Client Enrollment Form and Agreement
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Transcript of Client Enrollment Form and Agreement
APP. No.:
I’m here because of you!
Thank you Stem Cells
APP. NO. ...........................................
*Client's Name
Husband's Name
Client's Date of Birth
Husband Client
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 1 of 36
*Parent or legal guardian of the child.
Signature of Client Signature of Husband
Page No. 2 of 36
APP. NO. ...........................................
Husband Client
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 3 of 36
APP. NO. ...........................................
Protect BabyProtect Mom
Protect Baby, Protect Mom
Husband's Initials Birth Mother, if not ClientClient's Initials
PROTECT BABY, PROTECT MOM
obtained from Child.
Testing, Processing and Storage of minimally manipulated cord blood and minimally expanded cord tissue
stem cells obtained from Child; Expansion up to 50 Million umbilical cord tissue derived mesenchymal stem
cells to be provided at the time of transplant; Testing, Processing, and Storage of minimally expanded menstrual
blood stem cells obtained from Client; Expansion up to 150 Million menstrual blood derived mesenchymal stem
cells to be provided at the time of transplant.
Page No. 4 of 36
Testing, processing and storage of minimally manipulated cord blood and minimally expanded cord tissue
stem cells obtained from Child. Expansion up to 50 Million umbilical cord tissue derived mesenchymal stem
cells to be provided at the time of transplant.
I wish to subscribe for New Born Genetic Testing at an additional payment of Rs. 6,000 which I agree to pay upfront.
3,250
12,500
6,250
APP. NO. ...........................................
39,500
47,000
74,900
4,000
4,000
58,000
67,000
1,14,900
4,900
9,600
19,150
Value added service
6,000New Born Genetic Testing
Optional service which can be combined with any of the above services
I/We, the undersigned (the 'Client'), on behalf of myself /ourselves and my /our unborn child (the 'Child'), engage LifeCell
International Private Limited ('LifeCell') to process, and store stem cells obtained from the umbilical cord tissue and /or
stem cells from umbilical cord blood and /or placental blood collected at birth of the Child and to test the blood of the
birth mother of the Child on the following terms (this 'Agreement').
'Collection Kit' means the kit consisting of all
necessary materials provided by LifeCell to the Client
after enrolment, for the purpose of collection of
Maternal Blood and the Specimen.
1.5
'Mesenchymal Stem Cell’ means multipotent stem
cells that can differentiate into a variety of cell types
and are characterized by expression of markers
CD90 and CD105.
LifeCell also conducts the following tests:
(a) a microbio log ica l screen on the Specimen.
(b) hematology analysis including blood grouping and
cell counting on the Specimen.
(c ) in fect ious d isease scr een ing o f the Mat erna l
Blood for Syphilis, Malaria, Hepatitis B, Hepatitis C,
HIV and Cytomegalovirus.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 5 of 36
'Minimally Expanded stem cells' means cells that
have been obtained from ex-vivo isolation and not
subjected to further passaging.
1.9
1.10
1.11
1.12
p
‘Maternal Blood’ means peripheral blood taken from
Birth Mother of the Child, observing standard
phlebotomy procedures, before or after the birth of
the Child.
Client must select qualified personnel to collect,
prepare and label the Maternal B lood and
the Specimen for delivery to LifeCell in accordance with
the instructions given in the Collection Kit. In particular
the Client must ensure that a minimum of 40 milliliters of
cord blood and /or placental blood, 15 centimeters of
cord tissue, and 15 milliliters of Maternal Blood is
collected, since smaller Specimen's may not be suitable for
processing. The selection of qualified personnel to collect,
prepare and label the Maternal Blood and Specimen and
payment for their services is Client's sole responsibility.
The Client or the authorized representative of the Client
shall also ensure that the forms included in the Collection
Kit are duly filled up and sent to LifeCell.
3.2
It is the responsibility of the Client for delivery of the
Maternal Blood and Specimen to LifeCell's Laboratory
within 48 hours of collection of Specimen. For purposes of
convenience LifeCell has identified a courier company, who
has the required expertise in handling the same for proper
transportation. Client may choose this agency for
forwarding the Maternal Blood and Specimen to LifeCell.
The courier charges will be borne by LifeCell. The selected
courier is not an agent of LifeCell and LifeCell is not liable
for any deterioration, loss or destruction of the Maternal
Blood or Specimen prior to receipt by LifeCell at LifeCell
Laboratory.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 6 of 36
If the client or the child consents his/her willingness to
continue the storage beyond twenty one years, the child
shall enter into a new Agreement with LifeCell as
per the then prevailing terms.
5. Terms of Agreement:
If the client signs-up for the Annual Storage Plan,
this agreement will continue for one year from the
date of birth of the Child and will automatically
renew for successive one year periods until the Child
completes the age of twenty one years. This automatic
renewal is subject to the Client making payment
of the annual storage fee on or before the due date
every year and the agreement is not terminated
under Section 19.
21-Year Storage Plan. Pursuant to the 21-year
Storage Plan, Client makes a one-time payment which
includes the processing and testing fee and storage
of the Specimen for a period of twenty one years.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 7 of 36
The decision to collect the Specimen and Maternal Blood,
test the Maternal Blood and process and store the
Specimen is a completely voluntary act of Client;
7. Informed Consent of Mother for Infectious DiseaseTesting.
7.1. By signing this Agreement and the Informed Consent for
Infectious Disease & HIV testing the Birth Mother grants
her consent to perform the testing on Maternal Blood.
If any test results are positive, the results will be shown to
both the mother and physician indicated in the Enrolment
Form. If the screening test is positive, another test will be
required to confirm the result. If the positive screening is
confirmed, the Birth Mother consents to the delivery of
these results to the mother's physician indicated in the
Informed Consent Form. In the event of laws requiring the
disclosure of results to any authority by LifeCell, the Birth
Mother is deemed to have given her consent.
The Specimen will initially be stored in LifeCell Laboratory in
Chennai, Tamil Nadu. LifeCell reserves the right to relocate
the Specimen to another location which is equivalent to
LifeCell's Laboratory.
If any of the tests are positive, LifeCell may decline to
continue storing the Specimen. Client shall pay the cost of
any confirmatory testing, including the cost of shipping the
Maternal Blood to another testing laboratory, with the
prior consent of the Client. LifeCell does not assume
responsibility or liability for confirmatory testing
performed by another testing laboratory.
7.2.
8.3.
Client has had the opportunity to consult Client’s own
legal counsel to review this agreement and related
forms and Client has carefully read and understood all
the terms of this agreement.
Client acknowledges that he/she has been fully informed
of, accepts and agrees to the conditions, risks, limitations,
and costs of processing, testing and storage of the
Specimen. Client assumes all risks associated with the
collection, preparation and delivery of the Specimen and
Maternal Blood to LifeCell.
9.1.
Client is aware that banking a Child's Specimen does NOT
guarantee that a stem cell transplant would be the first or
best course of treatment for any particular disease or that
a Child's own stem cell is useful for every disease treatable
by stem cell transplantation. A medical care provider
ultimately decides whether the use of the Child's Specimen
is indicated, based on the nature and progression of the
disease and the HLA matching for donor and recipient.
9.2.
There is no fee payable by the Client to LifeCell for retrieval
of Specimen. Any of blood or third party expenses, will have
to be borne by the Client.
11.1.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 8 of 36
The Child must be positively diagnosed from any one of the
75 hematological malignancies treatable using that stored
Specimen.
