Document:

EX-10.16

 Exhibit 10.16 

FORTIVE CORPORATION 

2016 STOCK INCENTIVE PLAN 

STOCK OPTION AGREEMENT 

Unless otherwise defined herein, the terms defined in the Fortive Corporation 2016 Stock Incentive Plan (the “Plan”) will have the
same defined meanings in this Stock Option Agreement (the “Agreement”). 
 I. NOTICE OF STOCK OPTION GRANT 

Name: 
 Participant ID:

 The undersigned Optionee has been granted an Option to purchase Common Stock of the Company, subject to the terms and conditions of
the Plan and this Agreement, as follows: 
  

			
		
	Date of Grant	  	  

		
	Exercise Price per Share	  	 $

		
	Total Number of Shares Granted	  	  

		
	Type of Option	  	Nonstatutory Stock Option
		
	Expiration Date	  	Tenth anniversary of Date of Grant
		
	Vesting Schedule:	  	
		
	Time-Based Vesting Criteria	  	The time-based vesting criteria will be satisfied with respect to             % of the Options on each of the
                         anniversaries of the Date of Grant.

 II. AGREEMENT 

1. Grant of Option. The Company hereby grants to the Optionee named in this Notice of Stock Option Grant (the “Optionee”), an
option (the “Option”) to purchase the number of shares (the “Shares”) set forth in the Notice of Stock Option Grant, at the exercise price per Share set forth in the Notice of Stock Option Grant (the “Exercise Price”),
and subject to the terms and conditions of this Agreement and the Plan, which are incorporated herein by reference. Except as set forth in Section 2(c) below, in the event of a conflict between the terms and conditions of the Plan and this
Agreement, the terms and conditions of the Plan shall prevail. 
 2. Vesting. 

(a) Vesting Schedule. Except as may otherwise be set forth in this Agreement or in the Plan, Options awarded to an Optionee shall not
vest until the Optionee continues to be actively employed with, or actively providing services to, the Company or an Eligible Subsidiary for the periods required to satisfy the time-based vesting criteria (“Time-Based Vesting Criteria”)
applicable to such Options. The Time-Based Vesting Criteria applicable to an Option are referred to as “Vesting Conditions,” and the earliest date upon which all Vesting Conditions are satisfied is referred to as the “Vesting
Date.” The Vesting Conditions for an Option received by an Optionee shall be established by the Compensation Committee (the “Committee”) of the Company’s Board of Directors (or by one or more members of Company management, if
such power has been delegated in accordance with the Plan and applicable law) and reflected in the account maintained for the Optionee by an external third party administrator of the Option awards. Further, during any approved leave of absence (and
without limiting the application of any other rules governing leaves of absence that the Committee may approve from time to time pursuant to the Plan), to the extent permitted by applicable law the Committee shall have discretion to provide that the
vesting of the Options shall be frozen as of the first day of the leave (or as of any subsequent day during such leave, as applicable) and shall not resume until and unless the Optionee returns to active employment prior to the Expiration Date of
the Options. 
 (b) Addendum. The provisions of Addendum A are incorporated by reference herein and made a part of this Agreement,
and to the extent any provision in Addendum A conflicts with any provision set forth elsewhere in this Agreement (including without limitation any provisions relating to Retirement), the Addendum A provision shall control. 

(c) Fractional Shares. The Company will not issue fractional shares of Common Stock upon the exercise of an Option. Any fractional
share will be rounded up and issued to the Optionee in a whole share. 
 3. Exercise of Option. 

(a) Right to Exercise. This Option shall be exercisable during its term in accordance with the Vesting Schedule set out in the Notice
of Stock Option Grant and with the applicable provisions of the Plan and this Agreement. 

  
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 (b) Method and Time of Exercise. This Option shall be exercisable by any method permitted
by the Plan and this Agreement that is made available from time to time by the external third party administrator of the Option awards. An exercise may be made with respect to whole Shares only, and not for a fraction of a Share. Shares shall not be
issued under the Plan unless the issuance and delivery of such Shares comply with (or are exempt from) all applicable requirements of law, including (without limitation) the Securities Act, the rules and regulations promulgated thereunder, state
securities laws and regulations, and the regulations of any stock exchange or other securities market on which the Company’s securities may then be traded. The Committee may require the Optionee to take any reasonable action in order to comply
with any such rules or regulations. Assuming such compliance, for income tax purposes the Shares shall be considered transferred to the Optionee on the date the Option is exercised with respect to such Shares. 

(c) Acknowledgment of Potential Securities Law Restrictions. Unless a registration statement under the Securities Act covers the Shares
issued upon exercise of an Option, the Committee may require that the Optionee agree in writing to acquire such Shares for investment and not for public resale or distribution, unless and until the Shares subject to the Award are registered under
the Securities Act. The Committee may also require the Optionee to acknowledge that he or she shall not sell or transfer such Shares except in compliance with all applicable laws, and may apply such other restrictions as it deems appropriate. The
Optionee acknowledges that the U.S. federal securities laws prohibit trading in the stock of the Company by persons who are in possession of material, non-public information, and also acknowledges and understands the other restrictions set forth in
the Company’s Insider Trading Policy. 
 (d) Automatic Exercise Upon Expiration Date. Notwithstanding any other provision of
this Agreement (other than this Section), on the last trading day on which all or a portion of the outstanding Option may be exercised, if as of the close of trading on such day the then Fair Market Value of a share of Common Stock exceeds the per
share Exercise Price of the Option by at least $.01 (such expiring portion of the Option that is so in-the-money, an “Auto-Exercise Eligible Option”), Optionee will be deemed to have automatically exercised such Auto-Exercise Eligible
Option (to the extent it has not previously been exercised or forfeited) as of the close of trading in accordance with the provisions of this Section. In the event of an automatic exercise pursuant to this Section, the Company will reduce the number
of shares of Common Stock issued to Optionee upon such automatic exercise of the Auto-Exercise Eligible Option in an amount necessary to satisfy (1) Optionee’s Exercise Price obligation for the Auto-Exercise Eligible Option, and
(2) the minimum, applicable Federal, state, local and, if applicable, foreign income and employment tax and social insurance withholding requirements arising upon the automatic exercise in accordance with the procedures of Section 6(f) of
the Plan (unless the Committee deems that a different method of satisfying the tax withholding obligations is practicable and advisable), in each case based on the Fair Market Value of the Common Stock as of the close of trading on the date of
exercise. Optionee may notify the Plan record-keeper in writing in advance that Optionee does not wish for the Auto-Exercise Eligible Option to be exercised. This Section shall not apply to the Option to the extent that this Section causes the
Option to fail to qualify for favorable tax treatment under applicable law. In its discretion, the Company may determine to cease automatically exercising Options at any time. 

  
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 4. Method of Payment. Unless the Committee consents otherwise, payment of the aggregate
Exercise Price shall be by any of the following, or a combination thereof, at the election of the Optionee: 
 (a) cash, delivered to the
external third party administrator of the Option awards in any methodology permitted by such third party administrator; 
 (b) payment under
a cashless exercise program approved by the Company or through a broker-dealer sale and remittance procedure pursuant to which the Optionee (i) shall provide written instructions to a licensed broker acceptable to the Company and acting as
agent for the Optionee to effect the immediate sale of some or all of the purchased Shares and to remit to the Company, out of the sale proceeds available on the settlement date, sufficient funds to cover the aggregate Exercise Price payable for the
purchased Shares and (ii) shall provide written direction to the Company to deliver the purchased Shares directly to such brokerage firm in order to complete the sale transaction; or 

(c) surrender of other Shares which have a Fair Market Value on the date of surrender equal to the aggregate Exercise Price of the exercised
Shares. 
 5. Termination of Employment. 

(a) General. In the event the Optionee’s active employment or other active service-providing relationship with the Company or an
Eligible Subsidiary terminates for any reason (other than death, Early Retirement or Normal Retirement) whether or not in breach of applicable labor laws, all unvested Options shall be automatically forfeited by the Optionee as of the date of
termination and Optionee’s right to receive options under the Plan shall also terminate as of the date of termination. The Committee shall have discretion to determine whether the Optionee has ceased to be actively employed by (or, if the
Optionee is a consultant or director, has ceased actively providing services to) the Company or Eligible Subsidiary, and the effective date on which such active employment (or active service-providing relationship) terminated. The Optionee’s
active employer-employee or other active service-providing relationship will not be extended by any notice period mandated under applicable law (e.g., active employment shall not include a period of “garden leave”, paid
administrative leave or similar period pursuant to applicable law) and in the event of an Optionee’s termination of employment (whether or not in breach of applicable labor laws), Optionee’s right to exercise any Option after termination
of employment, if any, shall be measured by the date of termination of active employment or service and shall not be extended by any notice period mandated under applicable law. Unless the Committee provides otherwise (1) termination of the
Optionee’s employment will include instances in which the Optionee is terminated and immediately rehired as an independent contractor, and (2) the spin-off, sale, or disposition of the
Optionee’s employer from the Company or an Eligible Subsidiary (whether by transfer of shares, assets or otherwise) such that the Optionee’s employer no longer constitutes an Eligible Subsidiary will constitute a termination of employment
or service. 
 (b) General Post-Termination Exercise Period. In the event the Optionee’s employment with the Company or an
Eligible Subsidiary terminates for any reason (other than death, Disability, Early Retirement, Normal Retirement or Gross Misconduct), whether or not in 

  
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breach of applicable labor laws, the Optionee shall have a period of 90 days, commencing with the date the Optionee is no longer actively employed, to exercise the vested portion of any
outstanding Options, subject to the Expiration Date of the Option. However, if the exercise of an Option following Optionee’s termination of employment (to the extent such post-termination exercise is permitted under Section 11(a) of the
Plan) is not covered by an effective registration statement on file with the U.S. Securities and Exchange Commission, then the Option will terminate upon the later of (i) thirty (30) days after such exercise becomes covered by an effective
registration statement, (ii) in the event that a sale of shares of Common Stock would subject the Participant to liability under Section 16(b) of the Exchange Act, thirty (30) days after the last date on which such sale would result
in liability, or (iii) the end of the original post-termination exercise period, but in no event may an Option be exercised after the Expiration Date of the Option. 

(c) Death. Upon Optionee’s death prior to termination of employment, all unexpired Options shall become fully exercisable and may
be exercised for a period of twelve (12) months thereafter (subject to the Expiration Date of the Option) by the personal representative of the Optionee’s estate or any other person to whom the Option is transferred under a will or under
the applicable laws of descent and distribution. 
 (d) Disability. In the event the Optionee’s employment with the Company or
an Eligible Subsidiary terminates by reason of the Optionee’s Disability, all unvested Options shall be automatically forfeited by the Optionee as of the date of termination and the Optionee shall have until the first anniversary of the
Optionee’s termination of employment for Disability (subject to the Expiration Date of the Option) to exercise the vested portion of any outstanding Options. 

(e) Early Retirement. In the event the Optionee ceases to be an Employee as a result of Early Retirement, and the Date of Grant of this
Option precedes the Optionee’s Early Retirement date by at least six (6) months, with respect to each Tranche that is unvested as of the Early Retirement date (a “Tranche” consists of all portions of the Option as to which the
Time-Based Vesting Criteria are scheduled to be satisfied on the same date), a pro-rata portion of such Tranche (i.e. based on the ratio of (x) the number of full or partial months worked by the Optionee from the Date of Grant to the Early
Retirement date to (y) the total number of months in the original time-based vesting schedule of the Tranche) will continue to vest and such Options together with any Options that are vested as of the Optionee’s Early Retirement date shall
remain outstanding and (once vested) may be exercised until the fifth anniversary of the Early Retirement date (or if earlier, the Expiration Date of the Option). If the Date of Grant of this Option does not precede the Optionee’s Early
Retirement date by at least six (6) months, the post-termination exercise period with respect to such Option shall be governed by the other provisions of this Section 5, as applicable. 

(f) Normal Retirement. In the event the Optionee ceases to be an Employee as a result of Normal Retirement, and the Date of Grant of
this Option precedes the Optionee’s Normal Retirement date by at least six (6) months, the Optionee’s unvested Options will continue to vest and such Options together with any Options that are vested as of the Optionee’s Normal
Retirement date shall remain outstanding and (once vested) may be exercised until the 

  
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fifth anniversary of the Normal Retirement date (or if earlier, the Expiration Date of the Option). If the Date of Grant of this Option does not precede the Optionee’s Normal Retirement date
by at least six (6) months, the post-termination exercise period with respect to such Option shall be governed by the other provisions of this Section 5, as applicable. 

