Document:

Exhibit 10.5

    

    

    

    
      INDEMNITY AGREEMENT

      

      

      DATED this _____ day of _________________,
          _____.

       

      BETWEEN:

       

      VIEMED HEALTHCARE, INC., a corporation
          incorporated under the laws of the Province of British Columbia

       

      (hereinafter referred to as the “Indemnifier”)

       

      - and -

       

      ____________________, an individual residing in the _________________

       

      (hereinafter referred to as the “Indemnified Party”).

       

      WHEREAS the Indemnified Party has been
          elected and/or appointed a director and/or officer of the Indemnifier;

       

      AND WHEREAS the Indemnifier desires to
          indemnify the Indemnified Party in certain circumstances in respect of liability which the Indemnified Party may incur as a result of such Indemnified Party acting as the director and/or officer of the Indemnifier;

       

      NOW THEREFORE, IN CONSIDERATION OF the
          premises and mutual covenants herein contained, and in consideration of the sum of One Dollar ($1.00) paid by the Indemnified Party to the Indemnifier (the receipt of which is hereby acknowledged) and in consideration of the Indemnified Party
          acting as the director and/or officer of the Indemnifier, the Indemnifier and the Indemnified Party do hereby covenant and agree as follows:

       

      
        
          	1.	
                  Indemnification

                

        

      

       

      
        
          	

                	(a)	
                  To the full extent allowed by applicable law, the Indemnifier irrevocably agrees to indemnify and save harmless the Indemnified Party, his or her heirs, successors and
                      legal representatives from and against any and all damages, liabilities, losses, costs, charges and expenses suffered or incurred at any time by the Indemnified Party, his or her heirs, successors or legal representatives as a result
                      or by reason of the Indemnified Party acting as the director and/or officer of the Indemnifier or by reason of any action taken or not taken by such Indemnified Party in such capacity, including without limitation, any liability
                      arising under applicable corporate and securities legislation or otherwise, and including any costs, charges and expenses the Indemnified Party may incur in enforcing this Agreement, provided that such damages, liabilities, losses,
                      costs, charges or expenses were not suffered or incurred as a direct result of such Indemnified Party’s own gross negligence, fraud, dishonesty or wilful default.

                

        

      

       

      
        
          	

                	(b)	
                  The Indemnifier irrevocably agrees:

                

        

      

       

      
        
          

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                	(i)	
                  except in respect of an action by or on behalf of the Indemnifier to procure a judgment in its favour, to indemnify the Indemnified Party and his or her heirs, successors
                      and legal representatives against all damages, liabilities, losses, costs, charges, expenses, penalties and fines including an amount paid to settle an action where such settlement has been consented to by the Indemnifier, acting
                      reasonably, cause of action, proceeding, claim or demand whatsoever or to satisfy a judgment, reasonably incurred by the Indemnified Party in respect of any civil, criminal, quasi criminal or administrative action or proceeding to
                      which the Indemnified Party is made a party by reason of such Indemnified Party acting as the director and/or officer of the Indemnifier, if:

                

        

      

       

      
        
          	

                	(1)	
                  the Indemnified Party acted honestly and in good faith with a view to the best interests of the Indemnifier; and

                

        

      

       

      
        
          	

                	(2)	
                  in the case of a criminal, quasi criminal or administrative action or proceeding that is enforced by monetary penalty, the Indemnified Party had reasonable grounds for
                      believing that the Indemnified Party’s conduct was lawful;

                

        

      

       

      
        
          	

                	(ii)	
                  to indemnify the Indemnified Party and his or her heirs, successors and legal representatives in respect of an action by or on behalf of the Indemnifier to procure a
                      judgment in its favour, to which the Indemnified Party is made a party by reason of such Indemnified Party acting as the director and/or officer of the Indemnifier against all costs, charges and expenses reasonably incurred by the
                      Indemnified Party in connection with the action if the Indemnified Party has fulfilled the conditions set forth in Clauses 1(b)(i)(1) and (2) set out above and if the Indemnifier obtains the approval of a court of competent
                      jurisdiction to grant such indemnity;

                

        

      

       

      
        
          	

                	(iii)	
                  in the event that the approval of a court of competent jurisdiction is required to effect any indemnification granted hereunder, the Indemnifier agrees to make
                      application at its expense for and use its best efforts to obtain the court’s approval to such indemnification provided that the Indemnified Party has fulfilled the conditions set forth in Clauses 1(b)(i)(1) and (2) herein;

                

        

      

       

      
        
          	

                	(iv)	
                  notwithstanding Clauses 1(b)(i) and (ii) above, to indemnify the Indemnified Party and his or her heirs, successors and legal representatives in respect of all costs,
                      charges and expenses reasonably incurred by the Indemnified Party in connection with the defence of any civil, criminal, quasi criminal or administrative action or proceeding to which the Indemnified Party is made a party by reason of
                      such Indemnified Party acting as the director and/or officer of the Indemnifier, if the Indemnified Party:

                

        

      

       

      
        
          	

                	(1)	
                  was substantially successful on the merits in such Indemnified Party’s defence of the action or proceeding; and

                

        

      

       

      
        
          	

                	(2)	
                  fulfills the conditions set out in Clauses 1(b)(i)(1) and (2) set out above; and

                

        

      

       

      
        
          	

                	(v)	
                  to indemnify the Indemnified Party and his or her heirs, successors and legal representatives in respect of all costs, charges and expenses reasonably incurred by the
                      Indemnified Party in connection with defence of any threatened civil, criminal, quasi criminal or administrative action or proceeding or alleged wrongdoing (or settlement thereof with the consent of the Indemnifier acting reasonably)
                      against the Indemnified Party by reason of such Indemnified Party acting as the director and/or officer of the Indemnifier.

                

        

      

       

      
        
          

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                	(c)	
                  For the purposes of this Agreement, the termination of any action, claim, demand or proceeding by judgement, order, settlement, conviction, plea or similar or other
                      result shall not, of itself, create a presumption either that the Indemnified Party did not act honestly or in good faith with a view to the best interests of the Indemnifier or that, in the case of a criminal, quasi criminal or
                      administrative action or proceeding that is enforced by a monetary penalty, the Indemnified Party did not have reasonable grounds for believing that his conduct was lawful.

                

        

      

       

      
        
          	

                	(d)	
                  Without limiting the generality of the foregoing and notwithstanding anything contained herein:

                

        

      

       

      
        
          	

                	(i)	
                  nothing in this Agreement shall be interpreted, by implication or otherwise, in limitation of the scope of the indemnification provided in Subsections 1(a) and (b)
                      hereof; and

                

        

      

       

      
        
          	

                	(ii)	
                  Subsection 1(b) is intended to provide indemnification to the Indemnified Party to the fullest extent permitted by applicable laws (the “Applicable Laws”) and, in the event that such Applicable Laws or the interpretation thereof are amended to permit a broader scope of indemnification (including, without
                      limitation, the deletion or limiting of one or more of the provisos to the applicability of indemnification), Subsection 1(b) shall be deemed to be amended concurrently with such amendment to the Applicable Law so as to provide such
                      broader indemnification.

                

        

      

       

      
        
          	2.	
                  Prepaid Expenses

                

        

      

       

      To the full extent allowed by applicable law, all costs, charges and expenses reasonably incurred by the Indemnified Party in
          investigating, defending or appealing any civil, criminal, quasi criminal or administrative action or proceeding, actual or threatened, covered hereunder shall, at the request of such Indemnified Party, be paid by the Indemnifier in advance or
          promptly reimbursed if paid by the Indemnified Party as may be appropriate to enable the Indemnified Party to properly investigate, defend or appeal such action or proceeding, with the understanding and agreement being herein made that, in the
          event it is ultimately determined as provided hereunder that the Indemnified Party was not entitled to be so indemnified, or was not entitled to be fully so indemnified, that the Indemnified Party shall indemnify and hold harmless the
          Indemnifier, and pay to the Indemnifier forthwith after such ultimate determination such amount or the appropriate portion thereof, so paid in advance.

       

      
        
          	3.	
                  Other Rights and Remedies

                

        

      

       

      Indemnification and advance payment of costs, charges and expenses as provided by this Agreement shall not be deemed to derogate from
          or exclude any other rights to which the Indemnified Party may be entitled under any provision of the Applicable Laws or otherwise at law, as the same may be amended from time to time, this Agreement, the Articles of the Indemnifier, any vote of
          shareholders of the Indemnifier, or otherwise, both as to matters arising out of the Indemnified Party’s position as the director and/or officer of the Indemnifier, or as to matters arising out of another capacity with the Indemnifier. The
          Indemnifier hereby agrees that it will not amend its Articles in any way that will be inconsistent with this Agreement.

       

      
        
          

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          	4.	
                  Notice of Proceedings

                

        

      

       

      The Indemnified Party agrees to give notice to the Indemnifier promptly after being served with any statement of claim, writ, notice
          of motion, indictment or other document commencing or continuing any civil, criminal, quasi criminal or administrative action or proceeding against the Indemnified Party, or receiving notice of any threatened civil, criminal, quasi criminal or
          administrative action or proceeding or alleged wrongdoing against the Indemnified Party, and in respect of which the Indemnified Party is entitled to be indemnified hereunder and the Indemnifier agrees to give notice to the Indemnified Party in
          writing within seven days of (a) being served with any such statement of claim, writ, notice of motion, indictment or other document commencing or continuing any civil, criminal, quasi criminal or administrative action or proceeding naming the
          Indemnified Party as a party, or (b) receiving notice of any such threatened civil, criminal, quasi criminal or administrative action or proceeding or alleged wrongdoing against the Indemnified Party.

