NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 3 contracts
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.), Convertible Security Agreement (Legend Oil & Gas, Ltd.), Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 8% Senior Secured Convertible Debenture due March 1February 8, 2018 2014 of Legend Oil and GasRecovery Energy, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:: The 8% Senior Secured Convertible Debentures due on February 8, 2014 in the aggregate principal amount of $____________ are issued by Recovery Energy, Inc., a Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture. Dated: Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company Attest
Appears in 2 contracts
Samples: Securities Purchase Agreement (Recovery Energy, Inc.), Convertible Security Agreement (Recovery Energy, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 12.5% Senior Convertible Debenture Note due March 1_________, 2018 of Legend Oil and Gas2020 issued by Emmaus Life Sciences, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Convertible Security Agreement (Emmaus Life Sciences, Inc.), Convertible Security Agreement (Emmaus Life Sciences, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 12% Senior Convertible Debenture Note due March 12017 of InterCloud Systems, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. In the event of a partial Conversion, Amortization Dates from which Amortization Amount is to be deducted: Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Convertible Security Agreement (Intercloud Systems, Inc.), Convertible Security Agreement (Intercloud Systems, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Secured Convertible Debenture Promissory Note due March 1September __, 2018 2016 of Legend Oil and Gas, Ltd.CannaVest Corp., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Securities Purchase Agreement (CannaVEST Corp.), Securities Purchase Agreement (CannaVEST Corp.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Secured Convertible Debenture Promissory Note due March 1May 19, 2018 2016 of Legend Oil and Gas, Ltd.CannaVest Corp., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Securities Purchase Agreement (CannaVEST Corp.), Securities Purchase Agreement (CannaVEST Corp.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March January 1, 2018 2014 of Legend Oil and Gas, Ltd.NutraCea, a Colorado California corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Convertible Security Agreement (Nutracea), Convertible Security Agreement (Nutracea)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.), Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 110% Promissory Note, 2018 with an issue date of Legend Oil and GasOctober 7, Ltd.2022, a Colorado corporation of Creatd Inc. (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: :_____________________________ Name: Address for :________________________________ Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 2 contracts
Samples: Convertible Security Agreement (Creatd, Inc.), Convertible Security Agreement (Creatd, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 8% Senior Secured Convertible Debenture due March April 1, 2018 2017 of Legend Oil and GasStaffing 360 Solutions, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ________________ Account No:_____________
Appears in 1 contract
Samples: Subordination Agreement (Staffing 360 Solutions, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Secured Convertible Debenture due March August 1, 2018 2015 of Legend Oil and GasBOLDFACE Group, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the of applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :________________________ Account No:______________________
Appears in 1 contract
Samples: Convertible Security Agreement (Boldface Group, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due March 1[12 months], 2018 2019 of Legend Oil and GasAPPYEA, Ltd.Inc., a Colorado South Dakota corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture Promissory Note due March 1December __, 2018 2015 of Legend Oil and GasElectronic Cigarettes International Group, Ltd., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: __________ Account No:: __________ Funding: $ December __, 2014 First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment
Appears in 1 contract
Samples: Convertible Security Agreement (Electronic Cigarettes International Group, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 10% Secured Subordinated Convertible Debenture Promissory Note, due March 1January 28, 2018 2022 of Legend Oil and GasUnique Logitics International, Ltd.Inc.., a Colorado Nevada corporation (the “Company”), into shares of common stock stock, $0.001 par value per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Unique Logistics International Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due March 121, 2018 2019 of Legend Oil and Gas, Ltd.Dthera Sciences, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Outstanding Principal: Outstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares of Common Stock Note to be issuedConverted: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture Promissory Note due March 1, 2018 of Legend Oil and GasElectronic Cigarettes International Group, Ltd., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :__________________ Account No:________________ Funding: $ First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment
Appears in 1 contract
Samples: Convertible Security Agreement (Electronic Cigarettes International Group, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 110% Promissory Note, 2018 with an issue date of Legend Oil and GasJune 9, Ltd.2022, a Colorado corporation of Cool Technologies, Inc. (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock yes no If yes, $ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: _________________________________ Name: Address for Delivery Instructions: This 10% Promissory Note, with an issue date of June 9, 2022, in the original principal amount of $176,471 is issued by Cool Technologies, Inc. (the “Company”). This Conversion Schedule with respect to the Common Stock Certificatesof the Company reflects conversions made under Section 5 of the above-referenced Note. Dated: DWAC Instructions: Broker No: Account No:THIS SECURITIES PURCHASE AGREEMENT (this “Agreement”), dated as of June 9, 2022 between COOL TECHNOLOGIES, INC., a Nevada corporation (the “Company”), and Coventry Enterprises, LLC, a Delaware limited liability company (“Investor”).