In the event of a transplant, the charges on the
The stored Specimen will be available for access or delivery thby or before the end of the 10 business day after LifeCell's
receipt of a written request from Client. However if the
Client's chosen plan also covers isolation and expansion of
stem cells at the time of retrieval, the expanded cells would
be available for access or delivery by or before the end of th90 business day after LifeCell's receipt of a written
request from Client.
11.2.
11.3. The request must be made on a request form provided by
LifeCell. This must be signed by the Client, and include
provide the name and address of the facility where the
Specimen is to be delivered and the date delivery is
requested.
If the retrieval is requested for a transplant, the request
form must be accompanied by transplant physician's
certification confirming the end-use. The stored Specimen
can only be released for use in Drug Controller General of
India and/or Indian Council of Medical Research approved
treatments or clinical trials.
11.4.
11.5.
LifeCell assures that your Child’s Specimen will be well
cared for throughout the storage term chosen by you.
LifeCell understands that there may be financial hardships
in the event your Child’s Specimen is required for a stem
cell transplant in which case LifeCell under its LifeCell
Cares Program will reimburse the Client up to ` 500,000
(Rupees Five Hundred Thousand Only) to offset treatment
related and personal family expenses, provided the
following conditions are satisfied:
LifeCell Cares Program12.
The Specimen must be retrieved for transplant and
used in an autologous manner for homologous use
(hematopoietic reconstitution) and must be administered
under the direction of a transplant physician in a medical
facility qualified and approved by competent authority
for stem cell transplantation.
12.2.
LifeCell Cares Program is valid for Clients who have signed
LifeCell's standard Agreement, and whose payments to
LifeCell for its services are continuing.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 5,00,000 (Rupees Five Hundred Thousand Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities
12.3.
The Child must be positively diagnosed with any of the 75
hematological malignancies treatable using the stored
Specimen, and must be scheduled for a stem cell
transplant.
13.1.
The Specimen is lost due to change in temperature
arising out of loss or damage to the cold storage
machinery due to operation of an insured peril i.e., fire,
lightning, explosion and implosion, aircraft damage, riot,
strike, malicious damage and terrorism, storm, tempest,
flood and inundation, impact damage, subsidence and
landslide/rockslide, bursting and/or overflowing of water
tanks, apparatus and pipes, missile testing, leakage from
automatic sprinkler installations, bush fire, earthquake
(fire and shock), and act of terrorism (Note that standard
exclusions apply).
13.2.
The claim is made by the Client during the term of
Agreement entered into with LifeCell, and is only valid
for Clients who have signed LifeCell’s standard contract
and Agreement and whose payments to LifeCell for
services are current.
13.3.
Lifecell Disaster Relief Program
While LifeCell shall ensure that the preserved Specimen
will be maintained with the utmost care, there may be
unforeseen events that may occur, which are beyond the
reasonable control of LifeCell, that may potentially
deteriorate the Specimen held in cold storage premises. In
the extremely unlikely occurrence of such event, LifeCell
offers up to ̀ 1,000,000 (Rupees One Million Only) subject
to the following conditions:
13.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 9 of 36
Client agrees to indemnify and hold LifeCell and Client's
hospital and physicians and their respective agents,
employees, officers, directors, shareholders and affiliates
harmless from any and all claims, liabilities, demands and
causes of action asserted against them by any person
or entity, including any third party beneficiary of this Agreement.
18. Indemnity and Hold Harmless.
19. Termination of Agreement.
in the event, the entire Specimen covered under this
agreement is retrieved. However, if the client
retrieves only a portion of the Specimen the
agreement would survive and continue until the
entire Specimen has been retrieved.
17. Force Majeure:
The client agrees that LifeCell shall not be responsible for any loss,
deterioration, or destruction of all or any part of the Specimen
resulting from causes or circumstances which are beyond
LifeCell’s reasonable control and not covered under the LifeCell
Disaster Relief Program.
The Specimen thawing procedure must be a validated
procedure used by the transplant facility and the Specimen
must be administered immediately upon thawing.
14.1.
The Specimen must be collected using LifeCell's Collection
Kit or approved alternative collection technique, and must
be processed and at all times be stored by LifeCell.
14.2.
Client agrees that LifeCell’s liability for any loss, harm,
damage or claim of any kind in connection with this
agreement or the services provided by LifeCell shall be
limited to the return of an amount equal to all fees paid by
client to LifeCell. Such limitation of liability shall in no way
be diminished as a result of the LifeCell Cares Program.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities
16. Limitation of liability
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 10 of 36
22. Confidentiality;
I/We, the undersigned (the 'Client'), on behalf of myself /ourselves and my /our unborn child (the 'Child'), engage LifeCell
International Private Limited ('LifeCell') to process, and store stem cells obtained from the umbilical cord tissue and /or
stem cells from umbilical cord blood and /or placental blood collected at birth of the Child and to test the blood of the
birth mother of the Child on the following terms (this 'Agreement').
'Collection Kit' means the kit consisting of all
necessary materials provided by LifeCell to the Client
after enrolment, for the purpose of collection of
Maternal Blood and the Specimen.
1.5
'Mesenchymal Stem Cell’ means multipotent stem
cells that can differentiate into a variety of cell types
and are characterized by expression of markers
CD90 and CD105.
LifeCell also conducts the following tests:
(a) a microbio log ica l screen on the Specimen.
(b) hematology analysis including blood grouping and
cell counting on the Specimen.
(c ) in fect ious d isease scr een ing o f the Mat erna l
Blood for Syphilis, Malaria, Hepatitis B, Hepatitis C,
HIV and Cytomegalovirus.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 11 of 36
'Minimally Expanded stem cells' means cells that
have been obtained from ex-vivo isolation and not
subjected to further passaging.
1.9
1.10
1.11
1.12
p
‘Maternal Blood’ means peripheral blood taken from
Birth Mother of the Child, observing standard
phlebotomy procedures, before or after the birth of
the Child.
Client must select qualified personnel to collect,
prepare and label the Maternal B lood and
the Specimen for delivery to LifeCell in accordance with
the instructions given in the Collection Kit. In particular
the Client must ensure that a minimum of 40 milliliters of
cord blood and /or placental blood, 15 centimeters of
cord tissue, and 15 milliliters of Maternal Blood is
collected, since smaller Specimen's may not be suitable for
processing. The selection of qualified personnel to collect,
prepare and label the Maternal Blood and Specimen and
payment for their services is Client's sole responsibility.
The Client or the authorized representative of the Client
shall also ensure that the forms included in the Collection
Kit are duly filled up and sent to LifeCell.
3.2
It is the responsibility of the Client for delivery of the
Maternal Blood and Specimen to LifeCell's Laboratory
within 48 hours of collection of Specimen. For purposes of
convenience LifeCell has identified a courier company, who
has the required expertise in handling the same for proper
transportation. Client may choose this agency for
forwarding the Maternal Blood and Specimen to LifeCell.
The courier charges will be borne by LifeCell. The selected
courier is not an agent of LifeCell and LifeCell is not liable
for any deterioration, loss or destruction of the Maternal
Blood or Specimen prior to receipt by LifeCell at LifeCell
Laboratory.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 12 of 36
If the client or the child consents his/her willingness to
continue the storage beyond twenty one years, the child
shall enter into a new Agreement with LifeCell as
per the then prevailing terms.
5. Terms of Agreement:
21-Year Storage Plan. Pursuant to the 21-year
Storage Plan, Client makes a one-time payment which
includes the processing and testing fee and storage
of the Specimen for a period of twenty one years.