       

      The Indemnifier further agrees to promptly retain counsel, who shall be reasonably satisfactory to the Indemnified Party, to represent the Indemnified
          Party in any such matter.

       

      
        
          	5.	
                  Right to Retain Other Counsel

                

        

      

       

      In any such matter the Indemnified Party shall have the right to retain other counsel to act on such Indemnified Party’s behalf,
          provided that the fees and disbursements of such other counsel shall be paid by such Indemnified Party unless (a) such Indemnified Party and the Indemnifier shall have mutually agreed to the retention of such other counsel, (b) the Indemnifier
          shall not have taken up or assumed the defense of such action, claim, demand or proceeding and employed counsel within the prescribed time after notice of such action, claim, demand or proceeding from the Indemnified Party, or (c) the named
          parties to any such action, claim, demand or proceeding (including any added third, or interpleaded parties) include the Indemnifier and the Indemnified Party and, in the written opinion of the Indemnified Party’s counsel, a copy of which is
          provided to the Indemnifier, representation by the same counsel would be inappropriate due to actual or potential differing interests between them (including the availability of different defences), in which event the Indemnifier agrees to pay
          the reasonable fees and disbursements of such counsel (on a solicitor and his own client basis).

       

      
        
          	6.	
                  Tax Gross Up

                

        

      

       

      If the Canada Revenue Agency or any provincial taxing authority, or the United States Internal Revenue Service or any state taxing
          authority, assesses the Indemnified Party on the basis that any indemnity payment received must be included in computing the Indemnified Party’s income for tax purposes, then, unless the Indemnifier elects to dispute such assessment at its
          expense and is successful in reversing the assessment, the Indemnifier will make an additional payment or payments from time to time, at such times in such amounts as will ensure the Indemnified Party is not out-of-pocket, to the Indemnified
          Party to fully ensure that, taking into account any income inclusion required in respect of any indemnity payment or such additional payment or payments, the Indemnified Party is after receiving such additional payment or payments, fully
          compensated for any actual tax liability (including any interest or penalty), or for the use of losses, deductions, credits or similar amounts used in offsetting an income inclusion or other assessed amounts relating to any indemnity payment or
          to any additional payment made under this Agreement.

       

      
        
          	7.	
                  Enforcement of Claim

                

        

      

       

      If any claim arising from any right to indemnification conferred by the Indemnifier upon the Indemnified Party pursuant to this
          Agreement is not paid in full by the Indemnifier within 30 days after a written claim has been received by the Indemnifier, the Indemnified Party may, at any time thereafter, bring suit against the Indemnifier to recover the unpaid amount of the
          claim and, if successful in whole or in part, the Indemnified Party will be entitled to be paid also the expense of prosecuting such claim.

       

      
        
          

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          	8.	
                  Insurance

                

        

      

       

      
        
          	

                	(a)	
                  The Indemnifier shall use commercially reasonable efforts to obtain and at all times maintain a policy of insurance with respect to liability relating to its directors
                      and officers, whether or not the Indemnifier would have the power to indemnify the Indemnified Party against such costs, charges, expenses, liabilities or losses under the applicable law, which policy shall (i) pursuant to its terms
                      extend to the Indemnified Party in his capacity as director and/or officer of the Indemnifier and (ii) be written, to the extent commercially available, on an occurrence basis.

                

        

      

       

      
        
          	

                	(b)	
                  In the event that the Indemnified Party is an insured under such policy and an insurable event occurs, the Indemnified Party will be indemnified promptly as agreed hereto
                      regardless of whether the Indemnifier has received the insurance proceeds. The Indemnified Party is entitled to full indemnification as agreed hereto notwithstanding any deductible amounts or policy limits contained in any such
                      insurance policy.

                

        

      

       

      
        
          	9.	
                  Indemnified Party to Cooperate

                

        

      

       

      The Indemnified Party agrees to give the Indemnifier such information and cooperation as the Indemnifier may reasonably require from
          time to time in respect of all matters hereunder.

       

      
        
          	10.	
                  Notices

                

        

      

       

      Any notice, document or other communication required or permitted by this Agreement to be given by a party hereto shall be in writing
          and is sufficiently given if delivered personally, or if sent by prepaid ordinary mail posted in Canada, or if transmitted by any form of telecommunication (which is tested prior to transmission, confirms to the sender the receipt of the entire
          transmission by the recipient and reproduces a complete written version of the transmission at the point of reception) to such party addressed as follows:

       

      
        	
                 

              	(a)	
                if to the Indemnified Party, at:

              	
                 

              
	
                 

              	
                 

              	
                 

              	
                 

              
	
                 

              	
                 

              	
                 

              	
                 

              
	
                 

              	
                 

              	
                 

              	
                 

              
	
                 

              	
                 

              	
                 

              	
                 

              

        

        

        	 	 	Email address:	 	 

      

       

      	 	(b)	
              if to the Indemnifier, at:

            	 
	 	 	 	 
	 	 	
              202 North Luke Street

            	 
	 	 	
              Lafayette, Louisiana 70506

            	 

       

      

      	 	 	Email address:	 	 

      

      
        
          

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      Notice so mailed shall be deemed to have been given on the third business day (“Business Day”)
        means a day other than a Saturday, Sunday or any day other than Saturday or Sunday on which the principal commercial banks located at Toronto, Ontario are not open for business during normal banking hours) after deposit in a post office or public
        letterbox. Neither party shall mail any notice, request or other communication hereunder during any period in which Canadian postal workers are on strike or if such strike is imminent and may reasonably be anticipated to affect the normal delivery
        of mail. Notice transmitted by a form of recorded telecommunication during normal business hours on a Business Day (9:00 a.m. to 5:00 p.m. local time at the place of receipt) shall be deemed to have been given on the day of transmission or, in the
        case of notice transmitted outside of normal business hours shall be deemed to have been given on the first Business Day after the day of transmission; provided that immediately following such transmission such notice is given by personal delivery.
        Notice delivered personally shall be deemed to have been given on the day it was delivered. Any party may from time to time notify the others in the manner provided herein of any change of address which thereafter, until changed by like notice,
        shall be the address of such party for all purposes hereof.
       

      
        
          	11.	
                  Severability

                

        

      

       

      If any provision or provisions of this Agreement shall be held to be invalid, illegal or unenforceable for any reason whatsoever (a)
          the validity, legality and enforceability of the remaining provisions of this Agreement (including, without limitation, all portions of any paragraph of this Agreement containing such provisions held to be invalid, illegal or unenforceable that
          are not of themselves in whole invalid, illegal or unenforceable) shall not in any way be affected or impaired thereby, and (b) to the fullest possible extent, the provisions of this Agreement (including, without limitation, all portions of any
          paragraphs of this Agreement containing any provisions held to be invalid, illegal or unenforceable, that are not of themselves in whole invalid, illegal or unenforceable) shall be construed so as to give effect to the intent manifested by the
          provision which is held to be invalid, illegal or unenforceable.

       

      
        
          	12.	
                  Governing Law

                

        

      

       

      The parties hereto agree that this Agreement shall be construed and enforced in accordance with the laws of the Province of Ontario
          and the laws of Canada applicable therein and shall be treated, in all respects, as a Ontario contract.

        

      

      
        
          	13.	
                  Modification and Waiver

                

        

      

       

      No supplement, modification or amendment of this Agreement shall be binding unless executed in writing by both parties hereto. No
          waiver of any of the provisions of this Agreement shall be deemed or shall constitute a waiver of any other provision hereof (whether or not similar) nor shall such waiver constitute a continuing waiver.

       

      
        
          	14.	
                  Entire Agreement

                

        

      

       

      This Agreement shall supersede and replace any and all prior agreements (except any written agreement of employment between the
          Indemnifier and the Indemnified Party, which shall remain in full force and effect), except to the extent augmented or amended hereby, between the parties hereto respecting the specific subject matter set forth herein, and shall constitute the
          entire agreement between the parties hereto in respect of the specific subject matter set forth herein.

       

      
        
          

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          	15.	
                  Survival; Successors and Assigns

                

        

      

       

      The indemnification and advance payment of costs, charges and expenses as provided by, and granted pursuant to, this Agreement will
          continue if the Indemnified Party ceases to be the director and/or officer, employee or agent of the Indemnifier for any actions, proceedings, claims or demands whatsoever arising out of the Indemnified Party’s relationship with the Indemnifier
          and notwithstanding any action, proceeding, claim or demand is made, filed or threatened after the Indemnified Party terminates such relationship. This Agreement shall be binding upon and enure for the benefit of the Indemnifier and its
          successors and assigns and to the Indemnified Party and his or her estates, executors, administrators, legal representatives, lawful heirs, successors and assigns.

       

      
        
          	16.	
                  Resignations Will Not Be Prevented

                

        

      

       

      Nothing contained in this Agreement shall prevent the Indemnified Party from resigning at any time from any office that the
          Indemnified Party holds with the Indemnifier or otherwise holds at the request of the Indemnifier.

       

      
        
          	17.	
                  Successor Legislation

                

        

      

       

      Any references herein to any enactment shall be deemed to be references to such enactment as the same may be amended or replaced from
          time to time.

