Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 79 contracts

Samples: Representative’s Warrant Agreement (Venu Holding Corp), Placement Warrant Agreement (Invizyne Technologies Inc), Underwriting Agreement (Better Choice Co Inc.)

Appears in 14 contracts

Samples: Underwriting Agreement (Venu Holding Corp), Underwriting Agreement (Sidus Space Inc.), Underwriting Agreement (Sidus Space Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] ~~shares~~ ADSs of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 11 contracts

Samples: Placement Agency Agreement (Nano Dimension Ltd.), Placement Agency Agreement (Nano Dimension Ltd.), Placement Agency Agreement (Nano Dimension Ltd.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 11 contracts

Samples: Placement Agent Warrant (Qualigen Therapeutics, Inc.), Underwriting Agreement (Alta Global Group LTD), Placement Agent Warrant (Qualigen Therapeutics, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 11 contracts

Samples: Security Agreement (Meridian Waste Solutions, Inc.), Security Agreement (Meridian Waste Solutions, Inc.), Security Agreement (Meridian Waste Solutions, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 11 contracts

Samples: Underwriting Agreement (Innovation Beverage Group LTD), Underwriting Agreement (Tharimmune, Inc.), Representative’s Warrant Agreement (Tharimmune, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 10 contracts

Samples: Underwriting Agreement (EzFill Holdings Inc), Underwriting Agreement (BriaCell Therapeutics Corp.), Warrant Agreement (BriaCell Therapeutics Corp.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of ~~Investing Entity~~Warrant Holder: ________________________________________________________________________ Signature of Authorized Signatory of ~~Investing Entity~~Warrant Holder: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 9 contracts

Samples: Warrant Agreement (Kingold Jewelry, Inc.), Common Stock Purchase Warrant (Bioxytran, Inc), Common Stock Purchase Warrant (Bioxytran, Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______________________________________________________________~~ Signature of Authorized Signatory of Investing Entity: ~~_________________________________________~~ Name of Authorized Signatory: ~~___________________________________________________________~~ Title of Authorized Signatory: ~~____________________________________________________________~~ Date: ~~________________________________________________________________________________~~ (To assign the foregoing warrant, execute this form and supply required information. Do not use this form to exercise the warrant.) FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 7 contracts

Samples: Securities Purchase Agreement (Ads in Motion, Inc.), Security Agreement (Ads in Motion, Inc.), Security Agreement (Ads in Motion, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: __________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 6 contracts

Samples: Underwriting Agreement (Forza X1, Inc.), Underwriting Agreement (EzFill Holdings Inc), Underwriting Agreement (EzFill Holdings Inc)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 5 contracts

Samples: Warrant Agreement (Perfect Moment Ltd.), Underwriting Agreement (Rise Oil & Gas, Inc.), Underwriting Agreement (Azitra Inc)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ____________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ______________________________________________________________________________ Name of Authorized Signatory: ________________________________________________________________________________________________ Title of Authorized Signatory: _________________________________________________________________________________________________ Date: ____________________________________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 4 contracts

Samples: Underwriting Agreement (Virios Therapeutics, LLC), Underwriting Agreement (Catasys, Inc.), Underwriting Agreement (Catasys, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Placement Agent Warrant (Akers Biosciences Inc), Placement Agent Warrant (Toughbuilt Industries, Inc), Warrant to Purchase Common Stock (LabStyle Innovations Corp.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Rule 501(a) of Regulation D D, promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, ___________ Holder’s Signature: _______________________________ Holder’s Address: _______________________________ _______________________________ Signature Guaranteed: ___________________________________________

Appears in 3 contracts

Samples: Common Stock Purchase Warrant (Enochian Biosciences Inc), Common Stock Purchase Warrant (Theralink Technologies, Inc.), Common Stock Purchase Warrant (Amesite Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] ~~Name of Investing Entity: _______________________________________________________________~~ Signature of Authorized Signatory of Investing Entity: ~~_________________________________________~~ Name of Authorized Signatory: ~~___________________________________________________________~~ Title of Authorized Signatory: ~~____________________________________________________________~~ Date: ~~________________________________________________________________________________~~ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Warrant Amendment Agreement (Wisa Technologies, Inc.), Placement Agent Agreement (Wisa Technologies, Inc.), Underwriting Agreement (Vision Marine Technologies Inc.)