If the client signs-up for the Annual Storage Plan,
this agreement will continue for one year from the
date of birth of the Child and will automatically
renew for successive one year periods until the Child
completes the age of twenty one years. This automatic
renewal is subject to the Client making payment
of the annual storage fee on or before the due date
every year and the agreement is not terminated
under Section 19.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 13 of 36
The decision to collect the Specimen and Maternal Blood,
test the Maternal Blood and process and store the
Specimen is a completely voluntary act of Client;
7. Informed Consent of Mother for Infectious DiseaseTesting.
7.1. By signing this Agreement and the Informed Consent for
Infectious Disease & HIV testing the Birth Mother grants
her consent to perform the testing on Maternal Blood.
If any test results are positive, the results will be shown to
both the mother and physician indicated in the Enrolment
Form. If the screening test is positive, another test will be
required to confirm the result. If the positive screening is
confirmed, the Birth Mother consents to the delivery of
these results to the mother's physician indicated in the
Informed Consent Form. In the event of laws requiring the
disclosure of results to any authority by LifeCell, the Birth
Mother is deemed to have given her consent.
The Specimen will initially be stored in LifeCell Laboratory in
Chennai, Tamil Nadu. LifeCell reserves the right to relocate
the Specimen to another location which is equivalent to
LifeCell's Laboratory.
If any of the tests are positive, LifeCell may decline to
continue storing the Specimen. Client shall pay the cost of
any confirmatory testing, including the cost of shipping the
Maternal Blood to another testing laboratory, with the
prior consent of the Client. LifeCell does not assume
responsibility or liability for confirmatory testing
performed by another testing laboratory.
7.2.
8.3.
Client has had the opportunity to consult Client’s own
legal counsel to review this agreement and related
forms and Client has carefully read and understood all
the terms of this agreement.
Client acknowledges that he/she has been fully informed
of, accepts and agrees to the conditions, risks, limitations,
and costs of processing, testing and storage of the
Specimen. Client assumes all risks associated with the
collection, preparation and delivery of the Specimen and
Maternal Blood to LifeCell.
9.1.
Client is aware that banking a Child's Specimen does NOT
guarantee that a stem cell transplant would be the first or
best course of treatment for any particular disease or that
a Child's own stem cell is useful for every disease treatable
by stem cell transplantation. A medical care provider
ultimately decides whether the use of the Child's Specimen
is indicated, based on the nature and progression of the
disease and the HLA matching for donor and recipient.
9.2.
There is no fee payable by the Client to LifeCell for retrieval
of Specimen. Any of blood or third party expenses, will have
to be borne by the Client.
11.1.
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 14 of 36
The Child must be positively diagnosed from any one of the
75 hematological malignancies treatable using that stored
Specimen.
In the event of a transplant, the charges on the
The stored Specimen will be available for access or delivery thby or before the end of the 10 business day after LifeCell's
receipt of a written request from Client. However if the
Client's chosen plan also covers isolation and expansion of
stem cells at the time of retrieval, the expanded cells would
be available for access or delivery by or before the end of th90 business day after LifeCell's receipt of a written
request from Client.
11.2.
11.3. The request must be made on a request form provided by
LifeCell. This must be signed by the Client, and include
provide the name and address of the facility where the
Specimen is to be delivered and the date delivery is
requested.
If the retrieval is requested for a transplant, the request
form must be accompanied by transplant physician's
certification confirming the end-use. The stored Specimen
can only be released for use in Drug Controller General of
India and/or Indian Council of Medical Research approved
treatments or clinical trials.
11.4.
11.5.
LifeCell assures that your Child’s Specimen will be well
cared for throughout the storage term chosen by you.
LifeCell understands that there may be financial hardships
in the event your Child’s Specimen is required for a stem
cell transplant in which case LifeCell under its LifeCell
Cares Program will reimburse the Client up to ` 500,000
(Rupees Five Hundred Thousand Only) to offset treatment
related and personal family expenses, provided the
following conditions are satisfied:
LifeCell Cares Program12.
The Specimen must be retrieved for transplant and
used in an autologous manner for homologous use
(hematopoietic reconstitution) and must be administered
under the direction of a transplant physician in a medical
facility qualified and approved by competent authority
for stem cell transplantation.
12.2.
LifeCell Cares Program is valid for Clients who have signed
LifeCell's standard Agreement, and whose payments to
LifeCell for its services are continuing.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 5,00,000 (Rupees Five Hundred Thousand Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities
12.3.
The Child must be positively diagnosed with any of the 75
hematological malignancies treatable using the stored
Specimen, and must be scheduled for a stem cell
transplant.
13.1.
The Specimen is lost due to change in temperature
arising out of loss or damage to the cold storage
machinery due to operation of an insured peril i.e., fire,
lightning, explosion and implosion, aircraft damage, riot,
strike, malicious damage and terrorism, storm, tempest,
flood and inundation, impact damage, subsidence and
landslide/rockslide, bursting and/or overflowing of water
tanks, apparatus and pipes, missile testing, leakage from
automatic sprinkler installations, bush fire, earthquake
(fire and shock), and act of terrorism (Note that standard
exclusions apply).
13.2.
The claim is made by the Client during the term of
Agreement entered into with LifeCell, and is only valid
for Clients who have signed LifeCell’s standard contract
and Agreement and whose payments to LifeCell for
services are current.
13.3.
Lifecell Disaster Relief Program
While LifeCell shall ensure that the preserved Specimen
will be maintained with the utmost care, there may be
unforeseen events that may occur, which are beyond the
reasonable control of LifeCell, that may potentially
deteriorate the Specimen held in cold storage premises. In
the extremely unlikely occurrence of such event, LifeCell
offers up to ̀ 1,000,000 (Rupees One Million Only) subject
to the following conditions:
13.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 15 of 36
Client agrees to indemnify and hold LifeCell and Client's
hospital and physicians and their respective agents,
employees, officers, directors, shareholders and affiliates
harmless from any and all claims, liabilities, demands and
causes of action asserted against them by any person
or entity, including any third party beneficiary of this Agreement.
18. Indemnity and Hold Harmless.
19. Termination of Agreement.
in the event, the entire Specimen covered under this
agreement is retrieved. However, if the client
retrieves only a portion of the Specimen the
agreement would survive and continue until the
entire Specimen has been retrieved.
17. Force Majeure:
The client agrees that LifeCell shall not be responsible for any loss,
deterioration, or destruction of all or any part of the Specimen
resulting from causes or circumstances which are beyond
LifeCell’s reasonable control and not covered under the LifeCell
Disaster Relief Program.
The Specimen thawing procedure must be a validated
procedure used by the transplant facility and the Specimen
must be administered immediately upon thawing.
14.1.
The Specimen must be collected using LifeCell's Collection
Kit or approved alternative collection technique, and must
be processed and at all times be stored by LifeCell.
14.2.
Client agrees that LifeCell’s liability for any loss, harm,
damage or claim of any kind in connection with this
agreement or the services provided by LifeCell shall be
limited to the return of an amount equal to all fees paid by
client to LifeCell. Such limitation of liability shall in no way
be diminished as a result of the LifeCell Cares Program.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities.
16. Limitation of liability
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 16 of 36
22. Confidentiality;
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 17 of 36
Husband's Initials Birth Mother, if not ClientClient's Initials
Page No. 18 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellfemme.com
Client’s SignaturePresident, LifeCell International
MENSTRUAL BLOOD STEM CELL TESTING, PROCESSING, STORAGE AND
INFORMED CONSENT AGREEMENT
1. Definitions:
In this Agreement, (including the recitals above), unless thecontext otherwise requires, the following expressions shallhave the following meanings:
1.1 ‘Client’ means the woman, from whom the
menstrual blood sample has been collected
1.2 ‘Collection Kit’ means the kit consisting of all
necessary materials provided by LifeCell to the
Client after enrollment, for the purpose of collection
of menstrual blood sample.