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Convertible Debenture due March 1September ___, 2018 2014 of Legend Oil and GasAmarantus BioScience Holdings, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :___________ Account No:__________
Appears in 1 contract
Samples: Convertible Security Agreement (Amarantus Bioscience Holdings, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Unsecured Convertible Debenture Promissory Note, due March 1August 19, 2018 2021, in the original principal amount of Legend Oil and Gas$365,168.54 (the “Note”), Ltd.issued by Infinity Energy Resources, Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock stock, par value $0.0001 per share, of the Company (the “Common Stock”), of the Company ) according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenturethe Note, as determined in accordance with Section 13(d) of the Securities Exchange ActAct of 1934, as amended. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Infinity Energy Resources, Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________ Account No:: ____________
Appears in 1 contract
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1May 9, 2018 of Legend Oil and GasTHE Therapeutics, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ___________________ Account No:: __________________
Appears in 1 contract
Samples: Convertible Security Agreement (THC Therapeutics, Inc.)
NOTICE OF CONVERSION. The undersigned registered holder hereby elects to convert principal under the Original Issue Discount Senior 10% Convertible Debenture due March 1May 6, 2018 2015 of Legend Oil and GasBlue Calypso, Ltd.Inc., a Colorado Delaware corporation (the “Company”), No. 2013-1 (the “Debenture”) into shares of common stock (the “Common Stock”), ) of the Company according to in accordance with the terms and conditions hereofof the Debenture, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the undersigned registered holder of the Debenture for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Securities Laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Blue Calypso, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March October 1, 2018 2017 of Legend Oil and GasPFO Global, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture due March 1______ __, 2018 2013 of Legend Oil and GasSpectrascience, Ltd.Inc., a Colorado Minnesota corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued. Number of Conversion Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Note: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Spectrascience Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture due March 1July 27, 2018 2012 of Legend Oil and GasSpectrascience, Ltd.Inc., a Colorado Minnesota corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued. Number of Conversion Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Note: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Spectrascience Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due March 1May 8, 2018 2021 of Legend Oil and GasGoIP Global, Ltd.Inc., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Outstanding Principal: Outstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares of Common Stock Note to be issuedConverted: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and interest under the Original Issue Discount Senior 15% OID Convertible Debenture Promissory Notes due March 1April 5, 2018 2022 of Legend Oil and GasmPhase Technologies, Ltd., a Colorado corporation Inc. (the “Company”), into shares of its common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: ____________________________________________ Principal Amount of Debenture Note to be Converted: ______________________________ Payment of Interest in Common Stock ___ yes ___ no If yes, $________of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for _________________ Signature Name Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Mphase Technologies Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1October 5, 2018 2019 of Legend Oil and Gas, Ltd.MMEX Resources Corporation, a Colorado Nevada corporation (the “Company”), into shares of Class A common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock yes no If yes, $______of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :________________ Account No:_______________
Appears in 1 contract
Samples: Convertible Security Agreement (MMEX Resources Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March August 1, 2018 2017 of Legend Oil and GasPFO Global, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture Unsecured Promissory Note due March 1November 10, 2018 2009 of Legend Oil and Gas, Ltd.The Saint Xxxxx Company, a Colorado North Carolina corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this Debenturethe Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 6% Senior Convertible Debenture due March 1, 2018 of Legend Oil and GasBoston Therapeutics, Ltd.Inc., a Colorado Delaware corporation (the “"Company”"), into shares of common stock (the “"Common Stock”"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Boston Therapeutics, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Convertible Debenture Note due March 1________ ___, 2018 of Legend Oil and Gasissued by Guided Therapeutics, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________________________ Account No:: _____________________________________
Appears in 1 contract
Samples: Convertible Security Agreement (Guided Therapeutics Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and interest under the Original Issue Discount Senior 15% OID Convertible Debenture Promissory Notes due March 18, 2018 2022 of Legend Oil and GasSurgePays, Ltd., a Colorado corporation Inc. (the “Company”), into shares of its common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: ____________________________________ Principal Amount of Debenture Note to be Converted: _______________________ Payment of Interest in Common Stock yes no If yes, $______of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for __________________ Signature Name Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2011 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _______________ Account No:: ____________ Schedule 1
Appears in 1 contract
Samples: Convertible Security Agreement (Magnolia Solar Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:: The Original Issue Discount Senior Secured Convertible Notes due on ________ __, 2013 in the aggregate Principal Amount of $_______ are issued by Magnolia Solar Corporation, a Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Note.
