Name of the Activity or Event: NUTONOMY-GRAB CUSTOMER RESEARCH PILOT

Activity Organiser: Grabtaxi Holdings Pte. Ltd.,. (“Grab”) and Nutonomy Inc. (“NI”).

Date of Activity or Event: __________________

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I HEREBY ACKNOWLEDGE and CONSENT to ride in a Self-Driving Vehicle (SDV) owned and operated by nuTonomy Inc. and its affiliate nuTonomy Asia Pte. Ltd. (collectively referred to as “nuTonomy”) voluntarily. I confirm that I understand the nature and concept of a SDV and therefore hereby AGREE to release nuTonomy, Grab and their government partners in Singapore, the Land Transport Authority (LTA) and the Jurong Town Council (JTC) from and against any liability, demands, claims, or injuries, including death that I may sustain or that may arise during or in conjunction with the ride.

I certify that I am physically fit, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by Grab and NI and that it will govern my actions and responsibilities at said activity or event.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: GRABTAXI PTE. LTD. and NUTONOMY INC., their government partners LTA and JTC, and/or their respective directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in paragraph (A) from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. I acknowledge that the entities or persons mentioned in paragraph (A) are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of GRABTAXI PTE. LTD. and/or NUTONOMY INC.

I acknowledge that this activity or event may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, technology, vehicular traffic, actions of other road users.

I hereby agree that I will comply with any instruction that may be given by the Safety Driver who will be in the SDV in all matters related to safety and I consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.

I understand that at this event or related activities, I may be photographed and/or video-graphed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns with no claim whatsoever for any license fee or royalty from GRAB or NI. These purposes may include, but is not limited to, customer research and the production of promotional videos. I further hereby waive any right to the intellectual property of my photo, video, or film likeness taken or recorded during and in connection to the activity.

The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

If any term of this Waiver and Release is to any extent invalid, illegal, or incapable of being enforced, such term shall be excluded to the extent of such invalidity, illegality, or unenforceability; all other terms hereof shall remain in full force and effect.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

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Participant’s Name:

NRIC/FIN/Passport number :

Date: