Acknowledgement of Independent Contractor

The undersigned acknowledges that it has been retained by (Company), for purposes of:

(Describe)

In consideration of the foregoing, the Company agrees to pay the undersigned payment as follows:

(Describe amount and method of payment)

It is further acknowledged that:

1. The undersigned shall be deemed an independent contractor and is not an employee, partner, agent, or engaged in a joint venture with Company.

2. Consistent with the foregoing, the Company shall not deduct withholding taxes or any other taxes required to be deducted by an employer as I acknowledge my responsibility to pay same as an independent contractor.

3. I further acknowledge that I shall not be entitled to any fringe benefits, superannuation, retirement, profit sharing or any other benefits accruing to employees.

Signed under seal this ______ day of _____ 20 __.

Signed: ________________________

(Corporation Seal)