terms in bold are defined in the “Definitions and Sources” section.          The three components that contribute to the Annual Plan calculation are:     Trade Combined Ratio      Surplus growth     Written premium growth        The Trade Combined Ratio (TCR) is a calculation that assesses the Company's ability to generate an underwriting profit    and serves as the heaviest weight for the overall Annual Plan calculation.  The Surplus component rewards our ability to    improve the strength of our policyholder's surplus.  The Written Premium component gauges our ability to increase    overall written premium volume. The impact from changes in Surplus and changes in Written Premium are subject to    minimum and maximum contributions.        For each of these components, a base percentage for meeting the pre‐determined corporate goal is adjusted, up or    down, to account for exceeding or missing the goal target.  The result for each of the three components is added    together to calculate the Unmodified Plan Percentage.  The Unmodified Plan Percentage is then adjusted, for each    Eligible Officer, using the Role Adjustment Factor (accounts for the officer level or committee membership), Service    Adjustment Factor (prorates the bonus percentage for any officers not eligible the entire year) and Retirement Notice    Adjustment Factor (adjusts the bonus for retirees based on whether adequate retirement notice was provided).  The    resulting percentage is the Individual Plan Percentage, which is then applied to the officer's Salary to calculate the    Annual Plan Payout.   Any payment is subject to all applicable taxes, withholdings and deductions. To assist participants    in calculating individual bonuses, tables will be provided each year to Annual Plan participants to show the bonus    percentages applicable for each component result in 1/10th point increments.        For each of the three components of the Annual Plan (Trade Combined Ratio, Surplus and Written Premium), the base    bonus percentage, corporate goal and performance factor will be set by the Executive Management Committee (upon    approval by the Senior Executive Compensation Committee) at the beginning of the plan year.           

 

TIMING OF PLAN PAYMENT        Any incentive compensation from the Annual Plan will be paid following the approval by the Senior Executive    Compensation Committee in the first quarter of the year following the Plan Year.            SEPARATION OF EMPLOYMENT        Any Eligible Officer who separates from the Company for any reason other than retirement, death or disability will not    receive payment from the Annual Plan.              SPECIAL CONSIDERATIONS        All provisions in the Annual Plan are approved by the Senior Executive Compensation Committee on an annual basis.     Any exceptions to the plan calculations or eligibility must be submitted to the Committee for consideration and the    decision of the Committee is final.        The following worksheet outlines the overall calculation for the plan.                   

 

Executive Annual Bonus Plan        Trade Combined Ratio:   ________    +    [(________ ‐ ________)  *  ________]     =     ________         TCR Base Bonus %    TCR Goal                 TCR Result                    TCR Performance Factor    TCR Contribution                                             +        Surplus Growth:    ________    +    [(________ ‐ ________)  *  ________]     =     ________         Surplus Base Bonus %    Surplus Result       Surplus Goal                 Surplus Performance Factor    Surplus Contribution                              MIN ‐15/MAX +30                                             +            Written Premium Growth:  ________    +    [(________ ‐ ________)  *  ________]     =     ________         WP Base Bonus %    WP Result              WP Goal                         WP Performance Factor    WP Contribution                              MIN ‐15/MAX +15          =        ________    Unmodified Plan    Percentage rounded to    1/10th MAX 125%                *        Role Adjustment Factor: officer's position within the Company as of 12/31 of the Plan Year.           ________    Role Adjustment Factor    Role or title  Adjustment Factor    President  1.3    Executive Management Committee Members  1.2    Policy Committee Members or Sr. VP  1.1    All other Vice Presidents  1.0                *        Service Adjustment Factor: # of days during the plan year participating/365.  Usually 1.0 except for new or retiring (death or disability) officers.  ________    Service Adjustment    Factor                       *    Retirement Notice Adjustment Factor: Will be 1.0 for current Eligible Officers or in the case of death, disability or retiring officers that     provide Adequate Retirement Notice.  Any retiring officers not providing adequate notice will use a factor of .50.          ________    Retirement Notice    Adjustment Factor        =        ________    Individual Plan    Percentage rounded to    1/10th            *        Salary: Officer's annual salary as shown in Workday as of December 15th of the Plan Year.            $___________    Salary            =        $___________    Annual Plan Payout     