(g) Gross Misconduct. If the Optionee’s employment with the Company or an Eligible Subsidiary is terminated for Gross Misconduct,
the Optionee’s unexercised Options shall terminate immediately as of the time of termination, without consideration. The Optionee acknowledges and agrees that the Optionee’s termination of employment shall also be deemed to be a
termination of employment by reason of the Optionee’s Gross Misconduct if, after the Optionee’s employment has terminated, facts and circumstances are discovered or confirmed by the Company that would have justified a termination for Gross
Misconduct. 
 (h) Violation of Post-Employment Covenant. To the extent that any of the Optionee’s Options remain outstanding
under the terms of the Plan or this Agreement after termination of the Optionee’s employment or service with the Company or an Eligible Subsidiary, such Options shall nevertheless expire as of the date the Optionee violates any covenant not to
compete or other post-employment covenant that exists between the Optionee on the one hand and the Company or any subsidiary of the Company, on the other hand. 

(i) Substantial Corporate Change. Upon a Substantial Corporate Change, the Optionee’s outstanding Options will terminate unless
provision is made in writing in connection with such transaction for the assumption or continuation of the Options, or the substitution for such Options of any options or grants covering the stock or securities of a successor employer corporation,
or a parent or subsidiary of such successor, with appropriate adjustments as to the number and kind of shares of stock and prices, in which event the Options will continue in the manner and under the terms so provided. 

6. Non-Transferability of Option; Term of Option. 

(a) Unless the Committee determines otherwise in advance in writing, this Option may not be transferred in any manner otherwise than by will
or by the applicable laws of descent or distribution and may be exercised during the lifetime of Optionee only by Optionee and/or by his or her duly appointed guardian. The terms of the Plan and this Agreement shall be binding upon the executors,
administrators, heirs and permitted successors and assigns of the Optionee. 
 (b) Notwithstanding any other term in this Agreement, this
Option may be exercised only prior to the Expiration Date set out in the Notice of Stock Option Grant, and may be exercised during such term only in accordance with the Plan and the terms of this Agreement. 

7. Amendment of Option or Plan. 

(a) The Plan and this Agreement constitute the entire understanding of the parties with respect to the subject matter hereof and supersede in
their entirety all prior undertakings and agreements of the Company and Optionee with respect to the subject matter hereof. Optionee expressly warrants that he or she is not accepting this Agreement in reliance on any promises, representations, or
inducements other than those contained herein. The Company’s Board may 

  
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amend, modify or terminate the Plan or any Option in any respect at any time; provided, however, that modifications to this Agreement or the Plan that materially and adversely affect the
Optionee’s rights hereunder can be made only in an express written contract signed by the Company and the Optionee. Notwithstanding anything to the contrary in the Plan or this Agreement, the Company reserves the right to revise this Agreement
and Optionee’s rights under outstanding Options as it deems necessary or advisable, in its sole discretion and without the consent of the Optionee, (1) upon a Substantial Corporate Change, (2) as required by law, or (3) to comply
with Section 409A of the Internal Revenue Code of 1986 (“Section 409A”) or to otherwise avoid imposition of any additional tax or income recognition under Section 409A in connection with this award of Options. 

(b) The Optionee acknowledges and agrees that if the Optionee changes classification from a full-time employee to a part-time employee the
Committee may in its sole discretion (1) reduce or eliminate the Optionee’s unvested Options, and/or (2) extend any vesting schedule to one or more dates that occur on or before the Expiration Date. 

8. Tax Obligations. 
 (a)
Withholding Taxes. Regardless of any action the Company or any Subsidiary employing the Optionee (the “Employer”) takes with respect to any or all federal, state, local or foreign income tax, social insurance, payroll tax, payment
on account or other tax related items (“Tax Related Items”), the Optionee acknowledges that the ultimate liability for all Tax Related Items associated with the Option is and remains the Optionee’s responsibility and that the Company
and the Employer (i) make no representations or undertakings regarding the treatment of any Tax Related Items in connection with any aspect of the Option, including, but not limited to, the grant, vesting or exercise of the Option, the
subsequent sale of Shares acquired pursuant to such exercise and the receipt of any dividends or dividend equivalents; and (ii) do not commit to structure the terms of the grant or any aspect of the Option to reduce or eliminate the
Optionee’s liability for Tax Related Items. Further, if Optionee is subject to tax in more than one jurisdiction, Optionee acknowledges that the Company and/or the Employer (or former employer, as applicable) may be required to withhold or
account for Tax-Related Items in more than one jurisdiction. 
 Prior to the relevant taxable event, Optionee shall pay or make adequate
arrangements satisfactory to the Company and/or the Employer (in its sole discretion) to satisfy all withholding and payment on account obligations for Tax Related Items of the Company and/or the Employer. In this regard, the Optionee authorizes the
Company and the Employer, or either of them, in such entity’s sole discretion, to satisfy the obligations with regard to all Tax Related Items legally payable by the Optionee (with respect to the Option granted hereunder as well as any equity
awards previously received by the Optionee under any Company stock plan) by one or a combination of the following: (i) requiring the Optionee to pay Tax-Related Items in cash with a cashier’s check or certified check or by wire transfer of
immediately available funds; (ii) withholding cash from the Optionee’s wages or other compensation payable to the Optionee by the Company and/or the Employer; (iii) accepting from the Optionee the delivery of unencumbered Shares;
(iv) withholding from the proceeds of a broker-dealer sale and remittance procedure as described in Section 4(b) above; or (v) withholding in Shares otherwise issuable to 

  
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the Optionee, provided that the Company withholds only the amount of Shares necessary to satisfy the minimum statutory withholding amount (or such other amount that will not cause adverse
accounting consequences for the Company and is permitted under applicable withholding rules promulgated by the Internal Revenue Service or another applicable governmental entity) using the Fair Market Value of the Shares on the date of the relevant
taxable event. Optionee shall pay to the Company or the Employer any amount of Tax Related Items that the Company or the Employer may be required to withhold as a result of the Optionee’s participation in the Plan or the Optionee’s
purchase of Shares that are not satisfied by any of the means previously described. The Company may refuse to honor the exercise and refuse to deliver the Shares to the Optionee if the Optionee fails to comply with Optionee’s obligations in
connection with the Tax Related Items as described in this Section. 
 (b) Code Section 409A. The intent of the parties is that
payments and benefits under this Agreement comply with Section 409A of Code to the extent subject thereto, and, accordingly, to the maximum extent permitted, this Agreement shall be interpreted and be administered to be in compliance
therewith. Notwithstanding anything contained herein to the contrary, to the extent required to avoid accelerated taxation and/or tax penalties under Section 409A of the Code, the Participant shall not be considered to have separated from
service with the Company for purposes of this Agreement and no payment shall be due to the Participant under this Agreement on account of a separation from service until the Participant would be considered to have incurred a “separation from
service” from the Company within the meaning of Section 409A of the Code. Any payments described in this Agreement that are due within the “short-term deferral period” as defined in Section 409A of the Code shall not be
treated as deferred compensation unless applicable law requires otherwise. Notwithstanding anything to the contrary in this Agreement, to the extent that any amounts are payable upon a separation from service and such payment would result in
accelerated taxation and/or tax penalties under Section 409A of the Code, such payment, under this Agreement or any other agreement of the Company, shall be made on the first business day after the date that is six (6) months following
such separation from service (or death, if earlier). The Company makes no representation that any or all of the payments described in this Agreement will be exempt from or comply with Section 409A of the Code and makes no undertaking to
preclude Section 409A of the Code from applying to any such payment. The Grantee shall be solely responsible for the payment of any taxes and penalties incurred under Section 409A. 

9. Rights as Shareholder. Until all requirements for exercise of the Option pursuant to the terms of this Agreement and the Plan have
been satisfied, the Optionee shall not be deemed to be a shareholder or to have any of the rights of a shareholder with respect to any Shares. 

10. No Employment Contract. Nothing in the Plan or this Agreement constitutes an employment contract between the Company and the
Optionee and this Agreement shall not confer upon the Optionee any right to continuation of employment or service with the Company or any of its Subsidiaries, nor shall this Agreement interfere in any way with the Company’s or any of its
Subsidiaries right to terminate the Optionee’s employment or service at any time, with or without cause (subject to any employment agreement an Optionee may otherwise have with the Company or a Subsidiary thereof and/or applicable law). 

  
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 11. Board Authority. The Board and/or the Committee shall have the power to interpret this
Agreement and to adopt such rules for the administration, interpretation and application of the Agreement as are consistent therewith and to interpret or revoke any such rules (including, but not limited to, the determination of whether any Options
have vested). All interpretations and determinations made by the Board and/or the Committee in good faith shall be final and binding upon Optionee, the Company and all other interested persons and such determinations of the Board and/or the
Committee do not have to be uniform nor do they have to consider whether optionees are similarly situated. No member of the Board and/or the Committee shall be personally liable for any action, determination or interpretation made in good faith with
respect to this Agreement. 
 12. Headings. The captions used in this Agreement and the Plan are inserted for convenience and shall
not be deemed to be a part of the Option for construction and interpretation. 
 13. Electronic Delivery. 

(a) If the Optionee executes this Agreement electronically, for the avoidance of doubt Optionee acknowledges and agrees that his or her
execution of this Agreement electronically (through an on-line system established and maintained by the Company or a third party designated by the Company, or otherwise) shall have the same binding legal effect as would execution of this Agreement
in paper form. Optionee acknowledges that upon request of the Company he or she shall also provide an executed, paper form of this Agreement. 

(b) If the Optionee executes this Agreement in paper form, for the avoidance of doubt the parties acknowledge and agree that it is their
intent that any agreement previously or subsequently entered into between the parties that is executed electronically shall have the same binding legal effect as if such agreement were executed in paper form. 

(c) If Optionee executes this Agreement multiple times (for example, if the Optionee first executes this Agreement in electronic form and
subsequently executes the Agreement in paper form), the Optionee acknowledges and agrees that (i) no matter how many versions of this Agreement are executed and in whatever medium, this Agreement only evidences a single grant of Options
relating to the number of Shares set forth in the Notice of Stock Option Grant and (ii) this Agreement shall be effective as of the earliest execution of this Agreement by the parties, whether in paper form or electronically, and the subsequent
execution of this Agreement in the same or a different medium shall in no way impair the binding legal effect of this Agreement as of the time of original execution. 

(d) The Company may, in its sole discretion, decide to deliver by electronic means any documents related to the Option, to participation in
the Plan, or to future awards granted under the Plan, or otherwise required to be delivered to the Optionee pursuant to the Plan or under applicable law, including but not limited to, the Plan, the Agreement, the Plan prospectus and any reports of
the Company generally provided to shareholders. Such means of electronic delivery may include, but do not necessarily include, the delivery of a link to the Company’s intranet or the internet site of a third party involved in administering the
Plan, the delivery of documents via electronic mail (“e-mail”) or such other means of electronic delivery 

  
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specified by the Company. By executing this Agreement, the Optionee hereby consents to receive such documents by electronic delivery. At the Optionee’s written request to the Secretary
of the Company, the Company shall provide a paper copy of any document at no cost to the Optionee. 
 14.
Data Privacy. Optionee hereby explicitly and unambiguously consents to the collection, use and transfer, in electronic or other form, of his or her Data (as defined below) by and among, as
necessary and applicable, the Employer, the Company and its Subsidiaries for the exclusive purpose of implementing, administering and managing Optionee’s participation in the Plan. 

Optionee understands that the Company and the Employer may hold certain personal information about Optionee, including, but not limited
to, Optionee’s name, home address and telephone number, date of birth, social security or insurance number or other identification number (e.g., resident registration number), salary, nationality, and job title, any Common Stock or
directorships held in the Company, and details of the Option or any other option or other entitlement to Shares, canceled, exercised, vested, unvested or outstanding in Optionee’s favor (“Data”), for the purpose of implementing,
administering and managing the Plan. Optionee understands that Data may be transferred to any third parties assisting in the implementation, administration and management of the Plan, that these recipients may be located in Optionee’s country
or elsewhere, including outside the European Economic Area, and that the recipients’ country may have different data privacy laws and protections than Optionee’s country. Optionee authorizes the recipients to receive, possess, use, retain
and transfer the Data, in electronic or other form, for the purposes of implementing, administering and managing Optionee’s participation in the Plan, including any requisite transfer of such Data as may be required to a broker or other third
party with whom Optionee may elect to deposit any Shares acquired upon exercise of the Option or any other option or other entitlement to Shares. 

