Document:

Stock Option Grant Notice

 Exhibit 10.4 
 CAPTARIS, INC. 
 STOCK OPTION GRANT NOTICE 
 FOR EXECUTIVE OFFICERS AND DIRECTORS 
 2006 EQUITY INCENTIVE PLAN 
 Captaris, Inc. (the “Company”) hereby grants to you an Option (the
“Option”) to purchase shares of the Company’s Common Stock. The Option is subject to all the terms and conditions set forth in this Stock Option Grant Notice (this “Grant Notice”), in the attached Stock Option Agreement and
in the Company’s 2006 Equity Incentive Plan (the “Plan”). 
  

			
	Participant:	  	___________________________
		
	Grant Date:	  	___________________________                 [date of Board approval of grant]
		
	Vesting Commencement Date:	  	___________________________               [typically grant date or date of hire]
		
	Number of Shares Subject to Option:	  	___________________________
		
	Exercise Price (per Share):	  	___________________________
		
	Option Expiration Date:	  	___________________________             (subject to earlier termination in accordance with the terms of the Plan and the Stock Option
Agreement) [option expiration date is typically 10 years from grant date]
		
	Type of Option:	  	 ̈ Incentive Stock Option*           ̈ Nonqualified Stock Option
		
	Vesting and Exercisability Schedule:	  	 [For Executives: 25% of the shares subject to the Option will vest and become exercisable on the one-year anniversary of the Vesting
Commencement Date.
  
 An additional 2.0833% of the shares subject to the Option will vest
and become exercisable monthly thereafter over the next three years.]
  
 [For
Directors: The Option will vest and become exercisable in full on the one-year anniversary of the Vesting Commencement Date.]

 Additional Terms/Acknowledgement: You acknowledge receipt of, and understand and agree to, this Grant
Notice, the Stock Option Agreement and the prospectus for the Plan. You further acknowledges that as of the Grant Date, this Grant Notice, the Stock Option Agreement and the Plan set forth the entire understanding between you and the Company
regarding the Option and supersede all prior oral and written agreements on the subject [with the exception of the following agreements:
                            ]. 
  

									
	CAPTARIS, INC.	 		 	PARTICIPANT
				
		 		 		 	  
	By:	 	  	 		 	Signature
	Its:	 	  	 		 		 	
		 		 		 	Date:	 	  
	Attachments:	 		 	Address:	 	  
	1. Stock Option Agreement	 		 		 	  
	2. Prospectus for 2006 Equity Incentive Plan	 		 	Taxpayer ID:	 	  

	*	See Sections 3 and 4 of the Stock Option Agreement. 

  

 CAPTARIS, INC. 
 2006 EQUITY INCENTIVE PLAN 
 STOCK OPTION AGREEMENT 
 FOR EXECUTIVE OFFICERS AND DIRECTORS 
 Pursuant to your Stock Option Grant Notice (the “Grant Notice”) and this Stock Option Agreement (this “Agreement”), Captaris, Inc. has granted you an option (the “Option”) under its 2006 Equity Incentive Plan
(the “Plan”) to purchase the number of shares of the Company’s Common Stock indicated in your Grant Notice (the “Shares”) at the exercise price indicated in your Grant Notice. Capitalized terms not explicitly defined in this
Agreement but defined in the Plan shall have the same definitions as in the Plan. 
 The details of the Option are as follows: 
 1. Vesting and Exercisability. Subject to the limitations contained herein, the Option will vest and become exercisable as provided in your Grant
Notice, provided that vesting will cease upon the termination of your employment or service relationship with the Company or a related corporation and the unvested portion of the Option will terminate. 
 2. Securities Law Compliance. Notwithstanding any other provision of this Agreement, you may not exercise the Option unless the Shares issuable
upon exercise are registered under the Securities Act of 1933 (the “Securities Act”) or, if such Shares are not then so registered, the Company has determined that such exercise and issuance would be exempt from the registration
requirements of the Securities Act. The exercise of the Option must also comply with other applicable laws and regulations governing the Option, and you may not exercise the Option if the Company determines that such exercise would not be in
material compliance with such laws and regulations. 
 3. Incentive Stock Option Qualification. If so designated in your Grant Notice,
all or a portion of the Option is intended to qualify as an incentive stock option under federal income tax law, but the Company does not represent or guarantee that the Option qualifies as such. 
 If the Option has been designated as an incentive stock option and the aggregate fair market value (determined as of the grant date) of the shares of
Common Stock subject to the portions of the Option and all other incentive stock options you hold that first become exercisable during any calendar year exceeds $100,000, any excess portion will be treated as a nonqualified stock option, unless the
Internal Revenue Service changes the rules and regulations governing the $100,000 limit for incentive stock options. A portion of the Option may be treated as a nonqualified stock option if certain events cause exercisability of the Option to
accelerate. 
 4. Notice of Disqualifying Disposition. To the extent the Option has been designated as an incentive stock option, to
obtain certain tax benefits afforded to incentive stock options, you must hold the Shares issued upon the exercise of the Option for two years 

