Grant Thornton referral company details 1Company Details2Acquired Solution3Participants Board Evaluation Order formThis Order Form effective as of the Order Form Effective Date, is entered into by and between BoardClic Ltd, a private company in Sweden, under registration number 559152-7063 and whose registered address is at No 18, Birger Jarlsgatan 18, 114 34 Stockholm, Sweden, (hereinafter referred to as BoardClic) AND Grant Thornton UK LLP , a limited liability partnership registered in England and Wales under company number OC307742 and whose registered address is 30 Finsbury Square, London, EC2A 1AG (Grant Thornton) (hereinafter referred to as Grant Thornton) pursuant to the terms and conditions set forth in the Agreement dated [Date] executed between the Parties (Agreement). Grant Thornton and BoardClic are hereinafter referred to as a “Party” individually and “Parties” collectively.Order Form NumberFormat to be agreed by BoardClic and Grant Thornton Order Form TermStart Date to End Date Grant Thornton Contact DetailsGrant Thornton Contact nameName of Grant Thornton Contact Grant Thornton Contact email addressEnter email address of Grant Thornton Contact Grant Thornton Contact telephone numberEnter telephone number of Grant Thornton Contact Grant Thornton Client DetailsName of Grant Thornton ClientEnter full Company Name of Grant Thornton Client Grant Thornton Client Company NumberEnter Company Registration Number of Grant Thornton Client HiddenGrant Thornton Client Company NumberEnter Company Registration Number of Grant Thornton Client Grant Thornton Client Company AddressEnter Company Address of Grant Thornton Client Key contact at Grant Thornton ClientEnter name of key contact at Grant Thornton Client Email address of key contact at Grant Thornton ClientEnter email address of key contact at Grant Thornton Client Number Of Board Meetings annually:Enter number of Grant Thornton Client Board Meetings annuallyAnnual revenue of Grant Thornton Client in last year:Enter last reported revenueOwnership of Grant Thornton Client:Select one Listed Partner held Private State ownership PE backed PE firmSector of Grant Thornton Client: Financial Industry Consumer Discretionary Information Technology Real Estate Communication Services Healthcare Materials Consumer Staples Utilities Energy Please specify other sector Market capSelect one Large Mid Small BoardClic Service to be provided to Grant Thornton ClientEvaluation packageSelect BoardClic evaluation package Essential Pro Investor Enterprise Desired start and end dates for survey:(suggest no more than 10 days between start and finish):HiddenDesired start and end dates for survey(suggest no more than 10 days between start and finish): Start YYYY dash MM dash DD Expire YYYY dash MM dash DD Survey recipientsFor each survey beneficiary provide the following information (add rows as appropriate)Role (e.g. Chair; CEO; Finance Director: Senior Manager etc)First nameSurnameEmail AddressTelephone Number HiddenSurvey recipients:For each survey beneficiary provide the following informationHiddenIncluded committees Official to be complete for each Order FormTermination: Either Party may terminate this Order Form by giving the other Party ten (10) Business Days’ written notice.Service Levels (if any variation from Schedule 6 of the Agreement):No variation or list the variation to the Service Levels in Other No variation Miscellaneous Terms & Conditions:Select: ‘No miscellaneous Terms & Conditions’ or list the miscellaneous Terms & Conditions No miscellaneous Terms & Conditions HiddenAgreed Charges:Confirm the charges in pounds sterling based on the Schedule 5 and note potential fee due to BoardClic subject to terms of Schedule 5 No miscellaneous Terms & Conditions Agreed Charges:Confirm the charges in pounds sterling based on the Schedule 5 and note potential fee due to BoardClic subject to terms of Schedule 5 Additional Services / Additional Charges (if any)Select: ‘None specified’ or set out the Additional Services and Additional Charges None specified Additional Instructions (if any):Select ‘None specified’ or set out the additional instructions None specified IN WITNESS WHEREOF, the parties have caused their Authorised Representative to execute this Order Form.Grant Thornton UK LLP Sign Name Title Date Month Day Year