Appears in 1 contract
Samples: Second Note Amendment Agreement (Magnolia Solar Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal certain amounts owed under the 10% Original Issue Discount Senior Secured Convertible Debenture due March 1October [___], 2018 20215 of Legend Oil and Gas, Ltd.Greenbox POS, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Interest Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Conversion Price: Principal Remaining: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March 1, 2018 2017 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________ Account No:: ____________
Appears in 1 contract
Samples: Exhibit 4.1 (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March September 1, 2018 2017 of Legend Oil and GasPFO Global, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1May 14, 2018 2012 of Legend Oil and GasOctavian Global Technologies, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ______________________ Account No:: ____________________
Appears in 1 contract
Samples: Convertible Security Agreement (Octavian Global Technologies, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Original Issue Discount Senior Convertible Debenture Promissory Note, due March 1June 28, 2018 2017 of Legend Oil and GasGuided Therapeutics, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Guided Therapeutics Inc)
NOTICE OF CONVERSION. The undersigned registered holder hereby elects to convert principal under the Original Issue Discount 5% Senior Secured Convertible Debenture due March 1July 2, 2018 2015 of Legend Oil and Gas, Ltd.PLC Systems Inc., a Colorado Yukon Territory corporation (the “Company”), No. R-69 (the “Debenture”) into shares of common stock (the “Common Stock”), ) of the Company according to in accordance with the terms and conditions hereofof the Debenture, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the undersigned registered holder of the Debenture for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Securities Laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Zero Coupon Secured Convertible Debenture Note due March 1December 26, 2018 2012 of Legend Oil and GasPure Bioscience, Ltd.Inc., a Colorado Delaware corporation (the “Company”), ) into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount Issue Price of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: [SIGNATURE OF HOLDER] Name of Holder: Signature of Authorized Signatory of Holder: Name of Authorized Signatory: Title of Authorized Signatory: Date: Schedule 1
Appears in 1 contract
Samples: Zero Coupon Secured Convertible Note (Pure Bioscience, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________ Account No:: ___________
Appears in 1 contract
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Secured Convertible Debenture due March 1________ of InspireMD, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Accrued and Unpaid Interest Amount of Debenture to be Converted Conversion Adjustment Amount to be Converted Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :_________________________ Account No:_______________________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Secured Convertible Debenture due March January 1, 2018 2017 of Legend Oil and GasPFO Global, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ___________ Account No:: _________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Secured Convertible Debenture due March 1Note of Oncolix, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Florida corporation (the “Company”), due on August 1, 2019, into shares of common stock stock, par value $0.0001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Note. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Notes to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____________ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account NoAddress:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ____________ Account No:: ___________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Convertible Debenture due March 1Secured Note of Jupiter Neurosciences, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Delaware corporation (the “Company”), due on April 11, 2023, into shares of common stock stock, of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4(c) of this Note. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Notes to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____________of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Address: Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Jupiter Neurosciences, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 12.5% Senior Secured Convertible Debenture due March 1April 21, 2018 2020 of Legend Oil and GasSocial Reality, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: __________ Account No:: __________ The 12.5% Senior Secured Convertible Debenture due April 21, 2020 are issued by Social Reality, Inc., a Delaware corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Debenture.
