BIOLASE TECHNOLOGY, INC.
This Indemnification Agreement (this “ Agreement ”) is entered into as of , 2005 (the “ Effective Date ”), by
and between BIOLASE TECHNOLOGY, INC., a Delaware corporation (the “ Company ”), and (“ Indemnitee ”).
A. Indemnitee is either a member of the board of directors of the Company (the “ Board of Directors ”) or an officer of the
Company, or both, and in such capacity or capacities, or otherwise as an Agent (as hereinafter defined) of the Company, is
performing a valuable service for the Company.
B. Indemnitee is willing to serve, continue to serve and to take on additional service for or on behalf of the Company on
the condition that he or she be indemnified as herein provided.
C. It is intended that Indemnitee shall be paid promptly by the Company all amounts necessary to effectuate in full the
indemnity provided herein.
NOW, THEREFORE, in consideration of the premises and the covenants in this Agreement, and of Indemnitee continuing
to serve the Company as an Agent and intending to be legally bound hereby, the parties hereto agree as follows:
1. Services by Indemnitee . Indemnitee agrees to serve (a) as a director or an officer of the Company, or both, so
long as Indemnitee is duly appointed or elected and qualified in accordance with the applicable provisions of the Certificate of
Incorporation and bylaws of the Company, and until such time as Indemnitee resigns or fails to stand for election or is removed
from Indemnitee’s position, or (b) as an Agent of the Company. Indemnitee may from time to time also perform other services at
the request or for the convenience of, or otherwise benefiting, the Company. Indemnitee may at any time and for any reason
resign or be removed from such position (subject to any other contractual obligation or other obligation imposed by operation
of law), in which event the Com