Common use of NOTICE OF CONVERSION Clause in Contracts

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Vaccinex, Inc., Vaccinex, Inc.

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NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 ________202[5] of Vaccinex, Progressive Care Inc., a Delaware corporation (the “Company”), into shares of common stock Common Shares (the “Common StockShares”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock Shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock Shares does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockShares. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock Shares __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock Shares to be issued: Signature: Name: Address for Delivery of Common Stock Shares Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 ________ 202[5] in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, Progressive Care Inc., a Delaware corporationcompany. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Securities Purchase Agreement (NextPlat Corp), Securities Purchase Agreement (NextPlat Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3[________], 2021 20___ of Vaccinex, Inc.Digital Power Corp., a Delaware California corporation (the "Company"), into shares of common stock (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ___________________ Account No: __________________ Schedule 1 CONVERSION SCHEDULE The 7% This Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3[_____], 2021 in 20___in the aggregate original principal amount of $8,640,000 are [________] is issued by Vaccinex, Inc.Digital Power Corp., a Delaware California corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Digital Power Corp, Digital Power Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 __________ of VaccinexAgEagle Aerial Systems, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3June 30, 2021 2017 in the aggregate principal amount of $8,640,000 _________________are issued by VaccinexAgEagle Aerial Systems, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: AgEagle Aerial Systems Inc., AgEagle Aerial Systems Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture Note due August 3March 14, 2021 2023 of VaccinexGrom Social Enterprises, Inc., a Delaware Florida corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_________________ Account No: :________________ Schedule 1 CONVERSION SCHEDULE The 710.0% Original Issue Discount Senior Secured Convertible Debentures Notes due on August 3March 13, 2021 2023 in the aggregate principal amount of $8,640,000 4,400,000.00 are issued by VaccinexGrom Social Enterprises, Inc., a Delaware Florida corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Grom Social Enterprises, Inc., Grom Social Enterprises, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3July 1, 2021 2014 of VaccinexSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures due on August 3July 1, 2021 2014 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexSG Blocks, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Sg Blocks, Inc., Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 3, 2021 ______________ of VaccinexNotis Global, Inc., a Delaware Nevada corporation (the “Company”)) and Pueblo Agriculture Supply and Equipment, LLC, into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 10% Original Issue Discount Senior Secured Convertible Debentures Promissory Note, due on August 3__________, 2021 in the aggregate original principal amount of $8,640,000 are _________ is issued by VaccinexNotis Global, Inc., a Delaware corporationNevada corporation (the “Company”) and Pueblo Agriculture Supply and Equipment, LLC. This Conversion Schedule with respect to the Common Stock of the Company reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: _____________ Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Companies Attest

Appears in 2 contracts

Samples: Notis Global, Inc., Notis Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7[___ % [Original Issue Discount [Senior [Secured Convertible Debenture due August 3, 2021 [________ of Vaccinex, Inc.[____________, a Delaware [____________ corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7[____ % [Original Issue Discount [Senior [Secured Convertible Debentures due on August 3, 2021 [________ in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, Inc.[____________, a Delaware [________ corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: Beyond Commerce, Beyond Commerce

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3July 1, 2021 2017 of VaccinexPFO Global, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3July 1, 2021 2017 in the aggregate principal amount of $8,640,000 _________ are issued by VaccinexPFO Global, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: PFO Global, Inc., PFO Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3February 8, 2021 2014 of VaccinexRecovery Energy, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3February 8, 2021 2014 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexRecovery Energy, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest ANNEX B PROPERTY SUBJECT TO SECURITY INTEREST INSOFAR AND ONLY INSOFAR AS THE LEASES COVER THE LAND DESCRIBED IN THIS ANNEX "B"

Appears in 2 contracts

Samples: Securities Purchase Agreement (Recovery Energy, Inc.), Recovery Energy, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 ________202[5] of Vaccinex, Progressive Care Inc., a Delaware corporation (the “Company”), into shares of common stock Common Shares (the “Common StockShares”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock Shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock Shares does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockShares. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock Shares __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock Shares to be issued: Signature: Name: Address for Delivery of Common Stock Shares Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 ________ 202[5] in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, Progressive Care Inc., a Delaware corporationcompany. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest Exhibit B Form of Registration Rights Agreement REGISTRATION RIGHTS AGREEMENT This Registration Rights Agreement (this “Agreement”) is made and entered into as of November 16, 2022, between Progressive Care, Inc., a Delaware corporation (the “Company”), and NextPlat Corp (“Purchaser”). This Agreement is made pursuant to the Securities Purchase Agreement, dated as of the date hereof, between the Company and Purchaser (the “Purchase Agreement”). The Company and Purchaser hereby agree as follows:

Appears in 2 contracts

Samples: Securities Purchase Agreement (NextPlat Corp), Securities Purchase Agreement (NextPlat Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 3, 2021 ______________ of VaccinexNotis Global, Inc., a Delaware Nevada corporation (the “Company”)) and Pueblo Agriculture Supply and Equipment, LLC, into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 10% Original Issue Discount Senior Secured Convertible Debentures Promissory Note, due on August 3_____________, 2021 in the aggregate original principal amount of $8,640,000 are __________ is issued by VaccinexNotis Global, Inc., a Delaware corporationNevada corporation (the “Company”) and Pueblo Agriculture Supply and Equipment, LLC. This Conversion Schedule with respect to the Common Stock of the Company reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Companies Attest

Appears in 2 contracts

Samples: Notis Global, Inc., Notis Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 712% Original Issue Discount Senior Secured Convertible Debenture due August 3______, 2021 2016 of VaccinexWorld Moto, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. In the event of a partial Conversion, Amortization Dates from which Amortization Amount is to be deducted: Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 712% Original Issue Discount Senior Secured Convertible Debentures due on August 3____, 2021 2016 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexWorld Moto, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 2 contracts

Samples: World Moto, Inc., World Moto, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 the Maturity Date of VaccinexFoldera, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _________________ Account No: _______________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 the Maturity Date in the aggregate principal amount of $8,640,000 7,000,000 are issued by VaccinexFoldera, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: ______________, ____ Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest ANNEX B DRAW DOWNS Date of Draw Down (or for first entry, Original Issue Date) Amount of Draw Down Aggregate Principal Amount Drawn Down Company Attest

Appears in 1 contract

Samples: Foldera, Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc.CyberDefender Corporation, a Delaware California corporation (the “Company”), due on _________________, 2010, into shares of common stock stock, no par value per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress: Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3_________________, 2021 2010, in the aggregate principal amount of $8,640,000 are __________ issued by Vaccinex, Inc., a Delaware corporationCyberDefender Corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Consent and Waiver (Cyberdefender Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3December __, 2021 2015 of VaccinexElectronic Cigarettes International Group, Inc.Ltd., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: __________ Account No: __________ Appendix A Amortization Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3Transaction Amount Timing Funding: $ December __, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion 2014 Amortization Payments First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest1

Appears in 1 contract

Samples: Electronic Cigarettes International Group, Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Ten Percent (10%) Junior Secured Collateralized Convertible Debenture Promissory Note due August 3, 2021 on the Deferral End Date of VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________________ Account No: ___________________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount This Ten Percent (10%) Senior Secured Junior Collateralized Convertible Debentures Promissory Note due on August 3, 2021 Deferral End Date in the aggregate original principal amount of $8,640,000 are _________ issued by VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Xenetic Biosciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3Promissory Note, 2021 with an issue date of VaccinexJune 9, Inc.2022, a Delaware corporation of Cool Technologies, Inc. (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: _________________________________ Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: ANNEX A Schedule 1 CONVERSION SCHEDULE The 7This 10% Original Issue Discount Senior Secured Convertible Debentures due on August 3Promissory Note, 2021 with an issue date of June 9, 2022, in the aggregate original principal amount of $8,640,000 are 176,471 is issued by VaccinexCool Technologies, Inc., a Delaware corporationInc. (the “Company”). This Conversion Schedule with respect to the Common Stock of the Company reflects conversions made under Section 4 5 of the above above-referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount and Guaranteed Interest Remaining Subsequent to Conversion (or original Principal Amount) Company AttestCompany’s Attest SCHEDULE 1 SECURITIES PURCHASE AGREEMENT THIS SECURITIES PURCHASE AGREEMENT (this “Agreement”), dated as of June 9, 2022 between COOL TECHNOLOGIES, INC., a Nevada corporation (the “Company”), and Coventry Enterprises, LLC, a Delaware limited liability company (“Investor”).

