Common use of FORM OF ASSIGNMENT Clause in Contracts

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 7 contracts

Samples: Securities Purchase Agreement (Adial Pharmaceuticals, Inc.), Securities Purchase Agreement (Adial Pharmaceuticals, Inc.), ID Global Solutions Corp

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FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 7 contracts

Samples: Exercise Agreement (Globalnet Corp), Exercise Agreement (Globalnet Corp), Exercise Agreement (Sti Group Inc)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 5 contracts

Samples: Exercise Agreement (Globalnet Corp), Exercise Agreement (Central Wireless Inc), Exercise Agreement (IGIA, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans-fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 4 contracts

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

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 4 contracts

Samples: Exercise Agreement (Admiralty Holding Co), Ameriresource Technologies Inc, Ameriresource Technologies Inc

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 3 contracts

Samples: Securities Purchase Agreement (Adial Pharmaceuticals, Inc.), Securities Purchase Agreement (ID Global Solutions Corp), AMP Holding Inc.

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, assigns and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints _____________________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporationCompany, with full power of substitution in the premises. Dated: ________________ ___, 2020 ___ In the presence of: __________________ Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 3 contracts

Samples: Purchase Agreement (Environmental Tectonics Corp), Purchase Agreement (Environmental Tectonics Corp), Environmental Tectonics Corp

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-within named corporation, with full power of substitution in the premises. Dated: ________ _______, 20___ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 3 contracts

Samples: Exercise Agreement (Maverick Energy Group, Ltd.), Exercise Agreement (Maverick Energy Group, Ltd.), Maverick Energy Group, Ltd.

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 2 contracts

Samples: Exercise Agreement (GBS Enterprises Inc), Exercise Agreement (GBS Enterprises Inc)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ 200 In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 2 contracts

Samples: Series B Amendment Agreement (Lithium Technology Corp), Series B Amendment Agreement (Lithium Technology Corp)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-within named corporation, with full power of substitution in the premises. Dated: ________ _______, 20___ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 2 contracts

Samples: Exercise Agreement (Mag Mile Capital, Inc.), Form of Exercise Agreement (Myson, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ ____, 20200__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Admiralty Holding Co

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Class B Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Class B Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Class B Warrant, if applicable.

Appears in 1 contract

Samples: Securities Purchase Agreement (Trestle Holdings, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Name Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 1 contract

Samples: Solar Energy Initiatives, Inc.

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: :________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Securities Purchase Agreement

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares NAME OF ASSIGNEE ADDRESS NO. OF SHARES , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ _, __, 20__ . In the presence of: of Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Santa Fe Energy Trust

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ --------------------- In the presence of: of --------------------------- Name: ---------------------------- Signature: ----------------------- Title of Signing Officer or Agent (if any): Address: ------------------------- Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Exercise Agreement (Worldquest Networks Inc)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Note Conversion Agreement (GlyEco, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: :________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Exercise Agreement (Eastside Distilling, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares ---------------- ------- ------------ , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: ------------------------- Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 1 contract

Samples: Securities Purchase Agreement (Smartsources Com Inc)

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FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Exercise Agreement (Pediatric Prosthetics Inc)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares NAME OF ASSIGNEE ADDRESS NO. OF SHARES , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: , ________ __, 20__ . In the presence of: of Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Texoil Inc /Nv/

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans-fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Address Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Securities Purchase Agreement (IGIA, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_201_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Exercise Agreement (Eastside Distilling, Inc.)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ____________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ ______ , 20200__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Admiralty Holding Co

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No of Shares ---------------- ------- ------------ , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ , __, 20__ . In the presence of: of Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Avanir Pharmaceuticals

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Lithium Technology Corp

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelowherein below, to: Name of Assignee Address No No. of Shares , ---------------- ------- ------------- and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: :_______________, ___ In the presence of ________________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Open Market Inc

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares NAME OF ASSIGNEE ADDRESS NO. OF SHARES , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: ----------------------- Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Breakaway Solutions Inc

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans-fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20_200_ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Skreem Entertainment Corp

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-within named corporation, with full power of substitution in the premises. Dated: ________ _______, 20___ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.

Appears in 1 contract

Samples: Maverick Energy Group, Ltd.

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned represented by and under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No No. of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ ________, 20_______ In the presence of: of Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 1 contract

Samples: Stock Purchase Warrant (Pet DRx CORP)

FORM OF ASSIGNMENT. FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers all the rights of the undersigned under the within Warrant, with respect to the number of shares of Common Stock covered thereby set forth hereinbelow, to: Name of Assignee Address No of Shares , and hereby irrevocably constitutes and appoints ___________________________________ as agent and attorney-in-fact to transfer trans­fer said Warrant on the books of the within-named corporation, with full power of substitution in the premises. Dated: ________ __, 20__ In the presence of: Name: Signature: Title of Signing Officer or Agent (if any): Address: Note: The above signature should correspond exactly with the name on the face of the within Warrant, if applicable.:

Appears in 1 contract

Samples: Securities Purchase Agreement (Medite Cancer Diagnostics, Inc.)

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