 
after the date of grant and one year after the date of exercise. You may be subject to the alternative minimum tax at the time of exercise. You should obtain
tax advice when exercising the Option and prior to the disposition of the Shares. By accepting the Option, you agree to promptly notify the Company if you dispose of any of the Shares within one year from the date you exercise all or part of the
Option or within two years from the date of grant. 
 5. Method of Exercise. You may exercise the Option by giving written notice to
the Company, in form and substance satisfactory to the Company, which will state your election to exercise the Option and the number of Shares for which you are exercising the Option. The written notice must be accompanied by full payment of the
exercise price for the number of Shares you are purchasing. You may make this payment in any combination of the following: (a) by cash; (b) by check acceptable to the Company; (c) by using shares of Common Stock you have owned for at
least six months (or such other period required to avoid adverse accounting consequences to the Company); (d) if the Common Stock is registered under the Exchange Act of 1934 and to the extent permitted by law, by instructing a broker to
deliver to the Company the total payment required, all in accordance with the regulations of the Federal Reserve Board; or (e) by any other method permitted by the Plan Administrator. 
 6. Treatment Upon Termination of Employment or Service Relationship. The unvested portion of the Option will terminate automatically and without
further notice immediately upon termination of your employment or service relationship with the Company or a related corporation for any reason (“Termination of Service”). You may exercise the vested portion of the Option as follows:

 (a) General Rule. You must exercise the vested portion of the Option on or before the earlier of (i) 12 months
after your Termination of Service and (ii) the expiration date of the Option. If you die after your Termination of Service but while the Option is still exercisable, the vested portion of the Option may be exercised until the earlier of
(x) 12 months after the date of death and (y) the expiration date of the Option. 
 (b) Cause. The Option
will automatically expire at the time the Company first notifies you of your termination for cause. If your employment or service relationship is suspended pending an investigation of whether you will be terminated for cause, all your rights under
the Option likewise will be suspended during the period of investigation. 
 The Option must be exercised within three months after
termination of employment for reasons other than death or total disability and one year after termination of employment due to total disability to qualify for the beneficial tax treatment afforded incentive stock options. 
 It is your responsibility to be aware of the date the Option terminates. 