       

      
        
          	18.	
                  Counterparts

                

        

      

       

      For the convenience of the parties, this Agreement may be executed in several counterparts, each of which when so executed shall be,
          and be deemed to be, an original instrument and such counterparts together shall constitute one and the same instrument (and notwithstanding their date of execution shall be deemed to bear date as of the date of this Agreement). A signed
          facsimile, portable document format (PDF) or telecopied copy of this Agreement shall be effective and valid proof of execution and delivery.

       

      
        
          	19.	
                  Effective Date

                

        

      

       

      For greater certainty, notwithstanding the date of execution hereof, the indemnities provided herein shall be effective as against the
          Indemnifier as of the date the Indemnified Party first was appointed or elected the director and/or officer of the Indemnifier.

       

      IN WITNESS WHEREOF the parties hereto have executed this Agreement as at the date first written above.

       

      	Signed, sealed and	)	 
	
              delivered, in the presence of:

            	)	 
	 	)	 
	 	)	 
	 	)	 
	 	)	 
	
              Witness

            	)	
              Name:

            

      

      

      
        
          

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              VIEMED HEALTHCARE, INC.

            
	 	 	 
	 	
              Per:

            	 
	 	 	
              Name:

            
	 	 	
              Title:

            
	 	
              I have authority to bind the Corporation.Exhibit 10.6

  

   

    AMENDED AND RESTATED STOCK OPTION PLAN OF

    VIEMED HEALTHCARE, INC.

    (effective as of July 17, 2018)

    

    

    PART 1 - INTRODUCTION

    

    

    
      	
              1.01

            	
              Purpose

            

    

    

    

    The purpose of the Plan is to secure for the Corporation and its shareholders the benefits of incentive inherent in share ownership by
        the directors, officers, key employees and, subject to the terms and conditions herein, service providers of the Corporation and its Affiliates who, in the judgment of the Board, will be largely responsible for its future growth and success.

    

    

    
      	
              1.02

            	
              Definitions

            

    

    

    

    
      
        	

              	(a)	
                "Affiliate" has the meaning ascribed thereto in the Business Corporations Act
                    (British Columbia) as amended from time to time.

              

      

    

    

    

    
      
        	

              	(b)	
                "Associate" has the meaning ascribed to such term in the TSX Company Manual.

              

      

    

    

    

    
      
        	

              	(c)	
                "Blackout Period" means a period during which the Corporation prohibits Optionees from exercising their Options.

              

      

    

    

    

    
      
        	

              	(d)	
                "Board" means the board of directors of the Corporation.

              

      

    

    

    

    
      
        	

              	(e)	
                "Code" means the U.S. Internal Revenue Code of 1986, as amended.

              

      

    

    

    

    
      
        	

              	(f)	
                "Corporation" means Viemed Healthcare, Inc., a corporation duly incorporated under the laws of the Province of British Columbia, and its Affiliates, if any, and includes
                    any successor or assignee entity or entities into which the Corporation may be merged, changed, or consolidated; any entity for whose securities the securities of the Corporation shall be exchanged; and any assignee of or successor to
                    substantially all of the assets of the Corporation.

              

      

    

    

    

    
      
        	

              	(g)	
                "Market Price" has the meaning ascribed to such term in Part I of the TSX Company Manual.

              

      

    

    

    

    
      
        	

              	(h)	
                "Disability" or "Disabled" means permanent and total disability as defined in Section 22(e)(3) of the Code.

              

      

    

    

    

    
      
        	

              	(i)	
                "Eligible Person" shall mean an officer or director of the Corporation ("Executive")

                    or an employee of the Corporation ("Employee") or a Service Provider.

              

      

    

    

    

    
      
        	

              	(j)	
                "Exchange" or the “TSX” means the Toronto Stock Exchange.

              

      

    

    

    

    
      
        	

              	(k)	
                "Exercise Notice" means the U.S. Optionee Exercise Notice or the Non-U.S. Optionee Exercise Notice, as applicable.

              

      

    

    

    

    
      
        	

              	(l)	
                "Exercise Price" means the price at which an Option may be exercised as determined in accordance with section 2.03.

              

      

    

    

    

    
      
        	

              	(m)	
                "Fair Market Value" means, if the Shares are listed on any national securities exchange within the meaning of Section 409A of the Code, the closing sales price, if any, on
                    the largest such exchange on the valuation date, or, if none, on the most recent trade date immediately prior to the valuation date provided such trade date is no more than thirty (30) days prior to the valuation date. If the Shares are
                    not then listed on any such exchange, or there has been no trade date within such thirty (30) day period, the fair market value shall be determined in good faith by the Board.

              

         

        

      

    

    
      
        

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              	(n)	
                "Section 422 Stock Option" means an Option which is intended to qualify as an incentive stock option under Section 422 of the Code.

              

      

    

    

    

    
      
        	

              	(o)	
                "Insider" has the meaning ascribed to that term in Part I of the TSX Company Manual.

              

      

    

    

    

    
      
        	

              	(p)	
                "Material Information" has the meaning ascribed to such term in Section 407 of the TSX Company Manual.

              

      

    

    

    

    
      
        	

              	(q)	
                "Non-U.S. Optionee Exercise Notice" means the notice respecting the exercise of an Option, substantially in the form attached to the Option Certificate as Appendix I, duly
                    executed by the Optionee.

              

      

    

    

    

    
      
        	

              	(r)	
                "Option" shall mean an option granted under the terms of the Plan.

              

      

    

    

    

    
      
        	

              	(s)	
                "Option Certificate" means the certificate, substantially in the form set out as Schedule “A” hereto, evidencing an Option.

              

      

    

    

    

    
      
        	

              	(t)	
                "Option Period" shall mean the period during which an option may be exercised.

              

      

    

    

    

    
      
        	

              	(u)	
                "Optionee" shall mean an Eligible Person to whom an Option has been granted under the terms of the Plan.

              

      

    

    

    

    
      
        	

              	(v)	
                "Outstanding Issue" means the number of Shares outstanding on a non-diluted basis.

              

      

    

    

    

    
      
        	

              	(w)	
                "Plan" means this amended and restated stock option plan established and operated pursuant to Part 2 hereof.

              

      

    

    

    

    
      
        	

              	(x)	
                “Security-Based Compensation Arrangement” has the meaning ascribed to it in section 613(b) of Part VI of TSX Company Manual

              

      

    

    

    

    
      
        	

              	(y)	
                “Service Provider” has the meaning ascribed to it in section 613(b) of Part VI of TSX Company Manual.

              

      

    

    

    

    
      
        	

              	(z)	
                “TSX Company Manual” means the TSX Company Manual published by the TSX setting out the requirements relating to listed companies, as amended and updated from time to time.

              

      

    

    

    

    
      
        	

              	(aa)	
                "Shares" shall mean the common shares of the Corporation.

              

      

    

    

    

    
      
        	

              	(bb)	
                "U.S. Optionee Exercise Notice" means the notice respecting the exercise of an Option, substantially in the form attached to the Option Certificate as Appendix II, duly
                    executed by the Optionee.

              

      

    

    

    

    PART 2 - SHARE OPTION PLAN

    

    

    
      	
              2.01

            	
              Participation

            

    

    

    

    Options shall be granted only to Eligible Persons.

    

    

    
      	
              2.02

            	
              Determination of Option Recipients

            

    

    

    

    The Board shall make all necessary or desirable determinations regarding the granting of Options to Eligible Persons and may take into
        consideration the present and potential contributions of a particular Eligible Person to the success of the Corporation and any other factors which it may deem proper and relevant.

     

      

    
      
        

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              2.03

            	
              Price

            

    

    

    

    The price at which an Optionee may purchase a Share upon the exercise of an Option shall be determined from time to time by the Board
        and shall be as set forth in the Option Certificate issued in respect of such Option but, in any event, shall not be less than the Market Price, and in the case of an Eligible Person employed or performing services in the United States or otherwise
        subject to Section 409A of the Code, shall not be less than Fair Market Value on the date of grant. If the Optionee owns directly or by reason of the applicable attribution rules more than 10% of the total combined voting power of all classes of
        stock of the Corporation, the Option price per share of the Shares covered by each Option which is intended to be a Section 422 Stock Option shall be not less than one hundred ten percent (110%) of the Fair Market Value on the date of the grant.

    

    

    
      	
              2.04

            	
              Grant of Options

            

    

    

    

    The Board may at any time authorize the granting of Options to such Eligible Persons as it may select for the number of Shares that it
        shall designate, subject to the provisions of the Plan. The date of each grant of Options shall be determined by the Board when the grant is authorized. Except for the setting of the Option price hereunder, no Option shall be granted and no
        purported grant of any Option shall be effective until such Option Certificate shall have been duly executed on behalf of the Corporation.

    

    

    In the event that Options are granted to Employees, or Service Providers, the Corporation represents that such Optionees shall be bona
        fide Employees, or Service Providers, as the case may be.

    

    

    The Corporation may at the time of granting options hereunder provide for additional terms and conditions which are not inconsistent
        with Part 2 hereof including, without limitation, terms and conditions deferring or delaying the date at which an Option may be exercised in whole or in part. Such additional terms and conditions shall be as set forth in the Option Certificate
        issued in respect of such Option.

    

    

    The Option Certificate of any Option which is intended to qualify as an Section 422 Stock Option shall contain such limitations and
        restrictions upon the exercise of the Option as shall be necessary in order that such Option qualifies as an “incentive stock option” within the meaning of Section 422 of the Code. Further, the Option Certificate authorized under the Plan shall be
        subject to such other terms and conditions including, without limitation, restrictions upon the exercise of the Option, as the Board shall deem advisable and which are not inconsistent with the requirements of Section 422 of the Code.

