EXHIBIT 99.7
CLASS C WARRANT
TO PURCHASE COMMON STOCK
NO PAR VALUE OF
PREMIER LASER SYSTEMS, INC.
__ Warrants (Partial Shares)/1// __________, 1998
This certifies that _________________________________________ ("Holder"),
for value received, is entitled, subject to the other terms set forth below, to
purchase from Premier Laser Systems, Inc., a California corporation (the
"Company"), having a place of business at 0 Xxxxxx, Xxxxxx, Xxxxxxxxxx 00000, at
any time from the Notice Date defined below until 5:00 P.M. (California time) on
the ninetieth day following the Notice Date (the "Expiration Date"), unless
earlier terminated pursuant to the provisions of Section 2.4 hereof, at which
time this Warrant shall expire and become void, a fraction of a share, of the
Company's Common Stock, no par value (the "Common Stock") in an amount
determined pursuant to Section 2 below. The purchase or exercise price per
share (the "Exercise Price") shall be one cent ($0.01) regardless of the number
of Warrants which must be exercised to obtain a Warrant Share (as defined
below).
The number and character of the securities purchasable upon exercise of
this Warrant are subject to adjustment as provided in Section 3.3 hereof.
This Warrant is subject to the following terms and conditions:
1. EXERCISE; ISSUANCE OF CERTIFICATES; PAYMENT FOR SHARES.
1.1 DURATION OF EXERCISE OF WARRANT. This Warrant is exercisable at
the option of Holder at any time from the Notice Date until 5:00 P.M.
(California time) on the Expiration Date for all or a portion of the shares of
Common Stock that may be purchased hereunder. This Warrant shall be exercised
upon surrender to the Company of this Warrant properly endorsed with a completed
and executed Subscription Agreement in the form attached hereto as Exhibit A,
and upon payment in cash or cashier's check of the aggregate Exercise Price for
the number of shares of Common Stock for which this Warrant is being exercised
(the "Warrant Shares"). The Company agrees that any Warrant Shares purchased
under this Warrant shall be deemed to be issued to Xxxxxx as the record
/1// (Does not represent ___ shares - See Paragraph 2 for computation.)
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owner of such shares as of the close of business on the date on which this
Warrant shall have been surrendered and payment made for such shares.
Certificates for the Warrant Shares so purchased, together with any other
securities or property to which Xxxxxx is entitled upon such exercise, shall be
delivered to Holder by the Company or its transfer agent at the Company's
expense as soon as practicable after the rights represented by this Warrant have
been exercised. Each stock certificate so delivered shall be in such
denominations of Common Stock as may be reasonably requested by Holder and shall
be registered in the name of Holder or such other name as shall be designated by
Holder. If, upon exercise of this Warrant, fewer than all of the shares issuable
upon exercise of this Warrant are purchased, one or more new warrants
substantially in the form of, and on the terms contained in, this Warrant will
be issued for the remaining number of shares not exercised.
1.2 SECURITIES TO BE FULLY PAID; RESERVATION OF WARRANT SHARES. The
Company covenants and agrees that all Warrants and Warrant Shares that may be
issued upon the exercise of the rights represented by this Warrant will, upon
issuance, be duly authorized, validly issued, fully paid and nonassessable and
such issuance will not violate any pre-emptive rights under applicable law, the
Premier Articles of Incorporation or By-laws, contracts, or agreement, or
otherwise. The Company covenants that it will at all times from the date hereof
reserve and keep available a sufficient number of shares of its authorized but
unissued Common Stock (or other securities) solely for issuance and delivery to
Holder upon exercise of this Warrant. The Company will take all such reasonable
action as may be necessary to assure that such Warrants and Warrant Shares may
be issued as provided herein without violation of any applicable law or
regulation.
2. NOTICE OF EXERCISABILITY AND DETERMINATION OF NUMBER OF WARRANT
SHARES.
2.1 CONDITION TO EXERCISE. This Warrant shall not become exercisable
unless the Net Sales of Qualified Products (both as defined herein) for the
twelve (12) month period ended August 31, 1998 (the "Determination Date") equal
or exceed Seven Million Dollars ($7,000,000). "Net Sales" shall mean net sales
of Qualified Products as determined by generally accepted accounting principles,
as consistently applied by Ophthalmic Imaging Systems ("OIS"). "Qualified
Products" shall mean products sold by and in connection with the current core
business of OIS including: (i) products related to or arising out of such
current core products; (ii) products under development as of the date hereof;
and (iii) those same products if sold by any successor owner of OIS' operations.
