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BIOTIME INC filed this Form 10-Q on 08/09/2017
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Informed Consent Form to participate in an experiment with human beings

First and last name:
ID Number:
Address and Zip Code:

For the spouse:
First and last name:
ID Number:
Address and Zip Code:

We hereby declare that we agree to participate in a medical experiment as described in this document.
We hereby declare that we do not participate in any other medical experiment at the time of the signature on this document and we declare that we will not participate in any other medical experiment during the time of this experiment.
I declare that __________ [name of researcher], explained to me that:
The leading researchers are: Professor Neri Laufer and Binyamin Reubinoff, and that they received an approval form the CEO of the Institution to perform this experiment on human beings, as described in the Israeli Public Health Regulations -1980.
The Leading Researcher- Neri Laufer, is affiliated with the Initiator of the experiment- Professor Reubinoff Binaymin.
The subject of the experiment is: Producing lines of human embryonic stem cellsà “an infinite potential source of cells for transplantation”.
We are free to choose not to participate in the medical experiment, and we are free to choose to leave the experiment and to terminate out participation in the experiment at any time we choose, and this is without jeopardizing out right to receive the appropriate medical treatment.
[ * ] = Certain confidential information contained in this document, marked by brackets, has been omitted and filed separately with the Securities and Exchange Commission pursuant to Rule 24b-2 of the Securities Exchange Act of 1934, as amended.
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