PURCHASE FORM. The Undersigned hereby exercises the Warrant Certificate to subscribe for and purchase shares of Common Stock, $.001 par value ("Common Shares"), of NEWTOWN LANE MARKETING, INCORPORATED, a Delaware Corporation, evidenced by the within the Warrant Certificate and herewith makes payment of the Exercise Price. Kindly issue certificates for the Common Shares in accordance with the instructions given below. The certificate for the unexercised balance, if any, of the within Warrant Certificate will be registered in the name of the undersigned. Dated: _______________________________________ (Signature) Instructions for registration of Common Shares _______________________________________ Name (Please print) _______________________________________ Social Security or Other Identifying Number: _______________________________________ Address: _______________________________________ Street _______________________________________ City, State and Zip Code HOLDER: PUBLIC SECURITIES, INC. By: ___________________________________ Title: President Instructions for registration of certificate representing the unexercised balance of Warrant (if any) _______________________________________ Name (Please print) _______________________________________ Social Security or Other Identifying Number: _______________________________________ Address: _______________________________________ Street _______________________________________ City, State and Zip Code FORM OF ASSIGNMENT (to be executed by the registered holder hereof) FOR VALUE RECEIVED, ____________________________ does hereby sell, assign and transfer unto ___________________________________________ the right to purchase shares of the Common Stock of the Company, $.001 par value ("Common Shares"), of NEWTOWN LANE MARKETING, INCORPORATED, a Delaware Corporation, evidenced by the within Warrant, and does hereby irrevocably constitute and appoint ____________________________ attomey, to transfer such right on the books of the Company with full power of substitution in the premises. DATED: ________________, 200___
PURCHASE FORM. The undersigned hereby irrevocably elects to exercise the within Warrant as to________ Shares and hereby makes payment of $________ in payment of the actual exercise price thereof. INSTRUCTIONS FOR REGISTRATION OF COMMON STOCK: Name: (Please typewrite or print in block letters) Address: Dated: Signature:
PURCHASE FORM. To: Mayor’s Jewelers, Inc. The undersigned irrevocably exercises the Warrant for the purchase of shares (subject to adjustment) of Common Stock of Mayor’s Jewelers, Inc., for the Warrant and herewith makes payment of $ (the “Exercise Price”) through the following method: • such payment of the Exercise Price being in cash or by certified or official bank check payable to the order of Mayor’s Jewelers, Inc. or • such payment of the Exercise Price made by surrendering of such additional part of the Warrant having an aggregate Spread (as such term is defined in the Warrant Agreement) equal to the aggregate Exercise Price, all at the Exercise Price and on the terms and conditions specified in the within the Warrant Agreement therein referred to, surrenders the Warrant and all right, title and interest therein to Mayor’s Jewelers, Inc. and directs (subject to Section 9 of the Warrant Agreement) that the shares of Common Stock deliverable upon the exercise of such Warrant be registered or placed in the name and at the address specified below and delivered thereto. The undersigned hereby certifies to Mayor’s Jewelers, Inc. that it is, at the time of exercise of the Warrant, an “accredited investor” as defined in Rule 501(a) of the Securities Act of 1933, as amended. Date: , (Signature of Owner)1 (Street Address) (City) (State) (Zip Code) Securities and/or check to be issued to: Please insert social security or identifying number: Name: Street Address: City, State and Zip Code:
PURCHASE FORM. (To be executed upon exercise of Warrant) To BioTime, Inc.: The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Warrant Certificate for, and to purchase thereunder, _______ shares of Common Stock, as provided for therein, and tenders herewith payment of the Warrant Price in full in the form of a bank wire transfer to the account of the Company or by bank cashier's check in the amount of $______________. Please issue a certificate or certificates for such shares of Common Stock in the name of, and pay any cash for any fractional share to: ____________________________________ (Please Print Name) ____________________________________ (Please Print Address) ____________________________________ (Social Security Number or Other Taxpayer Identification Number) ____________________________________ (Signature) NOTE: The above signature should correspond exactly with the name on the face of this Warrant Certificate or with the name of the assignee appearing in the assignment form below. And, if said number of shares shall not be all the shares purchasable under the within Warrant Certificate, a new Warrant Certificate is to be issued in the name of said undersigned for the balance remaining of the share purchasable thereunder less any fraction of a share paid in cash.