Appears in 1 contract

Samples: Securities Purchase Agreement (Cool Technologies, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Senior Secured Original Issue Discount Senior Secured Convertible Debenture due August 3_____, 2021 2019 of VaccinexRennova Health, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Applicable Conversion at Issue. Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :______________ Account No: :_____________ Schedule 1 CONVERSION SCHEDULE The 7% Senior Secured Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 ________ in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexRennova Health, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest EXHIBIT C NEITHER THIS SECURITY NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS. THIS SECURITY AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES. SERIES [A/B/C] COMMON STOCK PURCHASE WARRANT RENNOVA HEALTH, INC. Warrant Shares: _______ Initial Exercise Date: August __, 2017

Appears in 1 contract

Samples: Securities Purchase Agreement (Rennova Health, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3July 8, 2021 2011 of VaccinexQPC Lasers, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :____________________ Account No: :___________________ Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3July 8, 2021 2011 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexQPC Lasers, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: QPC Lasers

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3September 30, 2021 2019 of VaccinexxG Technology, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ____________________ Account No: __________________ Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3September 30, 2021 2019, in the aggregate principal amount of $8,640,000 ________________ are issued by VaccinexxG Technology, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: xG TECHNOLOGY, INC.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7Second Amended and Restated 6% Original Issue Discount Senior Secured Convertible Debenture due August 3September 30, 2021 2019 of VaccinexxG Technology, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7Second Amended and Restated 6% Original Issue Discount Senior Secured Convertible Debentures due on August 3September 30, 2021 2019, in the aggregate principal amount of $8,640,000 _____________ are issued by VaccinexxG Technology, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: xG TECHNOLOGY, INC.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 712% Original Issue Discount Senior Secured Convertible Debenture due August 3January __, 2021 2016 of VaccinexCatasys, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 712% Original Issue Discount Senior Secured Convertible Debentures due on August 3January __, 2021 2016 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexCatasys, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Catasys, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture due August 3April 20, 2021 2012 of VaccinexAethlon Medical, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account Accrued. Number of Conversion at Issue. Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Note: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 75% Original Issue Discount Senior Secured Unsecured Convertible Debentures Debenture due on August 3April 20, 2021 2012 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexAethlon Medical, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Aethlon Medical Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3January 5, 2021 2017 of VaccinexAvant Diagnostics, Inc., a Delaware corporation Inc. (the "Company"), into shares of common stock (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ____________ Account No: __________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured This Convertible Debentures Promissory Note due on August 3January 5, 2021 2017 in the aggregate original principal amount of $8,640,000 are _____ is issued by VaccinexAvant Diagnostics, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or Conversion(or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or Conversion(or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Avant Diagnostics, Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Subordinated Convertible Debenture Promissory Note, due August 3October 6, 2021 of VaccinexInnocap, Inc.Inc.., a Delaware Nevada corporation (the “Company”), into shares of common stock stock, $0.001 par value per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock [ ] yes [ ] no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery Instructions: ANNEX B ACKNOWLEDGMENT OF CONVERSION The Company hereby (a) acknowledges this Notice of Conversion, (b) certifies that the above indicated number of shares of Common Stock Certificates[are][are not] eligible to be resold by the Holder either (i) pursuant to Rule 144 (subject to the Holder’s execution and delivery to the Company of a customary Ru;e 144 representation letter) or (ii) an effective and available registration statement covering such shares of Common Stock and (c) hereby directs _________________ to issue the above indicated number of shares of Common Stock in accordance with the Transfer Agent Instructions dated _____________, 20__ from the Company and acknowledged and agreed to by ________________________. INNOCAP, INC. By: Or DWAC InstructionsName: Broker NoTitle: Account No: Schedule SCHEDULE 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion Schedule is part of, and reflects conversions made under Section 4 of, the 10% Secured Subordinated Convertible Promissory Note, due on October 6, 2021, in the original principal amount of the above referenced Debenture$1,111,000 issued by Innocap, Inc., a Nevada corporation. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest SCHEDULE 6(a) OPTIONAL REDEMPTION AMOUNT Subject to compliance with Section 6(a), the Company may redeem any portion of the principal amount of this Note, any accrued and unpaid interest, and any other amounts due under this Note in accordance with the following formulae: if the Company exercises its right to redeem the Note, the Company shall make payment to the Holder of (i) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 110%, if such voluntary redemption occurs on or before December 5, 20201, (ii) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 115%, if such voluntary prepayment occurs after December 5, 2020 and before January 4, 20212, (iii) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 120%, if such voluntary prepayment occurs after January 4, 2021 and before February 3, 20213, (iv) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 125%, if such voluntary prepayment occurs after February 3, 2021 and before March 5, 20214, (v) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 130%, if such voluntary prepayment occurs after March 5, 2021 and before April 4, 20215, and (vi) an amount in cash equal to the product of (x) the sum of the principal amount of this Note and any accrued and unpaid interest and (y) 135%, if such voluntary prepayment occurs after April 4, 20216 and before the Maturity Date. _________________________________

Appears in 1 contract

Samples: Innocap Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3September 1, 2021 2018 of VaccinexToughBuilt Industries, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________ Account No: :___________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3September 1, 2021 2018 in the aggregate principal amount of $8,640,000 5,700,000 are issued by VaccinexToughBuilt Industries, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Toughbuilt Industries, Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 712% Original Issue Discount Senior Subordinated Secured Convertible Debenture due August 3May __, 2021 2009 of VaccinexHealthcare Providers Direct, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: :___________________________________ Name: :______________________________________ Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 712% Original Issue Discount Senior Subordinated Secured Convertible Debentures Debenture due on August 3May __, 2021 2008 in the aggregate original principal amount of $8,640,000 are ____________ is issued by Vaccinex, Inc.Healthcare Providers Direct, a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Healthcare Providers Direct Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 720% Original Issue Discount Senior Secured Convertible Debenture due August 3September 30, 2021 2017 of VaccinexProtea Biosciences Group, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account Accrued. Number of Conversion at Issue. Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Debenture: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 720% Original Issue Discount Senior Secured Unsecured Convertible Debentures Debenture due on August 3, 2021 September 30 2017 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexProtea Biosciences Group, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Protea Biosciences Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 72.25% Original Issue Discount Series B Senior Secured Unsecured Convertible Debenture due August 3June 22, 2021 2020 of VaccinexMELA Sciences, Inc., a Delaware corporation (the “Company”), into shares of common stock Common Stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of common stock of the Common Stock Company does not exceed the amounts specified under Section 4 of this Series B Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Series B Debenture to be Converted: Payment of Interest in Common Stock ____ yes _____ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ________________ Account No: :________________ Schedule 1 CONVERSION SCHEDULE The 72.25% Original Issue Discount Series B Senior Secured Unsecured Convertible Debentures due on August 3June 22, 2021 2020 in the aggregate principal amount of $8,640,000 500,000 are issued by VaccinexMELA Sciences, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Series B Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Mela Sciences, Inc. /Ny