 7. Limited Transferability. During your lifetime only you can exercise the Option. The Option is
not transferable except by will or by the applicable laws of descent and distribution. The Plan Administrator may permit you to designate a beneficiary on a Company-approved form who may exercise your Option after your death. Notwithstanding the
foregoing and to the extent permitted by Section 422 of the Internal Revenue Code of 1986, the Plan Administrator, in its sole discretion, may permit you to assign or transfer the Option, subject to such terms and conditions as specified by the
Plan Administrator. 
 8. Withholding Taxes. As a condition to the exercise of any portion of an Option, you must make such
arrangements as the Company may require for the satisfaction of any federal, state, local or foreign withholding tax obligations that may arise in connection with such exercise. 
 9. Option Not an Employment or Service Contract. Nothing in the Plan or any Option granted under the Plan will be deemed to constitute an
employment contract or confer or be deemed to confer any right for you to continue in the employ of, or to continue any other relationship with, the Company or any related corporation or limit in any way the right of the Company or any related
corporation to terminate your employment or other relationship at any time, with or without cause. 
 10. No Right to Damages. You
will have no right to bring a claim or to receive damages if you are required to exercise the vested portion of the Option within twelve months of the Termination of Service or if any portion of the Option is cancelled or expires unexercised. The
loss of existing or potential profit in Options will not constitute an element of damages in the event of your Termination of Service for any reason even if the termination is in violation of an obligation of the Company or a related corporation to
you. 
 11. Binding Effect. This Agreement will inure to the benefit of the successors and assigns of the Company and be binding upon
you and your heirs, executors, administrators, successors and assigns. 
 [Insert these sections for non-US Residents:
12. Limitation on Rights; No Right to Future Grants; Extraordinary Item of Compensation. By entering into this Agreement and accepting the grant of the Option evidenced hereby, you acknowledge: (a) that the Plan is discretionary in
nature and may be suspended or terminated by the Company at any time; (b) that the grant of the Option is a one-time benefit which does not create any contractual or other right to receive future grants of options, or benefits in lieu of
options; (c) that all determinations with respect to any such future grants, including, but not limited to, the times when options will be granted, the number of shares subject to each option, the option price, and the time or times when each
option will be exercisable, will be at the sole discretion of the Company; (d) that your participation in the Plan is voluntary; (e) that the value of the Option is an extraordinary item of compensation which is outside the scope of your
employment contract, if any; (f) that the Option is not part of normal or expected compensation for purposes of calculating any severance, resignation, redundancy, end of service payments, bonuses, long-service awards, pension or retirement
benefits or similar 

 
payments; (g) that the vesting of the Option ceases upon your Termination of Service for any reason except as may otherwise be explicitly provided in
the Plan or this Agreement or otherwise permitted by the Plan Administrator; (h) that the future value of the Shares underlying the Option is unknown and cannot be predicted with certainty; and (i) that if the Shares underlying the Option
do not increase in value, the Option will have no value. 
 13. Employee Data Privacy. By entering this Agreement, you
(a) authorize the Company and your employer, if different, and any agent of the Company administering the Plan or providing Plan recordkeeping services, to disclose to the Company or any of its affiliates any information and data the Company
requests in order to facilitate the grant of the Option and the administration of the Plan; (b) waive any data privacy rights you may have with respect to such information; and (c) authorize the Company and its agents to store and transmit
such information in electronic form.Form of Restricted Stock Purchase Agreement

 Exhibit 10.2 
 NATUS MEDICAL INCORPORATED 
 2000 STOCK AWARDS PLAN 
 NOTICE OF RESTRICTED STOCK GRANT 
 You
have been granted an award of Restricted Shares of Common Stock of Natus Medical Incorporated (the “Company”) under the Company’s 2000 Stock Awards Plan (the “Plan”) on the following terms: 
  

						
	 1.
	  	Name of Participant:	  	 	________
	 2.
	  	Total Number of Shares of Restricted Stock Awarded:	  	 	________
	 3.
	  	Fair Market Value per Share of Restricted Stock:	  	$	________
	 4.
	  	Total Fair Market Value of Award:	  	$	________
	 5.
	  	Purchase Price per Share of Restricted Stock:	  	$	0.001
	 6.
	  	Total Purchase Price:	  	$	________
	 7.
	  	Date of Grant:	  	 	________
	 8.
	  	Vesting Commencement Date.	  	 	________

 9. Vesting Schedule: Subject to your continued service as a Service Provider, Shares shall vest fifty
percent (50%) of the Total Number of Shares of Restricted Stock Awarded stated above on the second anniversary of the Date of Grant stated above and then on each of the third and fourth anniversaries of the Date of Grant stated above at the
rate of twenty-five percent (25%) of the Total Number of Shares of Restricted Stock Awarded stated above. 
 By your signature and the
signature of the Company’s representative below, you and the Company agree that the Award of Restricted Stock is governed by the terms and conditions of the Plan and the Restricted Share Agreement (together with this notice the
“Restricted Stock Purchase Agreement”), which is attached hereto. If the Restricted Stock Purchase Agreement is not executed by you within thirty (30) days of the Date of Grant above, then this grant shall be void.