 

Executive Annual Bonus Plan ‐ SAMPLE        Trade Combined Ratio:   ________    +    [(________ ‐ ________)  *  ________]     =     ________         TCR Base Bonus %    TCR Goal                 TCR Result                    TCR Performance Factor    TCR Contribution                                             +        Surplus Growth:    ________    +    [(________ ‐ ________)  *  ________]     =     ________         Surplus Base Bonus %    Surplus Result       Surplus Goal                 Surplus Performance Factor    Surplus Contribution                              MIN ‐15/MAX +30                                             +            Written Premium Growth:  ________    +    [(________ ‐ ________)  *  ________]     =     ________         WP Base Bonus %    WP Result              WP Goal                         WP Performance Factor    WP Contribution                              MIN ‐15/MAX +15          =        ________    Unmodified Plan    Percentage rounded to    1/10th MAX 125%                *        Role Adjustment Factor: officer's position within the Company as of 12/31 of the Plan Year.           ________    Role Adjustment Factor    Role or title  Adjustment Factor    President  1.3    Executive Management Committee Members  1.2    Policy Committee Members or Sr. VP  1.1    All other Vice Presidents  1.0                *        Service Adjustment Factor: # of days during the plan year participating/365.  Usually 1.0 except for new or retiring (death or disability) officers.  ________    Service Adjustment    Factor                       *    Retirement Notice Adjustment Factor: Will be 1.0 for current eligible officers or in the case of death, disability or retiring officers that have     provided Adequate retirement notice.  Any retiring officers not providing adequate notice will use a factor of .50.         ________    Retirement Notice    Adjustment Factor        =        ________    Individual Plan    Percentage rounded to    1/10th            *        Salary: Officer's annual salary as shown in Workday as of December 15th  of the Plan Year.            $___________    Salary            =        $___________    Annual Plan Payout    Assume the following information is available.  Executive Management sets the following base bonus    percentages, goals and performance factors at the beginning of the year:    TCR Base = 35%, Goal = 99, Performance Factor = 7    Surplus Base = 7.5%, Goal = 7.5%, Performance Factor = 2    Written Premium Base = 7.5%, Goal 3%, Performance Factor= 2    Eligible Vice President that is a Policy Committee member, not retiring and eligible the entire plan year.        35%    7.5%    7.5%    99%  7    7.5%  2    3%  2    97%    10.5%    3%    49%    13.5%    7.5%    70%    1.0    1.1    1.0    77%    150,000    115,500     

 

PLAN DEFINITIONS AND SOURCES        Adequate Retirement Notice:  Written notification of an officer's intent to retire is received by his/her supervisor and    human resources or a member of the Executive Management Committee no less than:         Role or title  Notice Required    President  one year prior to retirement date    Executive Management Committee Members  one year prior to retirement date    Policy Committee Members or SVP  nine months prior to retirement date    All other Vice Presidents  six months prior to retirement date        Annual Plan Payout: (Unmodified Plan Percentage * Role Adjustment Factor * Service Adjustment Factor * Retirement    Notice Adjustment Factor) * Salary        Eligible Officer: Officers holding titles of Vice President, Senior Vice President, Executive Vice President or President for    Employers Mutual Casualty Company on or before December 31st of the Plan Year who are not otherwise eligible for a    separate bonus plan. Additionally, retirees (death or disability) holding the title of Vice President, Senior Vice President,    Executive Vice President or President for Employers Mutual Casualty Company during the Plan Year.        Executive Management Committee: EMC President and CEO, EMC EVP/COO, EMC EVP for Corporate Development,    EMC EVP Finance and Analytics, SVP Branch Operations.        Individual Plan Percentage: The percentage applied to the officer’s Salary calculated by Unmodified Plan Percentage *    Role Adjustment Factor * Service Adjustment Factor * Retirement Notice Adjustment Factor.  This percentage yields    the gross payment which is subject to all applicable taxes, withholdings, and deductions.         Plan Year: The calendar year for the Annual Plan commencing on January 1st and ending on December 31st.        Retirement Notice Adjustment Factor: A factor of 1.0 unless Adequate Retirement Notice was not received.  Lack of    Adequate Retirement Notice will generate a .50 factor.        Role Adjustment Factor: Provides distinction among individual Eligible Officers based on title and service on either the    Policy Committee or Executive Management Committee as of December 31st of the Annual Bonus Plan Year.         Role or title  Adjustment Factor    President  1.3    Executive Management Committee Members  1.2    Policy Committee Members or Sr. VP  1.1    All other Vice Presidents  1.0        Salary: Officer's annual salary as shown in Workday as of December 15th of the Plan Year.  For retiree's (death or    disability) salary shall be the annual salary shown in Workday as of the date of retirement (death or disability).        Service Adjustment Factor: Provides the proportion of time, during the bonus plan year, that an officer was eligible for    the Annual Plan.  This is a calculated factor expressed as Number of Days as an Eligible Officer during Plan Year/365.     The result will be 1.0 except in those cases where an employee became an Eligible Officer during the Plan Year or where    Eligible Officer retired, died or became disabled.        Senior Executive Compensation Committee: Select members of either the EMCC Board of Directors or EMCI Board of    Directors providing governance and oversight of executive compensation and stock award administration.           