    

    

    Notwithstanding any of the foregoing provisions, the Board may authorize the grant of an Option to a person not then in the employ of
        the Corporation or of an Affiliate, conditioned upon such person becoming eligible to become an Eligible Person at or prior to the execution of the Option Certificate evidencing the actual grant of such Option.

    

    

    
      	
              2.05

            	
              Term of Options

            

    

    

    

    Unless otherwise expired pursuant to the terms of the Plan, all Options granted to an Optionee pursuant to this Plan shall expire at the
        close of business ten (10) years from the date of grant or such earlier date as the Board shall decide when the Option is granted, subject to earlier termination as herein provided; provided, however, that if the Option price is required under
        section 2.03 to be at least 110% of Fair Market Value, each such Option shall terminate not more than five (5) years from the date of the grant thereof, and shall be subject to earlier termination as herein provided.

    

    

    Upon the expiration of the Option Period, the Options granted shall forthwith expire and terminate and be of no further force or effect
        whatsoever as to such of the Shares in respect of which the Option hereby granted has not then been exercised.

    

    

    Notwithstanding the foregoing, if the expiration of the Option Period falls within a Blackout Period the expiration of the Option Period
        shall be automatically extended for ten (10) business days after the expiry of the Blackout Period on the condition that (i) the Blackout Period was formally imposed by the Corporation pursuant to its internal trading policies as a result of the
        bona fide existence of undisclosed Material Information, (ii) the Blackout Period must be deemed to have expired upon the general disclosure of the undisclosed Material Information, and (iii) the automatic extension of an Optionee’s options will
        not be permitted where the Optionee or the Corporation is subject to a cease trade order (or similar order under applicable securities laws) in respect of the Corporation’s securities.

     

      

    
      
        

      - 4 -

    

    No Optionee or his or her legal representative, legatees or distributees will be, or will be deemed to be, a holder of any Shares
        subject to an Option, unless and until certificates for such Shares are issued to him, her or them or a securities intermediary with whom the Optionee (or his or her legal representative, legatees or distributees) has an account, is recorded as the
        owner of such Shares in a book-entry system under the terms of the Plan.

    

    

    
      	
              2.06

            	
              Exercise of Options

            

    

    

    

    Except as set forth in section 2.10, no Option may be exercised unless the Optionee is at the time of such exercise;

    

    

    
      
        	

              	(a)	
                in the case of an Employee, in the employ of the Corporation or any Affiliate and shall have been continuously so employed since the grant of his or her Option, or have
                    been a Service Provider of the Corporation during such time thereafter, but absence on leave, having the approval of the Corporation or such Affiliate, shall not be considered an interruption of employment for any purpose of the Plan;

              

      

    

    

    

    
      
        	

              	(b)	
                in the case of a Service Provider, under contract with the Corporation or any Affiliate and shall have been continuously so contracted since the grant of the Option; or

              

      

    

    

    

    
      
        	

              	(c)	
                in the case of an Executive, a director or officer of the Corporation or any Affiliate and shall have been such a director or officer continuously since the grant of his or
                    her Option.

              

      

    

    

    

    No Option may be exercised by an Optionee until the Plan has been approved by the shareholders of the Corporation.

    

    

    The exercise of any Option will be contingent upon receipt by the Corporation of cash payment of the full Exercise Price of the Shares
        being purchased by 5:00 p.m. (EST) on the last day of the Option Period by delivering to the Corporation the applicable form of Exercise Notice, the applicable Option Certificate and a certified cheque or bank draft payable to the Corporation in an
        amount equal to the aggregate Exercise Price of the Shares to be purchased pursuant to the exercise of the Option.

    

    

    
      	
              2.07

            	
              Vesting of Options

            

    

    

    

    All Options granted to an Eligible Person pursuant to this Plan shall vest and become fully exercisable as determined by the Board when
        the Option is granted.

    

    

    
      	
              2.08

            	
              Restrictions on Grant of Options

            

    

    

    

    The granting of Options shall be subject to the following conditions:

    

    

    
      
        	

              	(a)	
                unless the Corporation has obtained disinterested shareholder approval, the maximum number of Shares reserved for issuance under Options granted to Insiders under the Plan,
                    together with any other Security-Based Compensation Arrangements, may not exceed 10% of the Outstanding Issue, at any time;

              

      

    

    

    

    
      
        	

              	(b)	
                unless the Corporation has obtained disinterested shareholder approval, the maximum number of Shares that may be granted to Insiders under the Plan, together with any other
                    Security-Based Compensation Arrangements, within a 12-month period, may not exceed 10% of the Outstanding Issue, calculated at the date an Option is granted; and

              

      

    

    

    

    
      
        	

              	(c)	
                unless the Corporation has obtained disinterested shareholder approval, the Corporation shall not decrease the Exercise Price of Options previously granted to Insiders.

              

         

        

      

    

    
      
        

      - 5 -

    

    No Options shall be granted after the expiration of ten (10) years from the earlier of the date of the adoption of the Plan by the
        Corporation or the approval of the Plan by the stockholders of the Corporation, and provided further, that the fair market value of the Shares (determined at the time the Option is granted) as to which Options designated as Section 422 Stock
        Options are exercisable for the first time by any Eligible Person during any single calendar year (under the Plan and under any other incentive stock option plan of the Corporation or an Affiliate) shall not exceed US$100,000.

    

    

    If disinterested shareholder approval is required, the proposed grant(s) or plan must be approved by a majority of the votes cast by all
        shareholders at the shareholders’ meeting excluding votes attaching to shares beneficially owned by (i) Insiders to whom options may be granted under the stock option plan; and (ii) Associates of such Insiders. Holders of non-voting and subordinate
        voting shares must be given full voting rights on a resolution that requires disinterested shareholder approval.

    

    

    
      	
              2.09

            	
              Lapsed Options

            

    

    

    

    If Options are surrendered, terminated or expire without being exercised in whole or in part, new Options may be granted covering the
        Shares not purchased under such lapsed Options.

    

    

    
      	
              2.10

            	
              Effect of Termination of Employment, Death or Disability

            

    

    

    

    
      
        	

              	(a)	
                If an Optionee shall die while employed or retained by the Corporation, or while an Executive, any Options held by the Optionee at the date of death, which have vested
                    pursuant to section 2.07, shall become exercisable, in whole or in part, but only by the persons or persons to whom the Optionee's rights under the Option shall pass by the Optionee's will or the laws of descent and distribution (the "Successor Optionee"). All such Options shall be exercisable only to the extent that the Optionee was entitled to exercise the Option at the date of his
                    or her death and only for one (1) year after the date of death or prior to the expiration of the Option Period in respect thereof, whichever is sooner, except that in the event the expiration of the Option Period is earlier than one (1)
                    year after the date of death, with the consent of the Exchange, the Options shall be exercisable for up to one (1) year after the date of death of the Optionee as determined by the Board. Notwithstanding the foregoing, the Board, in its
                    discretion, may resolve that up to all of the Options held by an Optionee at the date of death which have not yet vested shall vest immediately upon death.

              

      

    

    

    

    
      
        	

              	(b)	
                If the employment or engagement of an Optionee shall terminate with the Corporation due to Disability while the Optionee is employed or retained by the Corporation, any
                    Option held by the Optionee on the date the employment or engagement of the Optionee is terminated due to Disability, which have vested pursuant to section 2.07, shall become exercisable, in whole or in part. All such Options shall be
                    exercisable only to the extent that the Optionee was entitled to exercise the Option at the date of his or her termination due to Disability and only for one (1) year after the date of termination or prior to the expiration of the
                    Option Period in respect thereof, whichever is sooner, provided that Options that become exercisable due to Disability shall only be exercisable by the person or persons who have the legal authority to act on behalf of the Optionee in
                    connection with the rights of the Optionee to the Options. Notwithstanding the foregoing, the Board, in its discretion, may resolve that up to all of the Options held by an Optionee on the date the employment or engagement of the
                    Optionee is terminated due to Disability which have not yet vested shall vest immediately upon such date.

              

      

    

    

    

    
      
        	

              	(c)	
                Subject to section 2.10 (d), if an Optionee ceases to be an Eligible Person (other than as provided in section 2.10 (a) or (b)), any Options held by the Optionee on the
                    date such Optionee ceased to be an Eligible Person, which have vested pursuant to section 2.07, shall be exercisable only to the extent that the Optionee was entitled to exercise the Option at the date such Optionee ceased to be an
                    Eligible Person and only for ninety (90) days after the date such Optionee ceased to be an Eligible Person, subject to the Board’s discretion to extend such period for up to one (1) year, or prior to the expiration of the Option Period
                    in respect thereof, whichever is sooner. Notwithstanding the foregoing, the Board, in its discretion, may resolve that up to all of the Options held by an Optionee on the date the Optionee ceased to be an Eligible Person which have not
                    yet vested shall vest immediately upon such date.

              

         

        

      

    

    
      
        

      - 6 -

    

    
      
        	

              	(d)	
                If the employment of an Employee or Service Provider is terminated for cause (as determined by the Board) no Option held by such Optionee may be exercised following the
                    date upon which Termination occurred.

              

      

    

    

    

    To the extent required by law, the Company shall make adjustments to, and interpret, the Options as required by the U.S. Uniformed Services Employment and
        Reemployment Rights Act.