As soon as practicable after the Determination Date, the Company shall determine
the Net Sales of Qualified Products for the twelve (12) month period ended on
the Determination Date and shall mail to the holder of the Warrant, and shall
publish in a newspaper of national circulation a notice (the "Exercise Notice")
stating whether this condition to exercisability has been met. The date of such
mailing and publication is the "Notice Date."
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2.2 SHARES ISSUABLE. To determine the number of Warrant Shares for
which the Warrant may be exercised, the Company shall determine the average
Closing Price (as defined below) of the Common Stock for the (i) fifteen (15)
consecutive trading days immediately preceding the Determination Date and (ii)
the thirty (30) consecutive trading days ending fifteen (15) trading days prior
to the Determination Date, and shall calculate the number of shares of the
Common Stock, or fraction thereof, which could be purchased at the greater of
such two average Closing Prices for a purchase price of twenty-five cents
($0.25). The result of this calculation shall be the "Share Factor." The Share
Factor shall be multiplied by the number of Warrants stated on the first page of
this Warrant to determine the number of whole shares for which this Warrant may
be exercised. Fractional shares resulting from aggregate exercises shall be
rounded to the nearest whole share.
2.3 NOTICE. The Exercise Notice sent to the Holder shall state the
number of Warrant Shares for which the Warrant has become exercisable.
2.4 EXERCISE. If the Exercise Notice states that the condition
stated in Section 2.1 has not been satisfied, then the Notice Date shall become
the Expiration Date, this Warrant shall expire effective as of the Notice Date
and the Holder shall have no further rights hereunder. If the Exercise Notice
states the condition has been met, this Warrant shall thereafter be exercisable
for the number of whole shares determined as provided in Section 2.2 and
specified in the applicable Exercise Notice.
2.5 CLOSING PRICE. For purposes of any computation pursuant to this
Section 2, the term "Closing Price" for any day shall mean the last reported
sale price, regular way, of the Common Stock, or, in case no such reported sale
takes place on such day, the average of the closing bid and asked prices,
regular way, for such day, in either case on the principal national securities
exchange on which the Common Stock is listed or admitted to trading, or if it is
not listed or admitted to trading on any national securities exchange, but is
traded on Nasdaq, the closing sale price of the Common Stock or, in case no sale
is reported, the average of the closing bid and asked quotations for the Common
Stock on Nasdaq, or any comparable system.
3. CERTAIN NOTICES.
3.1 NOTICE OF CERTAIN EVENTS. If at any time after the
Determination Date and before the Expiration Date:
3.1.1 the Company shall declare any cash dividend upon its
Common Stock;
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3.1.2 the Company shall declare any dividend upon its Common
Stock payable in stock (other than a dividend payable solely in shares of Common
Stock) or make any special dividend or other distribution to the holders of its
Common Stock;
3.1.3 the Company shall offer for subscription pro rata to the
holders of its Common Stock any additional shares of stock of any class or other
rights;
3.1.4 there shall be any capital reorganization or
reclassification of the capital stock of the Company; or consolidation or merger
of the Company with, or sale or leases, exchanges or other conveyances (other
than pledges, mortgages and liens related to loans) of substantially all of its
assets to, another corporation;
3.1.5 there shall be a voluntary or involuntary dissolution,
liquidation or winding-up of the Company; or
3.1.6 any purchase, retirement, or redemption by the Company of
its Common Stock;
then, in any one or more of said cases, the Company shall give to the registered
holder of this Warrant, by the means specified in Section 7 herein, (i) at least
twenty (20) days' prior written notice of the date on which the books of the
Company shall close or a record shall be taken for such dividend, distribution
or subscription rights or for determining rights to vote in respect of any such
reorganization, reclassification, consolidation, merger, sale, dissolution,
liquidation or winding-up, and (ii) in the case of any such reorganization,
reclassification, consolidation, merger, sale, dissolution, liquidation,
winding-up, at least twenty (20) days' prior written notice of the date when the
same shall take place; provided, however, that the Company shall not be required
to send any notice pursuant to this Section 3.1 if the Company determines the
condition in Section 2.1 has not been met. Any notice given in accordance with
the foregoing clause (i) shall also specify, in the case of any such dividend,
distribution or subscription rights, the date on which the holders of Common
Stock shall be entitled thereto. Any notice given in accordance with the
foregoing clause (ii) shall also specify the date on which the holders of Common
Stock shall be entitled to exchange their Common Stock for securities or other
property deliverable upon such reorganization, reclassification, consolidation,
merger, sale, dissolution, liquidation, winding-up, conversion or public
offering, as the case may be. If Holder does not exercise this Warrant prior to
the occurrence of an event described above, Holder shall not be entitled to
receive the benefits accruing to then existing holders of Common Stock.
