COMPANY RELIANCE ON THIS QUESTIONNAIRE. The undersigned is informed of the significance to the Company of the foregoing representations and answers contained in this Section VII and such answers have been provided under the assumption that the Company and its counsel will rely on them. SIGNATURE PAGE Date Signed: , 2004 Number of shares of Series B Preferred Stock: Multiplied by Offering Price per share: x $ 100.00 Equals subscription amount: = “INVESTOR” (Name in which securities should be issued) By: Print Name: Title: Address City, State and Zip Code Telephone-Business Facsimile-Business Tax ID # or Social Security # *The attached Certificate of Signatory must also be completed. This Subscription Agreement is agreed to and accepted as of , 2004. AKORN, INC. By: Name: Title: 30 CERTIFICATE OF SIGNATORY (To be completed if Securities are being subscribed for by an entity) I, , am the of (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Agreement and to purchase and hold the Securities, and certify further that the Subscription Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.
COMPANY RELIANCE ON THIS QUESTIONNAIRE. The undersigned is informed of the significance to the Company of the foregoing representations and answers contained in this Section VII and such answers have been provided under the assumption that the Company and its counsel will rely on them. SIGNATURE PAGE Date Signed: , 2001 Number of shares:
COMPANY RELIANCE ON THIS QUESTIONNAIRE. The undersigned is informed of the significance to the Company of the foregoing representations and answers contained in this Section VII and such answers have been provided under the assumption that the Company and its counsel will rely on them. SIGNATURE PAGE Date Signed: _____________ , 2001 Number of shares: Multiplied by Offering Price per share: x $ Equals subscription amount: = $ Signature Second Signature (if purchasing jointly) Printed Name Printed Second Name Entity Name Entity Name Address Address City, State and Zip Code City, State and Zip Code Telephone-Business Telephone — Business Facsimile-Business Facsimile — Business Tax ID # or Social Security # Tax ID # or Social Security # Name in which securities should be issued: Leerink Sxxxx & Company Account Number: This Subscription Agreement is agreed to and accepted as of ______________ , 2001. BIOJECT MEDICAL TECHNOLOGIES INC. By: Name: Jxxxx X. X’Xxxx Title: Chairman and Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if Securities are being subscribed for by an entity) I, _________________________________, am the ___________________________________ of _________________________________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Subscription Agreement and to purchase and hold the Securities, and certify further that the Subscription Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.
