Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] (THE “WARRANT”) DATE:
Appears in 2 contracts
Samples: Actividentity Corp, Actividentity Corp
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION IMPINJ, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON PREFERRED STOCK ISSUED ON [INSERT DATE] JULY 13, 2012 (THE “WARRANT”) DATE:
Appears in 2 contracts
Samples: Purchase Agreement (Impinj Inc), Purchase Agreement (Impinj Inc)
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement and Market Stand-Off Agreement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION DERMTECH INTERNATIONAL WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] _________________________ (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: Constellation Alpha Capital Corp.
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) [Signature Page to Investment Representation Statement] EXHIBIT B ASSIGNMENT FORM ASSIGNOR: AS IDENTIFIED ON THE SIGNATURE PAGE HERETO COMPANY: ACTIVIDENTITY CONTRAFECT CORPORATION WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] JUNE [ ], 2015 (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: CONTRAFECT Corp
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature Signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street addressAddress) (City, state and ZIPJurisdiction of Residency) (Email Address) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION SUNRUN INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] SEPTEMBER 30, 2015 (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: Sunrun Inc.
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page followsSignature Page Follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR INVESTOR: (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION Q THERAPEUTICS, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON CAPITAL STOCK ISSUED ON [INSERT DATE] AUGUST 30, 2011 (THE “WARRANT”) DATE:: ________________________
Appears in 1 contract
Samples: Q Holdings, Inc.
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION Kior, Inc. WARRANT: THE WARRANT TO PURCHASE SHARES OF CLASS A COMMON STOCK ISSUED ON [INSERT DATE] _____________ (THE “WARRANT”) DATE:: _________________________
Appears in 1 contract
Samples: Kior Inc
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement and Market Stand-Off Agreement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION TINTRÍ, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: Tintri, Inc.
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) (e-mail address of investor) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION SUMMIT MATERIALS, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF CLASS A COMMON STOCK ISSUED ON [INSERT DATE] [ ], 2015 (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: Summit Materials, Inc.
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION IMPINJ, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON PREFERRED STOCK ISSUED ON [INSERT DATE] (THE “WARRANT”) DATE:: ____________
Appears in 1 contract
Samples: Impinj Inc
Tax Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands that it (and not the Company) shall be responsible for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant. (signature page follows) The Investor is signing this Investment Representation Statement Agreement on the date first written above. INVESTOR (Print name of the investor) (Signature) (Name and title of signatory, if applicable) (Street address) (City, state and ZIP) EXHIBIT B ASSIGNMENT FORM ASSIGNOR: COMPANY: ACTIVIDENTITY CORPORATION DERMTECH, INC. WARRANT: THE WARRANT TO PURCHASE SHARES OF COMMON STOCK ISSUED ON [INSERT DATE] FEBRUARY 4, 2020 (THE “WARRANT”) DATE:
Appears in 1 contract
Samples: DermTech, Inc.