 

Surplus Base Bonus Percentage: A percentage that will reflect the contribution of the surplus component if the Surplus    Goal and Surplus Result are identical.        Surplus Contribution: Surplus Base Bonus Percentage + ((Surplus Result ‐ Surplus Goal) X Surplus Performance Factor)        Surplus Goal: This Surplus growth goal is established by the Executive Management Committee at the beginning of the    year.  The Senior Executive Compensation Committee must approve the surplus growth goal each Plan Year as it relates    to the calculation of the Annual Plan.        Surplus Performance Factor: The multiplier used to increase or decrease the Surplus Contribution for every point the    Surplus Result is above or below the Surplus Goal.          Surplus Result: The one‐year percentage change in policyholder's surplus for the company on a consolidated basis.  The    source data for this calculation can be found in the current year consolidated financial statement.  It is calculated by    dividing Surplus as regards policyholders, December 31 current year (page 4, column 1, line 39) by Surplus as regards    policyholders, December 31 prior year (page 4, column 1, line 21) and subtracting one.        TCR Base Bonus Percentage: A percentage that will reflect the contribution of the Trade combined ratio component if    the TCR Goal and TCR Result are identical.        TCR Contribution: TCR Base Bonus Percentage + ((TCR Goal ‐ TCR Result) X TCR Performance Factor)         TCR Goal: This Trade Combined Ratio is established by the Executive Management Committee at the beginning of the    year and sent out as a companywide message for the Contingent Salary Plan Threshold.  The Senior Executive    Compensation Committee must approve the trade combined ratio goal each Plan Year as it relates to the calculation of    the Annual Plan.        TCR Performance Factor: The multiplier used to increase or decrease the TCR Contribution for every point the TCR    Result is above or below the TCR Goal.        TCR Result: The calculated trade combined ratio result for the company on a consolidated basis. The TCR can be found    in the supplement to the financial statement. The supplement provides the final TCR, but a detailed calculation can be    determined from the consolidated annual statement by calculating two ratios and adding them together. The first ratio    is calculated by adding the amounts for Losses incurred (page 4, column 1, line 2), Loss adjustment expenses incurred    (page 4, column 1, line 3), and Dividends to policyholders (page 4, column 1, line 17) together, and dividing the total by    Premiums earned in the current year (page 4, column 1, line 1). The second ratio is calculated by dividing other    Underwriting expenses incurred (page 4, column 1, line 4) by Total net premiums written (page 8, column 6, line 35). The    TCR Result is the sum of these two ratios.        Unmodified Plan Percentage: The addition of the TCR Contribution, Surplus Contribution and WP Contribution.        WP Result: The one‐year percentage change in written premium for the company on a consolidated basis.  This number    is published in the supplement to the financial statement.  It can be calculated from the consolidated annual statement    by dividing Total net premiums written in the current year (page 8, column 6, line 35 from the current year statement)    by Total net premiums written in the prior year (page 8, column 6, line 35 from the prior year statement) and subtracting    one.        WP Base Bonus Percentage: A percentage that will reflect the contribution of the Written Premium component if the    WP Corporate Goal and WP Result are identical.        WP Goal: This Written Premium growth goal is established by the Executive Management Committee at the beginning    of the year.  The Senior Executive Compensation Committee must approve the written premium growth goal each Plan    Year as it relates to the calculation of the Annual Plan.     