Optionee understands that he or she may request a list with the names and addresses of any potential recipients of the Data by
contacting his or her local human resources representative. Optionee understands that Data shall be held as long as is reasonably necessary to implement, administer and manage his or her participation in the Plan, and he or she may, at any time,
view Data, request additional information about the storage and processing of Data, require any necessary amendments to Data or refuse or withdraw the consents herein, in any case without cost, by contacting in writing his or her local human
resources representative. Further, Optionee understands that Optionee is providing the consents herein on a purely voluntary basis. If Optionee does not consent, or if Optionee later seeks to revoke his or her consent, his or her employment status
or service and career with his or her employer will not be adversely affected; the only adverse consequence of refusing or withdrawing Optionee’s consent is that the Company would not be able to grant Options or other equity awards to Optionee
or to administer or maintain such awards. Therefore, Optionee understands that refusing or withdrawing such consent may affect his or her ability to participate in the Plan. In addition, Optionee understands that the Company and its Subsidiaries
have separately implemented procedures for the handling of Data which the Company believes permits the Company to use the Data in the manner set forth above notwithstanding Optionee’s withdrawal of such consent. For more information on the
consequences of refusal to consent or withdrawal of consent, Optionee understands that he or she may contact his or her local human resources representative. 

  
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 15. Waiver of Right to Jury Trial. Each party, to the fullest extent permitted by law,
waives any right or expectation against the other to trial or adjudication by a jury of any claim, cause or action arising with respect to the Option or hereunder, or the rights, duties or liabilities created hereby. 

16. Agreement Severable. In the event that any provision of this Agreement shall be held invalid or unenforceable, such provision shall
be severable from, and such invalidity or unenforceability shall not be construed to have any effect on, the remaining provisions of this Agreement. 

17. Governing Law and Venue. The laws of the State of Delaware (other than its choice of law provisions) shall govern this Agreement and
its interpretation. For purposes of litigating any dispute that arises with respect to this Option, this Agreement or the Plan, the parties hereby submit to and consent to the jurisdiction of the State of Delaware, and agree that such litigation
shall be conducted in the courts of New Castle County, or the United States Federal court for the District of Delaware, and no other courts; and waive, to the fullest extent permitted by law, any objection that the laying of the venue of any legal
or equitable proceedings related to, concerning or arising from such dispute which is brought in any such court is improper or that such proceedings have been brought in an inconvenient forum. Any claim under the Plan, this Agreement or any Award
must be commenced by Optionee within twelve (12) months of the earliest date on which Optionee’s claim first arises, or Optionee’s cause of action accrues, or such claim will be deemed waived by Optionee. 

18. Nature of Option. In accepting the Option, Optionee acknowledges and agrees that: 

(a) the award of the Option is voluntary and occasional and does not create any contractual or other right to receive future grants of
options, benefits in lieu of options or other equity awards, even if options have been granted repeatedly in the past; 
 (b) all decisions
with respect to future equity awards, if any, shall be at the sole discretion of the Company; 
 (c) Optionee’s participation in the
Plan is voluntary; 
 (d) the Option, and the income and value of same, is an extraordinary item that (i) does not constitute
compensation of any kind for services of any kind rendered to the Company or any Subsidiary, and (ii) is outside the scope of Optionee’s employment or service contract, if any; 

(e) the Option, and the income and value of same, is not part of normal or expected compensation or salary for any purposes, including, but
not limited to, calculating any severance, resignation, termination, redundancy, end of service payments, bonuses, long-service awards, pension or retirement or welfare benefits or similar payments and in no event should be considered as
compensation for, or relating in any way to, past services for the Company or any Subsidiary; 

  
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 (f) unless otherwise agreed with the Company, the Option, and the income and value of same, are
not granted as consideration for, or in connection with, any service Optionee may provide as a director of any Subsidiary; 
 (g) the Option
and Optionee’s participation in the Plan shall not be interpreted to form an employment or service contract with the Company or any Subsidiary of the Company; 

(h) the future value of the underlying Shares is unknown and cannot be predicted with certainty; 

(i) if the Shares do not increase in value, the Option will have no value; 

(j) if Optionee exercises the Option and obtains Shares, the value of the Shares obtained upon exercise may increase or decrease in value,
even below the Exercise Price; 
 (k) in consideration of the award of the Option, no claim or entitlement to compensation or damages shall
arise from termination of the Option or diminution in value of the Option, or Shares purchased through the exercise of the Option, resulting from termination of Optionee’s employment or continuous service by the Company or any Subsidiary (for
any reason whatsoever and whether or not in breach of applicable labor laws of the jurisdiction where Optionee is employed or the terms of Optionee’s employment agreement, if any, and whether or not later found to be invalid) and in
consideration of the grant of the Option, Optionee irrevocably releases the Company and any Subsidiary from any such claim that may arise; if, notwithstanding the foregoing, any such claim is found by a court of competent jurisdiction to have
arisen, then, by signing/electronically accepting the Agreement, Optionee shall be deemed irrevocably to have waived Optionee’s entitlement to pursue or seek remedy for any such claim; 

(l) the Company is not providing any tax, legal or financial advice, nor is the Company making any recommendations regarding Optionee’s
participation in the Plan or Optionee’s acquisition or sale of the underlying Shares; and 
 (m) Optionee is hereby advised to consult
with Optionee’s own personal tax, legal and financial advisors regarding Optionee’s participation in the Plan before taking any action related to the Plan. 

19. Language. If Optionee has received this Agreement, the Plan or any other document related to the Plan translated into a language
other than English and if the meaning of the translated version is different than the English version, the English version will control, unless otherwise prescribed by applicable law. 

20. Severability. The provisions of this Agreement are severable and if any one or more provisions are determined to be illegal or
otherwise unenforceable, in whole or in part, the remaining provisions shall nevertheless be binding and enforceable. 

  
 12 

 21. Waiver. Optionee acknowledges that a waiver by the Company of breach of any provision
of this Agreement shall not operate or be construed as a waiver of any other provision of this Agreement, or of any subsequent breach by Optionee or any other participant. 

22. Insider Trading/Market Abuse Laws. Optionee acknowledges that, depending on Optionee’s country, Optionee may be subject to
insider trading restrictions and/or market abuse laws, which may affect his or her ability to acquire or sell Shares or exercise Options under the Plan during such times as Optionee is considered to have “inside information” regarding the
Company (as defined by the laws in Optionee’s country). Any restrictions under these laws or regulations are separate from and in addition to any restrictions that may be imposed under any applicable insider trading policy of the Company.
Optionee acknowledges that it is his or her responsibility to comply with any applicable restrictions, and Optionee is advised to consult with his or her own personal legal and financial advisors on this matter. 

23. Addendum. The Option shall be subject to the special terms and provisions (if any) set forth in the Addendum A to this Agreement for
Optionee’s country of residence. Moreover, if Optionee relocates to one of the countries included in the Addendum A, the special terms and conditions for such country will apply to Optionee, to the extent the Company determines that the
application of such terms and conditions is necessary or advisable in order to comply with applicable law or facilitate the administration of the Plan and provided the imposition of the term or condition will not result in any adverse accounting
expense with respect to the Option. Addendum A constitutes part of this Agreement. In addition, the Company reserves the right to impose other requirements on the Option and any Shares acquired under the Plan, to the extent the Company determines it
is necessary or advisable in order to comply with applicable law or facilitate the administration of the Plan and provided the imposition of the term or condition will not result in adverse accounting expense to the Company, and to require Optionee
to sign any additional agreements or undertakings that may be necessary to accomplish the foregoing. 
 24. Recoupment. The Options
granted pursuant to this Agreement are subject to the terms of the Fortive Corporation Recoupment Policy as it exists from time to time (a copy of the Recoupment Policy as it exists from time to time is available on the Company’s internal
website) (the “Policy”) if and to the extent such Policy by its terms applies to the Options, and to the terms required by applicable law; and the terms of the Policy and such applicable law are incorporated by reference herein and made a
part hereof. 
 25. Notices. The Company may, directly or through its third party stock plan administrator, endeavor to provide
certain notices to Optionee regarding certain events relating to awards that the Optionee may have received or may in the future receive under the Plan, such as notices reminding Optionee of the vesting or expiration date of certain awards. Optionee
acknowledges and agrees that (1) the Company has no obligation (whether pursuant to this Agreement or otherwise) to provide any such notices; (2) to the extent the Company does provide any such notices to Optionee the Company does not
thereby assume any obligation to provide any such notices or other notices; and (3) the Company, its affiliates and the third party stock plan administrator have no liability for, and the Optionee has no right whatsoever (whether pursuant to
this Agreement or otherwise) to make any claim against the Company, any of its affiliates or the third party stock plan administrator based on any allegations of, damages or harm suffered by the Optionee as a result of the Company’s failure to
provide any such notices or Optionee’s failure to receive any such notices. 

  
 13 

 26. Consent and Agreement With Respect to Plan. Optionee (1) acknowledges that the
Plan and the prospectus relating thereto are available to Optionee on the website maintained by the Company’s third party stock plan administrator; (2) represents that he or she has read and is familiar with the terms and provisions
thereof, has had an opportunity to obtain the advice of counsel of his or her choice prior to executing this Agreement and fully understands all provisions of the Agreement and the Plan; (3) accepts this Option subject to all of the terms and
provisions thereof; (4) consents and agrees to all amendments that have been made to the Plan since it was adopted in 2016 (and for the avoidance of doubt consents and agrees to each amended term reflected in the Plan as in effect on the date
of this Agreement), and consents and agrees that all options and restricted stock units, if any, held by Optionee that were previously granted under the Plan as it has existed from time to time are now governed by the Plan as in effect on the date
of this Agreement (except to the extent the Committee has expressly provided that a particular Plan amendment does not apply retroactively); and (5) agrees to accept as binding, conclusive and final all decisions or interpretations of the
Committee upon any questions arising under the Plan or this Agreement. 
 [If the Agreement is signed in paper form, complete
and execute the following:] 
  

					
			
	OPTIONEE	 		 	FORTIVE CORPORATION
			
	  
	 		 	  

	Signature	 		 	Signature
			
	  
	 		 	  

	Print Name	 		 	Print Name
			
	  
	 		 	  

	  
  
	 		 	Title
	Residence Address	 		 	

  
 14 

 ADDENDUM A 

This Addendum includes additional terms and conditions that govern the Option granted to Optionee if Optionee works and/or resides in one of the countries
listed herein. Capitalized terms used but not defined herein shall have the same meanings ascribed to them in the Notice of Stock Option Grant, the Agreement or the Plan. 

This Addendum may also include information regarding exchange controls and certain other issues of which Optionee should be aware with respect to
Optionee’s participation in the Plan. The information is based on the securities, exchange control and other laws concerning Options in effect as of March 2016. Such laws are often complex and change frequently. As a result, the Company
strongly recommends that Optionee not rely on the information noted herein as the only source of information relating to the consequences of Optionee’s participation in the Plan as the information may be out of date at the time Optionee
exercises the Option or sells Shares acquired under the Plan. 
 In addition, this Addendum is general in nature and may not apply to Optionee’s
particular situation, and the Company is not in a position to assure Optionee of any particular result. Accordingly, Optionee should to seek appropriate professional advice as to how the relevant laws in Optionee’s country apply to
Optionee’s specific situation. 
 If Optionee is a citizen of a country other than the one in which Optionee is currently working, transfers
employment and/or residency after the Option was granted or is considered a resident of another country for local law purposes, the information contained herein may not be applicable to Optionee in the same manner. 

OPTIONEES IN AUSTRALIA, CZECH REPUBLIC, GERMANY, HUNGARY, IRELAND, NEW ZEALAND, SLOVAKIA AND THE UNITED KINGDOM 

Sections 5(e) and (f) of this Agreement, (Early Retirement and Normal Retirement, respectively), shall not apply to any Optionee who as of the Date of
Grant is on permanent, non-temporary assignment in Australia, the Czech Republic, Germany, Hungary, Ireland, New Zealand, Slovakia or the United Kingdom. Instead, the provisions of Section 5(a) (General), shall apply, notwithstanding the
provisions therein regarding Early Retirement and Normal Retirement to the contrary. 
 OPTIONEES IN AUSTRIA, BELGIUM, DENMARK, FINLAND, FRANCE,
ITALY, THE NETHERLANDS, POLAND, SLOVENIA, SPAIN AND SWEDEN 
 Section 5(e) of this Agreement (regarding Early Retirement) shall not apply to any
Optionee who as of the Date of Grant is on permanent, non-temporary assignment in Austria, Belgium, Denmark, Finland, France, Italy, the Netherlands, Poland, Slovenia, Spain or Sweden (collectively, the “Statutory Retirement Age
Countries”). Instead, the provisions of Section 5(a) (General), shall apply, notwithstanding the provisions therein regarding Early Retirement to the contrary. 