Accredited Investor. If the Warrant is being exercised via cash ~~exercise~~exercise and no registration statement covering the issuance of the Warrant Shares is effective, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Representative’s Warrant Agreement (Silynxcom Ltd.), Warrant Agreement (Sushi Ginza Onodera, Inc.), Representative’s Warrant Agreement (Silynxcom Ltd.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _____________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _______________________________________________________________________________ Name of Authorized Signatory: _________________________________________________________________________________________________ Title of Authorized Signatory: __________________________________________________________________________________________________ Date: _____________________________________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Representative’s Warrant Agreement (Odd Burger Corp), Warrant Agreement (Nuvectis Pharma, Inc.), Representative’s Warrant Agreement (Vallon Pharmaceuticals, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________~~ Name of Authorized Signatory: ~~___________________________________________________________~~ Title of Authorized Signatory: ~~____________________________________________________________ Date: ________________________________________________________________________________~~ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Underwriting Agreement (Lirum Therapeutics, Inc.), Underwriting Agreement (Lirum Therapeutics, Inc.), Underwriting Agreement (Lirum Therapeutics, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 3 contracts

Samples: Placement Agent Warrant (RedHill Biopharma Ltd.), Warrant Agreement (RedHill Biopharma Ltd.), Placement Agent Warrant (RedHill Biopharma Ltd.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended [~~amended. SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______~~________________________________________________________ Signature of Authorized Signatory of Investing Entity: __________________________________~~______~~_ Name of Authorized Signatory: ___________________________________________________~~_______~~_ Title of Authorized Signatory: ~~_______~~_____________________________________________________ Date: ________________________________________________________________________~~_______~~_ FOR VALUE RECEIVED, ~~[____] all of or [_______] shares of~~ the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 3 contracts

Samples: Warrant Agreement (OverNear, Inc.), Warrant Agreement (OverNear, Inc.), Warrant Agreement (OverNear, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Rule 501(a) of Regulation D D, promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ ~~Signature of Authorized Signatory of Investing Entity:~~ _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, ___________ Holder’s Signature: _______________________________ Holder’s Address: _______________________________ _______________________________ Signature Guaranteed: ___________________________________________

Appears in 2 contracts

Samples: Common Stock Purchase Warrant (Theralink Technologies, Inc.), Common Stock Purchase Warrant (Theralink Technologies, Inc.)

Appears in 2 contracts

Samples: Warrant Agreement (T1V, Inc.), Warrant Agreement (T1V, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to ~~_________~~Name: ______________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s (Please Print) Address~~: _____________________________ _____________________________~~:

Appears in 2 contracts

Samples: Placement Agent Warrant (RedHill Biopharma Ltd.), Warrant Agreement (RedHill Biopharma Ltd.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________~~_ Date:~~ ________~~______________~~_ Date: __________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Rennova Health, Inc.), Underwriting Agreement (Rennova Health, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _______________________________________________________________________________________ Name of Authorized Signatory: _________________________________________________________________________________________________________ Title of Authorized Signatory: __________________________________________________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to~~ _______________________________________________ ~~whose address is~~ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ______________________________________ (Please Print) Address: _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Securities Agreement (Midatech Pharma PLC), Securities Agreement (Midatech Pharma PLC)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ Signature Guaranteed: ___________________________________________