    

    

    
      	
              2.11

            	
              Effect of Offer or Sale

            

    

    

    

    If at any time when the Option hereby granted remains unexercised with respect to any Shares, (a) a general offer to purchase all of the
        issued shares of the Corporation is made by a third party or (b) the Corporation proposes to sell all or substantially all of its assets and undertaking or to merge, amalgamate or be absorbed by or into any other company (save and except for a
        subsidiary or subsidiaries of the Corporation) under any circumstances which involve or may involve or require the liquidation of the Corporation, a distribution of its assets among its shareholders, or the termination of its corporate existence,
        the Corporation shall use its reasonable best efforts to provide notice of such offer or proposal to the Optionee as soon as practicable and (i) the Corporation may, at its option, permit the Option hereby granted to be exercised, as to all or any
        of the Optioned Shares in respect of which such Option has not previously been exercised by the Optionee at any time up to and including (but not after) a date twenty (20) days following the date of notice of such offer, sale or other similar
        transaction or prior to the close of business on the expiration date of the Option Period, whichever is the later; and (ii) the Corporation may, at its option, determine that upon the expiration of such twenty (20) day period, all rights to
        exercise the Option shall terminate and cease to have any further force or effect.

    

    

    The Corporation may, in its sole discretion and without the consent of Optionees, provide for one or more of the following: (i) the
        assumption of the Plan and outstanding Options by the surviving entity or its parent; (ii) the substitution by the surviving entity or its parent of Options with substantially the same terms for such outstanding Options; (iii) immediate
        exercisability of such outstanding Options followed by cancellation of such Options; and (iv) settlement of the intrinsic value of the outstanding vested Options in cash or cash equivalents or equity followed by the cancellation of all Options
        (whether or not then vested or exercisable).

    

    

    
      	
              2.12

            	
              Effect of Amalgamation, Consolidation or Merger

            

    

    

    

    If the Corporation amalgamates, consolidates with or merges with or into another corporation, upon the exercise of an Option following
        such amalgamation, consolidation or merger, the Optionee shall be entitled to receive, and shall accept, in lieu of Shares, the securities, property or cash which the Optionee would have received upon such amalgamation, consolidation or merger if
        the Optionee had exercised his Option and held Shares immediately prior to the effective date of such amalgamation, consolidation or merger, and the number of Shares and the option price shall be adjusted appropriately by the directors of the
        Corporation and such adjustment shall be binding for all purposes herein.

    

    

    
      	
              2.13

            	
              Adjustment in Shares Subject to the Plan

            

    

    

    

    If there is any change in the Shares through or by means of a declaration of stock dividends of Shares or consolidations, subdivisions
        or reclassification of Shares, or otherwise, the number of Shares available under the Plan, the Shares subject to any Option, and the Exercise Price thereof shall be adjusted appropriately by the Board and such adjustment shall be effective and
        binding for all purposes of the Plan. No such adjustment shall be made under the Plan which shall, within the meaning of Sections 424 and 409A of the Code, constitute such a modification, extension, or renewal of an Option as to cause the
        adjustment to be considered as the grant of a new Option.

    

    

    
      	
              2.14

            	
              Hold Period

            

    

    

    

    All Options and any Shares issued on the exercise of Options may be subject to and legended with a four month hold period commencing on
        the date the Options were granted pursuant to the rules of the Exchange and applicable securities laws. Any Shares issued on the exercise of Options may be subject resale restrictions contained in National Instrument 45-102 – Resale of Securities which would apply to the first trade of the Shares.

     

      

    
      
        

      - 7 -

    

    
      	
              2.15

            	
              Notification of Grant of Option

            

    

    

    

    Following the granting of an Option by the Board, the Corporation shall notify the Optionee in writing of the Option and shall enclose
        with such notice the Option Certificate representing the Option so granted. Each Optionee, concurrently with the notice of the grant of an Option, shall be provided with a copy of the Plan.

    

    

    
      	
              2.16

            	
              Options Granted To Corporations

            

    

    

    

    Except in relation to a Service Provider that is a corporation, Options may only be granted to an individual or a corporation that is
        wholly-owned by an Eligible Person. If a corporation is an Optionee, it must provide the Exchange with a completed Form 4F – Certification and Undertaking Required
          from a Corporation Granted an Incentive Stock Option. The corporation must agree not to effect or permit any transfer of ownership or option of shares of the corporation nor to issue further shares of any class in the corporation to any
        other individual or entity as long as the Option remains outstanding, except with the written consent of the Exchange.

    

    

    PART 3 - GENERAL

    

    

    
      	
              3.01

            	
              Number of Shares

            

    

    

    

    The aggregate number of Shares that may be reserved for issuance, at any time, under the Plan and under any other Security-Based
        Compensation Arrangement adopted by the Corporation, including the Corporation’s Restricted Share Unit and Deferred Share Unit Plan, shall not exceed 7,581,925 Shares, being 20% of the total Outstanding Issue as at the date hereof.

    

    

    
      	
              3.02

            	
              Transferability

            

    

    

    

    All benefits, rights and options accruing to any Optionee in accordance with the terms and conditions of the Plan shall not be
        transferable or assignable unless specifically provided herein. During the lifetime of an Optionee, all benefits, rights and options may only be exercised by the Optionee.

    

    

    
      	
              3.03

            	
              Employment

            

    

    

    

    Nothing contained in any Plan shall confer upon any Optionee any right with respect to employment or continuance of employment with the
        Corporation or any Affiliate, or interfere in any way with the right of the Corporation or any Affiliate to terminate the Optionee's employment at any time. Participation in any Plan by an Optionee is voluntary.

    

    

    
      	
              3.04

            	
              Approval of Plan

            

    

    

    

    Options issued under the Plan shall only become exercisable after the Plan has been approved by the shareholders of the
        Corporation; provided, however:

    

    

    
      
        	

              	(a)	
                unless consistent with the terms contained herein and approved by the Board, nothing contained herein shall in any way affect Options previously granted by the Corporation
                    and currently outstanding;

              

      

    

    

    

    
      
        	

              	(b)	
                the Plan must receive shareholder approval yearly, at the Corporation's annual general meeting.

              

      

    

    

    

    The obligation of the Corporation to sell and deliver Shares in accordance with the Plan is subject to the approval of any governmental
        authority having jurisdiction or any stock exchanges on which the Shares are listed for trading which may be required in connection with the authorization, issuance or sale of such Shares by the Corporation. If any Shares cannot be issued to any
        Optionee for any reason including, without limitation, the failure to obtain such approval, then the obligation of the Corporation to issue such Shares shall terminate and any Optionee's option price paid to the Corporation shall be returned to the
        Optionee.

     

      

    
      
        

      - 8 -

    

    
      	
              3.05

            	
              Administration of the Plan

            

    

    

    

    The Board is authorized to interpret the Plan from time to time and to adopt, amend and rescind rules and regulations for carrying out
        the Plan. The interpretation and construction of any provision of the Plan by the Board shall be final and conclusive. Administration of the Plan shall be the responsibility of the appropriate officers of the Corporation and all costs in respect
        thereof shall be paid by the Corporation.

    

    

    
      	
              3.06

            	
              Income Taxes

            

    

    

    

    As a condition of and prior to participation in the Plan, if requested by the Board, a Optionee shall authorize the Corporation in
        written form to withhold from any remuneration otherwise payable to such Optionee any amounts required by any taxing authority to be withheld for taxes of any kind as a consequence of such participation in the Plan.

    

    

    In addition, if the Corporation is required under the Income Tax Act (Canada) or any other applicable law to make source deductions in respect of employee stock option benefits to the Optionee and to remit to the applicable governmental authority an amount on account of tax on the
        value of the taxable benefit associated with the issuance of Shares on exercise of Options, then the Optionee shall (i) pay to the Corporation, in addition to the Exercise Price for the Options, sufficient cash as is reasonably determined by the
        Corporation to be the amount necessary to permit the required tax remittance, (ii) authorize the Corporation, on behalf of the Optionee, to sell in the market on such terms and at such time or times as the Corporation determines a portion of the
        Shares being issued upon exercise of the Options to realize cash proceeds to be used to satisfy the required tax remittance, or (iii) make other arrangements acceptable to the Corporation to fund the required tax remittance.

    

    

    
      	
              3.07

            	
              Amendment and Termination of the Plan

            

    

    

    

    The Board reserves the right to amend, modify, terminate or discontinue the Plan when it is advisable in the absolute discretion of the
        Board, without the consent of the Optionees, provided that such termination or discontinuance will not alter or impair any Option previously granted under the Plan.

    

    

    The Board may by resolution amend this Plan and any Options granted under it without shareholder approval, however, the Board will not be entitled, in the
        absence of shareholder and Exchange approval, to:

    

    

    
      
        	

              	(a)	
                reduce the exercise price of an outstanding Option, including a cancellation of an Option and re-grant of an Option in conjunction therewith, constituting a reduction of
                    the exercise price of the Option;

              

      

    

    

    

    
      
        	

              	(b)	
                extend the expiry date of an Option held by an Insider of the Corporation (subject to such date being extended by virtue of paragraph 2.05);

              

      

    

    

    

    
      
        	

              	(c)	
                amend the limitations on the maximum number of Shares reserved or issued to Insiders under paragraph 2.08 hereof;

              

      

    

    

    

    
      
        	

              	(d)	
                make any amendments to the Plan that would permit a Participant to transfer or assign Options to a new beneficial owner other than for estate settlement purposes;

              

      

    

    

    

    
      
        	

              	(e)	
                increase the maximum number of Shares issuable pursuant to this Plan; or

              

      

    

    

    

    
      
        	

              	(f)	
                amend the amendment provisions of this Plan under this Section 3.07.