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3April 1, 2021 2015 of VaccinexAspen Group, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_______________ Account No: :______________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3April 1, 2021 2015 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexAspen Group, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Aspen Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture Note due August 3December 31, 2021 2019, of VaccinexShiftPixy, Inc., a Delaware Wyoming corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _____________________ Account No: :____________________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured SENIOR SECURED Convertible Debentures Notes due on August 3December 31, 2021 2019 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexShiftPixy, Inc., a Delaware Wyoming corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: ShiftPixy, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3___________ , 2021 of VaccinexLithium Exploration Group, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ _of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ____________________ Account No: __________________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 __________ in the aggregate principal amount of $8,640,000 1,680,,000.00 are issued by VaccinexLithium Exploration Group, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Lithium Exploration Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3February 28, 2021 2011 of VaccinexAccentia Biopharmaceuticals, Inc., a Delaware Florida corporation (the “Company”), into shares of common stock stock, par value $.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3February 28, 2021 2011 in the aggregate principal amount of $8,640,000 $ are issued by VaccinexAccentia Biopharmaceuticals, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Accentia Biopharmaceuticals Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710.0% Original Issue Discount Senior Secured Convertible Debenture due August 3November 29, 2021 2023 of VaccinexTheralink Technologies, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: ________ Principal Amount of Debenture to be Converted: Payment of ___________ Accrued Interest in Common Stock to be Converted through __________ [date]: $____________ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: _______ Signature: ________________ Name: _________________ Address for Delivery of Common Stock Certificates: ____________________ Or DWAC Instructions: Broker No: :______________ Account No: :____________ Schedule 1 CONVERSION SCHEDULE The 710.0% Original Issue Discount Senior Secured Convertible Debentures due on August 3November 29, 2021 2023 in the aggregate principal amount of $8,640,000 are ____________ is issued by VaccinexTheralink Technologies, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Principal Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Theralink Technologies, Inc.

NOTICE OF CONVERSION. The undersigned registered holder hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture due August 3January 16, 2021 2016 of Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation (the “Company”), No. R- (the “Debenture”) into shares of common stock (the “Common Stock”), ) of the Company according to in accordance with the terms and conditions hereofof the Debenture, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the undersigned registered holder of the Debenture for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Securities Laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 75% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3January 16, 2021 2016 No. R- in the aggregate original principal amount of $8,640,000 are 250,000 is issued by Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Converted Principal Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: PLC Systems Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 716% Original Issue Discount Senior Secured Convertible Debenture due August 3March 21, 2021 2018 of Vaccinex, Inc.Vuzix Corporation, a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_________________ Account No: :________________ Schedule 1 CONVERSION SCHEDULE The 716% Original Issue Discount Senior Secured Convertible Debentures due on August 3March 21, 2021 2018 in the aggregate principal amount of $8,640,000 800,000 are issued by Vaccinex, Inc.Vuzix Corporation, a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Vuzix Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 329, 2021 2019 of Vaccinex, Attis Industries Inc., a Delaware New York corporation (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: __________________ Please confirm the following information: Conversion Price: ______________ Please check the following box if the Conversion Price is determined by: EOD Conversion Price ☐ Principal Amount of Debenture Note to be Converted: ____________ Payment of Interest in Common Stock __ Yes __ No If Yes, $_____ of Interest Accrued on Account of Conversion at Issue. If Yes, $_____ of Make-Whole Amount on Account of Conversion at Issue Number of shares Shares of Common Stock to be issuedIssued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures Promissory Note, due on August 329, 2021 2019, in the aggregate original principal amount of $8,640,000 are [●] is issued by Vaccinex, Attis Industries Inc., a Delaware New York corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest Schedule 2 PERMITTED INDEBTEDNESS AND LIENS

Appears in 1 contract

Samples: Permitted Indebtedness and Liens (Attis Industries Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3July 1, 2021 2015 of VaccinexBOLDFACE Group, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the of applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :___________ Account No: :_________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3July 1, 2021 2015 in the aggregate principal amount of $8,640,000 281,120.00 are issued by VaccinexBOLDFACE Group, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Boldface Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7Amended and Restated 10% Original Issue Discount Senior Secured Convertible Debenture due August 3September 1, 2021 2018 of VaccinexToughBuilt Industries, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: __________________ Account No: ________________ Schedule 1 CONVERSION SCHEDULE The 7Amended and Restated 10% Original Issue Discount Senior Secured Convertible Debentures due on August 3September 1, 2021 2018 in the aggregate principal amount of $8,640,000 ___________ are issued by VaccinexToughBuilt Industries, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Toughbuilt Industries, Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3May 1, 2021 2022 of VaccinexRapid Therapeutic Science Laboratories, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest Interest, if any, in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: _______________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3May 1, 2021 2022 in the aggregate principal amount of $8,640,000 1,941,1760 are issued by VaccinexRapid Therapeutic Science Laboratories, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Rapid Therapeutic Science Laboratories, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3May ___, 2021 2011 of VaccinexQPC Lasers, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ______________ Account No: ____________ Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3May ___, 2021 2011 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexQPC Lasers, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: QPC Lasers

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3June 30, 2021 2017 of VaccinexOXIS International, Inc., a Delaware corporation (the "Company"), into shares of common stock (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3June 30, 2021 2017 in the aggregate original principal amount of $8,640,000 XXXXXXX.00 are issued by VaccinexOXIS International, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Oxis International Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3April 1, 2021 2016 of VaccinexSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________________ Account No: :___________________ Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures due on August 3April 1, 2021 2016 in the aggregate original principal amount of $8,640,000 are ________ is issued by VaccinexSG Blocks, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 on the Maturity Date of VaccinexSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_________________ Account No: :_______________ Schedule 1 CONVERSION SCHEDULE The 7% This Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 the Maturity Date in the aggregate original principal amount of $8,640,000 are [$1,750,000] is issued by VaccinexSG Blocks, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3May 30, 2021 2011 of VaccinexCapital Growth Systems, Inc., a Delaware Florida corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Calculations Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Manner in which Conversion is to be Applied to Subsequent Quarterly Redemption Amounts and/or Principal Amount of Debenture: Signature: Name: Address for Delivery of Common Stock Certificates: Or OR DWAC Instructions: Instructions Broker No: Account No: Schedule SCHEDULE 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3May 30, 2021 2011 in the aggregate original principal amount of $8,640,000 are $ is issued by VaccinexCapital Growth Systems, Inc., a Delaware Florida corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Capital Growth Systems Inc /Fl/

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 76% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc.Generex Biotechnology Company, a Delaware corporation (the “Company”), due on April 5, 2007, into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Debentures to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Is conversion to be applied against next Monthly Redemption Payment and if so, what portion? (note failure to answer deemed entire portion to be applied) $_________ Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress: Schedule 1 CONVERSION SCHEDULE The 76% Original Issue Discount Senior Secured Convertible Debentures due on August 3January 27, 2021 2007, in the aggregate principal amount of $8,640,000 are ____________ issued by Vaccinex, Inc., a Delaware corporationGenerex Biotechnology Company. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Generex Biotechnology Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3May 20, 2021 2024 of VaccinexXxxx Xxxxxxx, Inc., a Delaware New York corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3May 20, 2021 2024 in the aggregate principal amount of $8,640,000 _________ are issued by VaccinexXxxx Xxxxxxx, Inc., a Delaware New York corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Enzo Biochem Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 76% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc.Generex Biotechnology Company, a Delaware corporation (the “Company”), due on May 20, 2007, into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Debentures to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Is conversion to be applied against next Monthly Redemption Payment and if so, what portion? (note failure to answer deemed entire portion to be applied) $_________ Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress: Schedule 1 CONVERSION SCHEDULE The 76% Original Issue Discount Senior Secured Convertible Debentures due on August 3May 20, 2021 2007, in the aggregate principal amount of $8,640,000 are ____________ issued by Vaccinex, Inc., a Delaware corporationGenerex Biotechnology Company. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Generex Biotechnology Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 3December 29, 2021 2023 of VaccinexHWN, Inc.Inc. (f/k/a Spectrum Global Solutions, Inc.., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule SCHEDULE 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion Schedule is part of, and reflects conversions made under Section 4 of, the Senior Secured Convertible Promissory Note, due on December 29, 2023, in the original principal amount of the above referenced Debenture$2,500,000 is issued by HWN, Inc. (f/k/a Spectrum Global Solutions, Inc.), a Delaware corporation. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest SCHEDULE 2(G) PAYMENT SCHEDULE1 Month Date Principal Interest If in Stock If in Cash Remaining Principal Closing 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1 To be replaced by Schedule A to Term Sheet.

