Common use of Date of Conversion Clause in Contracts

Date of Conversion. Applicable Conversion Price: -------------------------- Amount of Accrued and Unpaid Interest on the Principal Amount to be converted, if any: ---------------------------------------------- Amount of Conversion Default Payments to be Converted, if any: ----------------------------- Number of Shares of Common Stock to be Issued: --------------------------- Signature: ------------------------------------------- Name: ------------------------------------------------ Address: ---------------------------------------------

Date of Conversion. Applicable Conversion Price: -------------------------- ----------------------- Amount of Accrued and Unpaid Interest on the Principal Amount to be converted, if any: ---------------------------------------------- --------------------------------- Amount of Conversion Default Payments or Prepayment Default Payments to be Convertedconverted, if any: ----------------------------- --------------------------------- Number of Shares of Common Stock to be Issued: --------------------------- ------------------------- Signature: ------------------------------------------- ----------------------------------------- Name: ------------------------------------------------ ---------------------------------------------- Address: ----------------------------------------------------------------------------------------

Date of Conversion. Applicable Conversion Price: -------------------------- --------------- Amount of Accrued and Unpaid Interest on the Principal Amount Original Issue Price to be converted, if any: ---------------------------------------------- ------------------------------------ Amount of Conversion Default Payments to be Converted, if any: ----------------------------- ------------------- Number of Shares of Common Stock Ordinary Shares to be Issued: --------------------------- -------------- Signature: ------------------------------------------- --------------------------------- Name: ------------------------------------------------ Address: -----------------------------------------------------------------------------------

Date of Conversion. Applicable Conversion Price: -------------------------- ---------------------------- Amount of Accrued and Unpaid Interest on the Principal Amount ("Unpaid Interest") to be converted, if any: ---------------------------------------------- ------------------------------------------------- Amount of Conversion Default Payments Unpaid Interest to be Convertedpaid in cash, if any: ----------------------------- Default Amount to be converted, if any: ----------------- Number of Shares of Common Stock to be Issued: --------------------------- ------------------------------ Signature: ------------------------------------------- ---------------------------------------------- Name: ------------------------------------------------ Address: ------------------------------------------------------------------------------------------------

Date of Conversion. Applicable Conversion Price: -------------------------- ------------------- Amount of Accrued and Unpaid Interest on the Principal Amount to be converted, if any: ---------------------------------------------- ----------------------- Default Amount of Conversion Default Payments to be Convertedconverted, if any: ----------------------------- ---------------------------------------- Number of Shares of Common Stock to be Issued: --------------------------- ---------------------------- Signature: ------------------------------------------- ------------------------------------- Name: ------------------------------------------------ ------------------------------------------ Address: ------------------------------------------------------------------------------------

Date of Conversion. Applicable Conversion Price: -------------------------- ---------------------------- Amount of Accrued and Unpaid Interest on the Principal Amount to be converted, if any: ---------------------------------------------- ------------------------------------------------- Amount of Conversion Default Payments to be Converted, if any: ----------------------------- -------------------------------- Number of Shares of Common Stock to be Issued: --------------------------- ------------------------------ Signature: ------------------------------------------- ---------------------------------------------- Name: ------------------------------------------------ --------------------------------------------------- Address: ---------------------------------------------------------------------------------------------