For purposes of applying the Plan and Section 5(f) of this Agreement (regarding Normal Retirement) to any Optionee who as of the Date of Grant is on
permanent, non-temporary assignment in any of the Statutory Retirement Age Countries, the definition of “Normal Retirement” set forth in the Plan shall not apply and instead “Normal Retirement” shall mean such Optionee’s
attainment of the statutory retirement age in the jurisdiction in which the Optionee is on permanent, non-temporary assignment as of the Date of Grant. In the absence of a statutory retirement age in such jurisdiction, “Normal Retirement”
shall mean attainment of the customary age for retirement in such jurisdiction. 

  
 15 

 Notwithstanding the foregoing, in the event that subsequent to the Date of Grant such Optionee works in a
jurisdiction other than in the jurisdiction in which the Optionee was on permanent, non-temporary assignment as of the Date of Grant, if required to comply with applicable law, the Committee shall have sole and absolute discretion to instead apply
to such Optionee the retirement provisions of this Agreement that are applicable in such other jurisdiction. 
 OPTIONEES IN CHINA AND ITALY

 Method of Exercise 
 Optionee acknowledges that
due to regulatory requirements, and notwithstanding any terms or conditions of the Plan or the Agreement to the contrary, Optionees residing in mainland China and Italy will be restricted to the cashless sell-all method of exercise with respect to
their Options. To complete a cashless sell-all exercise, Optionee understands that Optionee needs to instruct the broker to: (i) sell all of the purchased Shares issued upon exercise; (ii) use the proceeds to pay the Exercise Price,
brokerage fees and any applicable Tax-Related Items; and (iii) remit the balance in cash to Optionee. In the event of changes in regulatory requirements, the Company reserves the right to eliminate the cashless sell-all method of exercise
requirement and, in its sole discretion, to permit cash exercise, cashless sell-to-cover exercise or any other method of exercise and payment deemed appropriate by the Company. 

OPTIONEES IN ARGENTINA 
 Securities Law Notice

 Optionee understands that neither the grant of the Option nor the purchase of Shares constitute a public offering as defined by the Law N° 17,811,
or any other Argentine law. The offering of the Option is a private placement. As such, the offering is not subject to the supervision of any Argentine governmental authority. 

Labor Law Acknowledgement 
 Any benefits awarded under the
Plan accrue no more frequently than on an annual basis. In addition, Optionee acknowledges that the grant is made by the Company on behalf of Optionee’s local employer. 

Exchange Control Notice 
 Following the sale of Shares
and/or the receipt of dividends, Argentine residents may be subject to certain restrictions in bringing such funds back into Argentina. The Argentine bank handling the transaction may request certain documentation in connection with the request to
transfer proceeds into Argentina (e.g., evidence of the sale, proof of the source of the funds used to purchase such shares, etc.). The Optionee must comply with any and all Argentine currency exchange restrictions, approvals and reporting
requirements in connection with the exercise of the option, the subsequent sale of any Shares acquired upon exercise and the receipt of any dividends paid on such shares. 

Please note that exchange control regulations in Argentina are subject to frequent change. The Optionee should consult with his or her personal legal advisor
regarding any exchange control obligations the Optionee may have in connection with the Optionee’s participation in the Plan. 

  
 16 

 Foreign Asset/Account Reporting Information 

If Optionee holds Shares as of December 31 of any year, Optionee is required to report the holding of the Shares on his or her personal tax return for the
relevant year. In addition, certain periodic reporting obligations also apply; specifically, when Optionee acquires, sells, transfers or otherwise disposes of Shares on or after January 1, 2012, Optionee must register the transaction with the
Federal Tax Administration. 
 OPTIONEES IN AUSTRALIA 

Securities Law Notice 
 If you acquire Shares under the
Plan and subsequently offer the Shares for sale to a person or entity resident in Australia, such an offer may be subject to disclosure requirements under Australian law, and you should obtain legal advice regarding any applicable disclosure
requirements prior to making any such offer. 
 Exchange Control Notice 

Exchange control reporting is required for cash transactions exceeding A$10,000 and international fund transfers of any amount. The Australian bank assisting
with the transaction will file the report for Optionee. If there is no Australian bank involved in the transfer, Optionee will be responsible for filing the report. 

OPTIONEES IN AUSTRIA 
 Exchange Control Notice

 If the Optionee holds Shares acquired under the Plan outside of Austria, the Optionee must submit a report to the Austrian National Bank as follows:
(i) on a quarterly basis if the value of the shares as of any given quarter meets or exceeds €30,000,000; the deadline for filing the quarterly report is the 15th day of the month following the end of the respective quarter and
(ii) on an annual basis if the value of the shares as of December 31 meets or exceeds €5,000,000; the deadline for filing the annual report is January 31 of the following year. 

When the Optionee sells Shares acquired under the Plan, the Optionee may be required to comply with certain exchange control obligations if the cash proceeds
from the sale are held outside of Austria. If the transaction volume of all accounts abroad exceeds €3,000,000, the movements and balances of all accounts must be reported monthly, as of the last day of the month, on or before the fifteenth day
of the following month. 
 OPTIONEES IN BELGIUM 

Terms and Conditions 
 Options granted to Optionees in
Belgium shall not be accepted by Optionee earlier than the 61st day following the Offer Date. The Offer Date is the date on which the Company notifies Optionee of the material terms and conditions
of the Option grant. Any acceptance given by Optionee before the 61st day following the grant date shall be null and void. 

  
 17 

 Foreign Asset/Account Reporting Information 

The Optionee is required to report any taxable income attributable to this Option on his or her annual tax return. The Optionee is also required to report any
security or bank account opened and maintained outside of Belgium on Optionee’s annual tax return. In a separate report, Optionee is required to provide a central point of contact point to the National Bank of Belgium with the account number,
bank name and country in which said bank account was opened. This report, as well as additional information on how to complete it, can be found on the website of the National Bank of Belgium, www.nbb.be, under the Kredietcentrales / Centrales des
crédits caption. 
 OPTIONEES IN BRAZIL 

Compliance with Law 
 By accepting the Option, the Optionee
acknowledges that he or she agrees to comply with applicable Brazilian laws and pay any and all applicable taxes associated with the exercise of the Option, the receipt of any dividends, and the sale of Shares acquired under the Plan. 

Nature of Grant 
 By accepting the Options, Optionee
agrees that Optionee is making an investment decision, the Options will become exercisable only if the vesting conditions are met and any necessary services are rendered by Optionee, and the value of the underlying Shares is not fixed and may
increase or decrease in value over the vesting period without compensation to Optionee. 
 Labor Law Acknowledgement 

Optionee agrees that, for all legal purposes, (i) the benefits provided under the Agreement and the Plan are the result of commercial transactions
unrelated to Optionee’s employment; (ii) the Agreement and the Plan are not part of any terms and conditions of Optionee’s employment; and (iii) the income from the Options, if any, is not part of Optionee’s remuneration
from employment. 
 Securities Law Notice 
 The Options
and the securities acquired under the Plan have not been and will not be publicly issued, place, distributed, offered or negotiated in the Brazilian capital markets and, as a result, will not be registered with the Brazilian Securities Commission
(Comissão de Valores Mobiliários, the CVM). Therefore, the Options and the securities acquired upon exercise of the Options will not be offered or sold in Brazil, except in circumstances which do not constitute a public
offering, placement, distribution or negotiation under the Brazilian capital markets regulation. 
 Exchange Control Notice 

If Optionee is a resident or domiciled in Brazil, Optionee will be required to submit annually a declaration of assets and rights held outside of Brazil to the
Central Bank of Brazil if the aggregate value of such assets and rights is equal to or greater than US$100,000. Assets and rights that must be reported include Shares acquired under the Plan. Foreign individuals holding Brazilian visas are
considered Brazilian residents for purposes of this reporting requirement and must declare the assets held abroad that were acquired subsequent to the date of admittance as a resident of Brazil. Please note that the US$100,000 threshold may be
changed annually. 

  
 18 

 OPTIONEES IN CANADA 

Consent to Receive Information in English for Optionees in Quebec 

The parties acknowledge that it is their express wish that this Agreement, as well as all documents, notices and legal proceedings entered into, given or
instituted pursuant hereto or relating directly or indirectly hereto, be written in English. 
 Les parties reconnaissent avoir exigé la
rédaction en anglais du présent Contrat, ainsi que de tous documents exécutés, avis donnés et procédures judiciaires intentées, directement ou indirectement, relativement à ou suite au
présent Contrat. 
 Data Privacy 
 Optionee
hereby authorizes the Company and the Company’s representatives to discuss with and obtain all relevant information from all personnel, professional or not, involved in the administration and operation of the Plan. Optionee further authorizes
the Company and its Subsidiaries and affiliates, and any stock plan service provider that may be selected by the Company, to assist with the Plan to disclose and discuss the Plan with their respective advisors. Optionee further authorizes the
Company and its Subsidiaries and affiliates to record such information and to keep such information in his or her employee file. 
 Securities Law Notice

 Optionee is permitted to sell Shares acquired through the Plan through the designated broker appointed under the Plan, if any (or any other broker
acceptable to the Company), provided the resale of Shares acquired under the Plan takes place outside of Canada through the facilities of a stock exchange on which the Shares are listed. The Shares are currently listed on the New York Stock
Exchange. 
 Foreign Asset/Account Reporting Information 

Foreign property, including Options, Shares acquired under the Plan and other rights to receive shares of a non-Canadian company held by a Canadian resident
must generally be reported annually on a Form T1135 (Foreign Income Verification Statement) if the total cost of the foreign property exceeds C$100,000 at any time during the year. Thus, such Options must be reported – generally at a nil cost
– if the C$100,000 cost threshold is exceeded because Optionee holds other foreign property. When Shares are acquired, their cost generally is the adjusted cost base (“ACB”) of the shares. The ACB would ordinarily equal the fair
market value of the shares at the time of acquisition, but if Optionee owns other shares of the same company, this ACB may need to be averaged with the ACB of the other shares. Optionee should consult his or her personal legal advisor to ensure
compliance with applicable reporting obligations. 
 OPTIONEES IN CHILE 

Securities Law Notice 
 The grant of the Options hereunder
is not intended to be a public offering of securities in Chile but instead is intended to be a private placement. 
  

	 	a)	The starting date of the offer will be the Grant Date (as defined in the Agreement), and this offer conforms to General Ruling no. 336 of the Chilean Superintendence of Securities and Insurance; 

  
 19 

	 	b)	The offer deals with securities not registered in the registry of securities or in the registry of foreign securities of the Chilean Superintendence of Securities and Insurance, and therefore such securities are not
subject to its oversight; 

  

	 	c)	The issuer is not obligated to provide public information in Chile regarding the foreign securities, as such securities are not registered with the Chilean Superintendence of Securities and Insurance; and

  

	 	d)	The foreign securities shall not be subject to public offering as long as they are not registered with the corresponding registry of securities in Chile. 

 

	 	a)	La fecha de inicio de la oferta será el de la fecha de otorgamiento (o “Grant Date”, según este término se define en el documento denominado “Agreement”) y esta oferta se
acoge a la norma de Carácter General n° 336 de la Superintendencia de Valores y Seguros Chilena; 

  

	 	b)	La oferta versa sobre valores no inscritos en el registro de valores o en el registro de valores extranjeros que lleva la Superintendencia de Valores y Seguros Chilena, por lo que tales valores no están
sujetos a la fiscalización de ésta; 

  

	 	c)	Por tratar de valores no inscritos no existe la obligación por parte del emisor de entregar en chile información pública respecto de esos valores; y 

 

	 	d)	Esos valores no podrán ser objeto de oferta pública mientras no sean inscritos en el registro de valores correspondiente. 

Exchange Control Notice 
 It is the Optionee’s
responsibility to make sure that Optionee complies with exchange control requirements in Chile when the value of his or her stock transaction is in the excess of US$10,000. 