1.3 ‘LifeCell Laboratory’ means LifeCell’s laboratory
facilities situated at No 26, Vandalur Kelambakkam
Main Road, Keelakottiyur, Chennai – 600048, or any
such other laboratory that LifeCell may designate
from time to time.
1.4
1.5 Mesenchymal Stem Cell’ means multipotent stem
cells that can differentiate into a variety of cell types
and are characterized by expression of markers
CD90 and CD105.
1.6 ‘Specimen’ means and includes stem cells obtained
from menstrual blood
2. Services of LifeCell; Testing, Processing,Preserving and Storage:
2.1. LifeCell offers its services under various options
which the Client must choose in the Enrollment Form
(Exhibit 1).
2.2. LifeCell shall obtain all statutory permissions and
licenses that might be required for providing the
services contemplated under this Agreement.
2.3.
'Minimally Expanded stem Cells' means cells
that have been obtained from ex-vivo isolation and
not subjected to further passaging.
LifeCell also conducts the following tests on the
Specimen:(a) cell counting and (b) cell proliferation assay
I, the undersigned (the ‘Client’), on behalf of myself, engage LifeCell International Private Limited (‘LifeCell’) to
process, and store stem cells obtained from the menstrual blood on the following terms (this ‘Agreement’).
This Agreement is entered into this ......................... day of ........................................., 201.................. (the ‘Enrollment Date’)
and legally binds LifeCell and the Client, including the legal heir of the client.
2.4. Upon successful enrollment, LifeCell will provide
the Client with the following:
2.4.1. A Collection Kit
2.4.2. A copy of the Agreement
2.4.3. A unique Client Relationship Management (CRM)
identification number that enables the Client to
quote for all communications with LifeCell.
3. Client Responsibilities:
3.1. On the Enrollment Date, Client must complete the
Enrollment Form (Exhibit 1), and Health History
(Exhibit 3).
3.2. Client must collect, prepare, and properly label the
Specimen, in accordance with the instructions given
in the Collection Kit. In particular the Client must
ensure that a minimum of 10 milliliters of menstrual
blood sample is collected, since smaller quantities of
menstrual blood sample may not be suitable for
processing. The Client shall also ensure that the
forms included in the Collection Kit are duly filled up
and sent to LifeCell.
3.3. It is the responsibility of the Client for delivery of the
menstrual blood sample to LifeCell’s Laboratory
within 48 hours of collection of menstrual blood
sample. For purposes of convenience LifeCell has
identified a courier company, who has the required
expertise in handling the same for proper
transportation. Client may choose this agency for
forwarding the menstrual blood sample to LifeCell.
The courier charges will be borne by LifeCell. The
selected courier is not an agent of LifeCell and
LifeCell is not liable for any deterioration, loss or
destruction of the menstrual blood sample prior to
receipt by LifeCell at LifeCell Laboratory.
3.4. Client must promptly notify LifeCell in writing of any
change in Client’s name or current mailing address
Page No. 19 of 36
4. Fees for Services:
4.1. At Enrollment Date, Client must choose either the
Annual Storage Plan or the Lifetime Storage Plan by
completing Exhibit 2.
4.1.1. Annual Storage Plan. The Annual Storage Plan
includes a processing and testing Fee and an Annual
Storage Fee.
4.1.2. Lifetime Storage Plan. Pursuant to the Lifetime
Storage Plan, Client makes a one-time payment
which includes the processing and testing Fee and
storage of the Specimen until the Client attains the
age of sixty.
4.2. All fees paid by Client to LifeCell are non-refundable.
However in the event of the Menstrual Blood being
insufficient/ unfit for processing, the processing
fees would be refunded, and in case the Specimen is
found to be unfit for storage for any reason, the
storage component of the fees would be refunded.
4.3. In the unlikely event that LifeCell elects to terminate
this Agreement under Section 16, a pro-rated
refund of the prepaid storage fees will be made by
LifeCell to the Client. Further, LifeCell guarantees
the continuity of your storage by transferring your
Specimen at its own cost to a comparable stem cell
bank facility, nominated by LifeCell at no extra
charge. If the Client elects to nominate an alternative
facility for the transfer, the Client will have to bear the
cost of transportation.
5. Terms of Agreement:
5.1 If the Client signs up for the Annual Storage Plan, this
Agreement will continue for one year after the
processing and storage of the Specimen, and will
automatically renew for successive one year periods
until Client attains the age of sixty. This automatic
renewal is subject to the Client making payment
of the annual storage fee on or before the due date
every year and the Agreement is not terminated
under Section 16.
5.2 If the Client signs up for the Lifetime Storage Plan,
this Agreement will continue until the Client attains
the age of sixty.
5.3 At least sixty days before the completion of Client
attains the age of sixty LifeCell would make
reasonable attempts to notify Client about the
scheduled expiration of Agreement. If the Client
intimates her willingness to continue the storage for
further period, the Client shall enter into a new
agreement with LifeCell, as per the then prevailing
terms.
6. Storage Terms:
The Specimen will be stored as follows:
6.1. The Specimen will initially be stored in LifeCell
Laboratory in Chennai, Tamil Nadu. LifeCell reserves
the right to relocate the Specimen to another
location which is equivalent to LifeCell’s Laboratory.
6.2. If the Specimen is relocated, LifeCell will notify Client
within sixty days after such relocation.
6.3. The Specimen will be stored so long as all fees have
been timely paid.
7. Representations and Warranties of Client:
Client represents and warrants that
7.1. Client has had the opportunity to consult Client’s own
legal counsel to review this Agreement and related
forms and Client has carefully read and understood
all the terms of this Agreement;
7.2. The decision to collect the Specimen, test and
process and store the Specimen is a completely
voluntary act of Client;
7.3. Client has discussed this Agreement with a
competent medical professional, who is not an
employee or agent of LifeCell.
7.4. Client understands and agrees that to enroll with
LifeCell the Client must be at least eighteen years
of age. By entering into this Agreement the Client
certifies and represents that she is over eighteen
years of age.
8. Assumption of risk by Client:
8.1. Client acknowledges that she has been fully
informed of, accepts and agrees to the conditions,
risks, limitations and costs of processing, testing
and storage of the Specimen.
President, LifeCell International Client’s Signature
Page No. 20 of 36
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8.2. Client assumes all risks associated with the
collection, preparation and delivery of the Specimen
to LifeCell.
8.3. Client is aware that banking the Specimen does NOT
guarantee that a stem cell transplant would be the
first or best course of treatment for any particular
disease or for every disease treatable by stem cell
transplantation. A medical care provider ultimately
decides whether the use of the Specimen is
indicated, based on the nature and progression of
the disease.
8.4. Client is aware that the Specimen is being stored for
autologous use, and that further processing of the
Specimen would be required before use.
8.5. If an unforeseen circumstance should occur,
ownership of the product will be controlled by
Client’s estate.
9. Obligations and Rights to Specimen:
9.1. Client is solely liable for all of the obligations and
responsibilities herein under and shall have all rights
of the Client, including control of the Specimen. The
exercise of any rights and control over the Specimen
will require written notice to LifeCell signed by the
Client.
9.2. Any components that remain after the Specimen is
processed and that are not being stored, will be
disposed of by LifeCell.