              

      

    

    

    

    Where shareholder approval is sought for amendments under subsections (a), (b) and (c) above, the votes attached to Shares held directly
        or indirectly by Insiders benefiting from the amendments will be excluded.

    

    

    
      
        

      - 9 -

    

    
      	
              3.08

            	
              No Representation or Warranty

            

    

    

    

    The Corporation makes no representation or warranty as the future market value of any Shares issued in accordance with the provisions of
        the Plan.

    

    
      	
              3.09

            	
              Interpretation

            

    

    

    

    The Plan will be governed by and construed in accordance with the laws of the Province of British Columbia and the laws of Canada
        applicable therein. Terms used but not otherwise defined herein shall have the meanings ascribed thereto in the TSX Company Manual.

    

    

    
      	
              3.10

            	
              Savings Clause

            

    

    

    

    This Plan is intended to comply in all respects with applicable law and regulations, including Section 409A of the Code. In case any one
        or more provisions of this Plan shall be held invalid, illegal, or unenforceable in any respect under applicable law and regulation (including Section 409A of the Code), the validity, legality, and enforceability of the remaining provisions shall
        not in any way be affected or impaired thereby and the invalid, illegal, or unenforceable provision shall be deemed null and void; however, to the extent permitted by law, any provision that could be deemed null and void shall first be construed,
        interpreted, or revised retroactively to permit this Plan to be construed in compliance with all applicable law (including Section 409A of the Code) so as to foster the intent of this Plan.

    

    

    
      	
              3.11

            	
              Compliance with Applicable Law, etc.

            

    

    

    

    If any provision of the Plan or of any Option Certificate delivered pursuant to the Plan contravenes any law or any order, policy,
        by-law or regulation of any regulatory body or stock exchange having authority over the Corporation or the Plan then such provision shall be deemed to be amended to the extent required to bring such provision into compliance therewith.

     

      

    
      
        

      A-1

    

    
    SCHEDULE “A”

    VIEMED HEALTHCARE, INC.

    STOCK OPTION PLAN

    

    

    Insert the following U.S. legend if the Option is being issued to an Optionee who is in the United States or who is a U.S. person:

    

    

    [THE OPTION REPRESENTED BY THIS CERTIFICATE AND THE COMMON SHARES ISSUABLE UPON EXERCISE THEREOF HAVE NOT BEEN REGISTERED UNDER THE
        UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE "U.S. SECURITIES ACT"), OR THE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES. THE HOLDER HEREOF, BY ACQUIRING SUCH SECURITIES, AGREES FOR THE BENEFIT OF THE CORPORATION THAT SUCH SECURITIES
        MAY BE OFFERED, SOLD OR OTHERWISE TRANSFERRED ONLY (A) TO THE CORPORATION, (B) OUTSIDE THE UNITED STATES IN ACCORDANCE WITH RULE 904 OF REGULATION S UNDER THE U.S. SECURITIES ACT AND IN COMPLIANCE WITH APPLICABLE LOCAL LAWS AND REGULATIONS, (C)
        PURSUANT TO THE EXEMPTION FROM REGISTRATION UNDER THE U.S. SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER, IF AVAILABLE, AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS, OR (D) IN A TRANSACTION THAT DOES NOT REQUIRE REGISTRATION UNDER
        THE U.S. SECURITIES ACT OR ANY APPLICABLE STATE LAWS AND REGULATIONS GOVERNING THE OFFER AND SALE OF SECURITIES, AND IT HAS, IN THE CASE OF EACH OF (C) AND (D), PRIOR TO SUCH TRANSFER FURNISHED TO THE CORPORATION AN OPINION OF COUNSEL OF RECOGNIZED
        STANDING IN FORM AND SUBSTANCE SATISFACTORY TO THE CORPORATION TO SUCH EFFECT.]

    

    

    VIEMED HEALTHCARE, INC.

    

    

    STOCK OPTION PLAN

    OPTION CERTIFICATE

    

    

    This Certificate is issued pursuant to the provisions of the Viemed Healthcare, Inc. (the “Corporation”) stock option plan (the “Plan”) and evidences that ______________________________ is the holder (the “Optionee”) of an option (the “Option”) to purchase up to
        _______________________________ common shares (the “Shares”) in the capital stock of the Corporation at a purchase price of CAD$_________ per Share (the “Exercise Price”).

    

    

    The Plan provides for the granting of stock options that either (i) are intended to qualify as “Incentive Stock Options” within the meaning of Section 422
        of the United States Internal Revenue Code of 1986 (“Section 422 Stock Options”), as amended (the “Code”), or (ii) do not qualify as Section 422 Stock Options (“Non-Qualified Stock Options”). This Option is intended to be
        (select one):

     

      

    ☐ a Section 422 Stock Option; or

     

      

    ☐ a Non-Qualified Stock Option.

     

      

    Subject to the provisions of the Plan:

    

    

    
      
        	

              	(a)	
                the effective date of the grant of the Option is __________, 20__;

              

      

    

    
      
        	

              	(b)	
                the Option expires at 5:00 p.m. (EST) on ______________, 20__; and

              

      

    

    
      
        	

              	(c)	
                the Options shall vest as follows:

              

      

    

    

    

    	
            Date

          	
            Percent of Stock 

            Options Vested

          	
            Number of Stock 

            Options Vested

          	
            Aggregate Number of 

            Stock Options Vested

          
	 	 	 	 

    

    

    
      
        

      A-2

    

    	
            Date

          	
            Percent of Stock 

            Options Vested

          	
            Number of Stock 

            Options Vested

          	
            Aggregate Number of 

            Stock Options Vested

          
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 

     

      

    The vested portion or portions of the Option may be exercised at any time and from time to time from and including the date of the grant of the Option
        through to 5:00 p.m. (EST) on the expiration date of the Option Period by delivering to the Corporation, in the case of a person other than a U.S. Person, the form of Exercise Notice attached as Appendix “I” hereto, and in the case of a U.S.
        Person, the form of Exercise Notice attached as Appendix “II” hereto, together with this Certificate and a certified cheque or bank draft payable to the Corporation in an amount equal to the aggregate of the Exercise Price of the Shares in respect
        of which the Option is being exercised.

     

      

    All Options and any Shares issued on the exercise of Options may be subject to resale restrictions and may be subject to and legended with a four month
        hold period commencing on the date the Options were granted pursuant to the rules of the Exchange and applicable securities laws. The Options hereby granted are subject to the approval of the Exchange.

     

      

    This Certificate and the Option evidenced hereby is not assignable, transferable or negotiable and is subject to the detailed terms and conditions
        contained in the Plan, the terms and conditions of which the Optionee hereby expressly agrees with the Corporation to be bound by. This Certificate is issued for convenience only and in the case of any dispute with regard to any matter in respect
        hereof, the provisions of the Plan and the records of the Corporation shall prevail.

     

      

    If the Optionee is a U.S. person or is located in the United States, the Optionee acknowledges and agrees as follows:

     

      

    
      
        	

              	(a)	
                The Option and the Shares (collectively, the “Securities”) have not been and will
                    not be registered under the United States Securities Act of 1933, as amended (the “U.S. Securities Act”), or the securities laws of any state of
                    the United States, and the Option is being granted to the Optionee in reliance on an exemption from the registration requirements of the U.S. Securities Act and applicable state securities laws.

              

         

        

      

    

    
      
        	

              	(b)	
                The Securities will be “restricted securities”, as defined in Rule 144 under the U.S. Securities Act, and the rules of the United States Securities and Exchange Commission
                    provide in substance that the Optionee may dispose of the Securities only pursuant to an effective registration statement under the U.S. Securities Act or an exemption therefrom, and the Corporation has no obligation to register any of
                    the Securities or to take action so as to permit sales pursuant to the U.S. Securities Act (including Rule 144 thereunder, if available).

              

         

        

      

    

    
      
        	

              	(c)	
                If the Optionee decides to offer, sell or otherwise transfer any of the Shares, the Optionee will not offer, sell or otherwise transfer the Option directly or indirectly,
                    unless:

              

         

        

      

    

    
      
        	

              	(i)	
                the sale is to the Corporation;

              

         

        

      

    

    
      
        	

              	(ii)	
                the sale is made outside the United States in a transaction meeting the requirements of Rule 904 of Regulation S under the U.S. Securities Act (“Regulation S”) and in compliance with applicable local laws and regulations;

              

         

        

      

    

    
      
        	

              	(iii)	
                the sale is made pursuant to the exemption from the registration requirements under the U.S. Securities Act provided by Rule 144 thereunder, if available, and in accordance
                    with any applicable state securities or “blue sky” laws; or

              

         

        

        
          
            

          A-3

        

      

    

    
      
        	

              	(iv)	
                the Shares are sold in a transaction that does not require registration under the U.S. Securities Act or any applicable state laws and regulations governing the offer and
                    sale of securities;

              

         

        

      

    

    and, in the case of each of (iii) and (iv) it has prior to such sale furnished to the Corporation an opinion of counsel reasonably
        satisfactory to the Corporation stating that such transaction is exempt from registration under applicable securities laws.