If the Optionee pays the Exercise Price in cash or check and remits funds in excess of US$10,000 out of Chile, the remittance must be made through the Formal
Exchange Market (“FEM,” i.e., a commercial bank or registered foreign exchange office). 
 If the Optionee pays the Exercise Price under a
cashless exercise program implemented by the Company in connection with the Plan, and the aggregate value of the Exercise Price exceeds US$10,000, a report must be filed with the Central Bank within 10 days of the exercise date. 

If the Optionee repatriates to Chile sale proceeds from Shares that were purchased by funds that were required to be transferred out of Chile through the FEM
or if the amount of sale proceeds repatriated to Chile exceeds US$10,000, he or she must use the FEM for transferring the proceeds into Chile. 
 If the
Optionee’s aggregate investments held outside of Chile exceed US$5,000,000 (including the investments made under the Plan), the Optionee must report the status of such investments annually to the Central Bank, using Annex 3.1 of Chapter XII of
the Foreign Exchange Regulations. 

  
 20 

 Annual Tax Reporting Obligation 

The CIRS requires all taxpayers to provide information annually regarding (i) the results of investments held abroad in quotas or shares in which the
taxpayer participates directly or indirectly in the direction, control, equity or profits; and (ii) the taxes paid abroad which the taxpayers will use as credit against Chilean income tax. To comply with these annual reporting obligations
Optionee must submit a sworn statements setting forth the required information before March 15 of each year. The forms to be use to submit the sworn statement are Tax Form 1853 “Annual Sworn Statement Regarding Permanent Investments Held
Abroad” and Tax Form 1851 “Annual Sworn Statement Regarding Investments Held Abroad.” If Optionee is not a Chilean citizen and has been a resident in Chile for less than 3 years, Optionee will be exempt from the requirements to file
Tax Form 1853. These statements must be submitted electronically through the CIRS website at www.sii.cl. Optionee should consult with his or her personal tax advisor to determine the applicable reporting obligations. 

OPTIONEES IN CHINA 
 Terms and
Conditions—Exchange Control Restrictions Applicable to Optionees who are PRC Nationals 
 Optionee understands that, except as otherwise provided
herein, his or her Options can be exercised only by means of the cashless sell-all method, under which all Shares underlying the option are immediately sold upon exercise. 

In addition, Optionee understands and agrees that, pursuant to local exchange control requirements, Optionee is required to repatriate the cash proceeds from
the cashless sell-all method of exercise of options, (i.e., the sale proceeds less the Exercise Price and any administrative fees). Optionee agrees that the Company is authorized to instruct its designated broker to assist with the immediate sale of
such shares (on Optionee’s behalf pursuant to this authorization), and Optionee expressly authorizes such broker to complete the sale of such shares. Optionee acknowledges that the Company’s broker is under no obligation to arrange for the
sale of the shares at any particular price. The Company reserves the right to provide additional methods of exercise depending on the development of local law. 

In addition, Optionee understands and agrees that the cash proceeds from the exercise of his or her Options, (i.e., the proceeds of the sale of the shares
underlying the Options, less the Exercise Price and any administrative fees) will be repatriated to China. Optionee further understands that, under local law, such repatriation of the cash proceeds may be effectuated through a special foreign
exchange control account to be approved by the local foreign exchange administration, and Optionee hereby consents and agrees that the proceeds from the sale of Shares acquired under the Plan, net of the Exercise Price and administrative fees, may
be transferred to such special account prior to being delivered to Optionee. The proceeds, net of Tax-Related Items, may be paid to Optionee in U.S. Dollars or local currency at the Company’s discretion. In the event the proceeds are paid to
Optionee in U.S. Dollars, Optionee understands that he or she will be required to set up a U.S. Dollar bank account in China and provide the bank account details to the Employer and/or the Company so that the proceeds may be deposited into this
account. In addition, Optionee understands and agrees that Optionee will be responsible for converting the proceeds into Renminbi Yuan at Optionee’s expense. 

If the proceeds are paid to Optionee in local currency, Optionee agrees to bear any currency fluctuation risk between the time the shares are sold and the
time the sale proceeds are distributed through any such special exchange account. 
 Exchange Control Notice Applicable to Optionees in the PRC 

Optionee understands that exchange control restrictions may limit Optionee’s ability to access and/or convert funds received under the Plan, particularly
if these amounts exceed US$50,000. Optionee should confirm the procedures and requirements for withdrawals and conversions of foreign currency with his or her local bank prior to option exercise. 

  
 21 

 Optionee agrees to comply with any other requirements that may be imposed by the Company in the future in order
to facilitate compliance with exchange control requirements in the Peoples’ Republic of China. 
 Foreign Asset Reporting Information 

PRC residents are required to report to SAFE details of their foreign financial assets and liabilities, as well as details of any economic transactions
conducted with non-PRC residents, either directly or through financial institutions. Optionee may be subject to reporting obligations for the Shares or awards acquired under the Plan and Plan-related transactions. It is Optionee’s
responsibility to comply with this reporting obligation and Optionee should consult his/her personal tax advisor in this regard. 
 OPTIONEES IN
COLOMBIA 
 Labor Law Acknowledgement The following provision supplements Section 10 of the Award Agreement: 

Optionee acknowledges that pursuant to Article 128 of the Colombian Labor Code, the Plan, the Option, the underlying Shares, and any other amounts or payments
granted or realized from participation in the Plan do not constitute a component of Optionee’s “salary” for any purpose. To this extent, they will not be included and/or considered for purposes of calculating any and all labor
benefits, such as legal/fringe benefits, vacations, indemnities, payroll taxes, social insurance contributions or any other labor-related amount which may be payable. 

Foreign Asset/Account Reporting Information 
 Investments
held abroad (including Shares issued at exercise) must be registered with the Central Bank of Colombia(Banco de la República) if the aggregate investment held by an individual (as of December 31 of the applicable calendar year) equal or
exceed a prescribed threshold. If the threshold is met or exceeded, Optionee must register the investments with the Central Bank by filing a Form No. 11 and submitting it to Señores, Banco de la República, Atn: Jefe Sección
Inversiones, Departamento de Cambios Internacionales, Carrera 7 No. 14—18, Bogotá, Colombia” by June 30 of the following year. Upon the sale or disposition of the investments previously registered with the Central Bank,
Optionee must cancel the registration by no later than March 31 of the year following the sale or disposition or certain fines could apply. 
 If the
Optionee uses the cashless sell-all method of exercise, then no registration is required because no funds are remitted from Colombia and no shares are held abroad. 

In addition, when Optionee sells or otherwise disposes of any Shares acquired under the Plan, Optionee may either choose to keep the resulting sums abroad, or
to repatriate them to Colombia. If Optionee chooses to repatriate funds to Colombia and Optionee has not registered his or her investment with Banco de la República, Optionee will need to file with Banco de la República Form No. 5
upon conversion of funds into local currency, which should be duly completed to reflect the nature of the transaction. If Optionee has registered his or her investment with Banco de la República, then Optionee will need to file with Banco de
la República Form No. 4 upon conversion of funds into local currency, which should be duly completed to reflect the nature of the transaction. 

  
 22 

 Optionee should consult his/her personal legal advisor to ensure compliance with applicable Colombian exchange
control regulations. 
 OPTIONEES IN CZECH REPUBLIC 

Exchange Control Notice 
 Upon request of the Czech
National Bank (the “CNB”), Optionee may be required to fulfill certain notification duties in relation to the acquisition of Shares and the opening and maintenance of a foreign account. Because exchange control regulations change
frequently and without notice, Optionee should consult his or her personal legal advisor prior to the exercise of the Options and the subsequent sale of Shares to ensure compliance with current regulations. It is Optionee’s responsibility to
comply with Czech exchange control laws, and neither the Company nor any Subsidiary or affiliate will be liable for any resulting fines or penalties. 

OPTIONEES IN DENMARK 
 Danish Stock Option Act

 By accepting this Award, the Optionee acknowledges that he or she has received a Danish translation of an Employer Statement, which is being provided
to comply with the Danish Stock Option Act. 
 Exchange Control Notice 

The establishment of an account holding Shares or an account holding cash outside Denmark must be reported to the Danish Tax Administration. The form which
should be used in this respect may be obtained from a local bank. (Please note that these obligations are separate from and in addition to the securities/tax reporting obligations described below.) 

Securities/Tax Reporting Notice 
 If Optionee holds Shares
acquired under the Plan in a brokerage account with a broker or bank outside Denmark, Optionee is required to inform the Danish Tax Administration about the account. For this purpose, Optionee must file a Form V (Erklaering V) with the Danish Tax
Administration. Both Optionee and the bank/broker must sign the Declaration V. By signing the Declaration V, the bank/broker undertakes an obligation, without further request each year and not later than on February 1 of the year following the
calendar year to which the information relates, to forward certain information to the Danish Tax Administration concerning the content of the account. In the event that the applicable broker or bank with which the account is held does not wish to,
or, pursuant to the laws of the country in question, is not allowed to assume such obligation to report, Optionee acknowledges that he or she is solely responsible for providing certain details regarding the foreign brokerage account and Shares
deposited therein to the Danish Tax Administration as part of his or her annual income tax return. By signing the Form V, Optionee authorizes the Danish Tax Administration to examine the account. A sample of the Form V can be found at the following
website: www.skat.dk. 
 In addition, if Optionee opens a brokerage account (or a deposit account with a U.S. bank) for the purpose of holding cash outside
Denmark, Optionee is also required to inform the Danish Tax Administration about this account. To do so, Optionee must also file a Form K (Erklaering K) with the Danish Tax Administration. The Form K must be signed both by Optionee and by the
applicable broker or bank where the account is held. By signing the Form K, the broker/bank undertakes an obligation, without further request each year and not later than on February 1 of the year following the calendar year to which

  
 23 

 
the information relates, to forward certain information to the Danish Tax Administration concerning the content of the account. In the event that the applicable financial institution (broker or
bank) with which the account is held, does not wish to, or, pursuant to the laws of the country in question, is not allowed to assume such obligation to report, Optionee acknowledges that he or she is solely responsible for providing certain details
regarding the foreign brokerage or bank account to the Danish Tax Administration as part of Optionee’s annual income tax return. By signing the Form K, Optionee authorizes the Danish Tax Administration to examine the account. A sample of Form K
can be found at the following website: www.skat.dk. 
 OPTIONEES IN FRANCE 

Consent to Receive Information in English 
 By accepting
the Options, Optionee confirms having read and understood the Plan, the Notice of Grant, the Agreement and this Addendum, including all terms and conditions included therein, which were provided in the English language. Optionee accepts the terms of
those documents accordingly. 
 Consentement afin de Recevoir des Informations en Anglais 

En acceptant les Options d’Achat d’Actions, le Bénéficiaire confirme qu’il ou elle a lu et compris le Plan, la Notification
d’Attribution, le Contrat et les présentes Annexes, en ce compris tous les termes et conditions y relatifs, qui sont fournis en langue anglaise. Le Bénéficiaire accepte les termes de ces documents en connaissance de
cause. 
 Exchange Control Notice 
 If the
Optionee holds Shares outside of France or maintains a foreign bank account, he or she is required to report the maintenance of such to the French tax authorities when filing his or her annual tax return. 

OPTIONEES IN GERMANY 
 Exchange Control Notice

 Cross-border payments in excess of €12,500 must be reported monthly to the German Federal Bank (Bundesbank). If Optionee receives a payment in
excess of €12,500 in connection with the sale of Shares under the Plan, Optionee must report the payment to Bundesbank electronically using the “General Statistics Reporting Portal” (Allgemeines Meldeportal Statistik) available in
both German and English via Bundesbank’s website (www.bundesbank.de). Optionee is responsible for complying with applicable reporting requirements. 

OPTIONEES IN HONG KONG 
 Terms and
Conditions 
 This provision supplements Section 3 of the Agreement: 

If, for any reason, the Option vests and becomes exercisable and the Option is exercised and Shares are issued to the Optionee within six months of the date of
grant, the Optionee agrees that he or she will not dispose of any such Shares prior to the six-month anniversary of the Date of Grant. 

