Your name *

Your email address *

Company Legal Name *

Registered Address of Company *

Under which legal jurisdiction is the company incorporated? *

Name of Authorized Company Signatory for this Agreement *

Mitacs Project Title *

Name of UBC Supervising Faculty Member * Dr.

Name of trainees/students *

UBC Department *

Non-confidential project description as submitted to Mitacs *

Please confirm the following before submitting the Express Assignment Agreement

The Company represents and warrants that the Project is based upon Company Background IP AND that the Project will not be using UBC Resources.