 

    Written Premium Contribution: WP Base Bonus Percentage + ((WP Result ‐ WP Goal) X WP Performance Factor)        WP Performance Factor: The multiplier used to increase or decrease the WP Contribution for every point the WP Result    is above or below the WP Goal.                   

 

CLAWBACK PROVISION        EMPLOYERS MUTUAL CASUALTY COMPANY     POLICY FOR RECOVERY OF ERRONEOUSLY AWARDED INCENTIVE‐BASED COMPENSATION    Executive officers (as defined below) of Employers Mutual Casualty Company (the “Company”) may be required to repay    previously awarded incentive‐based compensation to the Company in certain circumstances and to the extent required    under applicable law. For incentive compensation performance periods in progress as of the adoption of this policy and    paid on or after January 1, 2015, the statement of terms and conditions accompanying any incentive‐based    compensation award made by the Company shall include a provision incorporating the requirements of this policy.        To the extent there is a determination made that the Company is required to prepare an accounting restatement due to    the material noncompliance of the Company with any financial reporting requirements, the Compensation Committee    of the Company’s Board of Directors and the Compensation Committee of EMC Insurance Group Inc.’s Board of    Directors (EMCI) (collectively referred to as the Compensation Committees) will determine whether, and to what extent,    recovery of any  incentive‐based compensation previously paid is appropriate based on the facts and circumstances    involved.  If it is determined that a recovery is appropriate, the Compensation Committees shall direct that the Company    recover that portion of any incentive‐based compensation (whether in the form of cash or equity, if applicable) paid to    current and former executive officers during the 36‐month period preceding the date the Company is required to issue    the accounting restatement that is in excess of what would have been paid to the executive officers under the    accounting restatement.  The amount to be recovered from the executive officers based on an accounting restatement    shall be the amount by which the affected incentive‐based compensation exceeded the amount that would have been    payable to such executive officers had the accounting statements initially been issued as restated; provided, however,    the Compensation Committees reserve the authority to recover different amounts from different executive officers on    such bases as they shall deem appropriate, such as in the case of an executive officer’s misconduct that contributes to    the need for the accounting restatement.         The Compensation Committees shall determine, subject to applicable law, whether the Company shall effect such    recovery of incentive‐based compensation  (i) by seeking recovery from the executive officer; (ii) by reducing the    amount that would otherwise be payable to the executive officer under any compensatory plan, program or    arrangement maintained by the Company; (iii) by withholding payment of future increases in compensation (including    the payment of any discretionary bonus amount);  or (iv) by any combination of the foregoing.        For purposes of this policy, the term “executive officers” means those persons who received incentive‐based    compensation under the Company’s Senior Executive Compensation Bonus Program, Senior Executive Long Term    Incentive Plan, or the incentive‐based compensation plans applicable to the Company’s  Bond Manager and the    President of EMC Reinsurance Company.  The term “incentive‐based compensation” means, as applicable, cash or equity    compensation paid under any of the above mentioned  plans, the amount of which was  determined in whole, or in part,    upon specific performance‐based goals relating to the financial results of EMC Insurance Companies, or its individual    operating segments.         The remedies outlined herein are in addition to, and not in lieu of, any action deemed necessary by the Compensation    Committees, the Company’s Board of Directors, EMCI’s Board of Directors, or the Company (up to and including    termination of employment), and any legal rights available to the Company to recover incentive‐based compensation,    and any action imposed by law enforcement agencies, regulators, or other authorities.

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