Study Suspension Request Form

This Study Suspension Request Form authorizes Medidata to suspend the services under a Single Study SO for the study indicated below, in accordance with the Study Postponement and Suspension Policy posted at https://www.medidata.com/en/study-postponement-suspension-policy. Except as set forth herein, all terms and conditions of the Agreement between Medidata and Customer or Partner, as applicable (herein collectively referenced to as “Client”) shall apply to this request.

“Anniversary Day” means: The day after the current end date of the Sales Order or Change Order. Please note the anniversary date of a SO will never be between the 28th – 31st of a month.

Date of Request (MM/DD/YYYY):

Requests for study suspension CANNOT be backdated

Requested Suspension Date (MM/DD/YYYY):

(The effective date of the suspension must be future dated and coincide with Anniversary date of the single study Sales Order).

Client Name: Client Address: Sales Order Number: Study / Protocol Number: Sponsor Name (“Customer” — Partner Sales Order only): Reason For Study Suspension: Duration for Suspension of Service (# months (3-6)): Name: Title: Email By submitting this Study Suspension Request Form, you acknowledge that you are an authorized representative of Client with the authority to suspend services for the identified study. Following your completion and submission of this electronic Study Suspension Request Form, Medidata will issue a change order to the relevant Single Study SO, for signature by Client and Medidata. The detailed services suspension terms and associated fees will be documented in a change order to the Sales Order listed above, fully executed by Client and Medidata. I agree to the terms and conditions mentioned above.