Appears in 1 contract

Samples: Hwn, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 76% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc.Generex Biotechnology Company, a Delaware corporation (the “Company”), due on December 8, 2006 , into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Debentures to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Is conversion to be applied against next Monthly Redemption Payment and if so, what portion? (note failure to answer deemed entire portion to be applied) $_________ Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress: Schedule 1 CONVERSION SCHEDULE The 76% Original Issue Discount Senior Secured Convertible Debentures due on August 3December 8, 2021 2006, in the aggregate principal amount of $8,640,000 are ____________ issued by Vaccinex, Inc., a Delaware corporationGenerex Biotechnology Company. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Securities Purchase Agreement (Generex Biotechnology Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 [________ of VaccinexImmune Pharmaceuticals, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _______________ Account No: )____________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 [________ in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexImmune Pharmaceuticals, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Immune Pharmaceuticals Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3December 1, 2021 2014 of VaccinexLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3December 1, 2021 2014 in the aggregate principal amount of $8,640,000 1,008,000 are issued by VaccinexLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest EXHIBIT C NEITHER THIS SECURITY NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY. THIS SECURITY AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES. COMMON STOCK PURCHASE WARRANT LEGEND OIL AND GAS, LTD. Warrant Shares: _______ Initial Exercise Date: May _, 2013 THIS COMMON STOCK PURCHASE WARRANT (the “Warrant”) certifies that, for value received, _____________ or its assigns (the “Holder”) is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on or after May ___, 2013 (the “Initial Exercise Date”) and on or prior to the close of business on the five year anniversary of the Initial Exercise Date (the “Termination Date”) but not thereafter, to subscribe for and purchase from Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), up to ______ shares (as subject to adjustment hereunder, the “Warrant Shares”) of Common Stock. The purchase price of one share of Common Stock under this Warrant shall be equal to the Exercise Price, as defined in Section 2(b).

Appears in 1 contract

Samples: Security Agreement (Legend Oil & Gas, Ltd.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Secured Subordinated Original Issue Discount Senior Secured Convertible Debenture due August 3June __, 2021 2019 of Vaccinex, ReShape Lifesciences Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_______________ Account No: :______________ Schedule 1 CONVERSION SCHEDULE The 7% Secured Subordinated Original Issue Discount Senior Secured Convertible Debentures due on August 3June __, 2021 2019 in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, ReShape Lifesciences Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: ReShape Lifesciences Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7[___ % [Original Issue Discount [Senior [Secured Convertible Debenture due August 3, 2021 [________ of Vaccinex, Inc.[____________, a Delaware [____________ corporation (the “Company“ Company ”), into shares of common stock (the Common StockStock ”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________________ Account No: :___________________ Schedule 1 CONVERSION SCHEDULE The 7[____ % [Original Issue Discount [Senior [Secured Convertible Debentures due on August 3, 2021 [________ in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, Inc.[____________, a Delaware [________ corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Beyond Commerce

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Variable Rate Senior Secured Convertible Debenture due August 3January 31, 2021 2015 of VaccinexPeople’s Liberation, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_________ Account No: :________ Annex A Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Variable Rate Senior Secured Convertible Debentures due on August 3January 31, 2021 2015 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexPeople’s Liberation, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Peoples Liberation Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Ten Percent (10%) Senior Secured Collateralized Convertible Debenture Promissory Note due August 3July 1, 2021 2016 of VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: calculations Date to Effect Conversion: Conversion Principal Amount of Debenture Note to be Converted: Converted Payment of Interest in Common Stock $_____ yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: issued Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount /TPA This Ten Percent (10%) Senior Secured Collateralized Convertible Debentures Promissory Note due on August 3July 1, 2021 2016 in the aggregate original principal amount of $8,640,000 are 3,000,000 issued by VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest / Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest/

Appears in 1 contract

Samples: Xenetic Biosciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3November 30, 2021 2015 of Vaccinex, Inc.Victory Electronic Cigarettes Corporation., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Appendix A Amortization Schedule Transaction Amount Timing Funding: Amortization Payments First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment Eleventh Payment Twelfth Payment Schedule 1 CONVERSION SCHEDULE The 7This 5% Original Issue Discount Senior Secured Convertible Debentures Promissory Note due on August 3November 30, 2021 2015 in the aggregate original principal amount of $8,640,000 are _____________ is issued by Vaccinex, Inc.Victory Electronic Cigarettes Corporation., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Victory Electronic Cigarettes Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3__, 2021 2023 of VaccinexNovaBay Pharmaceuticals, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% This Original Issue Discount Senior Secured Convertible Debentures due on August 3________, 2021 2024 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexNovaBay Pharmaceuticals, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: NovaBay Pharmaceuticals, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 3July 7, 2021 2018 of VaccinexImmune Pharmaceuticals, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount This Senior Secured Convertible Debentures Promissory Note, due on August 3July 7, 2021 2018, in the aggregate original principal amount of $8,640,000 are 3,716,865.63 is issued by VaccinexImmune Pharmaceuticals, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest Schedule 2 On May 30, 2017, the Company received a summons from the bankruptcy court-liquidator to appear before the commercial court of Evry, France on September 19, 2017, relating to amounts due on a MabLife SAS loan for approximately $400,000. This has been disclosed in the Company’s Quarterly Report on Form 10-Q, filed with the Securities and Exchange Commission on June 14, 2017. HLHW IV LLC Convertible Note dated November 16, 2016, as amended, and Letter Agreement dated May 30, 2017.

Appears in 1 contract

Samples: Immune Pharmaceuticals Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 712% Original Issue Discount Senior Amended and Restated Secured Convertible Debenture due August 3December 31, 2021 2023 of Vaccinex, Inc.Prairie Operating Co., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $____Stock_ yes _ no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: No:- - - - - - - AccountNo:- - - - - - Schedule 1 CONVERSION SCHEDULE The 712% Original Issue Discount Amended and Restated Senior Secured Convertible Debentures Debenture due on August 3December 31, 2021 2023 in the aggregate principal amount of $8,640,000 are 1,000,000 is issued by Vaccinex, Inc.Prairie Operating Co., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Prairie Operating Co.

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NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and interest under the 715% Original Issue Discount Senior Secured Cumulative Convertible Debenture due August 3May ___, 2021 2013 of Vaccinex, Inc.Concentric Energy Corp., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ yes: o no: o If yes, $ of Interest Accrued on Account as of the Conversion at IssueDate. Number of shares of Common Stock to be issued: Signature: Name: Signature(s): Name(s): Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7Series A 15% Original Issue Discount Senior Secured Cumulative Convertible Debentures due on August 3May ___, 2021 2013 in the aggregate principal amount of $8,640,000 450,000 are issued by Vaccinex, Inc., a Delaware corporation. Concentric Energy Corp. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion Date of Conversion (or original (or for first entry, Amount of Principal Original Issue Date) Conversion Amount) Company Attest

Appears in 1 contract

Samples: Securities Purchase Agreement (Concentric Energy Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 320, 2021 2010 of Vaccinex, Blink Logic Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 320, 2021 2010 in the aggregate principal amount Principal Amount of $8,640,000 _______ are issued by Vaccinex, Blink Logic Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Blink Logic Inc.