9.3. Upon termination of this Agreement, if the Client has
not submitted to LifeCell a request form for retrieval
of Specimen within 30 days of the date of
termination, Client shall have relinquished all rights
and waives all claims to the Specimen, and LifeCell
shall have the right at its sole discretion to utilize,
donate for research or dispose of the Specimen.
10. Retrieval of Specimen:
10.1. There is no fee payable by the Client to LifeCell for
retrieval of Specimen. Any additional expenses
relating to third party expenses, if any, will have to be
borne by the Client.
10.2. The stored Specimen will be available for access or
delivery by or before the end of the 15th business day
after LifeCell's receipt of a written request from
Client. However if the Specimen is retrieved for use
in transplantation, the expanded cells would be
available for access or delivery by or before the end
of 90th business day after LifeCell's receipt of a
written request from Client.
10.3. The request must be made on a request form
provided by LifeCell. This must be signed by the
Client, and include provide the name and address of
the facility where the Specimen is to be delivered and
the date delivery is requested.
10.4. If the retrieval is requested for a transplant, the
request form must be accompanied by transplant
physician's certification confirming the end-use. The
stored Specimen can only be released for use in
Drug Controller General of India and/or Indian
Council of Medical Research approved treatments
or clinical trials.
10.5. Free Worldwide Shipment:
In the event of a transplant, charges on account of
courier/transportation etc., to the designated
destination anywhere in the world will be borne by
LifeCell. For the purpose of convenience LifeCell has
identified a courier company who has the required
expertise in handling the same for proper
transportation. The Client may choose this agency
for transporting the stored specimen from LifeCell
laboratory. The selected courier is not an agent of
LifeCell and LifeCell is not liable for any deterioration,
loss or destruction of the specimen during
transportation to the designated destination.
11. LifeCell Disaster Relief Program
While LifeCell shall ensure that the preserved Specimen
will be maintained with the utmost care, there may be
unforeseen events that may occur, which are beyond the
reasonable control of LifeCell, that may potentially
deteriorate the Specimen held in cold storage premises.
In the extremely unlikely occurrence of such event, LifeCell
offers up to ` 1,000,000 (Rupees One Million Only)
subject to the following conditions:
The Client must be positively diagnosed with any of the
hematological malignancies treatable using the stored
Specimen, and must be scheduled for a stem cell
transplant.
11.1.
President, LifeCell International Client’s Signature
Page No. 21 of 36
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President, LifeCell International Client’s Signature
Page No. 22 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellfemme.com
11.2.
11.3.
The Specimen is lost due to change in temperature
arising out of loss or damage to the cold storage
machinery due to operation of an insured peril i.e., fire,
lightning, explosion and implosion, aircraft damage,
riot, strike, malicious damage and terrorism, storm,
tempest, flood and inundation, impact damage,
subsidence and landslide/rockslide, bursting and/or
overflowing of water tanks, apparatus and pipes,
missile testing, leakage from automatic sprinkler
installations, bush fire, earthquake (fire and shock), and
act of terrorism (Note that standard exclusions apply).
The claim is made by the Client during the term of
Agreement entered into with LifeCell, and is only valid
for Clients who have signed LifeCell’s standard
contract and Agreement and whose payments to
LifeCell for services are current.
12. Disclaimers:
Client acknowledges that neither LifeCell nor any of
its officers, directors, shareholders, executives,
employees, agents or consultants have made any
representations, guarantee, warranties or
assurances, express or implied, to Client regarding
the success of the collection, transportation,
testing, processing, cryopreservation, storage
process or use of the Spec imen. C l ient
acknowledges the following express disclaimers:
12.1 LifeCell expressly disclaims any warranty or
guarantee that the Specimen will ever be of
therapeutic value or have any beneficial use.
12.2 LifeCell does not perform any medical services, give
any medical advice, or otherwise perform any
functions other than those expressly indicated;
12.3 LifeCell expressly disclaims any responsibility to
provide any other services beyond those it expressly
agrees to in this Agreement.
13. Limitation of Liability:
Client agrees that LifeCell’s liability for any loss, harm,
damage or claim of any kind in connection with this
agreement or the services provided by LifeCell shall be
limited to the return of an amount equal to all fees paid by
client to LifeCell.
14. Force Majeure:
15. Indemnity and Hold Harmless:
Client agrees to indemnify and hold LifeCell and Client’s
hospital and physicians and their respective agents,
employees, officers, directors, shareholders and affiliates
harmless from any and all claims, liabilities, demands and
causes of action asserted against them by any person or
entity, including any third party beneficiary of this
Agreement.
16. Termination of Agreement:
Both LifeCell and Client specifically agree that the notice
period for termination is fair and reasonable. Upon
termination of this Agreement, neither LifeCell nor Client will
have any continuing obligations, claims for any loss,
damages, expenses or liabilities to or against the other, save
in respect of any amount which remains outstanding and
payable by either party hereto.
17. Arbitration:
All disputes arising out of or relating to this Agreement will
be resolved by arbitration. Client agrees that prior to
arbitration, Client and LifeCell will attempt to resolve the
dispute through good faith negotiations. If Client and LifeCell
are unable to resolve a dispute, Client or LifeCell may initiate
arbitration by sending a notice to the other party and a
The client agrees that LifeCell shall not be responsible for any
loss, deterioration, or destruction of all or any part of the
Specimen resulting from causes or circumstances which are
beyond LifeCell’s reasonable control and not covered under the
LifeCell Disaster Relief Program.
in the event, the entire Specimen covered under this
agreement is retrieved. However, if the client
retrieves only a portion of the Specimen the
agreement would survive and continue until the
entire Specimen has been retrieved.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities.
written demand for arbitration to the other party. The
arbitration will take place in Chennai, Tamilnadu, India. The
Arbitration would be governed by the Arbitration and
Conciliation Act, 1996. All decisions of the arbitrator shall be
final, binding, and conclusive and arbitration constitutes the
only method of resolving disputes to this Agreement. This
Section shall survive any termination or expiration of the
Agreement.
18. Governing Law, Jurisdiction and Venue:
This Agreement is governed by, construed and interpreted
in accordance with the laws of India. Subject to the
compulsory arbitration provisions of Section 18, any judicial
proceedings brought against either LifeCell or Client under
this Agreement will be brought in a competent court in
Chennai, India. LifeCell and Client consent to the exclusive
jurisdiction of the aforesaid courts and waive any objection
to venue therein and irrevocably agree to be bound by any
judgment rendered thereby in connection with this
Agreement.
19. Confidentiality; Consent to Release:
LifeCell acknowledges the confidential nature of the
information provided by Client and agrees to use its
reasonable best efforts to maintain the confidentiality of the
information except as required by law or as permitted by this
Agreement. Client hereby agrees to the release of
information to the hospital, laboratory or physician
providing the services.
20. Assignment:
LifeCell may assign this Agreement to any individual or entity
providing a similar service. If LifeCell is acquired by or
merged with or into another company, LifeCell shall require
that the terms of this Agreement continue in full force and
effect.
21. Notice:
21.1. Any notice shall be sufficiently given if delivered in
person or sent by express mail or by registered or
certified mail, postage prepaid.
21.2. Notice to LifeCell must be delivered to LifeCell
International Private Limited, 26 Vandalur
Kelambakkam Main Road, Keelakotaiyur, Chennai –
600048.
21.3. Notice to Client will be delivered to the address set
forth after Client’s signature. Such notice will be
deemed to have been given when personally
delivered or received.