  

							
	NATUS MEDICAL INCORPORATED	 	RECIPIENT:
				
	By:	 	  
	 	Signature	 	  

	Its:	 	  
	 	Please Print Name	 	  

 NATUS MEDICAL INCORPORATED 
 2000 STOCK AWARDS PLAN 
 RESTRICTED SHARE AGREEMENT 
 THIS RESTRICTED SHARE AGREEMENT (this “Agreement”) is made as of
                    , 20     by and between Natus Medical Incorporated, a Delaware corporation (the
“Company”), and
                                        
(“Participant”) pursuant to the Company’s 2000 Stock Awards Plan (the “Plan”). To the extent any capitalized terms used in this Agreement are not defined, they shall have the meaning ascribed to them in the Plan. 

1. Sale of Stock. Subject to the terms and conditions of this Agreement, on the Purchase Date (as defined below) the Company will issue
and sell to Participant, and Participant agrees to purchase from the Company the number of Shares shown on the Notice of Restricted Stock Grant at a purchase price of $0.001 per Share. The per Share purchase price of the Shares shall be not less
than the par value of the Shares as of the date of the offer of such Shares to the Participant. The term “Shares” refers to the purchased Shares and all securities received in replacement of or in connection with the Shares pursuant to
stock dividends or splits, all securities received in replacement of the Shares in a recapitalization, merger, reorganization, exchange or the like, and all new, substituted or additional securities or other properties to which Participant is
entitled by reason of Participant’s ownership of the Shares. 
 2. Time and Place of Purchase. The purchase and sale of
the Shares under this Agreement shall occur at the principal office of the Company simultaneously with the execution of this Agreement by the parties, or on such other date as the Company and Participant shall agree (the “Purchase Date”).
On the Purchase Date, the Company will issue in Participant’s name a stock certificate representing the Shares to be purchased by Participant against payment of the purchase price therefor by Participant by (a) check made payable to the
Company, (b) cancellation of indebtedness of the Company to Participant, or (c) a combination of the foregoing. 
 3.
Restrictions on Resale. By signing this Agreement, Participant agrees not to sell any Shares acquired pursuant to the Plan and this Agreement at a time when applicable laws, regulations or Company or underwriter trading policies prohibit
exercise or sale. This restriction will apply as long as Participant is providing Service to the Company or a Subsidiary of the Company. 
 3.1 Repurchase Right on Termination Other Than for Cause. For the purposes of this Agreement, a “Repurchase Event” shall mean an occurrence of one of: 
 (i) termination of Participant’s service, whether voluntary or involuntary and with or without cause; 
 (ii) resignation, retirement or death of Participant; or 
  