NOTICE OF CONVERSION. (To be Executed by the Holder in order to Convert the Mandatory Convertible Preferred Stock) The undersigned hereby irrevocably elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc., a Delaware corporation (the “CompanyConversion”) 4.50% Mandatory Convertible Preferred Stock, Series A (the “Mandatory Convertible Preferred Stock”), of Crown Castle REIT Inc. (hereinafter called the “Corporation”), represented by stock certificate No(s). [ ] (the “Mandatory Convertible Preferred Stock Certificates”), into shares common stock, par value $0.01 per share, of common stock the Corporation (the “Common Stock”), of the Company ) according to the conditions hereofof the Certificate of Designations of the Mandatory Convertible Preferred Stock (the “Certificate of Designations”), as of the date written below. If shares of Common Stock are is to be issued in the name of a person Person other than the undersigned, the undersigned will shall pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxesthereto, if any. By Each Mandatory Convertible Preferred Stock Certificate (or evidence of loss, theft or destruction thereof) is attached hereto. Capitalized terms used but not defined herein shall have the delivery of this Notice of Conversion the undersigned represents and warrants meanings ascribed thereto in or pursuant to the Company that its ownership Certificate of Designations. Date of Conversion: Applicable Conversion Rate: Shares of the Common Mandatory Convertible Preferred Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares Shares of Common Stock to be issued: Issued:* Signature: Name: Address for Delivery of Address:** Fax No.: * The Corporation is not required to issue Common Stock Certificatesuntil the original Mandatory Convertible Preferred Stock Certificate(s) (or evidence of loss, theft or destruction thereof) to be converted are received by the Corporation or the Conversion and Dividend Disbursing Agent. ** Address where Common Stock and any other payments or certificates shall be sent by the Corporation. ASSIGNMENT FOR VALUE RECEIVED, the undersigned assigns and transfers the shares of the Mandatory Convertible Preferred Stock evidenced hereby to: Or DWAC Instructions(Insert assignee’s social security or taxpayer identification number, if any) (Insert address and zip code of assignee) and irrevocably appoints: Broker Noas agent to transfer the shares of the Mandatory Convertible Preferred Stock evidenced hereby on the books of the Transfer Agent. The agent may substitute another to act for him or her. Date: Account NoSignature: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due (Sign exactly as your name appears on August 3the other side of this Certificate) Signature Guarantee: (Signature must be guaranteed by an “eligible guarantor institution” that is a bank, 2021 stockbroker, savings and loan association or credit union meeting the requirements of the Transfer Agent, which requirements include membership or participation in the aggregate principal amount Securities Transfer Agents Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Transfer Agent in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of $8,640,000 are issued by Vaccinex1934, Inc.as amended.) Schedule I1 Crown Castle REIT Inc. Global Preferred Share 4.50% Mandatory Convertible Preferred Stock, a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 Series A Certificate Number: The number of shares of the above referenced DebentureMandatory Convertible Preferred Stock initially represented by this Global Preferred Share shall be [ ]. DatedThereafter the Transfer Agent and Registrar shall note changes in the number of shares of the Mandatory Convertible Preferred Stock evidenced by this Global Preferred Share in the table set forth below: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Decrease in Number of Shares Represented by this Global Preferred Share Amount Remaining Subsequent of Increase in Number of Shares Represented by this Global Preferred Share Number of Shares Represented by this Global Preferred Share following Decrease or Increase Signature of Authorized Officer of Transfer Agent and Xxxxxxxxx 0 Xxxxxx Xxxxxxxx I only to Conversion (or original Principal Amount) Company AttestGlobal Preferred Shares.

Appears in 1 contract

Samples: Agreement and Plan of Merger (Crown Castle International Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3June 14, 2021 2019 of VaccinexProgreen US, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ___________________ Account No: __________________ Schedule 1 CONVERSION SCHEDULE The 7% This Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3June 14, 2021 2018 in the aggregate original principal amount of $8,640,000 are 157,500 is issued by VaccinexProgreen US, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Original Principal Amount) Company Attest

Appears in 1 contract

Samples: Progreen US, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture due August 3June 25, 2021 of VaccinexGeoVax Labs, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 75% Original Issue Discount Senior Secured Convertible Debentures due on August 3June 25, 2021 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexGeoVax Labs, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: GeoVax Labs, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3December 28, 2021 2013 of VaccinexFirst Choice Healthcare Solutions, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________ Account No: :_____________ Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3December 28, 2021 2013 in the aggregate original principal amount of $8,640,000 2,320,000 are issued by VaccinexFirst Choice Healthcare Solutions, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion Date of Conversion (or original (or for first entry, Amount of Principal Original Issue Date) Conversion Amount) Company Attest

Appears in 1 contract

Samples: First Choice Healthcare Solutions, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3April 12, 2021 2017 of VaccinexSpiral Toys, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. and unpaid interest: Make-Whole Amount: Number of shares of Common Stock to be issued: Conversion Shares: Interest Conversion Shares (if any): Make-whole Shares (if any): Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures due on August 3April 12, 2021 2017 in the aggregate principal amount of $8,640,000 _______ are issued by VaccinexSpiral Toys, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Spiral Toys Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3Promissory Note, 2021 with an issue date of VaccinexMay 10, Inc.2022, a Delaware corporation of Eco Innovation Group, Inc. (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 10% Original Issue Discount Senior Secured Convertible Debentures due on August 3Promissory Note, 2021 with an issue date of May 10, 2022, in the aggregate original principal amount of $8,640,000 are 150,000 is issued by VaccinexEco Innovation Group, Inc., a Delaware corporationInc. (the “Company”). This Conversion Schedule with respect to the Common Stock of the Company reflects conversions made under Section 4 5 of the above above-referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount and Guaranteed Interest Remaining Subsequent to Conversion (or original Principal Amount) Company Company’s Attest

Appears in 1 contract

Samples: Eco Innovation Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior 8% Secured Convertible Debenture due August 3May ___, 2021 2010 of VaccinexEcotality, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior 8% Secured Convertible Debentures due on August 3May ___, 2021 2010 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexEcotality, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Ecotality, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3Promissory Note, 2021 with an issue date of Vaccinex____________________, Inc., a Delaware corporation of Principal Solar Inc. (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 10% Original Issue Discount Senior Secured Convertible Debentures due on August 3Promissory Note, 2021 with an issue date of ______________________, in the aggregate original principal amount of $8,640,000 are 150,000 is issued by VaccinexPrincipal Solar, Inc., a Delaware corporationInc. (the “Company”). This Conversion Schedule with respect to the Common Stock of the Company reflects conversions made under Section 4 5 of the above above-referenced DebentureNote. Dated: ____________________________ Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount and Guaranteed Interest Remaining Subsequent to Conversion (or original Principal Amount) Company Company’s Attest

Appears in 1 contract

Samples: Principal Solar, Inc.