3.2 NOTICE OF ADJUSTMENT. Upon the happening of an event requiring
an adjustment of the amount or the kind of securities or property purchasable
hereunder, the Company shall forthwith give notice to the Holder which indicates
the event requiring
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the adjustment, the adjusted number of Warrant Shares that may be acquired or
the amount or kind of any such securities or property so purchasable upon
exercise of this Warrant, as the case may be, and setting forth in reasonable
detail the method of calculation and the facts upon which such calculation is
based. The Company's independent public accountant shall determine the method
for calculating the adjustment and shall prepare a certificate setting forth
such calculations, the reason for the methodology chosen, and the facts upon
which such calculation is based. Such certificate shall accompany the notice to
be provided to the Holder pursuant to this Section 3.2.
3.3 ADJUSTMENT OF PURCHASE PRICE AND NUMBER OF WARRANT SHARES. The
number and kind of securities that may be acquired upon the exercise of this
Warrant shall be subject to adjustment following the Determination Date and
prior to the earlier of the exercise of, or the Expiration Date of this Warrant,
upon the happening of any of the following events:
(a) DIVIDENDS, SUBDIVISIONS, COMBINATIONS, OR CONSOLIDATIONS OF
COMMON STOCK.
(i) In the event the Company shall declare, pay, or make
any dividend upon its outstanding Common Stock payable in Common Stock or shall
effect a subdivision of the outstanding shares of Common Stock into a greater
number of shares of Common Stock, then the Share Factor shall be adjusted so
that the number of Warrant Shares that may thereafter be purchased upon the
exercise of the rights represented hereby shall be increased in proportion to
the increase in the number of outstanding shares of Common Stock through such
dividend or subdivision. In case the Company shall at any time combine the
outstanding shares of its Common Stock into a smaller number of shares of Common
Stock, the Share Factor shall be adjusted so that number of Warrant Shares that
may thereafter be acquired upon the exercise of the rights represented hereby
shall be decreased in proportion to the decrease through such combination. In
each case, the Exercise Price will not be adjusted.
(ii) If the Company declares, pays or makes any dividend
or other distribution upon its outstanding Common Stock payable in securities or
other property (excluding cash dividends and dividends payable in Common Stock,
but including, without limitation, shares of any other class of the Company's
stock or stock or other securities convertible into or exchangeable for shares
of Common Stock or any other class of the Company's stock or other interests in
the Company or its assets ("Convertible Securities")), a proportionate part of
those securities or that other property shall be set aside by the Company and
delivered to the Holder in the event that the Holder exercises this Warrant. The
securities and other property then deliverable to the Holder upon the exercise
of this Warrant shall be in the same ratio to the total securities and property
set aside for the Holder as the number of Warrant Shares with respect to which
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this Warrant is then exercised as to the total number of Warrant Shares that may
be acquired pursuant to this Warrant at the time the securities or property were
set aside for the Holder.
(iii) If the Company shall declare a dividend payable in
money on its outstanding Common Stock and at substantially the same time shall
offer to its shareholders a right to purchase new shares of Common Stock from
the proceeds of such dividend or for an amount substantially equal to the
dividend, all shares of Common Stock so issued shall, for purposes of this
Warrant, be deemed to have been issued as a stock dividend subject to the
adjustments set forth in Section 3.3 (a)(i).
(iv) If the Company shall declare a dividend payable in
money on its outstanding Common Stock and at substantially the same time shall
offer to its shareholders a right to purchase new shares of a class of stock
(other than Common Stock), Convertible Securities, or other interests from the
proceeds of such dividend or for an amount substantially equal to the dividend,
all shares of stock, Convertible Securities, or other interests so issued or
transferred shall, for purposes of this Warrant, be deemed to have been issued
as a dividend or other distribution subject to Section 3.3(a)(ii).
(v) If the Company shall declare a dividend payable in
cash on its outstanding Common Stock, such dividend shall be deemed to have been
issued as a dividend or other distribution subject to Section 3.3(a)(i).
(b) EFFECT OF RECLASSIFICATION, REORGANIZATION, CONSOLIDATION,
MERGER, OR SALE OF ASSETS.