Appears in 2 contracts

Samples: Securities Purchase Agreement (Ortec International Inc), Security Agreement (HyperSpace Communications, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ____________________________________________________________ Title of Authorized Signatory: _____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Biovie Inc.), Underwriting Agreement (Biovie Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________~~ Name of Authorized Signatory: ~~___________________________________________________________~~ Title of Authorized Signatory: ~~____________________________________________________________~~ Date: ~~________________________________________________________________________________~~ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ ___________~~__________________~~

Appears in 2 contracts

Samples: Underwriting Agreement (MAIA Biotechnology, Inc.), Underwriting Agreement (MAIA Biotechnology, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended [SIGNATURE OF HOLDER]~~ amended. Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [___________] all of or [____________] shares of the foregoing Series B Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 2 contracts

Samples: Securities Agreement (Phytomedical Technologies Inc), Securities Agreement (Phytomedical Technologies Inc)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________________ Name of Authorized Signatory: ___________________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________________ Date: _______________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Apimeds Pharmaceuticals US, Inc.), Underwriting Agreement (Apimeds Pharmaceuticals US, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______________~~________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________~~___________________~~_ Name of Authorized Signatory: ~~____________________________~~_______________________________ Title of Authorized Signatory: ________________________________________~~___________________~~_ Date: ~~______________~~__________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 2 contracts

Samples: Security Agreement (Protea Biosciences Group, Inc.), Exchange Agreement (Protea Biosciences Group, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ___________________________________________________________________________ Name of Authorized Signatory: _____________________________________________________________________________________________ Title of Authorized Signatory: ______________________________________________________________________________________________ Date: _________________________________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Towerstream Corp), Underwriting Agreement (Towerstream Corp)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] ~~Name~~ Signature of Authorized Signatory of Investing Entity: ____________________________________________________~~__________~~_ ~~Signature~~ Name of Authorized ~~Signatory of Investing Entity~~Signatory: ____________~~_____________________________ Name of Authorized Signatory:~~ ___________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: ______________________________ _______________________________

Appears in 2 contracts

Samples: Purchase Warrant Agreement (SQL Technologies Corp.), Representative’s Warrant Agreement (SQL Technologies Corp.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: :________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Warrant Agreement (SIMPLICITY ESPORTS & GAMING Co), Warrant Agreement (SIMPLICITY ESPORTS & GAMING Co)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _____________________________________________________~~_________~~_ Signature of Authorized Signatory of Investing Entity: ______________________________~~__________~~_ Name of Authorized Signatory: ~~___________~~________________________________________________ Title of Authorized Signatory: ___________________________________________________~~________~~_ Date: ~~__________~~______________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Innovation Beverage Group LTD), Underwriting Agreement (Innovation Beverage Group LTD)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Representative’s Warrant Agreement (CytoMed Therapeutics LTD), Representative’s Warrant Agreement (Vivakor, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ___________________________________________________ Name of Authorized Signatory: _____________________________________________________________________ Title of Authorized Signatory: ______________________________________________________________________ Date: _________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (CEA Industries Inc.), Underwriting Agreement (Immuron LTD)

Accredited Investor. If the Underwriter’s Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________~~________~~_ Signature of Authorized Signatory of Investing Entity: ~~________~~_________________________________ Name of Authorized Signatory: __________________________________________________~~________~~_ Title of Authorized Signatory: ~~________~~____________________________________________________ Date: _______________________________________________________________________~~________~~_ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Underwriter’s Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Underwriting Agreement (Harbor Custom Development, Inc.), Underwriting Agreement (Harbor Custom Development, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________~~_________________________________________ Signature of Authorized Signatory of Investing Entity:~~ _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 2 contracts

Samples: Representative’s Warrant Agreement (Second Sight Medical Products Inc), Underwriting Agreement (Second Sight Medical Products Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] _ all of or [_______] _ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 2 contracts