NOTICE OF CONVERSION. The undersigned registered holder hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture due August 3January 16, 2021 2016 of Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation (the “Company”), No. R-71 (the “Debenture”) into shares of common stock (the “Common Stock”), ) of the Company according to in accordance with the terms and conditions hereofof the Debenture, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the undersigned registered holder of the Debenture for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Securities Laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 75% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3January 16, 2021 2016, No. R-71 in the aggregate original principal amount of $8,640,000 are 125,000 is issued by Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Converted Principal Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: PLC Systems Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7Amended and Restated 6% Original Issue Discount Senior Secured Convertible Debenture due August 3May 29, 2021 2019 of VaccinexxG Technology, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7Amended and Restated 6% Original Issue Discount Senior Secured Convertible Debentures due on August 3May 29, 2021 2019 in the aggregate principal amount of $8,640,000 _______________ are issued by VaccinexxG Technology, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: xG TECHNOLOGY, INC.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 712% Original Issue Discount Senior Secured Convertible Debenture due August 3December 30, 2021 2018 of VaccinexWizard World, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :___________ Account No: :_________ Schedule 1 CONVERSION SCHEDULE The 712% Original Issue Discount Senior Secured Convertible Debentures due on August 3December 30, 2021 2018 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexWizard World, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Wizard World, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3February 1, 2021 2017 of VaccinexPFO Global, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :________________ Account No: :________________________________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3February 1, 2021 2017 in the aggregate principal amount of $8,640,000 _________ are issued by VaccinexPFO Global, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: PFO Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3October 15, 2021 2014 of VaccinexSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures due on August 3October 15, 2021 2014 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexSG Blocks, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned registered holder hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture due August 3January 16, 2021 2016 of Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation (the “Company”), No. R-72 (the “Debenture”) into shares of common stock (the “Common Stock”), ) of the Company according to in accordance with the terms and conditions hereofof the Debenture, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the undersigned registered holder of the Debenture for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Securities Laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 75% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3January 16, 2021 2016, No. R-72 in the aggregate original principal amount of $8,640,000 are 125,000 is issued by Vaccinex, PLC Systems Inc., a Delaware Yukon Territory corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Converted Principal Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: PLC Systems Inc

NOTICE OF CONVERSION. (To be Executed by the Holder in Order to Convert 6.75% Series A Convertible Preferred Stock) The undersigned hereby irrevocably elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 of Vaccinex, Inc., a Delaware corporation (the “CompanyConversion”) 6.75% Series A Convertible Preferred Stock (the “Series A Convertible Preferred Stock”), of Albertsons Companies, Inc. (hereinafter called the “Corporation”), represented by stock certificate No(s). [ ] (the “Series A Convertible Preferred Stock Certificates”), into shares Class A Non-Voting Common Stock, par value $0.01 per share, of common stock the Corporation (the “Common Stock”), of the Company ) according to the conditions hereofof the Certificate of Designations of Series A Convertible Preferred Stock (the “Certificate of Designations”), as of the date written below. If shares of Common Stock are is to be issued in the name of a person Person other than the undersigned, the undersigned will shall pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxesthereto, if any. By Each Series A Convertible Preferred Stock Certificate (or evidence of loss, theft or destruction thereof) is attached hereto. Capitalized terms used but not defined herein shall have the delivery of this Notice of Conversion the undersigned represents and warrants meanings ascribed thereto in or pursuant to the Company that its ownership Certificate of the Common Stock does not exceed the amounts specified under Section 4 Designations. Date of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount Applicable Conversion Rate: Shares of Debenture Series A Convertible Preferred Stock to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares Shares of Common Stock to be issued: Issued:* Signature: Name: Address for Delivery of Address:** Fax No.: * The Corporation is not required to issue Common Stock Certificatesuntil the original Series A Convertible Preferred Stock Certificate(s) (or evidence of loss, theft or destruction thereof) to be converted are received by the Corporation or the Conversion and Dividend Disbursing Agent. ** Address where Common Stock and any other payments or certificates shall be sent by the Corporation. ASSIGNMENT FOR VALUE RECEIVED, the undersigned assigns and transfers the shares of 6.75% Series A Convertible Preferred Stock evidenced hereby to: Or DWAC Instructions(Insert assignee’s social security or taxpayer identification number, if any) (Insert address and zip code of assignee) and irrevocably appoints: Broker Noas agent to transfer the shares of 6.75% Series A Convertible Preferred Stock evidenced hereby on the books of the Transfer Agent. The agent may substitute another to act for him or her. Date: Account NoSignature: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due (Sign exactly as your name appears on August 3the other side of this Certificate) Signature Guarantee: (Signature must be guaranteed by an “eligible guarantor institution” that is a bank, 2021 stockbroker, savings and loan association or credit union meeting the requirements of the Transfer Agent, which requirements include membership or participation in the aggregate principal amount Securities Transfer Agents Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Transfer Agent in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of $8,640,000 are issued by Vaccinex1934, as amended.) Exhibit D Form of Charter Amendment AMENDED & RESTATED CERTIFICATE OF INCORPORATION OF ALBERTSONS COMPANIES, INC. Albertsons Companies, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made corporation organized and existing under Section 4 the laws of the above referenced Debenture. Dated: Date State of Conversion (or for first entryDelaware, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attesthereby certifies as follows:

Appears in 1 contract

Samples: Registration Rights Agreement (Albertsons Companies, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 73% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3January 8, 2021 2016 of VaccinexNAC Global Technologies, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 3% Original Issue Discount Senior Secured Convertible Debentures Promissory Note due on August 3January 8, 2021 2016 in the aggregate original principal amount of $8,640,000 are 100,000 is issued by VaccinexNAC Global Technologies, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Nac Global Technologies, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7Series B 10% Original Issue Discount Senior Secured Unsecured Convertible Redeemable Debenture due August 3___, 2021 2014 of Vaccinex, Trunity Holdings Inc., a Delaware corporation (the “Company”) in the original principal amount of $__________ (the "Debenture"), into shares of common stock (the “Common Stock”), Units of the Company Company, each Unit consisting of one share of Common Stock and a Warrant to purchase a share of Common Stock for $.40 per share, according to the conditions hereof, as of the date written below. If shares of Common Stock and Warrants are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By Capitalized terms not otherwise defined herein shall have the delivery of this Notice of Conversion meanings set forth in the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock and Warrants to be issued: Signature: Name: Address for Delivery of Common Stock and Warrant Certificates: Or DWAC Instructions: Broker No: Account No: ANNEX B FORM OF WARRANT Schedule 1 CONVERSION SCHEDULE The 7Series B 10% Original Issue Discount Senior Secured Unsecured Convertible Debentures Redeemable Debenture due on August 3___, 2021 2014 in the aggregate original principal amount of $8,640,000 are ____________ is issued by Vaccinex, Trunity Holdings Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest EXHIBIT “C” FORM OF WARRANT NEITHER THIS WARRANT NOR THE WARRANT STOCK (AS HEREINAFTER DEFINED) HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF ANY STATE. THIS WARRANT AND THE WARRANT STOCK MAY BE TRANSFERRED ONLY IN COMPLIANCE WITH THE ACT AND SUCH LAWS. THIS LEGEND SHALL BE ENDORSED UPON ANY WARRANT ISSUED IN EXCHANGE FOR THIS WARRANT. Warrant No. ____ WARRANT For the Purchase of Common Stock of TRUNITY HOLDINGS, INC. a Delaware corporation VOID AFTER 5:00 P.M., EASTERN STANDARD TIME, ON _____________, ______. _______ Shares ___________, _____ FOR VALUE RECEIVED, TRUNITY HOLDINGS, INC., a Delaware corporation (the “Company”), hereby certifies that _____________, an individual (the “Holder”) is entitled, subject to the provisions of this warrant (“Warrant”), to purchase from the Company up to 50,000 shares of common stock (the “Common Shares”), par value $0.0001 per share (the “Common Stock”), of the Company at an exercise price per Common Share equal to $0.40 per Common Share (the “Exercise Price”), during the period commencing on the date hereof and expiring at 5:00 P.M., Eastern Standard time, on ____________, _______.