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 (iii) any attempted transfer by Participant of the Shares, or any interest therein, in violation
of this Agreement. 
 Upon the occurrence of a Repurchase Event, the Company shall have the right (but not an obligation) to purchase the Shares of
Participant at a price equal to the Price (the “Repurchase Right”). The Repurchase Right shall lapse in accordance with the vesting schedule set forth in the Notice of Restricted Stock Grant. For purposes of this Agreement,
“Unvested Shares” means Stock pursuant to which the Company’s Repurchase Right has not lapsed. 
 3.2
Exercise of Repurchase Right. Unless the Company provides written notice to Participant within 90 days from the date of termination of Participant’s Service Provider relationship that the Company does not intend to exercise its
Repurchase Right with respect to some or all of the Unvested Shares, the Repurchase Right shall be deemed automatically exercised by the Company as of the 90th day following such termination, provided that the Company may notify Participant that it
is exercising its Repurchase Right as of a date prior to such 90th day. Unless Participant is otherwise notified by the Company pursuant to the preceding sentence that the Company does not intend to exercise its Repurchase Right as to some or all of
the Unvested Shares, execution of this Agreement by Participant constitutes written notice to Participant of the Company’s intention to exercise its Repurchase Right with respect to all Unvested Shares to which such Repurchase Right applies at
the time of Termination of Participant. The Company, at its choice, may satisfy its payment obligation to Participant with respect to exercise of the Repurchase Right by either (A) delivering a check to Participant in the amount of the purchase
price for the Unvested Shares being repurchased, or (B) in the event Participant is indebted to the Company, canceling an amount of such indebtedness equal to the purchase price for the Unvested Shares being repurchased, or (C) by a
combination of (A) and (B) so that the combined payment and cancellation of indebtedness equals such purchase price. In the event of any deemed automatic exercise of the Repurchase Right by canceling an amount of such indebtedness equal to
the purchase price for the Unvested Shares being repurchased, such cancellation of indebtedness shall be deemed automatically to occur as of the 90th day following termination of Participant’s Service Provider relationship unless the Company
otherwise satisfies its payment obligations. As a result of any repurchase of Unvested Shares pursuant to the Repurchase Right, the Company shall become the legal and beneficial owner of the Unvested Shares being repurchased and shall have all
rights and interest therein or related thereto, and the Company shall have the right to transfer to its own name the number of Unvested Shares being repurchased by the Company, without further action by Participant. 
 3.3 Acceptance of Restrictions. Acceptance of the Shares shall constitute Participant’s agreement to such restrictions and the
legending of his or her certificates with respect thereto. Notwithstanding such restrictions, however, so long as Participant is the holder of the Shares, or any portion thereof, he or she shall be entitled to receive all dividends declared on and
to vote the Shares and to all other rights of a stockholder with respect thereto. 
 3.4 Non-Transferability of Unvested
Shares. In addition to any other limitation on transfer created by applicable securities laws or any other agreement between the Company and Participant, Participant may not transfer any Unvested Shares, or any interest therein, unless consented
to in writing by a duly authorized representative of the Company. Any purported transfer is void and of no effect, and no purported transferee thereof will be recognized 
  

 2 

 as a holder of the Unvested Shares for any purpose whatsoever. Should such a transfer purport to occur, the Company may
refuse to carry out the transfer on its books, set aside the transfer, or exercise any other legal or equitable remedy. In the event the Company consents to a transfer of Unvested Shares, all transferees of Shares or any interest therein will
receive and hold such Shares or interest subject to the provisions of this Agreement, including, insofar as applicable, the Repurchase Right. In the event of any purchase by the Company hereunder where the Shares or interest are held by a
transferee, the transferee shall be obligated, if requested by the Company, to transfer the Shares or interest to the Participant for consideration equal to the amount to be paid by the Company hereunder. In the event the Repurchase Right is deemed
exercised by the Company, the Company may deem any transferee to have transferred the Shares or interest to Participant prior to their purchase by the Company, and payment of the purchase price by the Company to such transferee shall be deemed to
satisfy Participant’s obligation to pay such transferee for such Shares or interest, and also to satisfy the Company’s obligation to pay Participant for such Shares or interest. 
 3.5 Assignment. The Repurchase Right may be assigned by the Company in whole or in part to any persons or organization. 
 4. Restrictive Legends and Stop Transfer Orders. 
 4.1 Legends. The certificate or certificates representing the Shares shall bear the following legend (as well as any legends required by applicable state and federal corporate and securities laws):