     

      

    
      
        	

              	(d)	
                The Option may not be exercised by or for the account or benefit of a person in the United States or a U.S. person unless registered under the U.S. Securities Act and any
                    applicable state securities laws, unless an exemption from such registration requirements is available.

              

         

        

      

    

    
      
        	

              	(e)	
                The certificate(s) representing the Shares will be endorsed with the following or a similar legend until such time as it is no longer required under the applicable
                    requirements of the U.S. Securities Act or applicable state securities laws:

              

         

        

      

    

    “THE SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED,
        (THE “U.S. SECURITIES ACT”), OR THE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES. THE HOLDER HEREOF, BY PURCHASING SUCH SECURITIES, AGREES FOR THE BENEFIT OF THE CORPORATION, THAT SUCH SECURITIES MAY BE OFFERED, SOLD OR OTHERWISE TRANSFERRED
        ONLY (A) TO THE CORPORATION; (B) OUTSIDE THE UNITED STATES IN ACCORDANCE WITH RULE 904 OF REGULATION S UNDER THE U.S. SECURITIES ACT; (C) IN ACCORDANCE WITH THE EXEMPTION FROM REGISTRATION UNDER THE U.S. SECURITIES ACT PROVIDED BY RULE 144
        THEREUNDER, IF AVAILABLE, AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS; OR (D) IN A TRANSACTION THAT DOES NOT REQUIRE REGISTRATION UNDER THE U.S. SECURITIES ACT AND ANY APPLICABLE STATE SECURITIES LAWS, AND, IN THE CASE OF CLAUSE (C)
        OR (D), THE SELLER FURNISHES TO THE CORPORATION AN OPINION OF COUNSEL OF RECOGNIZED STANDING IN FORM AND SUBSTANCE SATISFACTORY TO THE CORPORATION TO SUCH EFFECT. THE PRESENCE OF THIS LEGEND MAY IMPAIR THE ABILITY OF THE HOLDER HEREOF TO EFFECT
        “GOOD DELIVERY” OF THE SECURITIES REPRESENTED HEREBY ON A CANADIAN STOCK EXCHANGE.”

     

      

    provided, that if the Shares are being sold outside the United States in compliance with the requirements of Rule 904 of Regulation S
        and such Shares were issued at a time when the Corporation is a “foreign issuer” as defined in Regulation S, the legend set forth above may be removed by providing an executed declaration to the registrar and transfer agent of the Corporation, in
        substantially the form set forth as Appendix “II” hereto (or in such other form as the Corporation may prescribe from time to time) and, if requested by the Corporation or the transfer agent, an opinion of counsel of recognized standing in form and
        substance satisfactory to the Corporation and the transfer agent to the effect that such sale is being made in compliance with Rule 904 of Regulation S; and provided, further, that, if any Shares are being sold otherwise than in accordance with
        Regulation S and other than to the Corporation, the legend may be removed by delivery to the registrar and transfer agent and the Corporation of an opinion of counsel, of recognized standing reasonably satisfactory to the Corporation, that such
        legend is no longer required under applicable requirements of the U.S. Securities Act or state securities laws.

     

      

    
      
        	

              	(f)	
                Rule 905 of Regulation S provides in substance that any “restricted securities” that are equity securities of a “domestic issuer” (including an issuer that no longer
                    qualifies as a “foreign issuer”) will continue to be deemed to be restricted securities notwithstanding that they were acquired in a resale transaction pursuant to Rule 901 or 904 of Regulation S; that Rule 905 of Regulation S will
                    apply in respect of Shares if the Corporation is not a “foreign issuer” at the time of exercise of the related Options; and that the Corporation is not obligated to remain a “foreign issuer”.

              

         

        

      

    

    
      
        

      A-4

    

    
      
        	

              	(g)	
                “Domestic issuer”, “foreign issuer”, “United States” and “U.S. person” are as defined in Regulation S.

              

         

        

      

    

    
      
        	

              	(h)	
                If the Optionee is resident in the State of California on the effective date of the grant of the Option, then, in addition to the terms and conditions contained in the Plan
                    and in this Certificate, the Optionee acknowledges that the Corporation, as a reporting issuer under the securities legislation in the Provinces of British Columbia, Alberta and Ontario, is required to publicly file with the securities
                    regulators in those jurisdictions continuous disclosure documents, including audited annual financial statements and unaudited quarterly financial statements (collectively, the “Financial Statements”). Such filings are available on the System for Electronic Document Analysis and Retrieval (SEDAR), and documents filed on SEDAR may be viewed under the Corporation’s profile at
                    the following website address: www.sedar.com. Copies of Financial Statements will be made available to the Optionee by the Corporation upon the Optionee’s request.

              

         

        

      

    

    All terms not otherwise defined in this Certificate shall have the meanings given to them under the Plan.

     

      

    Dated this ____ day of _____________, 20___.

     

      

    VIEMED HEALTHCARE, INC.

    

    

    	
            Per:

          	 	 
	 	 	 
	 	
            Authorized Signatory

          	 

     

    

    
      
        

      I-1

    

    
    APPENDIX “I”

    VIEMED HEALTHCARE, INC.

    

    

    STOCK OPTION PLAN

    EXERCISE NOTICE FOR NON-U.S. OPTIONEES

     

          

    
      	
              TO:

            	
              VIEMED HEALTHCARE, INC. (the “Corporation”)

            

    

    

    

    1.          The undersigned (the “Optionee”), being the holder of options to purchase ________________ common shares of the Corporation at the exercise price of ______ per share, hereby irrevocably gives notice, pursuant to the stock option
        plan of the Corporation (the “Plan”), of the exercise of the Option to acquire and hereby subscribes for ____________ of such common shares of the Corporation.

    

    

    2.          The Optionee tenders herewith a certified cheque or bank draft payable to
        the Corporation in an amount equal to the aggregate Exercise Price of the aforesaid common shares exercised and directs the Corporation to issue a share certificate evidencing said common shares in the name of the Optionee to be mailed to the
        Optionee at the following address:

    

    

    	 	 	 
	 	

          	 
	 	

          	 
	 	

          	 

    

    

    3.          By executing this Exercise Notice, the Optionee hereby confirms that the
        undersigned has read the Plan and agrees to be bound by the provisions of the Plan. All terms not otherwise defined in this Exercise Notice shall have the meanings given to them under the Plan or the attached Option Certificate.

    

    

    4.          The Optionee is resident in ____________________ [name of country].

    

    

    5.          The Optionee represents, warrants and certifies that the Optionee at the
        time of exercise of the Option is not in the United States, is not a “U.S. person” as defined in Regulation S under the United States Securities Act of 1933, as amended (the “U.S. Securities Act”) and is not exercising the Option on behalf of, or
        for the account or benefit of a U.S. person or a person in the United States and did not execute or deliver this exercise form in the United States.

     

      

    6.          The undersigned Optionee hereby represents, warrants, acknowledges and
        agrees that there may be material tax consequences to the Optionee of an acquisition or disposition of any of the Shares. The Corporation gives no opinion and makes no representation with respect to the tax consequences to the Optionee under
        Canadian, Provincial, local or foreign tax law of the undersigned’s acquisition or disposition of such securities.

     

      

    7.          The undersigned Optionee hereby represents, warrants, acknowledges and
        agrees that the certificate(s) representing the Shares may be subject to and legended with a four month hold period commencing on the date the Options were granted pursuant to
        the rules of the Exchange and applicable securities laws.

    

    

    DATED the ________ day of ____________________, __________.

    

    

    	 	 
	 	
            Signature of Optionee

          

    

    

    
      
        

      II-1

    

    
    APPENDIX “II”

    VIEMED HEALTHCARE, INC.

    

    

    STOCK OPTION PLAN

    EXERCISE NOTICE FOR U.S. OPTIONEES

     

          

    
      	
              TO:

            	
              VIEMED HEALTHCARE, INC. (the “Corporation”)

            

    

    

    

    1.          The undersigned (the “Optionee”),

        being the holder of options to purchase ________________ common shares of the Corporation at the exercise price of ______ per share, hereby irrevocably gives notice, pursuant to the stock option plan of the Corporation (the “Plan”), of the exercise of the Option to acquire and hereby subscribes for ____________ of such common shares of the Corporation.

     

      

    2.          The Optionee tenders herewith a certified cheque or
        bank draft payable to the Corporation in an amount equal to the aggregate Exercise Price of the aforesaid common shares exercised and directs the Corporation to issue a share certificate evidencing said common shares in the name of the Optionee to
        be mailed to the Optionee at the following address:

     

      

    	 	 

          	 
	 	 

          	 
	 	 

          	 

    

    

    3.          By executing this Exercise Notice, the Optionee hereby confirms that the
        undersigned has read the Plan and agrees to be bound by the provisions of the Plan. All terms not otherwise defined in this Exercise Notice shall have the meanings given to them under the Plan or the attached Option Certificate.

     

      

    4.          The Optionee is resident in

     

      

    
      
        	

              	☐	
                the State of _______________________________________________, or

              

      

    

    

    

    
      
        	

              	☐	
                the District of Columbia, or

              

      

    

    

    

    
      
        	

              	☐	
                __________________________________________, a Territory of the United States of America.