Appears in 1 contract

Samples: Subscription Agreement (Trunity Holdings, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects If you want to convert this Security into Common Stock of the Company, check the box: ¨ To convert only part of this Security, state the principal under amount to be converted (which must be $1,000 or a multiple of $1,000): $ If you want the 7stock certificate, if any, made out in another person’s name, fill in the form below: (Insert other person’s social security or tax ID no.) (Print or type other person’s name, address and zip code) Date: Signed: (Sign exactly as your name appears on the other side of this Security) Signature Guarantee: Note: Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Security Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Security Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended. FORM OF FUNDAMENTAL CHANGE REPURCHASE NOTICE , The Bank of New York Mellon Trust Company, N.A. 000 Xxxxx Xxxxxx Xxxxxx, Xxxxx 000 Xxx Xxxxxxx, Xxxxxxxxxx 00000 Attention: Corporate Finance Unit Re: Rovi Corporation (the “Company”) 2.625% Original Issue Discount Convertible Senior Secured Convertible Debenture Notes due August 32040 This is a Fundamental Change Repurchase Notice as defined in Section 7.01(a)(i) of the Indenture dated as of March 17, 2021 2010 (the “Indenture”) between the Company and the Bank of VaccinexNew York Mellon Trust Company, Inc.N.A., a Delaware corporation as Trustee. Terms used but not defined herein shall have the meanings ascribed to them in the Indenture. Certificate No(s). of Securities: I intend to deliver the following aggregate principal amount of Securities for purchase by the Company pursuant to Section 7.01 of the Indenture (in multiples of $1,000): $ I hereby agree that the Securities will be purchased as of the Fundamental Change Repurchase Date pursuant to the terms and conditions thereof and of the Indenture. Date: Signed: (Sign exactly as your name appears on the other side of this Security) Signature Guarantee: Note: Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Security Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Security Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended. FORM OF REPURCHASE ELECTION NOTICE , The Bank of New York Mellon Trust Company, N.A. 000 Xxxxx Xxxxxx Xxxxxx, Xxxxx 000 Xxx Xxxxxxx, Xxxxxxxxxx 00000 Attention: Corporate Finance Unit Re: Rovi Corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Rovi Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture Note due August 3________ ___, 2021 of Vaccinex2018 issued by Guided Therapeutics, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _____________________________ Account No: ______________________________ Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures Note due on August 3__________ ___, 2021 2018 in the aggregate original principal amount of $8,640,000 ____________ are issued by VaccinexGuided Therapeutics, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Converted Principal Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Applicable Conversion Price Company Attest

Appears in 1 contract

Samples: Guided Therapeutics Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due August 3February 11, 2021 of Vaccinex, Inc.KBL Merger Corp. IV., a Delaware corporation (the “Company”), into shares of common stock stock, $0.0001 par value per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule SCHEDULE 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures due on August 3, 2021 in the aggregate principal amount of $8,640,000 are issued by Vaccinex, Inc., a Delaware corporation. This Conversion Schedule is part of, and reflects conversions made under Section 4 of, the 10% Senior Secured Convertible Promissory Note, due on February 11, 2021, in the original principal amount of the above referenced Debenture$ is issued by KBL Merger Corp. IV, a Delaware corporation. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: KBL Merger Corp. Iv

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7[___ % [Original Issue Discount [Senior [Secured Convertible Debenture due August 3, 2021 [________ of Vaccinex, Inc.[____________, a Delaware [____________ corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: __________________ Account No: :__________________ Schedule 1 CONVERSION SCHEDULE The 7[____ % [Original Issue Discount [Senior [Secured Convertible Debentures due on August 3, 2021 [________ in the aggregate principal amount of $8,640,000 ____________ are issued by Vaccinex, Inc.[____________, a Delaware [________ corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Beyond Commerce

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Ten Percent (10%) Senior Secured Collateralized Convertible Debenture Promissory Note due August 3, 2021 on the Outside Date of VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :____________ Account No: :__________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount This Ten Percent (10%) Senior Secured Collateralized Convertible Debentures Promissory Note due on August 3, 2021 the Outside Date in the aggregate original principal amount of $8,640,000 are 3,000,000 issued by VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Xenetic Biosciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3, 2021 [•] of Vaccinex, Inc., a Delaware corporation Premier Biomedical Inc. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures Promissory Note due on August 3, 2021 [•] in the aggregate original principal amount of $8,640,000 are [•] is issued by Vaccinex, Inc., a Delaware corporation. Premier Biomedical Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Securities Purchase Agreement (Premier Biomedical Inc)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3December __, 2021 2015 of Vaccinex, Inc.Vapor Corp., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% This Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3December __, 2021 2015 in the aggregate original principal amount of $8,640,000 are _______ is issued by Vaccinex, Inc.Vapor Corp., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Vapor Corp.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture Note due August 3December 11, 2021 2015 of VaccinexxG Technology, Inc., a Delaware corporation Inc. (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company ) according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By After giving effect to the delivery of conversion provided for in this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that (together with its ownership Affiliates) will beneficially own no more than ___________________ shares of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange ActStock. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures Note due on August 3December 11, 2021 2015 in the aggregate original principal amount of $8,640,000 are [____] is issued by VaccinexxG Technology, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: xG TECHNOLOGY, INC.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3November ___, 2021 2015 of VaccinexCapital Growth Systems, Inc., a Delaware Florida corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Manner in which Conversion is to be Applied to Subsequent Quarterly Redemption Amounts and/or Principal Amount of Debenture: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3November ___, 2021 2015 in the aggregate original principal amount of $8,640,000 are ____________ is issued by VaccinexCapital Growth Systems, Inc., a Delaware Florida corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Capital Growth Systems Inc /Fl/

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Ten Percent (10%) Senior Secured Collateralized Convertible Debenture Promissory Note due August 3October 1, 2021 2016 of VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :____________ Account No: :__________ Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount This Ten Percent (10%) Senior Secured Collateralized Convertible Debentures Promissory Note due on August 3October 1, 2021 2016 in the aggregate original principal amount of $8,640,000 are 3,000,000 issued by VaccinexXenetic Biosciences, Inc., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Xenetic Biosciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3January 17, 2021 2016 of VaccinexElectronic Cigarettes International Group, Inc.Ltd., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Appendix A Amortization Schedule Transaction Amount Timing Funding: $ July 17, 2014 Amortization Payments First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment Eleventh Payment Twelfth Payment Thirteenth Payment Fourteenth Payment Fifteenth Payment Sixteenth Payment Schedule 1 CONVERSION SCHEDULE The 7This 5% Original Issue Discount Senior Secured Convertible Debentures Promissory Note due on August 3January 17, 2021 2016 in the aggregate original principal amount of $8,640,000 are $ is issued by VaccinexElectronic Cigarettes International Group, Inc.Ltd., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest ELECTRONIC CIGARETTES INTERNATIONAL GROUP, LTD. July 17, 2014 To , Reference is made to that certain Exchange Agreement, dated July 17, 2014, by and between ELECTRONIC CIGARETTES INTERNATIONAL GROUP, LTD., a Nevada corporation (“ECIG” or the “Company”), and (the “Holder”) (the “Exchange Agreement”), pursuant to which the Company exchanged certain Term Notes of the Company held by the Holder for a convertible note issued by the Company (the “Convertible Note”) and a warrant to purchase common stock of the Company (the “Warrant”). Capitalized terms not defined herein shall have the meaning as set forth in the Convertible Note. The Company hereby acknowledges and agrees that, upon certain conditions of the Company, the Amortization Schedule of the Convertible Note issued to Holder pursuant to the exchange of the Term Note may be accelerated as detailed below. The Holder shall have the right, at any time thereafter at the Holder’s sole option, by delivery of written notice to the Company (the “Acceleration Election Notice”) to amend section 2(d) of the Convertible Note by adding the following to the end: Notwithstanding anything herein to the contrary, if the Holder delivers an Acceleration Election Notice (as defined in that certain letter agreement, dated July 17, 2014, by and between the Company and the Holder) to the Company (such date, the “Acceleration Date”), then on each Amortization Payment Date from and after the Acceleration Date, the applicable Amortization Payment shall equal either (1) the lesser of (x) 5/16th of the face amount of this Note and interest, (y) the remaining face amount of this Note and interest or (2) an Amortization amount to be mutually agreed upon in written by both parties. Except as specifically provided herein, nothing herein shall be deem to amend or waive any term of the Exchange Agreement, the Convertible Note or the Warrant. This letter Agreement may be executed simultaneously in any number of counterparts. Each counterpart shall be deemed to be an original, and all such counterparts shall constitute one and the same instrument. This letter agreement may be executed and accepted by facsimile signature and any such signature shall be of the same force and effect as an original signature. The terms of this letter agreement shall be binding upon and shall inure to the benefit of each of the Company and the Holder and their respective successors and assigns. This letter agreement may not be amended or modified except in writing signed by each of the Company and the Holder. All questions concerning the construction, validity, enforcement and interpretation of this letter agreement shall be governed by the internal laws of the State of New York, without giving effect to any choice of law or conflict of law provision or rule (whether of the State of New York or any other jurisdictions) that would cause the application of the laws of any jurisdictions other than the State of New York. Each party hereby irrevocably submits to the exclusive jurisdiction of the state and federal courts sitting in The City of New York, Borough of Manhattan, for the adjudication of any dispute hereunder or in connection herewith or with any transaction contemplated hereby or discussed herein, and hereby irrevocably waives, and agrees not to assert in any suit, action or proceeding, any claim that it is not personally subject to the jurisdiction of any such court, that such suit, action or proceeding is brought in an inconvenient forum or that the venue of such suit, action or proceeding is improper. Each party hereby irrevocably waives personal service of process and consents to process being served in any such suit, action or proceeding by mailing a copy thereof to such party at the address for such notices to it under this letter agreement and agrees that such service shall constitute good and sufficient service of process and notice thereof. Nothing contained herein shall be deemed to limit in any way any right to serve process in any manner permitted by law. Nothing contained herein shall be deemed to limit in any way any right to serve process in any manner permitted by law. Each party hereby irrevocably waives any right it may have, and agrees not to request, a jury trial for the adjudication of any dispute hereunder or in connection with or arising out of this letter agreement or any transaction contemplated hereby. Very truly yours, Agreed to by on the date first here written: Electronic Cigarettes International Group, Ltd. By: Name: Xxxxx Xxxxx Xxxxxx Title: Chairman and Chief Executive Officer Acknowledged by: By: Name:

Appears in 1 contract

Samples: Electronic Cigarettes International Group, Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 710% Original Issue Discount Senior Secured Convertible Debenture due August 3December 30, 2021 2010 of VaccinexT3 Motion, Inc., a Delaware corporation (the “Company”), into shares of common stock Series A Preferred Stock (the “Common Series A Preferred Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Series A Preferred Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Series A Preferred Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Series A Preferred Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Convertedconverted: Payment of Interest in Common Series A Preferred Stock o yes o no (as determined by the Company) If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Series A Preferred Stock to be issued: Signature: Name: Address for Delivery of Common Series A Preferred Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 710% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3December 30, 2021 2010 in the aggregate original principal amount of $8,640,000 are ___ is issued by VaccinexT3 Motion, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion Date of Conversion (or original (or for first entry, Amount of Principal Original Issue Date) Conversion Amount) Company Attest

Appears in 1 contract

Samples: T3 Motion, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 75% Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 3January 17, 2021 2016 of VaccinexElectronic Cigarettes International Group, Inc.Ltd., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Appendix A Amortization Schedule Transaction Amount Timing Funding: $ July 17, 2014 Amortization Payments First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment Eleventh Payment Twelfth Payment Thirteenth Payment Fourteenth Payment Fifteenth Payment Sixteenth Payment Schedule 1 CONVERSION SCHEDULE The 7This 5% Original Issue Discount Senior Secured Convertible Debentures Promissory Note due on August 3January 17, 2021 2016 in the aggregate original principal amount of $8,640,000 are $ is issued by VaccinexElectronic Cigarettes International Group, Inc.Ltd., a Delaware Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced DebentureNote. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Exchange Agreement (Electronic Cigarettes International Group, Ltd.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount Senior Secured Convertible Debenture due August 3, 2021 _________ of VaccinexPressure BioSciences, Inc., a Delaware corporation (the “Company”), into shares of common stock stock, par value $0.01 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3July 21, 2021 2017, 2015 in the aggregate original principal amount of $8,640,000 are $ is issued by VaccinexPressure BioSciences, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Debenture Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Pressure Biosciences Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount 5% Senior Secured Convertible Debenture due August 3May ___, 2021 2010 of VaccinexWiFiMed Holdings Company, Inc., a Delaware Nevada corporation (the "Company"), into shares of common stock (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount 5% Senior Secured Convertible Debentures due on August 3May ___, 2021 2010 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexWiFiMed Holdings Company, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Wifimed Holdings Company, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 7% Original Issue Discount 5% Senior Secured Convertible Debenture due August 3May 30, 2021 2010 of VaccinexWiFiMed Holdings Company, Inc., a Delaware Nevada corporation (the "Company"), into shares of common stock (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 7% Original Issue Discount 5% Senior Secured Convertible Debentures due on August 3May 30, 2021 2010 in the aggregate principal amount of $8,640,000 ____________ are issued by VaccinexWiFiMed Holdings Company, Inc., a Delaware corporation. Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Wifimed Holdings Company, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3April 1, 2021 2016 of VaccinexSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :______________________ Account No: :_____________________ Schedule 1 CONVERSION SCHEDULE The 7This 8% Original Issue Discount Senior Secured Convertible Debentures due on August 3April 1, 2021 2016 in the aggregate original principal amount of $8,640,000 are ________ is issued by VaccinexSG Blocks, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 72.25% Original Issue Discount Series A Senior Secured Convertible Debenture due August 3June 22, 2021 2020 of VaccinexMELA Sciences, Inc., a Delaware corporation (the “Company”), into shares of common stock Common Stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of common stock of the Common Stock Company does not exceed the amounts specified under Section 4 of this Series A Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Series A Debenture to be Converted: Payment of Interest in Common Stock ____ yes _____ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ________________ Account No: :________________ Schedule 1 CONVERSION SCHEDULE The 72.25% Original Issue Discount Series A Senior Secured Convertible Debentures due on August 3June 22, 2021 2020 in the aggregate principal amount of $8,640,000 __________ are issued by VaccinexMELA Sciences, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Series A Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: Mela Sciences, Inc. /Ny

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3April 1, 2021 2016 of VaccinexLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures due on August 3April 1, 2021 2016 in the aggregate principal amount of $8,640,000 448,000 are issued by VaccinexLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company AttestAttest EXHIBIT C NEITHER THIS SECURITY NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY. THIS SECURITY AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES. COMMON STOCK PURCHASE WARRANT LEGEND OIL AND GAS, LTD. Warrant Shares: 117,600,000 Initial Exercise Date: May 29, 2014 THIS COMMON STOCK PURCHASE WARRANT (the “Warrant”) certifies that, for value received, HILLAIR CAPITAL INVESTMENTS L.P. or its assigns (the “Holder”) is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on or after May 29, 2014 (the “Initial Exercise Date”) and on or prior to the close of business on the five (5) year anniversary of the Share Reservation Date (the “Termination Date”) but not thereafter, to subscribe for and purchase from Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), up to 117,600,000 shares (as subject to adjustment hereunder, the “Warrant Shares”) of Common Stock, provided that, in the event that the Share Reservation Date shall not occur, the Termination Date of this Warrant shall be May 29, 2024. The purchase price of one share of Common Stock under this Warrant shall be equal to the Exercise Price, as defined in Section 2(b).

Appears in 1 contract

Samples: Securities Purchase Agreement (Legend Oil & Gas, Ltd.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 78% Original Issue Discount Senior Secured Convertible Debenture due August 3February 1, 2021 2015 of Vaccinex, Inc.NEW WESTERN ENERGY CORPORATION, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: Schedule 1 CONVERSION SCHEDULE The 78% Original Issue Discount Senior Secured Convertible Debentures Debenture due on August 3February 1, 2021 2015 in the aggregate original principal amount of $8,640,000 are 1,232,000 is issued by Vaccinex, Inc., a Delaware corporationNEW WESTERN ENERGY CORPORATION. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest

Appears in 1 contract

Samples: New Western Energy Corp

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