Samples: Security Agreement (Staffing 360 Solutions, Inc.), Security Agreement (Peoples Liberation Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated~~Date: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (CrowdGather, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________ Signature of Authorized Signatory of Investing Entity: __________________________________________ Name of Authorized Signatory: ____________________________________________________________ Title of Authorized Signatory: _____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Placement Agent Warrant (Marizyme, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended [SIGNATURE OF HOLDER]~~ amended. Name of Investing Entity: _________________________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _______________________________________________________________________________________ Name of Authorized Signatory: _______________________________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________~~_ Date: ____________________________________________________~~____________________________ Date: __________________ (To assign the foregoing warrant, execute this form and supply required information. Do not use this form to exercise the warrant.) FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ___________________________________________________________________ whose address is _______________________________________________________________________________________. _______________________________________________________________________________________ Dated: ______________, _______ Holder’s Signature: ____________________________________________ Holder’s Address: ____________________________________________ ____________________________________________ Signature Guaranteed: ___________________________________________________________

Appears in 1 contract

Samples: Securities Agreement (Sionix Corp)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Id-Confirm, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Draganfly Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: _______________, _______ Holder’s 's Signature: _________________________________ Holder’s 's Address: __________________________________ __________________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Common Stock Purchase Warrant (Indoor Harvest Corp)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________~~___~~_ ~~Signature of Authorized Signatory of Investing Entity:~~ _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Invizyne Technologies Inc)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________ Signature of Authorized Signatory of Investing Entity: __________________________________________ Name of Authorized Signatory: ____________________________________________________________ Title of Authorized Signatory: _____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Snow Lake Resources Ltd.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Security Agreement (Lilis Energy, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, ______~~_ Holder’s Signature: ________________________~~_____ Holder’s Signature: Holder’s Address~~: _____________________________ _____________________________~~:

Appears in 1 contract

Samples: Underwriting Agreement (Harbor Custom Development, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Derycz Scientific Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _______________________________________________________ Name of Authorized Signatory: _________________________________________________________________________ Title of Authorized Signatory: __________________________________________________________________________ Date: _____________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Patient Safety Technologies, Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s 's Signature: _____________________________ Holder’s 's Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Oxis International Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ____________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ____________________________________________________________________ Name of Authorized Signatory: ____________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________~~_ Date:~~ ________~~________~~_ Date:________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ ~~Holder’s Signature~~Signature Guaranteed: ____________________________~~_ Holder’s Address:~~ _______________~~______________ _____________________________~~

Appears in 1 contract

Samples: Securities Agreement (CareView Communications Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s 's Signature: _____________________________ Holder’s 's Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Aurelio Resource Corp)

Appears in 1 contract

Samples: Warrant Agreement (Alfi, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ______________________________________________~~_ whose address is _______________________________________________________________. ________________________________________________________~~_______ ~~Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________~~whose address is

Appears in 1 contract

Samples: Representative’s Warrant Agreement (LMP Automotive Holdings, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ____________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ______________________________________________________________ Name of Authorized Signatory: ________________________________________________________________________________ Title of Authorized Signatory: _________________________________________________________________________________ Date: ____________________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Hepion Pharmaceuticals, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________~~_________________________________________ Signature of Authorized Signatory of Investing Entity:~~ _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ 4837-5958-0157.1 FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Representative’s Warrant Agreement (Generation Income Properties, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] ~~Name~~ Signature of Authorized Signatory of Investing Entity: _______________________________________________________________________________ ~~Signature~~ Name of Authorized ~~Signatory of Investing Entity~~Signatory: ______________________________________~~___ Name of Authorized Signatory:~~ ___________________________________________________________ Title of Authorized Signatory: __________________________________________________________________________________________________ Date: _____________________________________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Marpai, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________________ FOR VALUE RECEIVED, [____] hereby sells, assigns and transfers [all of of] or [_______] _ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ________________________________~~______________~~_ whose address is is: ______________________________~~_________________________________.~~ _______________________________________________________________ Dated: _____~~_________,~~ ,_______ Holder’s Signature: ______________________________ Holder’s Address: _______________________________ _____________________________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Bionik Laboratories Corp.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Warrant Agreement (RedHill Biopharma Ltd.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: ~~_____________________________~~ Holder’s Address: Signature Guaranteed: _____________________________ _______________~~______________~~