22. Entire Agreement:
This Agreement and the exhibits hereto constitute the
e n t i r e a g r e e m e n t b e t w e e n L i f e C e l l a n d t h e
Client, and supersedes any prior agreements or
understandings, oral and written.
23. Survival:
All provisions which by their terms require performance
after the termination of this Agreement will survive the
termination of this Agreement.
24. Binding Effect:
All of the obligations, terms, provisions and releases set
forth in this Agreement, shall be binding upon and inure to
the benefit of LifeCell and the Client, and their respective
heirs, personal representatives, successors, and assigns.
25. Severability:
If any part of this Agreement is found to be invalid or
unenforceable, such provision is deemed modified to the
extent necessary to make the Agreement enforceable, and
this Agreement shall otherwise remain in full force and
effect.
26. Headings:
The headings in this Agreement are for reference purposes
only and shall not affect the meaning or interpretation of this
Agreement.
I ACCEPT ALL TERMS AND CONDITIONS OF THIS AGREEMENT
President, LifeCell International Client’s Signature
Page No. 23 of 36
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THIS PAGE IS INTENTIONALLY LEFT BLANK
Page No. 24 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellfemme.com
Client’s SignaturePresident, LifeCell International
MENSTRUAL BLOOD STEM CELL TESTING, PROCESSING, STORAGE AND
INFORMED CONSENT AGREEMENT
I, the undersigned (the ‘Client’), on behalf of myself, engage LifeCell International Private Limited (‘LifeCell’) to
process, and store stem cells obtained from the menstrual blood on the following terms (this ‘Agreement’).
This Agreement is entered into this ......................... day of ........................................., 201.................. (the ‘Enrollment Date’)
and legally binds LifeCell and the Client, including the legal heir of the client.
Page No. 25 of 36
CLIENT COPY
2.4. Upon successful enrollment, LifeCell will provide
the Client with the following:
2.4.1. A Collection Kit
2.4.2. A copy of the Agreement
2.4.3. A unique Client Relationship Management (CRM)
identification number that enables the Client to
quote for all communications with LifeCell.
3. Client Responsibilities:
3.1. On the Enrollment Date, Client must complete the
Enrollment Form (Exhibit 1), and Health History
(Exhibit 3).
3.2. Client must collect, prepare, and properly label the
Specimen, in accordance with the instructions given
in the Collection Kit. In particular the Client must
ensure that a minimum of 10 milliliters of menstrual
blood sample is collected, since smaller quantities of
menstrual blood sample may not be suitable for
processing. The Client shall also ensure that the
forms included in the Collection Kit are duly filled up
and sent to LifeCell.
3.3. It is the responsibility of the Client for delivery of the
menstrual blood sample to LifeCell’s Laboratory
within 48 hours of collection of menstrual blood
sample. For purposes of convenience LifeCell has
identified a courier company, who has the required
expertise in handling the same for proper
transportation. Client may choose this agency for
forwarding the menstrual blood sample to LifeCell.
The courier charges will be borne by LifeCell. The
selected courier is not an agent of LifeCell and
LifeCell is not liable for any deterioration, loss or
destruction of the menstrual blood sample prior to
receipt by LifeCell at LifeCell Laboratory.
3.4. Client must promptly notify LifeCell in writing of any
change in Client’s name or current mailing address.
1. Definitions:
In this Agreement, (including the recitals above), unless thecontext otherwise requires, the following expressions shallhave the following meanings:
1.1 ‘Client’ means the woman, from whom the
menstrual blood sample has been collected
1.2 ‘Collection Kit’ means the kit consisting of all
necessary materials provided by LifeCell to the
Client after enrollment, for the purpose of collection
of menstrual blood sample.
1.3 ‘LifeCell Laboratory’ means LifeCell’s laboratory
facilities situated at No 26, Vandalur Kelambakkam
Main Road, Keelakottiyur, Chennai – 600048, or any
such other laboratory that LifeCell may designate
from time to time.
1.4
1.5 Mesenchymal Stem Cell’ means multipotent stem
cells that can differentiate into a variety of cell types
and are characterized by expression of markers
CD90 and CD105.
1.6 ‘Specimen’ means and includes stem cells obtained
from menstrual blood
2. Services of LifeCell; Testing, Processing,Preserving and Storage:
2.1. LifeCell offers its services under various options
which the Client must choose in the Enrollment Form
(Exhibit 1).
2.2 . LifeCell shall obtain all statutory permissions and
licenses that might be required for providing the
services contemplated under this Agreement.
2.3.
'Minimally Expanded stem Cells' means cells
that have been obtained from ex-vivo isolation and
not subjected to further passaging.
LifeCell also conducts the following tests on the
specimen.(a) cell counting and (b) cell proliferation assay
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellfemme.com
CLIENT COPY
President, LifeCell International Client’s Signature
Page No. 26 of 36
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4. Fees for Services:
4.1. At Enrollment Date, Client must choose either the
Annual Storage Plan or the Lifetime Storage Plan by
completing Exhibit 2.
4.1.1. Annual Storage Plan. The Annual Storage Plan
includes a processing and testing Fee and an Annual
Storage Fee.
4.1.2. Lifetime Storage Plan. Pursuant to the Lifetime
Storage Plan, Client makes a one-time payment
which includes the processing and testing Fee and
storage of the Specimen until the Client attains the
age of sixty.
4.2. All fees paid by Client to LifeCell are non-refundable.
However in the event of the Menstrual Blood being
insufficient/ unfit for processing, the processing
fees would be refunded, and in case the Specimen is
found to be unfit for storage for any reason, the
storage component of the fees would be refunded.
4.3. In the unlikely event that LifeCell elects to terminate
this Agreement under Section 16, a pro-rated
refund of the prepaid storage fees will be made by
LifeCell to the Client. Further, LifeCell guarantees
the continuity of your storage by transferring your
Specimen at its own cost to a comparable stem cell
bank facility, nominated by LifeCell at no extra
charge. If the Client elects to nominate an alternative
facility for the transfer, the Client will have to bear the
cost of transportation.
5. Terms of Agreement:
5.1 If the Client signs up for the Annual Storage Plan, this
Agreement will continue for one year after the
processing and storage of the Specimen, and will
automatically renew for successive one year periods
until Client attains the age of sixty. This automatic
renewal is subject to the Client making payment
of the annual storage fee on or before the due date
every year and the Agreement is not terminated
under Section 16.
5.2 If the Client signs up for the Lifetime Storage Plan,
this Agreement will continue until the Client attains
the age of sixty.
5.3 At least sixty days before the completion of Client
attains the age of sixty LifeCell would make
reasonable attempts to notify Client about the
scheduled expiration of Agreement. If the Client
intimates her willingness to continue the storage for
further period, the Client shall enter into a new
agreement with LifeCell, as per the then prevailing
terms.
6. Storage Terms:
The Specimen will be stored as follows:
6.1. The Specimen will initially be stored in LifeCell
Laboratory in Chennai, Tamil Nadu. LifeCell reserves
the right to relocate the Specimen to another
location which is equivalent to LifeCell’s Laboratory.
6.2. If the Specimen is relocated, LifeCell will notify Client
within sixty days after such relocation.
6.3. The Specimen will be stored so long as all fees have
been timely paid.
7. Representations and Warranties of Client:
Client represents and warrants that
7.1. Client has had the opportunity to consult Client’s own
legal counsel to review this Agreement and related
forms and Client has carefully read and understood
all the terms of this Agreement;
7.2. The decision to collect the Specimen, test and
process and store the Specimen is a completely
voluntary act of Client;
7.3. Client has discussed this Agreement with a
competent medical professional, who is not an
employee or agent of LifeCell.
