FORM OF SUBSCRIPTION. TO: Nexaira Wireless Inc. 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________, ______. In the presence of: Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Nexaira Wireless Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Inc. 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.00 1.50 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________, ______. In the presence of: Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address
Appears in 1 contract
Samples: Form of Subscription Agreement (Nexaira Wireless Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Colorado Goldfields Inc. 1404 – 00000 X. Xxxxxxx Xxxxxx, Xxxxx 000 Xxxx Xxxxxxxx Xxxxxx XxxxxxxxxXxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 Xxxxxxxx, XXX 00000 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “"Shares”") of Nexaira Wireless Colorado Goldfields Inc. (the “"Company”") pursuant to the within Warrants at US$1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this __________ day of __________________, _______. In the presence of: __________________________________________ __________________________________________ Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address_________________________________________________________ Address _________________________________________________________ _________________________________________________________
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Colorado Goldfields Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Colorado Goldfields Inc. 1404 – 00000 X. Xxxxxxx Xxxxxx, Xxxxx 000 Xxxx Xxxxxxxx Xxxxxx XxxxxxxxxXxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 Xxxxxxxx, XXX 00000 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “"Shares”") of Nexaira Wireless Colorado Goldfields Inc. (the “"Company”") pursuant to the within Warrants at US$1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of ___________________ , ______. In the presence of: __________________________________________ __________________________________________ Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address_________________________________________________________ Address _________________________________________________________ _________________________________________________________
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Colorado Goldfields Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Inc. 1404 – 000 Xxxx Xxxxxxxx Kore Nutrition Incorporated 0000 Xxxxxx Xxxxxxx, Xxxxx X-000 Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 00000 Attention: President Fax No. (000) 000-0000 c/o Xxxxxx X. Xxxx The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Nexaira Wireless Inc. Kore Nutrition Incorporated (the “Company”) pursuant to the within Warrants at US$1.00 0.15 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 subsections 6.1 and 10.3 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of ___________________ , ______. In the presence of: Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Kore Nutrition, Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Enterra Systems Inc. 1404 – 000 Xxxx Xxxxxxxx Xxxxxx 00 - 0000 Xxxxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for _for___________ common shares (the “Shares”) of Nexaira Wireless Enterra Systems Inc. (the “Company”) pursuant to the within Warrants at US$1.00 1.15 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and Holder hereby certifies that the undersigned pursuant to which these Warrants were issued are true is not a U.S. person and accurateis not subscribing for the Shares on Behalf of a U.S. person. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ 29 day of __________________November, ______2005. In the presence of: Signature of Warrant Holder C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature Please print below your name and address in full. Name (Mr./Mrs./Miss) AddressXx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX
Appears in 1 contract
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Global Health Ventures Inc. 1404 – 000 0000 Xxxx Xxxxxxxx 00xx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Nexaira Wireless Global Health Ventures Inc. (the “Company”) pursuant to the within Warrants at US$1.00 _____ per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of ___________________ , ______. In the presence of: Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Global Health Ventures Inc.)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Inc. 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for _____________ common shares (the “Shares”) of Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this _________ day of ___________________, ________. In the presence of: Signature of Witness Signature of Warrant Holder Signature of Witness Please print below your name and address in full. Name (Mr./Mrs./Miss) Address.
Appears in 1 contract
Samples: Form of Subscription Agreement (Nexaira Wireless Inc.)