Appears in 1 contract

Samples: Securities Agreement (SpendSmart Payments Co)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity~~: ___________~~:____________________________________________________ Signature of Authorized Signatory of Investing Entity: ____________________________~~____________~~_ Name of Authorized Signatory: ~~____________~~_______________________________________________ Title of Authorized Signatory: _______________________________________________~~____________~~_ Date: ~~____________~~____________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ~~______________, _______~~ Holder’s Signature: ~~_____________________________~~ Holder’s Address~~: _____________________________ _____________________________~~:

Appears in 1 contract

Samples: Purchase Warrant Agreement (PetVivo Holdings, Inc.)

Appears in 1 contract

Samples: Placement Agent’s Warrant Agreement (Vision Marine Technologies Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. ___________________________________________________________~~___~~_ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Bricktown Brewery Restaurants LLC)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s ~~Signature: _____________________________ Holder’s~~ Address~~: _____________________________ _____________________________~~:

Appears in 1 contract

Samples: Underwriting Agreement (iSpecimen Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended ~~[SIGNATURE OF HOLDER]~~ Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ______________________________________________~~_ whose address is~~ ________________~~_______________________________________________.~~ _ _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Twin Vee PowerCats, Co.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. The Warrant Shares shall be delivered to the following DWAC Account Number: ________________________________ ________________________________ ________________________________ [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriter’s Common Stock Purchase Warrant (InspireMD, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] _ all of or [_______] _ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s ~~Signature: _____________________________ Holder’s~~ Address~~: _____________________________ _____________________________~~:

Appears in 1 contract

Samples: Warrant Amendment Agreement (Mela Sciences, Inc. /Ny)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of ~~Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of~~ Authorized Signatory: ~~___________________________________________________________~~ Title of Authorized Signatory: ~~____________________________________________________________~~ Date: ~~________________________________________________________________________________~~ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Vallon Pharmaceuticals, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ __ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Vistula Communications Services, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] ~~Name~~ Signature of Authorized Signatory of Investing Entity: ________________________________________________~~______________~~_ ~~Signature~~ Name of Authorized ~~Signatory of Investing Entity~~Signatory: ________~~_________________________________ Name of Authorized Signatory:~~ ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Parkview Group Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ________________________________________________ Name of Authorized Signatory: __________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________________ Date: ______________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _______________________________

Appears in 1 contract

Samples: Security Agreement (Lilis Energy, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: :___________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ____________________________________________________________________ Name of Authorized Signatory: :_______________________________________________________________________________________ Title of Authorized Signatory: :________________________________________________________________________________________ Date: :_________________________________________________________________________________________________________ FOR VALUE RECEIVED, ~~[____~~[ ] all of or ~~[_______~~[ ] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ __________whose address is _______________________________________________________________. ____________. Dated: , ___________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Vision Marine Technologies Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, ~~[____]~~ all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Akeena Solar, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity~~: ________~~:_______________________________________________________ Signature of Authorized Signatory of Investing Entity~~: _______________~~:__________________________ Name of Authorized Signatory~~: ________~~:___________________________________________________ Title of Authorized Signatory~~: __________~~:__________________________________________________ Date: ASSIGNMENT FORM (To assign the foregoing warrant, execute this form and supply required information. Do not use this form to exercise the warrant.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to _________________________________________________whose address is __________________________________________________________________. Dated:_______________________,_______ Holder's Signature:___________________________________________ ~~FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to __~~Holder's Address:_____________________________________________ ~~whose address is~~ Signature Guaranteed:_______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Securities Agreement (Intrac Inc)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ~~____________________~~___________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: _____________________________________~~_____________________~~_ Title of Authorized Signatory: ______________________________________~~_____________________~~_ Date: ~~_________________________~~_______________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriter’s Warrant Agreement (Invizyne Technologies Inc)