PURCHASE FORM. Dated: , 20 The undersigned hereby irrevocably elects to exercise the within Warrant to the extent of purchasing shares of Common Stock and hereby makes payment of $ in payment of the stated exercise price thereof. Schedule 1 attached hereto specifies the Warrant Shares from which the shares of Common Stock are being purchased and the Warrant Exercise Price(s) for such shares.
PURCHASE FORM. (To be executed upon exercise of Warrant) To BioTime Acquisition Corporation: The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Warrant Certificate for, and to purchase thereunder, _______ shares of Series B Common Stock, as provided for therein, and tenders herewith payment of the Warrant Price in full in the form of a bank wire transfer to the account of the Company or by bank cashier's check in the amount of $______________. Please issue a certificate or certificates for such shares of Series B Common Stock in the name of, and pay any cash for any fractional share to: (Please Print Name) (Please Print Address) (Social Security Number or Other Taxpayer Identification Number)
PURCHASE FORM. To: __________________ __________________ __________________ The undersigned pursuant to the provisions set forth in the attached Warrant, hereby irrevocably elects to purchase ___________ shares of the Common Stock (the "Common Stock") covered by such Warrant and herewith makes payment of $_______, representing the full purchase price for such shares at the price per share provided for in such Warrant. The undersigned understands and acknowledges the terms and restrictions on the right to transfer or dispose of the Common Stock set forth in Section 6 of the attached Warrant, which the undersigned has carefully reviewed. The undersigned consents to the placing of a legend on its certificate for the Common Stock referring to such restrictions and the placing of stop transfer orders until the Common Stock may be transferred in accordance with the terms of such restrictions. By:_________________________________ Name:_______________________________ Title:______________________________ Date:_______________________________ ANNEX C METHOD FOR DETERMINING PRIVATE VALUATION OF ISSUER
PURCHASE FORM. The undersigned hereby irrevocably elects to exercise the Warrant represented by this Warrant Certificate to the extent of _____ shares of Common Stock, par value $.001 per share, of Alfacell Corporation, and hereby makes payment of $_______ in payment of the actual exercise price thereof.
PURCHASE FORM. The undersigned pursuant to the provisions set forth in the attached Warrant (No. ______) hereby irrevocably elects to purchase ____ shares of Warrant Shares covered by such Warrant and herewith makes payment of __________ representing the full purchase price for such shares of Warrant Shares at the price per share of Warrant Share provided for in such Warrant. If the shares of Warrant Shares are not to be issued in the name of the undersigned, the shares of Warrant Shares shall be issued in the names of permitted assigns and in the number of units as follows: Name: Name: Address: Address: Tax ID #: Tax ID #: No. of Units: No. of Units: Dated: Signature: Print Name: Address:
PURCHASE FORM. Dated __________________, 19__ The undersigned hereby irrevocably elects to exercise the within Warrant to the extent of purchasing ___________ shares of Series A Common Stock and hereby makes payment of ___________ in payment of the actual exercise price thereof. __________ Name____________________________________________________________ (Please typewrite or print in block letters) Address ________________________________________________________ Signature_______________________________________________________ ASSIGNMENT FORM FOR VALUE RECEIVED, ___________________________________ hereby sells, assigns and transfers unto Name____________________________________________________________ (Please typewrite or print in block letters) Address_________________________________________________________ the right to purchase Series A Common Stock represented by this Warrant to the extent of _______ shares as to which such right is exercisable and does hereby irrevocably constitute and appoint ________________ Attorney, to transfer the same on the books of the Company with full power of substitution in the premises. Date _______________, 19__ Signature__________________________