              

      

    

    

    

    5.          The Optionee represents, warrants and certifies as follows (please check the
        category that applies):

    

    

    
      
        	

              	(a) ☐	
                the Optionee is a natural person who is either: (i) a director, officer or employee of the Corporation or of a majority-owned subsidiary of the Corporation (each, an “Eligible Company Optionee”), (ii) a person or company engaged by the Corporation or of a majority-owned subsidiary of the Corporation to provide
                    services for an initial, renewable or extended period of twelve months or more (an “Eligible Service Provider”), or (iii) a former Eligible Company
                    Optionee or Eligible Service Provider; OR

              

      

    

    

    

    
      
        	

              	(b) ☐	
                the Optionee has delivered to the Corporation and the Corporation’s transfer agent an opinion of counsel (which will not be sufficient unless it is in form and substance
                    satisfactory to the Corporation) or such other evidence satisfactory to the Corporation to the effect that with respect to the securities to be delivered upon exercise of the Option, the issuance of such securities has been registered
                    under the U.S. Securities Act and applicable state securities laws or an exemption from the registration requirements of the U.S. Securities Act and applicable state securities laws is available;

              

      

    

    

    

    
      
        

      II-2

    

    
    
      
        
          6.          The undersigned Optionee further represents, warrants, acknowledges
              and agrees that:

        

         

        

        	

              	(a)	
                funds representing the subscription price for the Shares which will be advanced by the undersigned to the Corporation upon exercise of the Options will not represent
                    proceeds of crime for the purposes of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act (the “PATRIOT Act”), and the undersigned acknowledges that the Corporation may in the future be required by law to disclose the undersigned's name and other information relating to this exercise form and the undersigned's
                    subscription hereunder, on a confidential basis, pursuant to the PATRIOT Act. No portion of the subscription price to be provided by the undersigned (i) has been or
                    will be derived from or related to any activity that is deemed criminal under the laws of the United States of America, or any other jurisdiction, or (ii) is being tendered on behalf of a person or entity who has not been identified to
                    or by the undersigned, and it shall promptly notify the Corporation if the undersigned discovers that any of such representations ceases to be true and provide the Corporation with appropriate information in connection therewith;

              

      

    

    

    

    
      
        	

              	(b)	
                the financial statements of the Corporation have been prepared in accordance with Canadian generally accepted accounting principles or International Financial Reporting
                    Standards, which differ in some respects from United States generally accepted accounting principles, and thus may not be comparable to financial statements of United States companies;

              

      

    

    

    

    
      
        	

              	(c)	
                there may be material tax consequences to the Optionee of an acquisition or disposition of any of the Shares. The Corporation gives no opinion and makes no representation
                    with respect to the tax consequences to the Optionee under United States, state, local or foreign tax law of the undersigned’s acquisition or disposition of such securities. In particular, no determination has been made whether the
                    Corporation will be a “passive foreign investment company” within the meaning of Section 1297 of the United States Internal Revenue Code of 1986, as amended; and

              

      

    

    

    

    
      
        	

              	(d)	
                if the undersigned has marked Box 5(a) above, the Corporation may rely on the registration exemption
                    in Rule 701 under the U.S. Securities Act and a state registration exemption, but only if such exemptions are available; in the event such exemptions are determined by the Corporation to be unavailable, the undersigned may be required
                    to provide additional evidence of an available exemption, including, without limitation, the legal opinion contemplated by Box 5(b).

              

      

    

    

    

    7.          If the undersigned has marked Box 5(a) above on the basis that the
        exercise of the Option is subject to the registration exemption in Rule 701 under the U.S. Securities Act and an available state registration exemption, the undersigned also
          acknowledges and agrees that:

    

    

    
      
        	

              	(a)	
                the Shares have not been and will not be registered under the U.S. Securities Act or the securities laws of any state of the United States, and the Shares will be issued as
                    “restricted securities” (as such term is defined in Rule 144(a)(3) under the U.S. Securities Act) and may not be offered, sold, pledged, or otherwise transferred, directly or indirectly, without prior registration under the U.S.
                    Securities Act and applicable state securities laws absent an exemption from such registration requirements; and

              

      

    

    

    

    
      
        	

              	(b)	
                the certificate(s) representing the Shares will be endorsed with a U.S. restrictive legend substantially in the form set forth in the Option Certificate until such time as
                    it is no longer required under the applicable requirements of the U.S. Securities Act or applicable state securities laws.

              

      

    

    

    

    8.          The undersigned Optionee hereby represents, warrants, acknowledges and
        agrees that the certificate(s) representing the Shares may be subject to and legended with a four month hold period commencing on the date the Options were granted pursuant to
        the rules of the Exchange and applicable securities laws.

    DATED the ________ day of ____________________, __________.

    

    

    	 	 
	 	
            Signature of Optionee

          

     

    

    
      
        

      III-1

    

    
    APPENDIX “III”

    VIEMED HEALTHCARE, INC.

    

    

    STOCK OPTION PLAN

    FORM OF DECLARATION FOR REMOVAL OF LEGEND

     

          

    
      
        	TO:	
                Viemed Healthcare, Inc. (the “Company”)

              

         

        

      

    

    
      
        	AND TO:	
                Registrar and transfer agent for the common shares of the Company

              

         

        

      

    

    The undersigned (a) acknowledges that the sale of ____________________________________ (the "Securities") of the Company, represented by certificate number _________________________________, to which this declaration relates is being made in reliance on Rule 904 of Regulation S (“Regulation S”) under the United States Securities Act of 1933, as amended (the "U.S. Securities Act"), and (b) certifies that (1) the undersigned is not (A) an
        "affiliate" of the Company (as that term is defined in Rule 405 under the U.S. Securities Act), (B) a "distributor" as defined in Regulation S or (C) an affiliate of a distributor; (2) the offer of such securities was not made to a person in the
        United States and either (A) at the time the buy order was originated, the buyer was outside the United States, or the seller and any person acting on its behalf reasonably believed that the buyer was outside the United States, or (B) the
        transaction was executed on or through the facilities of the Toronto Stock Exchange, the TSX Venture Exchange, the Canadian Securities Exchange or another "designated offshore securities market", and neither the seller nor any person acting on its
        behalf knows that the transaction has been prearranged with a buyer in the United States; (3) neither the seller nor any affiliate of the seller nor any person acting on any of their behalf has engaged or will engage in any "directed selling
        efforts" in the United States in connection with the offer and sale of such securities; (4) the sale is bona fide and not for the purpose of "washing off" the resale restrictions imposed because the securities are "restricted securities" (as such
        term is defined in Rule 144(a)(3) under the U. S. Securities Act); (5) the seller does not intend to replace the securities sold in reliance on Rule 904 of Regulation S with fungible unrestricted securities; and (6) the contemplated sale is not a
        transaction, or part of a series of transactions, which, although in technical compliance with Regulation S, is part of a plan or scheme to evade the registration provisions of the U. S. Securities Act. Terms used herein have the meanings given to
        them by Regulation S.

     

      

    Dated _______________ 20_.

     

      

    	 	
            X

          	 

    	 	
            Signature of individual (if Seller is an individual)

          
	 	 

    	 	
            X

          	 

    	 	
            Authorized signatory (if Seller is not
                an individual)

          

    	 	 
	 	
            Name of Seller (please print)

          
	 	 
	 	
            Name of authorized signatory (please print)

          
	 	 
	 	
            Official capacity of authorized signatory (please print)

          

    

    

    
      
        

      III-2

    

    Affirmation by Seller's Broker-Dealer

    (Required for sales pursuant to Section (b)(2)(B) above)

     

      

    We have read the foregoing representations of our customer, _________________________ (the "Seller") dated _______________________, with regard to the sale, for such Seller's account, of
          _________________ common shares (the "Securities") of the Company represented by
          certificate number ______________. We have executed sales of the Securities pursuant to Rule 904 of Regulation S under the United States Securities Act of 1933, as amended (the
          “U.S. Securities Act”), on behalf of the Seller. In that connection, we hereby
          represent to you as follows:

     

        

    
      
        	(1)	
                no offer to sell Securities was made to a person in the United States;

              

         

        

      

    

    
      
        	(2)	
                the sale of the Securities was executed in, on or through the facilities of the Toronto Stock Exchange, the TSX Venture Exchange, the Canadian Securities Exchange or
                    another designated offshore securities market (as defined in Rule 902(b) of Regulation S under the U.S. Securities Act), and, to the best of our knowledge, the sale was not pre-arranged with a buyer in the United States;

              

         

        

      

    

    
      
        	(3)	
                no “directed selling efforts” were made in the United States by the undersigned, any affiliate of the undersigned, or any person acting on behalf of the undersigned; and

              

         

        

      

    

    
      
        	(4)	
                we have done no more than execute the order or orders to sell the Securities as agent for the Seller and will receive no more than the usual and customary broker’s
                    commission that would be received by a person executing such transaction as agent.

              

         

        

      

    

    For purposes of these representations: “affiliate” means a person
        that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the undersigned; “directed selling
          efforts” means any activity undertaken for the purpose of, or that could reasonably be expected to have the effect of, conditioning the market in the United States for the Securities (including, but not be limited to, the solicitation of
        offers to purchase the Securities from persons in the United States); and “United States” means the United States of America, its territories or possessions,
        any State of the United States, and the District of Columbia.

     

      

    Legal counsel to the Company shall be entitled to rely upon the representations, warranties and covenants contained herein to the same extent as if this
        affirmation had been addressed to them.

    
      

      

      	Dated:	
               

            	.	
               

            

      

        
        	
                 

              	 
	
                Name of Firm

              	 
	 	 	 
	
                By:

              	 	 
	 	
                Authorized Officer

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