  
 24 

 Wages 
 This
provision supplements Section 18 of the Agreement: 
 The Options and Shares subject to it do not form part of Optionee’s wages for purposes of
calculating any statutory or contractual payment under Hong Kong law. 
 Securities Law Notice 

WARNING: The contents of this document have not been reviewed by any regulatory authority in Hong Kong. Optionee is advised to exercise caution in relation
to the offer. If Optionee is in any doubt about any of the contents of this document, Optionee should obtain independent professional advice. Neither the offer of Options nor the issuance of Shares upon exercise of the Options constitutes a public
offering of securities under Hong Kong law and is available only to employees of the Company and its Subsidiaries. The Agreement, including this Addendum, the Plan and other incidental communication materials distributed in connection with the
Options (i) have not been prepared in accordance with and are not intended to constitute a “prospectus” for a public offering of securities under the applicable securities legislation in Hong Kong and (ii) are intended only for
the personal use of each eligible employee of the Company or its subsidiaries and may not be distributed to any other person. 
 OPTIONEES IN
INDIA 
 Exchange Control Notice 
 Optionee must
repatriate any proceeds from the sale of Shares and any cash dividends acquired under the Plan to India and convert the proceeds into local currency within a certain period of the receipt (90 days for sale proceeds and 180 days for dividend
payments). Optionee will receive a foreign inward remittance certificate (“FIRC”) from the bank where Optionee deposits the foreign currency. Optionee should maintain the FIRC as evidence of the repatriation of funds in the event the
Reserve Bank of India or the Employer requests proof of repatriation. 
 Because exchange control regulations can change frequently and without notice,
Optionee should consult his or her personal legal advisor before selling Shares to ensure compliance with current regulations. It is Optionee’s responsibility to comply with exchange control laws in India, and neither the Company nor the
Employer will be liable for any fines or penalties resulting from Optionee’s failure to comply with applicable local laws. 
 Foreign Asset/Account
Reporting Information 
 The Optionee is required to declare foreign bank accounts and any foreign financial assets (including Shares held outside India)
in his or her annual tax return. It is the Optionee’s responsibility to comply with this reporting obligation and the Optionee should consult with his or her personal tax advisor in this regard as significant penalties may apply in the case of
non-compliance. 
 OPTIONEES IN ITALY 
 Data
Privacy 
 This provision replaces the data privacy section in the Agreement: 

Optionee understands that the Company and his or her employer, as the Privacy Representative of the Company in Italy, may hold certain personal
information about Optionee, including, but not limited to, name, home address and telephone number, date of birth, social insurance or other identification 

  
 25 

 
number, salary, nationality, job title, any shares of common stock or directorships held in the Company or its Subsidiaries, affiliates or joint ventures details of all Awards or any other
entitlement to shares of common stock awarded, canceled, vested, unvested or outstanding in Optionee’s favor, and that the Company and his employer will process said data and other data lawfully received from a third party (“Personal
Data”) for the exclusive purpose of managing and administering the Plan and complying with applicable laws, regulations and Community legislation. 

Optionee also understands that providing the Company with Personal Data is mandatory for compliance with laws and is necessary for the performance of
the Plan and that his denial to provide Personal Data would make it impossible for the Company to perform its contractual obligations and may affect his ability to participate in the Plan. The Controller of personal data processing is Fortive
Corporation, with registered offices at 6920 Seaway Blvd., Everett, WA 98203. 
 Optionee understands that Personal Data will not be
publicized, but it may be accessible by Optionee’s employer and within the employer’s organization by its internal and external personnel in charge of processing, and by the data processor, if appointed. The updated list of processors and
of the subjects to which Personal Data are communicated will remain available upon request at Optionee’s employer. Furthermore, Personal Data may be transferred to banks, other financial institutions or brokers involved in the management and
administration of the Plan. Optionee understands that Personal Data may also be transferred to the independent registered public accounting firm engaged by the Company, and also to the legitimate addressees under applicable laws. Optionee further
understands that the Company or its Subsidiaries or affiliates will transfer Personal Data amongst themselves as necessary for the purpose of implementation, administration and management of the Optionee’s participation in the Plan, and that
the Company and its Subsidiaries or affiliates may each further transfer Personal Data to third parties assisting the Company in the implementation, administration and management of the Plan, including any requisite transfer of Personal Data to a
broker or other third party with whom he or she may elect to deposit any shares acquired under the Plan or any proceeds from the sale of such shares. Such recipients may receive, possess, use, retain and transfer Personal Data in electronic or other
form, for the purposes of implementing, administering and managing Optionee’s participation in the Plan. Optionee understands that these recipients may be acting as controllers, processors or persons in charge of processing, as the case may be,
according to applicable privacy laws, and that they may be located in or outside the European Economic Area, such as in the United States or elsewhere, in countries that do not provide an adequate level of data protection as intended under Italian
privacy law. 
 Optionee understands that Personal Data processing related to the purposes specified above shall take place under automated or
non-automated conditions, anonymously when possible, that comply with the purposes for which Personal Data is collected and with confidentiality and security provisions as set forth by applicable laws and regulations, with specific reference to
Legislative Decree no. 196/2003. 
 The processing activity, including the transfer of Personal Data abroad, including outside of the European
Economic Area, as specified herein and pursuant to applicable laws and regulations, does not require Optionee’s consent thereto as the it is necessary to performance of law and contractual obligations related to implementation, administration
and management of the Plan. Optionee understands that, pursuant to section 7 of the Legislative Decree no. 196/2003, Optionee has the right at any moment to, including, but not limited to, obtain confirmation that Personal Data exists or not; access
and verify its contents, origin and accuracy; delete, update, integrate or correct Personal Data; or block or stop, for legitimate reason, Personal Data processing. To exercise privacy rights, Optionee should contact his or her employer.
Furthermore, Optionee is aware that Personal Data will not be used for direct marketing purposes. In addition, Personal Data provided can be reviewed and questions or complaints can be addressed by contacting Optionee’s employer human resources
department. 

  
 26 

 Plan Document Acknowledgement 

In accepting the Option, Optionee acknowledges that he or she has received a copy of the Plan and the Agreement and has reviewed the Plan and the Agreement,
including this Addendum, in their entirety and fully understands and accepts all provisions of the Plan and the Agreement, including this Addendum. 

Optionee further acknowledges that he or she has read and specifically and expressly approves the following paragraphs of the Agreement: Tax Obligations; No
Employment Contract; Nature of Grant; Language; Governing Law and Venue; and the Data Privacy paragraph included in this Addendum. 
 Foreign
Asset/Account Reporting Information 
 Italian residents who, at any time during the fiscal year, hold foreign financial assets (including cash and
Shares) which may generate income taxable in Italy are required to report these assets on their annual tax returns (UNICO Form, RW Schedule) for the year during which the assets are held, or on a special form if no tax return is due. These reporting
obligations will also apply to Italian residents who are the beneficial owners of foreign financial assets under Italian money laundering provisions. 

OPTIONEES IN JAPAN 
 Exchange Control Notice

 If the Optionee acquires Shares valued at more than ¥100,000,000 in a single transaction, the Optionee must file a Securities Acquisition Report
with the Ministry of Finance through the Bank of Japan within 20 days of the purchase of the shares. 
 In addition, if the Optionee pays more than
¥30,000,000 in a single transaction for the purchase of shares when the Optionee exercises the Option, the Optionee must file a Payment Report with the Ministry of Finance through the Bank of Japan by the 20th day of the month following the
month in which the payment was made. The precise reporting requirements vary depending on whether or not the relevant payment is made through a bank in Japan. 

A Payment Report is required independently from a Securities Acquisition Report. Therefore, if the total amount that the Optionee pays upon a one time
transaction for exercising the Option and purchasing shares exceeds ¥100,000,000, then the Optionee must file both a Payment Report and a Securities Acquisition Report. 

Foreign Asset/Account Reporting Information 
 The Optionee
will be required to report details of any assets held outside of Japan as of December 31st (including any Shares acquired under the Plan) to the extent such assets have a total net fair market value exceeding ¥50,000,000. Such report will
be due by March 15th each year. The Optionee should consult with his or her personal tax advisor as to whether the reporting obligation applies to the Optionee and whether the Optionee will be required to include details of any outstanding
Option or Shares held by the Optionee in the report. 

  
 27 

 OPTIONEES IN KOREA 

Exchange Control Notice 
 Exchange control laws require
Korean residents who realize US$500,000 or more from the sale of Shares to repatriate the sale proceeds back to Korea within three (3) years of the sale. 

If Optionee remits funds to purchase Shares, the remittance must be “confirmed” by a foreign exchange bank in Korea. To receive the confirmation,
Optionee should submit the following to the foreign exchange bank: (i) a prescribed form application; (ii) the Agreement, Notice of Stock Option Gant and any other Plan documents received; and (iii) certificate of employment with the
local employer. Optionee should check with the bank to determine whether there are any additional requirements. 
 Foreign Asset/Account Reporting
Information 
 Korean residents must declare all foreign financial accounts (e.g., non-Korean bank accounts, brokerage accounts) based in foreign
countries that have not entered into an “inter-governmental agreement for automatic exchange of tax information” with Korea to the Korean tax authority and file a report with respect to such accounts if the value of such accounts exceeds
KRW 1 billion (or an equivalent amount in foreign currency). Optionee should consult with Optionee’s personal tax advisor for additional information about this reporting obligation, including whether or not there is an applicable
inter-governmental agreement between Korea and the U.S. (or any other country where Optionee may hold any Shares or cash acquired in connection with the Plan. 

OPTIONEES IN MEXICO 
 Labor Law Acknowledgement

 These provisions supplement the labor law acknowledgement contained in the Agreement: 

By accepting the Options, Optionee acknowledges that he or she understands and agrees that: (i) the Option is not related to the salary and other
contractual benefits granted to Optionee by the Employer; and (ii) any modification of the Plan or its termination shall not constitute a change or impairment of the terms and conditions of employment. 

Policy Statement 
 The invitation the Company is making
under the Plan is unilateral and discretionary and, therefore, the Company reserves the absolute right to amend it and discontinue it at any time without any liability. 

The Company, with registered offices at 6920 Seaway Blvd., Everett, WA, United States of America, is solely responsible for the administration of the Plan and
participation in the Plan and, in Optionee’ case, the acquisition of Shares does not, in any way establish an employment relationship between Optionee and the Company since Optionee is participating in the Plan on a wholly commercial basis and
the sole employer is the Subsidiary employing Optionee, as applicable, nor does it establish any rights between Optionee and the Employer. 

  
 28 

 Plan Document Acknowledgment 

By accepting the Option grant, Optionee acknowledges that he or she has received copies of the Plan, has reviewed the Plan and the Agreement in their entirety
and fully understands and accepts all provisions of the Plan and the Agreement. 
 In addition, by signing the Agreement, Optionee further acknowledges that
he or she has read and specifically and expressly approves the terms and conditions in the Nature of Grant, Section 18 of the Agreement, in which the following is clearly described and established: (i) participation in the Plan does not
constitute an acquired right; (ii) the Plan and participation in the Plan is offered by the Company on a wholly discretionary basis; (iii) participation in the Plan is voluntary; and (iv) the Company and its Subsidiaries are not
responsible for any decrease in the value of the Shares underlying the Option. 
 Finally, Optionee hereby declares that he or she does not reserve any
action or right to bring any claim against the Company for any compensation or damages as a result of participation in the Plan and therefore grants a full and broad release to the Employer and the Company and its Subsidiaries with respect to any
claim that may arise under the Plan. 
 Spanish Translation 

Reconocimiento de la Ley Laboral 
 Estas
disposiciones complementan el reconocimiento de la ley laboral contenida en el Acuerdo: 
 Por medio de la aceptación de la Opción,
quien tiene la opción manifiesta que entiende y acuerda que: (i) la Opción no se encuentra relacionada con el salario ni con otras prestaciones contractuales concedidas al que tiene la opción por parte del patrón; y
(ii) cualquier modificación del Plan o su terminación no constituye un cambio o desmejora en los términos y condiciones de empleo. 

Declaración de Política 
 La
invitación por parte de la Compañía bajo el Plan es unilateral y discrecional y, por lo tanto, la Compañía se reserva el derecho absoluto de modificar y discontinuar el mismo en cualquier momento, sin ninguna
responsabilidad. 
 La Compañía, con oficinas registradas ubicadas en 6920 Seaway Blvd., Everett, WA, United States of America, es la
única responsable de la administración del Plan y de la participación en el mismo y, en el caso del que tiene la opción, la adquisición de Acciones no establece de forma alguna, una relación de trabajo entre
el que tiene la opción y la Compañía, ya que la participación en el Plan por parte del que tiene la opción es completamente comercial y el único patrón es la Subsidiaria que esta contratando al que
tiene la opción, en caso de ser aplicable, así como tampoco establece ningún derecho entre el que tiene la opción y el patrón. 

