Reliq Health Technologies Inc. Loss Form

Purchases

Additional Purchases

Sales

Additional Sales

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I, duly certify and say, as to the claims asserted under the federal securities laws, that:

1. I have reviewed a complaint filed in the action.

2. I did not purchase the security that is the subject of this action at the direction of plaintiff's counsel or in order to participate in this action.

3. I am willing to serve as a representative party on behalf of the class, including providing testimony at deposition and trial, if necessary.

4. My transaction(s) in Reliq Health Technologies Inc. which are the subject of this litigation during the class period set forth in the complaint are set forth in the chart attached hereto.

5. Within the last 3 years,

6. I will not accept any payment for serving as a representative party on behalf of the class beyond the Plaintiff's pro rata share of any recovery, except as ordered or approved by the court, including any award for reasonable costs and expenses (including lost wages) directly relating to the representation of the class.

By your signature above, you confirm that have retained Levi & Korsinsky, LLP and agree to serve as a lead plaintiff in an action against Reliq Health Technologies Inc. We agree to advance all expenses in the litigation, which means that you are not liable to pay any of the expenses of the lawsuit, whether attorneys' fees or costs. Regardless of the result, we will never ask you to directly pay for any attorneys' fees or costs. Should we obtain a favorable result, we may ask the court to award us compensation and reimbursement of expenses to be paid by the defendants or as a portion of any benefit, but we will never ask you to directly pay any of the costs of this litigation. As our client, you are entitled to direct the litigation in any way you deem proper, and may at any time order us to dismiss the case. Should you choose to do so, we will never ask you to reimburse us directly for any legal fees or expenses. You further agree to cooperate in our prosecuting the action, including providing relevant documents and deposition testimony, if necessary. During the course of this litigation, we may employ and/or work with other law firms to prosecute your case. If the Court does not appoint you as a lead plaintiff or you are not added as a plaintiff to a complaint filed in the action, then this retainer agreement and Levi & Korsinsky, LLP's representation of you will terminate automatically.