 THE SHARE REPRESENTED BY THIS CERTIFICATE MAY BE TRANSFERRED ONLY IN ACCORDANCE WITH THE TERMS OF AN AGREEMENT BETWEEN THE COMPANY AND THE
STOCKHOLDER, A COPY OF WHICH IS ON FILE WITH THE SECRETARY OF THE COMPANY. 
 4.2 Stop-Transfer Notices. Participant agrees
that, in order to ensure compliance with the restrictions referred to herein, the Company may issue appropriate “stop transfer” instructions to its transfer agent, if any, and that, if the Company transfers its own securities, it may make
appropriate notations to the same effect in its own records. 
 4.3 Refusal to Transfer. The Company shall not be required
(i) to transfer on its books any Shares that have been sold or otherwise transferred in violation of any of the provisions of this Agreement or (ii) to treat as the owner or to accord the right to vote or pay dividends to any purchaser or
other transferee to whom such Shares shall have been so transferred. 
 5. No Rights as Service Provider. Nothing in this
Agreement shall affect in any manner whatsoever the right or power of the Company, or a Parent or Subsidiary of the Company, to terminate Participant’s relationship as a Service Provider, for any reason, with or without cause. 
  

 3 

 6. Miscellaneous. 
 6.1 Governing Law. This Agreement and all acts and transactions pursuant hereto and the rights and obligations of the parties hereto shall
be governed, construed and interpreted in accordance with the laws of the State of California, without giving effect to principles of conflicts of law. 
 6.2 The Plan and Other Agreements; Enforcement of Rights. The text of the Plan and the Notice of Restricted Stock Grant to which this Agreement is attached are incorporated into this Agreement by
reference. This Agreement, the Plan and the Notice of Restricted Stock Grant to which this Agreement is attached constitute the entire agreement and understanding of the parties relating to the subject matter herein and supersede all prior
discussions between them. Any prior agreements, commitments or negotiations concerning the purchase of the Shares of Restricted Stock hereunder are superseded. No modification of or amendment to this Agreement, nor any waiver of any rights under
this Agreement, shall be effective unless in writing and signed by the parties to this Agreement. The failure by either party to enforce any rights under this Agreement shall not be construed as a waiver of any rights of such party. 
 6.3 Severability. If one or more provisions of this Agreement are held to be unenforceable under applicable law, the parties agree to
renegotiate such provision in good faith. In the event that the parties cannot reach a mutually agreeable and enforceable replacement for such provision, then (i) such provision shall be excluded from this Agreement, (ii) the balance of this
Agreement shall be interpreted as if such provision were so excluded and (iii) the balance of this Agreement shall be enforceable in accordance with its terms. 
 6.4 Construction. This Agreement is the result of negotiations between and has been reviewed by each of the parties hereto and their respective counsel, if any; accordingly, this Agreement shall be
deemed to be the product of all of the parties hereto, and no ambiguity shall be construed in favor of or against any one of the parties hereto. 
 6.5 Notices. Any notice to be given under the terms of the Plan shall be addressed to the Company in care or its principal office, and any notice to be given to the Participant shall be addressed to such Participant at the
address maintained by the Company for such person or at such other address as the Participant may specify in writing to the Company. 
 6.6 Counterparts. This Agreement may be executed in two or more counterparts, each of which shall he deemed an original and all of which together shall constitute one instrument. 
 6.7 Successors and Assigns. The rights and benefits of this Agreement shall inure to the benefit of., and be enforceable by, the Company’s successors and assigns. The rights and obligations of Participant under this Agreement may only be assigned
with the prior written consent of the Company. 
 6.8 U.S. Tax Consequences. Upon vesting of Shares, Participant will include
in taxable income the difference between the fair market value of the vesting Shares, as determined on the date of their vesting, and the price paid for the Shares. This will be treated as 
  

