UMBILICAL CORD STEM CELL COLLECTION, TESTING, PROCESSING, STORAGE, RETRIEVAL AND INFORMED CONSENT AGREEMENT I/We, the undersigned (the Client ), on behalf of myself/ourselves and my/our unborn Child (the Child ), engage LifeCell International Private Limited, a company incorporated under the Companies Act, 1956, and having its registered office at #26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai 600127, Tamil Nadu, India ( LifeCell ), this day of ........................, 201 (the Enrollment Date ), to collect, process, test, store and retrieve stem cells obtained from the Umbilical Cord collected at birth of the Child ( Services ) on the following terms (this Agreement ). 1.
DEFINITIONS
3.2.
Client is responsible for providing the Collection Kit to the Caregiver and arranging for collection, preparation and labeling of the Maternal Blood and Umbilical Cord for delivery to LifeCell along with the duly filled up forms included in the Collection Kit, unless the same has been assigned to LifeCell.
3.3.
Client must promptly notify LifeCell in writing of any change in Client's name or contact details (including but not limited to mailing address, telephone numbers, etc.), or current mailing address or in the legal guardianship of the Child.
4.
STORAGE
4.1.
LifeCell will store the Specimen primarily at its licensed facility situated at #26, Vandalur Kelambakkam Main Road, Keelakottaiyur, Chennai 600127, Tamil Nadu, India.
In this Agreement, (including the recitals above), unless the context otherwise requires, the following expressions shall have the following meanings: 1.1.
Umbilical Cord means and includes the blood inside umbilical cord and/or placenta, and the tissue remaining after the collection of the blood.
1.2.
Child means the Client s baby (or babies in the event of multiple births)from whom the Umbilical Cord will be collected following his/her birth.
1.3.
Client means the parents or legal guardian of the Child.
1.4.
Caregiver means the Obstetrician Gynecologist or qualified medical professional/midwife who will be assisting in delivering the Child.
Y
P O C NT 4.2.
For disaster management, back-up and added retention security, LifeCell at the request of the Client and payment of additional fees will store the Specimen simultaneously in both of its licensed facilities situated at #26, Vandalur Kelambakkam Main Road, Keelakottaiyur, Chennai 600127, Tamil Nadu, India and Plot #26, Sector 4, IMT Manesar, Gurgaon 122001, Haryana, India.
CLIE
1.5.
Maternal Blood means peripheral blood from Birth Mother of the Child, that has been drawn by observing standard phlebotomy procedures, taken seven days before or after the birth of the Child.
1.6.
Specimen means and includes stem cells obtained from Umbilical Cord.
4.3.
LifeCell has the option to relocate the Specimen and will provide notice to Client within 30 days of relocation.
1.7.
Collection Kit means the kit consisting of all essential materials required for the purpose of collection and labeling of the Maternal Blood and Umbilical Cord.
5.
TERM OF AGREEMENT
5.1.
This Agreement will continue for one year from the date of birth of the Child ( Renewal Date ) and will automatically renew for successive one year period until the Child attains the age of twenty one years. This automatic renewal is subject to the Client paying the annual storage fee on or before the renewal date every year.
5.2
Client may opt for prepayment of the storage fees for the remainder of the Agreement at any point during the term of the Agreement. In the event that the fees related to prepayment (as advised by LifeCell from time to time) are made, the term of the Agreement shall be revised to twenty one years from the date of birth of the Child.
5.3.
At least 90 days before the expiration of the twenty one year period, LifeCell shall intimate the Client (and/or Child in case the Child has come of age) regarding the expiry of the Agreement, along with terms for continued storage. Accordingly the Client or Child can enter into a new Agreement and continue the storage.
2.
SERVICES: OPTION AND FEES
2.1.
LifeCell offers its umbilical cord banking services under different plans, fees and payment methods as detailed in Exhibit 2, which the Client must choose at the time of Enrollment by completing the Exhibit 2.
2.2.
All applicable taxes including but not limited to service tax is payable by the Client.
3.
CLIENT RESPONSIBILITIES
3.1.
Prior to the birth of the Child, the Client must complete all the applicable Exhibits [1 to 9] and make due payment of fees. If surrogate, egg donor or sperm was used, each must fill out Exhibit 3.
MD & CEO, LifeCell International
Client's Initials
Husband's Initials
Birth Mother, if not Client
LifeCell International Pvt Ltd, 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 600 127 | 044 4744 5353 | www.lifecell.in Page 11 of 20