Appears in 1 contract

Samples: Purchase Warrant Agreement (G Medical Innovations Holdings Ltd.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _ _______________________________________________________________ Dated: _______________, _______ Holder’s Signature: ~~_____________________________~~ Holder’s Address: ~~_____________________________ _____________________________~~Signature Guaranteed:

Appears in 1 contract

Samples: Security Agreement (VirnetX Holding Corp)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ (To assign the foregoing warrant, execute this form and supply required information. Do not use this form to exercise the warrant.) FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Immuron LTD)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “"accredited investor” " as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity~~: ________~~:_______________________________________________________ Signature of Authorized Signatory of Investing Entity~~: _______________~~:__________________________ Name of Authorized Signatory~~: ________~~:___________________________________________________ Title of Authorized Signatory~~: __________~~:__________________________________________________ Date~~: _____~~:___________________________________________________________________________ ASSIGNMENT FORM (To assign the foregoing warrant, execute this form and supply required information. Do not use this form to exercise the warrant.) FOR VALUE RECEIVED, ~~[____] all of or [_______] shares of~~ the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s 's Signature: :_____________________________ Holder’s 's Address: :_______________________________ Signature Guaranteed:_____________________________________________

Appears in 1 contract

Samples: Securities Agreement (On2 Technologies Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ~~_______~~________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________~~_______~~_ Name of Authorized Signatory: ~~_______~~____________________________________________________ Title of Authorized Signatory: ____________________________________________________~~_______~~_ Date: ~~________~~________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Aethlon Medical Inc)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ~~___________________________________________~~____________________ Signature of Authorized Signatory of Investing Entity: ___________________~~_____________________~~_ Name of Authorized Signatory: ~~_______________________________________~~____________________ Title of Authorized Signatory: ___________________~~________________________________________~~_ Date: ~~__________________________________________________________~~______________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______ Holder’s Signature~~Signature Guaranteed: ____________________________~~_ Holder’s Address:~~ __________________~~___________ _____________________________~~

Appears in 1 contract

Samples: Security Agreement (RestorGenex Corp)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Rule 501(a) of Regulation D D, promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _____________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________________________________________ Name of Authorized Signatory: _____________________________________________________________________________________ Title of Authorized Signatory: _____________________________________________________________________________________ Date: _____________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: :______________, ___________ Holder’s Signature: _______________________________ Holder’s Address: _______________________________ _______________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Common Stock Purchase Warrant (Theralink Technologies, Inc.)

Appears in 1 contract

Samples: Underwriting Agreement (Harbor Custom Development, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ________________________________________________________ Name of Authorized Signatory: __________________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [~~_______~~] shares of~~ _________ FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: ______________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Sub-Urban Brands, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Warrant Agreement (Blink Logic Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned certifies that it is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ______________________________________________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ________________________________________________________________________________________ Name of Authorized Signatory: __________________________________________________________________________________________________________ Title of Authorized Signatory: ___________________________________________________________________________________________________________ Date: _______________________________________________________________________________~~_ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to~~ _______________________________________________ FOR VALUE RECEIVED, _________ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _________________________whose address is ________________________________________________________. Holder’s Signature: _______. ______________________ Signature Guaranteed: ___________________________________________~~____________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________~~