 4 

 ordinary income by Participant and will be subject to withholding by the Company when required by applicable law. In the
absence of an Election (defined below) the Company shall withhold a number of vesting Shares with a fair market value (determined on the date of their vesting) equal to the amount the Company is required to withhold for income and employment taxes.
If Participant makes an Election, then Participant must, prior to making the Election, pay in cash (or check) to the Company an amount equal to the amount the Company is required to withhold for income and employment taxes. 
 7. Section 83(b) Election. Participant hereby acknowledges that he or she has been informed that, with respect to the purchase of the
Shares, an election may be filed by the Participant with the Internal Revenue Service, within 30 days of the purchase of the Shares, electing pursuant to Section 83(b) of the Code to be taxed currently on any difference between the purchase
price of the Shares and their Fair Market Value on the date of purchase (the “Election”). Making the Election will result in recognition of taxable income to the Participant on the date of purchase, measured by the excess, if
any, of the Fair Market Value of the Shares over the purchase price for the Shares. Absent such an Election, taxable income will be measured and recognized by Participant at the time or times on which the Company’s Repurchase Right lapses.
Participant is strongly encouraged to seek the advice of his or her own tax consultants in connection with the purchase of the Shares and the advisability of filing of the Election. PARTICIPANT ACKNOWLEDGES THAT IT IS SOLELY PARTICIPANT’S
RESPONSIBILITY, AND NOT THE COMPANY’S RESPONSIBILITY, TO TIMELY FILE THE ELECTION UNDER SECTION 83(b) OF THE CODE, EVEN IF PARTICIPANT REQUESTS THE COMPANY, OR ITS REPRESENTATIVE, TO MAKE THIS FILING ON PARTICIPANT’S BEHALF.

 The parties have executed this Agreement as of the date first set forth above. 
  

			
	NATUS MEDICAL INCORPORATED
		
	 By:
	 	  

	 Its:
	 	  

	
	RECIPIENT:
	
	 (Signature)

	
	 (Please Print Name)

  

 5 

 RECEIPT 
 Natus Medical Incorporated hereby acknowledges receipt of (check as applicable): 
  ̈ A check in the amount of
$                     
  ̈ The cancellation of indebtedness in the amount of
$                     
 given by
                     as consideration for Certificate No. -             for
             shares of Common Stock of Natus Medical Incorporated. 
 Dated:
                    , 20     
  

			
	NATUS MEDICAL INCORPORATED
		
	 By:
	 	  

	 Its:
	 	  

 RECEIPT AND CONSENT 
 The undersigned Participant hereby acknowledges receipt of a photocopy of Certificate No. -             for
             shares of Common Stock of Natus Medical Incorporated (the “Company”) 
 The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Restricted Shares Agreement that Participant has previously entered into with
the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. To facilitate any transfer of Shares to the Company pursuant to the
Restricted Shares Agreement, Participant has executed the attached Assignment Separate from Certificate. 
 Dated:
                    , 20     
 Signature
                                        
                                     
 Please Print Name
                                        
                       

 STOCK POWER AND ASSIGNMENT 
 SEPARATE FROM STOCK CERTIFICATE 
 FOR VALUE RECEIVED and pursuant to that certain Restricted Share Agreement dated as of                     ,
            , [COMPLETE AT THE TIME OF PURCHASE] (the “Agreement”), the undersigned Participant hereby sells, assigns and
transfers unto
                                        ,
             shares of the Common Stock             , par value per share, of Natus Medical Incorporated, a
Delaware corporation (the “Company”), standing in the undersigned’s name on the books of the Company represented by Certificate No(s).
            [COMPLETE AT THE TIME OF PURCHASE] delivered herewith, and does hereby irrevocably constitute and appoint the Secretary of the Company as the
undersigned’s attorney-in-fact, with full power of substitution, to transfer said stock on the books of the Company. THIS ASSIGNMENT MAY ONLY BE USED AS AUTHORIZED BY THE AGREEMENT AND ANY EXHIBITS THERETO. 
 Dated:                     ,
         
  

	
	 PARTICIPANT

	
	  

	 (Signature)

	
	  

	 (Please Print Name)

 Instructions to Participant: Please do not fill in any blanks other than the signature line.
The purpose of this document is to enable the Company and/or its assignee(s) to acquire the shares upon exercise of its “Repurchase Right” set forth in the Agreement without requiring additional action by the Participant.

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