Appears in 1 contract
Samples: Convertible Security Agreement (SOCIAL REALITY, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture due March 1September __, 2018 2014 of Legend Oil and GasSpectrascience, Ltd.Inc., a Colorado Minnesota corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued. Number of Conversion Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Note: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:____________________________
Appears in 1 contract
Samples: Convertible Security Agreement (Spectrascience Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 8% Senior Secured Convertible Debenture Promissory Note, due March 1November 27, 2018 2019 of Legend Oil and GasExactus, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: __________________ Please confirm the following information: Conversion Price: ______________ Please check the following box if the Conversion Price is determined by: EOD Conversion Price Principal Amount of Debenture Note to be Converted: ____________ Payment of Interest in Common Stock __ Yes __ No If Yes, $_____ of Interest Accrued on Account of Conversion at Issue. If Yes, $_____ of Make-Whole Amount on Account of Conversion at Issue Number of shares Shares of Common Stock to be issuedIssued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
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NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture Promissory Note due March 1, 2018 of Legend Oil and GasElectronic Cigarettes International Group, Ltd., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ____________ Account No:___________ Funding: $ First Payment Second Payment Third Payment Fourth payment Fifth Payment Sixth Payment Seventh Payment Eighth Payment Ninth Payment Tenth Payment
Appears in 1 contract
Samples: Convertible Security Agreement (Electronic Cigarettes International Group, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________ Account No: _______________ The Original Issue Discount Senior Secured Convertible Notes due on ________ __, 2011 in the aggregate Principal Amount of $_______ are issued by Magnolia Solar Corporation, a Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Note. Dated:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 6% Secured Convertible Debenture due March 1of Arkados Group, 2018 of Legend Oil and GasInc. (formerly XXXXxx.Xxx, Ltd.Inc.), a Colorado Delaware corporation (the “Company”), due on December 28 , 2008 into shares of common stock stock, par value $.0001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account NoAddress:
Appears in 1 contract
Samples: Convertible Security Agreement (Arkados Group, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 8% Convertible Debenture due March 1September __, 2018 2020 of Legend Oil and Gas, Safe-T Group Ltd., a Colorado corporation an Israeli company (the “Company”), into shares of common stock ADSs (the “Common StockOrdinary Shares”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock Ordinary Shares and/or ADSs are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock Ordinary Shares and/or ADSs does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockADSs. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in ADSs __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock ADSs to be issued: Signature: Name: Address for Delivery of Common Stock ADSs Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ___________________ Account No:: _________________
Appears in 1 contract
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and interest under the Original Issue Discount Senior 15% OID Convertible Debenture Promissory Notes due March 1May __, 2018 2022 of Legend Oil and GasmPhase Technologies, Ltd., a Colorado corporation Inc. (the “Company”), into shares of its common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: :______________________________________ Principal Amount of Debenture Note to be Converted: :________________________ Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for :___________________ Signature Name Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Mphase Technologies Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ___________ Account No:: __________
Appears in 1 contract
Samples: Second Note Amendment Agreement (Magnolia Solar Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 20% Original Issue Discount Senior Convertible Debenture due March 1[_______, 2018 2016] of Legend Oil and GasProtea Biosciences Group, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock ¨ yes ¨ no If yes, $_____ of Interest Accrued. Number of Conversion Shares payable on Principal or Interest that would exceed the limits set forth in Section 4(c) of the Note: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Protea Biosciences Group, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 8% Senior Unsecured Convertible Debenture due March 1November ___, 2018 2010 of Legend Oil and Gas, Ltd.Sona Mobile Holdings Corp., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockStock and will sell such shares of Common Stock pursuant to an effective Registration Statement and in accordance with the Transaction Documents within 5 Trading Days of receipt of said shares. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ________________ Account No:: _________________
Appears in 1 contract
Samples: Convertible Security Agreement (Sona Mobile Holdings Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1, 2018 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :__________________ Account No:_________________
Appears in 1 contract
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note, due March 1June 20, 2018 2019 of Legend Oil and Gas, Ltd.New Age Beverages Corporation, a Colorado Washington corporation (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number Payment of shares of Interest in Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker __ Yes __ No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (New Age Beverages Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 5% Convertible Debenture due March 1July __, 2018 2012 of Legend Oil and GasOriginOil, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _________________ Account No:: _______________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due March 1September 10, 2018 2021 of Legend Oil and Gas, Ltd.Can B Corp., a Colorado Florida corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculationsOutstanding Principal: Date to Effect ConversionOutstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares of Common Stock Note to be issuedConverted: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 5% Convertible Debenture Note due March 1, 2018 of Legend Oil and Gas2017 issued by Cool technologies, Ltd.Inc. , a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock yes no If yes, $of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ___________________ Account No:: _________________________
Appears in 1 contract