Reconocimiento del Plan de Documentos 
 Por
medio de la aceptación de la Opción, el que tiene la opción reconoce que ha recibido copias del Plan, que el mismo ha sido revisado al igual que la totalidad del Acuerdo y, que ha entendido y aceptado las disposiciones
contenidas en el Plan y en el Acuerdo. 
 Adicionalmente, al firmar el Acuerdo, el que tiene la opción reconoce que ha leído, y que
aprueba específica y expresamente los términos y condiciones contenidos en la Naturaleza del Otorgamiento, Apartado 15 del Acuerdo, sección en la cual se encuentra claramente descrito y establecido lo siguiente: (i) la
participación en el Plan no constituye un derecho adquirido; (ii) el Plan y la participación en el mismo es ofrecida por la Compañía de forma enteramente discrecional; (iii) la participación en el Plan es
voluntaria; y (iv) la Compañía, así como sus Subsidiarias no son responsables por cualquier detrimento en el valor de las Acciones en relación con la Opción. 

  
 29 

 Finalmente, por medio de la presente quien tiene la opción declara que no se reserva ninguna
acción o derecho para interponer una demanda en contra de la Compañía por compensación, daño o perjuicio alguno como resultado de la participación en el Plan y en consecuencia, otorga el más amplio
finiquito a su patrón, así como a la Compañía, a sus Subsidiarias con respecto a cualquier demanda que pudiera originarse en virtud del Plan. 

OPTIONEES IN THE NETHERLANDS 
 Labor Law
Acknowledgment 
 By accepting the Option, Optionee acknowledges that: (i) the Option is intended as an incentive for the Optionee to remain
employed with the Employer and is not intended as remuneration for labor performed; and (ii) the Option is not intended to replace any pension rights or compensation. 

OPTIONEES IN NEW ZEALAND 
 Securities Law Notice

 In compliance with New Zealand securities laws, the Optionee is hereby notified that the following information is available for review in connection
with the offer to purchase Shares under the Plan: 
  

	 	(i)	the Agreement, including this Appendix, which together with the Plan sets forth the terms and conditions of participation in the Plan; 

 

	 	(ii)	a copy of the Company’s most recent annual return (i.e., Form 10-K) and most recent financial reports; and 

  

	 	(iii)	a copy of the Plan and a description of the Plan (the “Description”) (i.e., the Company’s Form S-8 Plan Prospectus under the U.S. Securities Act of 1933, as amended); the Company will
provide any attachments or documents incorporated by reference into the Description upon written request. 

 The Optionee may request copies
of the documents described above by contacting Fortive’s corporate legal department using the contact details provided on www.fortive.com. The documents incorporated by reference into the Description are updated periodically. The Optionee
understands that should he or she request copies of the documents incorporated by reference into the Description, the Company will provide the Optionee with the most recent documents incorporated by reference. 

Warning Statement 
 Optionee is being offered an Option to
purchase Shares in the Company. Exercise of the Option will give Optionee a stake in the ownership of the Company. Optionee may receive a return if dividends are paid. 

If the Company runs into financial difficulties and is wound up, Optionee will be paid only after all creditors (and holders of preference shares) have been
paid. Optionee may lose some or all of his or her investment. 

  
 30 

 New Zealand law normally requires people who offer financial products to give information to investors before
they invest. This requires those offering financial products to have disclosure information that is important for investors to make an informed decision. 

The usual rules do not apply to this offer because it is made under an employee share purchase scheme. As a result, Optionee may not be given all of the
information usually required. Optionee will also have fewer other legal protections for this investment. 
 Ask questions, read all documents carefully, and
seek independent financial advice before committing to this investment. 
 The Shares are quoted. The Company intends to quote the Shares on the New York
Stock Exchange. This means Optionee may be able to sell them on the New York Stock Exchange if there are interested buyers. Optionee may get less than he or she invested. The price will depend on the demand for the Shares 

OPTIONEES IN POLAND 
 Exchange Control Notice

 Polish residents holding foreign securities (including Shares) abroad must report information to the National Bank of Poland on transactions and
balances of the securities deposited in such accounts if the value of such transactions or balances (calculated individually or together with other assets or liabilities held abroad) exceeds PLN 7,000,000. If required, the reports are due on a
quarterly basis. Polish residents are also required to transfer funds through a bank account in Poland if the transferred amount in any single transaction exceeds a specified threshold (currently €15,000). Further, upon the request of a Polish
bank, Polish residents are required to inform the bank about all foreign exchange transactions performed through such bank. Optionee should maintain evidence of such foreign exchange transactions for five (5) years, in case of a request for
their production by the National Bank of Poland. 
 OPTIONEES IN ROMANIA 

Exchange Control Notice 
 If Optionee deposits the proceeds
from the sale of Shares issued to him or her at exercise and settlement of the Shares in a bank account in Romania, Optionee may be required to provide the Romanian bank with appropriate documentation explaining the source of the funds. 

Optionee should consult his or her personal advisor to determine whether Optionee will be required to submit such documentation to the Romanian bank. 

English Language 
 Optionee hereby expressly agrees that
this Agreement, the Plan as well as all documents, notices and proceedings entered into, relating directly or indirectly hereto, be drawn up or communicated only in the English language. 

Angajatul consimte în mod expres prin prezentul ca acest Contract, Programul precum şi orice alte documente, notificări,
înştiinţări legate direct sau indirect de acest Contract să fie redactate sau efectuate doar în limba engleză. 

  
 31 

 OPTIONEES IN RUSSIA 

Securities Law Notification 
 The Plan and all other
materials that Optionee may receive concerning the grant of the Option and Optionee’s participation in the Plan do not constitute advertising or an offering of securities in Russia. The Shares to be issued upon exercise of the Option have not
and will not be registered in Russia and, therefore, the Shares described in any Plan documents may not be offered or placed in public circulation in Russia. In no event will Shares to be issued upon exercise of the Option be delivered to Optionee
in Russia. All Shares acquired under the Plan will be maintained on Optionee’s behalf outside of Russia. Optionee will not be permitted to sell Shares directly to a Russian legal entity or resident. 

Exchange Control Notification 
 If Optionee remits funds
out of Russia to purchase Shares under the Plan, the funds must be remitted from a foreign currency account in Optionee’s name at an authorized bank in Russia. In addition, Optionee must repatriate any proceeds from the sale of Shares to
Russia. Such funds must be initially credited to Optionee through a foreign currency account at an authorized bank in Russia. After the funds are initially received in Russia, they may be further remitted to foreign banks in accordance with Russian
exchange control laws. However, dividends can be held in a foreign currency account at a foreign individual bank account opened in certain countries (including the United States). Optionee should contact his or her personal advisor regarding
Optionee’s exchange control obligations resulting from participation in the Plan as significant penalties may apply in the case of non-compliance with such obligations. 

Data Privacy. This data privacy consent replaces the data privacy section of the Agreement: 

 
 

 

  
 32 

 

 

  
 33 

 

 

  
 34 

 

 
 OPTIONEES IN SINGAPORE 

Securities Law Notice 
 The grant of the Options is being
made pursuant to the “Qualifying Person” exemption” under section 273(1)(f) of the Securities and Futures Act (Chapter 289, 2006 Ed.) (“SFA”) and is not made to Optionee with a view to the Shares being subsequently offered
for sale to any other party. The Plan has not been lodged or registered as a prospectus with the Monetary Authority of Singapore. Optionee should note that the Options are subject to section 257 of the SFA and Optionee should not make (i) any
subsequent sale of the Shares in Singapore or (ii) any offer of such subsequent sale of the Shares subject to the Option in Singapore, unless such sale or offer is made after six (6) months of the grant of the Option or pursuant to the
exemptions under Part XIII Division 1 Subdivision (4) (other than section 280) of the SFA. 
 Chief Executive Officer and Director Notification
Requirement 
 If Optionee is a the Chief Executive Officer or director of a Singapore Subsidiary of the Company, Optionee must notify the Singapore
Subsidiary in writing of an interest (e.g., Options, Shares) in the Company or any Subsidiary within two days of (i) its acquisition or disposal, (ii) any change in a previously-disclosed interest (e.g., upon exercise of Options or
when Shares acquired under the Plan are subsequently sold), or (iii) becoming the CEO / a director. 
 OPTIONEES IN SLOVAK REPUBLIC 

Foreign Asset/Account Reporting Information 
 Optionee will
not have a foreign asset or account reporting requirement unless Optionee is an independent entrepreneur (i.e., Optionee conducts business activities on his or her own behalf and holds a corresponding business/trade license). 

  
 35 

 OPTIONEES IN SOUTH AFRICA 

Withholding Taxes. The following provision supplements Section 8(a) of the Agreement. 

By accepting the Option, the Optionee agrees to notify the Employer of the amount of any gain realized upon exercise of the Option. If the Optionee fails to
advise the Employer of the gain realized upon exercise of the Option, he or she may be liable for a fine. The Optionee will be responsible for paying any difference between the actual tax liability and the amount withheld. 

Tax Clearance Certificate for Cash Exercises. If the Optionee exercises the Option by a cash purchase exercise, the Optionee is required to obtain and
provide to the Employer, or any third party designated by the Employer or the Company, a Tax Clearance Certificate (with respect to Foreign Investments) bearing the official stamp and signature of the Exchange Control Department of the South African
Revenue Service (“SARS”). The Optionee must renew this Tax Clearance Certificate each twelve (12) months or in such other period as may be required by the SARS.  

If the Optionee exercises the Option by a cashless exercise whereby no funds are remitted offshore for the purchase of shares, he or she is not required to
obtain a Tax Clearance Certificate. 
 Exchange Control Notice 

To participate in the Plan, the Optionee must comply with exchange control regulations and rulings (the “Exchange Control Regulations”) in South
Africa. 
 Under current South African exchange control policy, South African residents may invest a maximum of ZAR11,000,000 per annum in offshore
investments, including in Shares. This limit does not apply to non-resident employees. The first ZAR1,000,000 annual discretionary allowance requires no prior authorization but Optionee understands that Optionee must obtain tax clearance for the
next ZAR10,000,000. It is Optionee’s responsibility to ensure that Optionee does not exceed this limit and obtain the necessary tax clearance for remittances exceeding ZAR1,000,000. This limit is a cumulative allowance; therefore,
Optionee’s ability to remit funds for a cash exercise will be reduced if Optionee’s foreign investment limit is utilized to make a transfer of funds offshore that is unrelated to the Plan. Optionee acknowledges that if the ZAR11,000,000
limit will be exceeded as a result of a cash exercise under the Plan, Optionee may still participate in the Plan; however, Optionee will be required to immediately sell the Shares acquired under the Plan and repatriate the proceeds to South Africa
in order to ensure that Optionee does not hold assets outside South Africa with a value in excess of the permitted offshore investment allowance amount. 

Because the Exchange Control Regulations change frequently and without notice, the Optionee understands that he or she should consult a legal advisor prior to
the purchase or sale of shares under the Plan to ensure compliance with current regulations. The Optionee understands that it is his or her responsibility to comply with South African exchange control laws, and neither the Company nor the Employer
will be liable for any fines or penalties resulting from failure to comply with applicable laws. 
 Securities Law Notice 

In compliance with South African Securities Law, Optionee acknowledges that a copy of Fortive’s most recent annual report and stock plan will be sent to
Optionee free of charge on written request. 
 Optionee should carefully read the materials provided before making a decision whether to participate in the
Plan and to contact Optionee’s tax advisor for specific information concerning Optionee’s personal tax situation with regard to Plan participation. 

  
 36 

 OPTIONEES IN SPAIN 

Vesting Schedule 
 This provision supplements
Section 2(a) of the Agreement. 
 The Optionee understands and agrees that, as a condition of the grant of the Option, upon the date that the Optionee
ceases to be a Service Provider for any reason (including the reasons listed below), all Options that have not yet vested (or that do not become vested as a result of the Optionee’s death) shall be forfeited. 