Appears in 1 contract

Samples: Security Agreement (Zurvita Holdings, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ~~___~~_____________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Red Cat Holdings, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: __________________________________________________~~____________~~_ Signature of Authorized Signatory of Investing Entity~~: ____________~~:_____________________________ Name of Authorized Signatory~~: ____________~~:_______________________________________________ Title of Authorized Signatory~~: ____________~~:________________________________________________ Date~~: _____________~~:___________________________________________________________________ FOR VALUE RECEIVED, [____] _ all of or [_______] _ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Security Agreement (Genius Brands International, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended ~~[SIGNATURE OF HOLDER]~~ Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: ______________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: :_________________________________________________________________________ Date: :___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ______________________________________________~~_ whose address is _______________________________________________________________. _____________~~__________________________________________________ Dated: :______________, _________________________ Holder’s Signature: :_____________________________ Holder’s Address: :______________________________ ____________________________________________

Appears in 1 contract

Samples: Representative’s Warrant Agreement (Forza X1, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: ~~_____________________________~~ Holder’s Address~~: _____________________________ _____________________________~~:

Appears in 1 contract

Samples: Purchase Warrant Agreement (PetVivo Holdings, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: ___________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _____________________________________________________ Name of Authorized Signatory: _______________________________________________________________________ Title of Authorized Signatory: ________________________________________________________________________ Date: ___________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] ~~shares~~ ADSs of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Nova Minerals LTD)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ ~~Dated: ______________, _______~~ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Common Stock Purchase Warrant (Stevia First Corp.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________ Name of Authorized Signatory: ___________________________________________________________ Title of Authorized Signatory: ____________________________________________________________ Date: ~~________________________~~________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Underwriting Agreement (Marpai, Inc.)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: ________________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: ________________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _ _______________________________________________________________ Dated: _______________, _______ Holder’s Signature: ~~_____________________________~~ Holder’s Address: ~~_____________________________ _____________________________~~Signature Guaranteed:

Appears in 1 contract

Samples: Security Agreement (VirnetX Holding Corp)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity~~: _____~~:__________________________________________________________ Signature of Authorized Signatory of Investing Entity~~: ______________________________~~:___________ Name of Authorized Signatory~~: __________~~:_________________________________________________ Title of Authorized Signatory: ~~_________~~___________________________________________________ Date: ____________________________________________________________________ _~~___________~~_ _ FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. _______________________________________________________________ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________ Signature Guaranteed: ___________________________________________

Appears in 1 contract

Samples: Securities Agreement (Trans Lux Corp)

Accredited Investor. ~~If the Warrant is being exercised via cash exercise, the~~ The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as ~~amended~~ amended. [SIGNATURE OF HOLDER] Name of Investing Entity: _______________________________________________________________________ Signature of Authorized Signatory of Investing Entity: _________________________________________________ Name of Authorized Signatory: ___________________________________________________________________ Title of Authorized Signatory: ____________________________________________________________________ Date: _______________________________________________________________________________________ FOR VALUE RECEIVED, [____] _ all of or [_______] _ shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to _______________________________________________ whose address is _______________________________________________________________. ~~_______________________________________________________________~~ Dated: ______________, _______ Holder’s Signature: _____________________________ Holder’s Address: _____________________________ _____________________________

Appears in 1 contract

Samples: Securities Agreement (Truli Media Group, Inc.)

Accredited Investor. If the Warrant is being exercised via cash exercise, the undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended [SIGNATURE OF HOLDER] Name of Investing Entity: :__________________________________________________________________ Signature of Authorized Signatory of Investing Entity: :____________________________________________ Name of Authorized Signatory: :______________________________________________________________ Title of Authorized Signatory: :_______________________________________________________________ Date: :_________________________________________________________________________________ FOR VALUE RECEIVED, [____] all of or [__________] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to ____________________________________________~~___~~ whose address is __________________________________________________________~~_____~~. ~~_______________________________________________________________~~ Dated: ~~_____~~_________, _______ Holder’s Signature~~: ________~~:_____________________ Holder’s Address~~: _______~~:______________________ _______________________~~______~~

Appears in 1 contract

Samples: Placement Agent Warrant (Toughbuilt Industries, Inc)

Common use of Accredited Investor Clause in Contracts