Samples: Convertible Security Agreement (Cool Technologies, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Convertible Debenture due March 1September ___, 2018 2014 of Legend Oil and GasAmarantus BioScience Holdings, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ____________ Account No:: ___________
Appears in 1 contract
Samples: Convertible Security Agreement (Amarantus Bioscience Holdings, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 8% Secured Convertible Debenture Note due March 1September 4, 2018 2019, of Legend Oil and GasShiftPixy, Ltd.Inc., a Colorado Wyoming corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: ______________ Account No:: ______________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No: The Original Issue Discount Senior Secured Convertible Notes due on ________ __, 2011 in the aggregate Principal Amount of $_______ are issued by Magnolia Solar Corporation, a Nevada corporation. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Note. Dated:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior 8% Secured Convertible Debenture Note due March 1September 4, 2018 2019, of Legend Oil and GasShiftPixy, Ltd.Inc., a Colorado Wyoming corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Secured Convertible Debenture due March December 1, 2018 2014 of Legend Oil and GasBOLDFACE Group, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the of applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Boldface Group, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Original Issue Discount Senior Secured Convertible Debenture due March 1August 9, 2018 of Legend Oil and Gas, Ltd.Sysorex Global, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :__________________ Account No:________________
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1________ of Rennova Health, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :_________________ Account No:: _______________
Appears in 1 contract
Samples: Securities Purchase Agreement (Rennova Health, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture Promissory Note due March 1, 2018 of Legend Oil and GasElectronic Cigarettes International Group, Ltd., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:: Funding: $ First Payment Second Payment Third Payment
Appears in 1 contract
Samples: Convertible Security Agreement (Electronic Cigarettes International Group, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 13.25% Senior Secured Convertible Debenture Note due March 1September 24, 2018 of Legend Oil and Gas2020 issued by Medite Cancer Diagnostics, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Cash Interest in Common Stock __ yes __ no If yes, $_____ of Cash Interest Accrued on Account of Conversion at issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (Medite Cancer Diagnostics, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Convertible Debenture Promissory Note due March 1June 9, 2018 2017 of Legend Oil and GasGrowlife, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares Shares of Common Stock to be issuedIssued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March 1May 16, 2018 2016 of Legend Oil and Gas, Ltd., a Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :______________________________ Account No:_____________________________
Appears in 1 contract
Samples: Convertible Security Agreement (Legend Oil & Gas, Ltd.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due March 1May 2, 2018 2017 of Legend Oil and GasRennova Health, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :_________________ Account No:: _______________
Appears in 1 contract
Samples: Convertible Security Agreement (Rennova Health, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Senior Convertible Debenture Promissory Note due March 1December __, 2018 2017 of Legend Oil and GasDirectView, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _____________ Account No:: ___________
Appears in 1 contract
Samples: Convertible Security Agreement (Directview Holdings Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due March 1______ __, 2018 2013 of Legend Oil and Gas, Ltd.Magnolia Solar Corporation, a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: _______________ Account No:: ______________
Appears in 1 contract
Samples: Second Note Amendment Agreement (Magnolia Solar Corp)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 16% Senior Secured Convertible Debenture due March 1June 27, 2018 2014 of Legend Oil and GasGenius Brands International, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The If there shall be an effective Registration Statement, the undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :_________________ Account No:__________________
Appears in 1 contract
Samples: Convertible Security Agreement (Genius Brands International, Inc.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 12% Senior Secured Convertible Debenture Promissory Note, due March 14, 2018 2022 of Legend Oil and Gas, Ltd., a Colorado corporation Endexx Corporation (the “Company”), ) into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Companies in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery Instructions: This 12% Senior Secured Convertible Promissory Note, due on March 4, 2022, in the original principal amount of $300,000.00 is issued by Endexx Corporation (the “Company”). This Conversion Schedule with respect to the Common Stock Certificatesof the Company reflects conversions made under Section 5 of the above-referenced Note. Dated: DWAC Instructions: Broker No: Account No:Date of Conversion (or for first entry, Original Issue Date) Amount of Conversion Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount) Company’s Attest
Appears in 1 contract
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and interest under the Original Issue Discount Senior Convertible Debenture Secured OID Promissory Notes due March 1November XX, 2018 2020 of Legend Oil and Gas, Ltd., a Colorado corporation ComSovereign Holding Corp (the “Company”), into shares of its common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: :______________________________________ Principal Amount of Debenture Note to be Converted: :________________________ Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for :___________________ Signature Name Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract
Samples: Convertible Security Agreement (ComSovereign Holding Corp.)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount 10% Senior Convertible Debenture Note due March 1July 18, 2018 2017 of Legend Oil and GasOncBioMune Pharmaceuticals, Ltd.Inc., a Colorado Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: :___________________ Account No:_____________________
Appears in 1 contract
Samples: Convertible Security Agreement (OncBioMune Pharmaceuticals, Inc)
NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due March 1on the Maturity Date of SG Blocks, 2018 of Legend Oil and Gas, Ltd.Inc., a Colorado Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: DWAC Instructions: Broker No: Account No:
Appears in 1 contract