7.4. Client understands and agrees that to enroll with
LifeCell the Client must be at least eighteen years
of age. By entering into this Agreement the Client
certifies and represents that she is over eighteen
years of age.
8. Assumption of risk by Client:
8.1. Client acknowledges that she has been fully
informed of, accepts and agrees to the conditions,
risks, limitations and costs of processing, testing
and storage of the Specimen.
CLIENT COPY
President, LifeCell International Client’s Signature
Page No. 27 of 36
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8.2. Client assumes all risks associated with the
collection, preparation and delivery of the Specimen
to LifeCell.
8.3. Client is aware that banking the Specimen does NOT
guarantee that a stem cell transplant would be the
first or best course of treatment for any particular
disease or for every disease treatable by stem cell
transplantation. A medical care provider ultimately
decides whether the use of the Specimen is
indicated, based on the nature and progression of
the disease.
8.4. Client is aware that the Specimen is being stored for
autologous use, and that further processing of the
Specimen would be required before use.
8.5. If an unforeseen circumstance should occur,
ownership of the product will be controlled by
Client’s estate.
9. Obligations and Rights to Specimen:
9.1. Client is solely liable for all of the obligations and
responsibilities herein under and shall have all rights
of the Client, including control of the Specimen. The
exercise of any rights and control over the Specimen
will require written notice to LifeCell signed by the
Client.
9.2. Any components that remain after the Specimen is
processed and that are not being stored, will be
disposed of by LifeCell.
9.3. Upon termination of this Agreement, if the Client has
not submitted to LifeCell a request form for retrieval
of Specimen within 30 days of the date of
termination, Client shall have relinquished all rights
and waives all claims to the Specimen, and LifeCell
shall have the right at its sole discretion to utilize,
donate for research or dispose of the Specimen.
10. Retrieval of Specimen:
10.1. There is no fee payable by the Client to LifeCell for
retrieval of Specimen. Any additional expenses
relating to third party expenses, if any, will have to be
borne by the Client.
10.2. The stored Specimen will be available for access or
delivery by or before the end of the 15th business day
after LifeCell's receipt of a written request from
Client. However if the Specimen is retrieved for use
in transplantation, the expanded cells would be
available for access or delivery by or before the end
of 90th business day after LifeCell's receipt of a
written request from Client.
10.3. The request must be made on a request form
provided by LifeCell. This must be signed by the
Client, and include provide the name and address of
the facility where the Specimen is to be delivered and
the date delivery is requested.
10.4. If the retrieval is requested for a transplant, the
request form must be accompanied by transplant
physician's certification confirming the end-use. The
stored Specimen can only be released for use in
Drug Controller General of India and/or Indian
Council of Medical Research approved treatments
or clinical trials.
10.5. Free Worldwide Shipment:
In the event of a transplant, charges on account of
courier/transportation etc., to the designated
destination anywhere in the world will be borne by
LifeCell. For the purpose of convenience LifeCell has
identified a courier company who has the required
expertise in handling the same for proper
transportation. The Client may choose this agency
for transporting the stored specimen from LifeCell
laboratory. The selected courier is not an agent of
LifeCell and LifeCell is not liable for any deterioration,
loss or destruction of the specimen during
transportation to the designated destination.
11. LifeCell Disaster Relief Program
While LifeCell shall ensure that the preserved Specimen
will be maintained with the utmost care, there may be
unforeseen events that may occur, which are beyond the
reasonable control of LifeCell, that may potentially
deteriorate the Specimen held in cold storage premises.
In the extremely unlikely occurrence of such event, LifeCell
offers up to ` 1,000,000 (Rupees One Million Only)
subject to the following conditions:
The Client must be positively diagnosed with any of the
hematological malignancies treatable using the stored
Specimen, and must be scheduled for a stem cell
transplant.
11.1.
President, LifeCell International Client’s Signature
Page No. 28 of 36
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CLIENT COPY
11.2.
11.3.
The Specimen is lost due to change in temperature
arising out of loss or damage to the cold storage
machinery due to operation of an insured peril i.e., fire,
lightning, explosion and implosion, aircraft damage,
riot, strike, malicious damage and terrorism, storm,
tempest, flood and inundation, impact damage,
subsidence and landslide/rockslide, bursting and/or
overflowing of water tanks, apparatus and pipes,
missile testing, leakage from automatic sprinkler
installations, bush fire, earthquake (fire and shock), and
act of terrorism (Note that standard exclusions apply).
The claim is made by the Client during the term of
Agreement entered into with LifeCell, and is only valid
for Clients who have signed LifeCell’s standard
contract and Agreement and whose payments to
LifeCell for services are current.
12. Disclaimers:
Client acknowledges that neither LifeCell nor any of
its officers, directors, shareholders, executives,
employees, agents or consultants have made any
representations, guarantee, warranties or
assurances, express or implied, to Client regarding
the success of the collection, transportation,
testing, processing, cryopreservation, storage
process or use of the Spec imen. C l ient
acknowledges the following express disclaimers:
12.1 LifeCell expressly disclaims any warranty or
guarantee that the Specimen will ever be of
therapeutic value or have any beneficial use.
12.2 LifeCell does not perform any medical services, give
any medical advice, or otherwise perform any
functions other than those expressly indicated;
12.3 LifeCell expressly disclaims any responsibility to
provide any other services beyond those it expressly
agrees to in this Agreement.
13. Limitation of Liability:
Client agrees that LifeCell’s liability for any loss, harm,
damage or claim of any kind in connection with this
agreement or the services provided by LifeCell shall be
limited to the return of an amount equal to all fees paid by
client to LifeCell.
14. Force Majeure:
15. Indemnity and Hold Harmless:
Client agrees to indemnify and hold LifeCell and Client’s
hospital and physicians and their respective agents,
employees, officers, directors, shareholders and affiliates
harmless from any and all claims, liabilities, demands and
causes of action asserted against them by any person or
entity, including any third party beneficiary of this
Agreement.
16. Termination of Agreement:
Both LifeCell and Client specifically agree that the notice
period for termination is fair and reasonable. Upon
termination of this Agreement, neither LifeCell nor Client will
have any continuing obligations, claims for any loss,
damages, expenses or liabilities to or against the other, save
in respect of any amount which remains outstanding and
payable by either party hereto.
17. Arbitration:
All disputes arising out of or relating to this Agreement will
be resolved by arbitration. Client agrees that prior to
arbitration, Client and LifeCell will attempt to resolve the
dispute through good faith negotiations. If Client and LifeCell
are unable to resolve a dispute, Client or LifeCell may initiate
arbitration by sending a notice to the other party and a
The client agrees that LifeCell shall not be responsible for any
loss, deterioration, or destruction of all or any part of the
Specimen resulting from causes or circumstances which are
beyond LifeCell’s reasonable control and not covered under the
LifeCell Disaster Relief Program.
in the event, the entire Specimen covered under this
agreement is retrieved. However, if the client
retrieves only a portion of the Specimen the
agreement would survive and continue until the
entire Specimen has been retrieved.
Upon appropriate verification of Client’s request, LifeCell
will pay ` 10,00,000 (Rupees One Million Only)
to the Client, and Client would thereby discharge and
release LifeCell from all its liabilities.