In particular, the Optionee understands and agrees that any Options that have not yet vested (or that do not become vested as a result of the Optionee’s
death) as of the date that the Optionee is no longer actively providing services shall be forfeited without entitlement to the underlying Shares or to any amount of indemnification in the event of the Optionee ceasing to be a Service Provider by
reason of, but not limited to, resignation, retirement, disciplinary dismissal adjudged to be with cause, disciplinary dismissal adjudged or recognized to be without cause, individual or collective dismissal on objective grounds, whether adjudged or
recognized to be with or without cause, material modification of the terms of employment under Article 41 of the Workers’ Statute, relocation under Article 40 of the Workers’ Statute, Article 50 of the Workers’ Statute, unilateral
withdrawal by the Employer and under Article 10.3 of the Royal Decree 1382/1985. 
 Nature of Plan 

This provision supplements Section 18 of the Agreement. In accepting the grant, Optionee acknowledges that he or she consents to participation in the Plan
and has received a copy of the Plan. 
 Optionee understands that the Company, in its sole discretion, has unilaterally and gratuitously decided to grant
Options under the Plan to individuals who may be Employees of the Company or a Subsidiary throughout the world. The decision is a limited decision that is entered into upon the express assumption and condition that any grant will not economically or
otherwise bind the Company or Subsidiary on an ongoing basis. Consequently, Optionee understands that the Option is granted on the assumption and condition that the Option and the Shares issued upon exercise of the Option shall not become a part of
any employment contract (either with the Company or a Subsidiary) and shall not be considered a mandatory benefit, salary for any purposes (including severance compensation) or any other right whatsoever. 

In addition, Optionee understands that the grant of the Option would not be made to Optionee but for the assumptions and conditions referred to above; thus,
Optionee acknowledges and freely accepts that should any or all of the assumptions be mistaken or should any of the conditions not be met for any reason, then any Option grant shall be null and void. 

Exchange Control Notice 
 When receiving foreign currency
payments derived from the ownership of Shares (i.e., as a result of the sale of the Shares), Optionee must inform the financial institution receiving the payment, the basis upon which such payment is made. Optionee will need to provide the
institution with the following information: (i) his or her name, address, and fiscal identification number; (ii) the name and corporate domicile of Company; (iii) the amount of the payment; (iv) the currency used; (v) the
country of origin; (vi) the reasons for the payment; and (vii) additional information that may be required. 
 If Optionee wishes to import the
ownership title of the Shares (i.e., share certificates) into Spain, he or she must declare the importation of such securities to the Dirección General de Política Comercial e Inversiones Exteriores. To participate in the Plan,
Optionee must comply with exchange control 

  
 37 

 
regulations in Spain that require that the purchase of Shares be declared for statistical purposes. If a Spanish financial institution executes the transaction, the institution will automatically
make the declaration on Optionee’s behalf; otherwise, it is Optionee’s responsibility to make the declaration. In addition, Optionee must file a declaration of ownership of foreign securities each January. 

In addition, Optionee may be required to electronically declare to the Bank of Spain any foreign accounts (including brokerage accounts held abroad), any
foreign instruments (including Shares acquired under the Plan), and any transactions with non-Spanish residents (including any payments of Shares made pursuant to the Plan), depending on the balances in such accounts together with the value of such
instruments as of December 31 of the relevant year, or the volume of transactions with non-Spanish residents during the relevant year. 
 Foreign
Asset/Account Reporting Information 
 To the extent Optionee holds rights or assets (e.g., cash or Shares held in a bank or brokerage account) outside
of Spain with a value in excess of €50,000 per type of right or asset as of December 31 each year (or at any time during the year in which Optionee sells or disposes of such right or asset), Optionee is required to report information
on such rights and assets on his or her tax return for such year. After such rights or assets are initially reported, the reporting obligation will only apply for subsequent years if the value of any previously-reported rights or assets increases by
more than €20,000. The reporting must be completed by the following March 31. 
 Spanish Translation 

Translations of the Agreement and this Addendum in Spanish can be provided to Optionee upon request. 

Se le facilitará una traducción al castellano de la documentación del incentivo (Award) si así lo solicitase. 

OPTIONEES IN SWITZERLAND 
 Securities Law Notice

 The grant of Options is considered a private offering in Switzerland and is therefore not subject to securities registration in Switzerland. Neither
this document nor any other materials relating to the Options constitute a prospectus as such term is understood pursuant to the Swiss Code of Obligations, and neither this document nor any other material relating to the Options may be publicly
distributed nor otherwise made publicly available in Switzerland. 
 OPTIONEES IN TAIWAN 

Securities Law Notice 
 The grant of Options and the Shares
to be issued under the Plan is available only for employees of the Company and its Subsidiaries. It is not a public offer of securities by a Taiwanese company; therefore, it is exempt from registration in Taiwan. 

Exchange Control Notice 
 Optionee may acquire foreign
currency, and remit the same out of Taiwan, up to US$5 million per year without justification. When remitting funds for the purchase of Shares pursuant to the Plan, such remittances should be made through an authorized foreign exchange bank. In
addition, if Optionee remits TWD$500,000 or more in a single transaction, he or she must submit a Foreign Exchange Transaction Form to the remitting bank. If the transaction amount is US$500,000 or more in a single transaction, Optionee also must
provide supporting documentation to the satisfaction of the remitting bank. 

  
 38 

 OPTIONEES IN THAILAND 

Exchange Control Notice 
 Optionee must immediately
repatriate the proceeds from the sale of Shares and any cash dividends received in relation to the Shares to Thailand and convert the funds to Thai Baht within 360 days of receipt. If the repatriated amount is US$50,000 or more, Optionee must report
the inward remittance by submitting the Foreign Exchange Transaction Form to an authorized agent, i.e., a commercial bank authorized by the Bank of Thailand to engage in the purchase, exchange and withdrawal of foreign currency. 

It is Optionee’s responsibility to comply with exchange control laws in Thailand, and neither the Company nor any Subsidiary or affiliate will be liable
for any fines or penalties resulting from Optionee’s failure to comply with applicable laws. Because exchange control regulations change frequently and without notice, Optionee should consult a legal advisor before selling Shares to ensure
compliance with current regulations. 
 OPTIONEES IN TURKEY 

Securities Law Notice 
 Under Turkish law, the Optionee is
not permitted to sell Shares acquired under the Plan in Turkey. The Shares are currently traded on the New York Stock Exchange, which is located outside of Turkey and the Shares may be sold through this exchange. 

Exchange Control Notice 
 The Optionee may be required to
engage a Turkish financial intermediary to assist with the cash exercise of an Option or the sale of Shares acquired under the Plan. To the extent a Turkish financial intermediary is required in connection with the Option exercise or the sale of any
Shares acquired upon exercise of the Option, the Optionee is solely responsible for engaging such Turkish financial intermediary. The Optionee should consult his or her personal legal advisor prior to the exercise of Option or any sale of Shares to
ensure compliance with the current requirements. 
 OPTIONEES IN UNITED ARAB EMIRATES 

Securities Law Notice 
 Participation in the Plan is being
offered only to selected Optionees and is in the nature of providing equity incentives to Optionees in the United Arab Emirates. The Plan and the Agreement are intended for distribution only to such Optionees and must not be delivered to, or relied
on by, any other person. Prospective purchasers of the securities offered should conduct their own due diligence on the securities. If Optionee does not understand the contents of the Plan and the Agreement, Optionee should consult an authorized
financial adviser. The Emirates Securities and Commodities Authority has no responsibility for reviewing or verifying any documents in connection with the Plan. Neither the Ministry of Economy nor the Dubai Department of Economic Development have
approved the Plan or the Agreement nor taken steps to verify the information set out therein, and have no responsibility for such documents. 

  
 39 

 OPTIONEES IN THE UNITED KINGDOM 

The following replaces Section 8(a) of the Agreement in its entirety: 

(a) Withholding Taxes. Regardless of any action the Company or any Subsidiary employing Optionee (the “Employer”) take with respect to any or
all income tax, primary and secondary Class 1 National Insurance contributions, payroll tax or other tax-related withholding attributable to or payable in connection with or pursuant to the grant, vesting, exercise, release or assignment of any
Option (the “Tax-Related Items”), Optionee acknowledges that the ultimate liability for all Tax Related Items associated with the Option is and remains Optionee’s responsibility and that the Company and/or the Employer (i) make
no representations or undertakings regarding the treatment of any Tax Related Items in connection with any aspect of the Option, including, but not limited to, the grant, vesting or exercise of the Option, the subsequent sale of Shares acquired
pursuant to such exercise and the receipt of any dividends; and (ii) do not commit to structure the terms of the grant or any aspect of the Option to reduce or eliminate Optionee’s liability for Tax Related Items. Further, if Optionee has
relocated to a different jurisdiction between the date of grant and the date of any taxable event, Optionee acknowledges that the Company and/or the Employer (or former employer, as applicable) may be required to withhold or account for Tax-Related
Items in more than one jurisdiction. 
 As a condition of the issuance of Shares upon exercise of the Option, the Company and/or the Employer shall be
entitled to withhold and Optionee agrees to pay, or make adequate arrangements satisfactory to the Company and/or the Employer to satisfy, all obligations of the Company and/or the Employer to account to HM Revenue & Customs
(“HMRC”) for any Tax-Related Items. In this regard, Optionee authorizes the Company and/or the Employer, in its sole discretion and to the extent permitted under local law, to satisfy the obligations with regard to all Tax Related Items
legally payable by Optionee by one or a combination of the following: (i) require Optionee to pay Tax-Related Items in cash with a cashier’s check or certified check; (ii) withholding cash from Optionee’s wages or other
compensation payable to Optionee by the Company and/or the Employer; (iii) withholding from the proceeds of a broker-dealer sale and remittance procedure as described in Section 4(b) above; or (iv) withholding in Shares otherwise
issuable to Optionee, provided that the Company withholds only the amount of Shares necessary to satisfy the minimum statutory withholding amount or such other amount as may be necessary to avoid adverse accounting treatment using the Fair Market
Value of the Shares on the date of the relevant taxable event. 
 Optionee shall pay to the Company or the Employer any amount of Tax-Related Items that the
Company or the Employer may be required to account to HMRC with respect to the event giving rise to the Tax-Related Items (the “Chargeable Event”) that cannot be satisfied by the means previously described. If payment or withholding is not
made within 90 days after the end of the UK tax year in which the Chargeable Event occurs, or such other period specified in Section 222(1)(c) of the U.K. Income Tax (Earnings and Pensions) Act 2003 (the “Due Date”), Optionee agrees
that the amount of any uncollected Tax-Related Items shall (assuming Optionee is not a director or executive officer of the Company (within the meaning of Section 13(k) of the U.S. Securities and Exchange Act of 1934, as amended)), constitute a
loan owed by Optionee to the Employer, effective on the Due Date. Optionee agrees that the loan will bear interest at the then-current HMRC Official Rate and it will be immediately due and repayable, and the Company and/or the Employer may recover
it at any time thereafter by any of the means referred to above. If any of the foregoing methods of collection are not allowed under applicable laws or if Optionee fails to comply with Optionee’s obligations in connection with the Tax-Related
Items as described in this Section, the Company may refuse to deliver the Shares acquired under the Plan. 

  
 40EX-10.21

 Exhibit 10.21 

POWERSECURE INTERNATIONAL, INC. 

Summary Sheet of Compensation of Non-Employee Directors 

As of March 1, 2016 
  

			
	Director Fees:	  	Cash retainer of $50,000 per year, plus per meeting fee (excluding regular quarterly meetings) of $2,000 per meeting.
		
	Board Chairman Fees:	  	$30,000 per year
		
	Committee Chairman Fees:	  	$12,500 per year (Audit Committee and Compensation Committee) $10,000 per year (Nominating and Corporate Governance Committee and Risk Committee)
		
	Committee Membership Fees:        	  	$7,500 per year per Committee
		
	Stock Awards:	  	 New Non-Employee Directors: Upon initial election or appointment, a new non-employee director receives a number of restricted
shares of Common Stock equal to $50,000 divided by the closing sale price of the Common Stock on the date of initial election or appointment (or, if such date is not a trading day, on the first trading day thereafter) as reported by the New York
Stock Exchange, vesting on (i) if the new director is elected by stockholders at an annual meeting of stockholders for a three year term, on the last full day of such new director’s term, and (i) for all other new directors, on the
third anniversary of election or appointment.
  
 Continuing Non-Employee
Directors: On the date of each Annual Meeting of Stockholders, each continuing non-employee director receives a number of restricted shares of Common Stock, or restricted stock units (RSUs) that may be settled at a date after vesting , or a
combination of restricted shares and RSUs, at the election of such director, equal to $50,000 divided by the closing sale price of the Common Stock on the date of initial election or appointment as reported by the New York Stock Exchange, vesting in
four equal quarterly installments commencing three months after the Annual Meeting.

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