CLIENT COPY
President, LifeCell International Client’s Signature
Page No. 29 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellfemme.com
written demand for arbitration to the other party. The
arbitration will take place in Chennai, Tamilnadu, India. The
Arbitration would be governed by the Arbitration and
Conciliation Act, 1996. All decisions of the arbitrator shall be
final, binding, and conclusive and arbitration constitutes the
only method of resolving disputes to this Agreement. This
Section shall survive any termination or expiration of the
Agreement.
18. Governing Law, Jurisdiction and Venue:
This Agreement is governed by, construed and interpreted
in accordance with the laws of India. Subject to the
compulsory arbitration provisions of Section 18, any judicial
proceedings brought against either LifeCell or Client under
this Agreement will be brought in a competent court in
Chennai, India. LifeCell and Client consent to the exclusive
jurisdiction of the aforesaid courts and waive any objection
to venue therein and irrevocably agree to be bound by any
judgment rendered thereby in connection with this
Agreement.
19. Confidentiality; Consent to Release:
LifeCell acknowledges the confidential nature of the
information provided by Client and agrees to use its
reasonable best efforts to maintain the confidentiality of the
information except as required by law or as permitted by this
Agreement. Client hereby agrees to the release of
information to the hospital, laboratory or physician
providing the services.
20. Assignment:
LifeCell may assign this Agreement to any individual or entity
providing a similar service. If LifeCell is acquired by or
merged with or into another company, LifeCell shall require
that the terms of this Agreement continue in full force and
effect.
21. Notice:
21.1. Any notice shall be sufficiently given if delivered in
person or sent by express mail or by registered or
certified mail, postage prepaid.
21.2. Notice to LifeCell must be delivered to LifeCell
International Private Limited, 26 Vandalur
Kelambakkam Main Road, Keelakotaiyur, Chennai –
600048.
21.3. Notice to Client will be delivered to the address set
forth after Client’s signature. Such notice will be
deemed to have been given when personally
delivered or received.
22. Entire Agreement:
This Agreement and the exhibits hereto constitute the
e n t i r e a g r e e m e n t b e t w e e n L i f e C e l l a n d t h e
Client, and supersedes any prior agreements or
understandings, oral and written.
23. Survival:
All provisions which by their terms require performance
after the termination of this Agreement will survive the
termination of this Agreement.
24. Binding Effect:
All of the obligations, terms, provisions and releases set
forth in this Agreement, shall be binding upon and inure to
the benefit of LifeCell and the Client, and their respective
heirs, personal representatives, successors, and assigns.
25. Severability:
If any part of this Agreement is found to be invalid or
unenforceable, such provision is deemed modified to the
extent necessary to make the Agreement enforceable, and
this Agreement shall otherwise remain in full force and
effect.
26. Headings:
The headings in this Agreement are for reference purposes
only and shall not affect the meaning or interpretation of this
Agreement.
I ACCEPT ALL TERMS AND CONDITIONS OF THIS AGREEMENT
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
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Page No. 30 of 36
Page No. 31 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
APP. NO. ...........................................
For LifeCell use only
(Name of the center incharge)
Signature of the center incharge
Payment received by
Designation
Center
Center’s Tel. No.
: ...........................................................................
: ...........................................................................
: ...........................................................................
: 1800-103-5353
: +9196771 12233
TOLL FREE
HELPLINE
: ...........................................................................
CLIENT COPY
LifeCell International Private LimitedRegd. Office :26, Vandalur-kelambakkam Road, Keelakottaiyur, Chennai - 600 048.
TEMPORARY RECEIPT
Receipt No: .................................................. Date:
Received with thanks from Mr./Ms. ............................................................................................................................................................................................
towards enrollment vide APP...No. ...........................................................................................a sum of Rs.............................................................................
(Rupees.............................................................................................................................................................................................................................................Only)
towards Enrollment/Processing/Storage fees by way of Cash/Credit Card/*Cheque/ *DD /EFT No.
Date...................................... Drawn on......................................................................................... Branch................................................ City..................................
Plan No. : ................................................................................................
Plan Name:..........................................................................................
EDD:..........................................................................................................
*Cheque/DD Subject to realization
Note : A computer generated “Receipt” will be sent along with the Preservation certificate
For LifeCell use only For LifeCell International Private Limited
Computer Receipt No : Authorised Signatory
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
THIS PAGE IS INTENTIONALLY LEFT BLANK
Page No. 32 of 36
Page No. 33 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
APP. NO. ...........................................
For LifeCell use only
(Name of the center incharge)
Signature of the center incharge
Payment received by
Designation
Center
Center’s Tel. No.
: ...........................................................................
: ...........................................................................
: ...........................................................................
: 1800-103-5353
: +9196771 12233
TOLL FREE
HELPLINE
LIFECELL COPY
: ...........................................................................
LifeCell International Private LimitedRegd. Office :26, Vandalur-kelambakkam Road, Keelakottaiyur, Chennai - 600 048.
TEMPORARY RECEIPT
Receipt No: .................................................. Date:
Received with thanks from Mr./Ms. ............................................................................................................................................................................................
towards enrollment vide APP...No. ...........................................................................................a sum of Rs.............................................................................
(Rupees.............................................................................................................................................................................................................................................Only)
towards Enrollment/Processing/Storage fees by way of Cash/Credit Card/*Cheque/ *DD /EFT No.
Date...................................... Drawn on......................................................................................... Branch................................................ City..................................
Plan No. : ................................................................................................
Plan Name:..........................................................................................
EDD:..........................................................................................................
*Cheque/DD Subject to realization
Note : A computer generated “Receipt” will be sent along with the Preservation certificate
For LifeCell use only For LifeCell International Private Limited
Computer Receipt No : Authorised Signatory
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
THIS PAGE IS INTENTIONALLY LEFT BLANK
Page No. 34 of 36
Page No. 35 of 36
CENTER COPY
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
APP. NO. ...........................................
(Name of the center incharge)
Signature of the center incharge
: 1800-103-5353
: +9196771 12233
For LifeCell use only
HELPLINE
Payment received by
Designation
Center
Center’s Tel. No.
LifeCell International Private LimitedRegd. Office :26, Vandalur-kelambakkam Road, Keelakottaiyur, Chennai - 600 048.
TEMPORARY RECEIPT
Receipt No: .................................................. Date:
Received with thanks from Mr./Ms. ............................................................................................................................................................................................
towards enrollment vide APP...No. ...........................................................................................a sum of Rs.............................................................................
(Rupees.............................................................................................................................................................................................................................................Only)
towards Enrollment/Processing/Storage fees by way of Cash/Credit Card/*Cheque/ *DD /EFT No.
Date...................................... Drawn on......................................................................................... Branch................................................ City..................................
Plan No. : ................................................................................................
Plan Name:..........................................................................................
EDD:..........................................................................................................
*Cheque/DD Subject to realization
Note : A computer generated “Receipt” will be sent along with the Preservation certificate
For LifeCell use only For LifeCell International Private Limited
Computer Receipt No : Authorised Signatory
TOLL FREE
: ...........................................................................
: ...........................................................................
: ...........................................................................
: ...........................................................................
Page No. 36 of 36
LifeCell International Pvt. Ltd., 26, Vandalur Kelambakkam Main Road, Keelakotaiyur, Chennai - 48. | 044 4744 5353 | www.lifecellinternational.com
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LifeCell International Private Limited, 26, Vandalur Kelambakkam Main Road, Keelakotaiyur,
Chennai - 600 048 | Phone: +91 44 4744 5353 | email: [email protected] EF
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TOLL FREE: | HELPLINE: | SMS TO | www.lifecellinternational.com 1800-103-5353 +91 96771 12233 ‘BABYCORD’ 53456