(i) Upon the occurrence of any of the following events,
the Company shall cause an effective provision to be made so that the Holder
shall have the right thereafter, by the exercise of this Warrant, to acquire for
the Exercise Price described in this Warrant the kind and amount of shares of
stock and other securities, property and interests as would be issued or payable
with respect to or in exchange for the number of Warrant Shares that are then
purchasable pursuant to this Warrant as if such Warrant Shares had been issued
to the Holder immediately prior to such event: (A) reclassification, capital
reorganization, or other change of outstanding Common Stock (other than a change
as a result of an issuance of Common Stock under Subsection 3.3(a)), (B)
consolidation or merger of the Company with or into another corporation or
entity (other than a consolidation or merger in which the Company is the
continuing corporation and that does not result in any reclassification, capital
reorganization or other change of the outstanding shares of Common Stock or the
Warrant Shares issuable upon exercise of this Warrant), or (C) spin-off of
assets, a subsidiary or any affiliated entity, or the sale, lease, conveyance
(other than pledges, mortgages and liens related to loans) or exchange of a
significant portion of the Company's assets taken as a whole, in a transaction
pursuant
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to which the Company's shareholders of record are to receive securities or other
interests in a successor entity. Any such provision made by the Company for
adjustments with respect to this Warrant shall be as nearly equivalent to the
adjustments otherwise provided for in this Warrant as is reasonably practicable.
The foregoing provisions of this Section 3.3(b)(i) shall similarly apply to
successive reclassifications, capital reorganizations and similar changes of
shares of Common Stock and to successive consolidations, mergers, spin-offs,
sales, leases or exchanges.
(ii) If any sale or exchange of all, or substantially all,
of the Company's assets or business or any dissolution, liquidation or winding
up of the Company (a "Termination of Business") shall be proposed, the Company
shall deliver written notice to the Holder of this Warrant in accordance with
Section 3.2 hereof as a condition precedent to the consummation of that
Termination of Business. If the result of the Termination of Business is that
shareholders of the Company are to receive securities or other interests of a
successor entity, the provisions of Section 3.3(b)(i) above shall apply.
However, if the result of the Termination of Business is that shareholders of
the Company are to receive money or property other than securities or other
interests in a successor entity, the Holder of this Warrant shall be entitled to
exercise this Warrant and, with respect to any Warrant Shares purchasable
pursuant to this Warrant so acquired, shall be entitled to all of the rights of
the other shareholders of Common Stock with respect to any distribution by the
Company in connection with the Termination of Business. In the event no
successor entity is involved and Section 3.3(b)(i) does not apply, all
acquisition rights under this Warrant shall terminate at the close of business
on the date as of which shareholders of record of the Common Stock shall be
entitled to participate in a distribution of the assets of the Company in
connection with the Termination of Business; provided, that, in no event shall
-------- ----
that date be less than 20 days after delivery to the Holder of this Warrant of
the written notice described above and in Section 3.2 hereof. If the termination
of acquisition rights under this Warrant is to occur as a result of the event at
issue, a statement to that effect shall be included in that written notice.
(c) OBLIGATION OF SUCCESSORS OR TRANSFEREES. The Company shall
not effect any consolidation, merger, or sale or conveyance of assets within the
meaning of Section 3.3(b)(i)(B)-(C) unless prior to or simultaneously with the
consummation thereof the successor corporation (if other than the Company)
resulting from such consolidation or merger or the corporation purchasing such
assets shall assume by written instrument executed and mailed or delivered to
the Holder pursuant to Section 8 herein, the obligation to deliver to the Holder
such shares of stock, securities, or assets as, in accordance with the foregoing
provisions, the Holder may be entitled to acquire. In no event shall the
securities received pursuant to this Section be registerable or transferable
other than pursuant and subject to the terms of this Warrant.
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(d) APPLICATION OF THIS SECTION. The provisions of this Section
3.3 shall apply to successive events that may occur from time to time but shall
only apply to a particular event if it occurs prior to the expiration of this
Warrant either by its terms or by its exercise in full.
(e) DEFINITION OF COMMON STOCK. Unless the context requires
otherwise, whenever reference is made in this Section 3.3 to the issue or sale
of shares of Common Stock, the term "Common Stock" shall mean (i) the no par
value Class A Common Stock of the Company, (ii) any other class of stock ranking
on a parity with, and having substantially similar rights and privileges as the
Company's no par value Class A Common Stock, and (iii) any Convertible Security
convertible into either (i) or (ii). However, subject to the provisions of
Section 3.3(b)(i) above, Common Stock issuable upon the exercise of this Warrant
shall include only shares of Common Stock designed as no par value Class A
Common Stock of the Company as of the date of this Warrant.
(f) COMPANY-HELD STOCK. For purposes of Sections 3.3(a) above,
shares of Common Stock owned or held at any relevant time by, or for the account
of, the Company in its treasury or otherwise, shall not be deemed to be
outstanding for purposes of the calculation and adjustments described therein.
4. ISSUE TAX. The issuance of certificates for Warrant Shares upon the
exercise of the Warrant shall be made without charge to Holder of any issue tax
or other governmental charges in respect thereof; provided, however, that the
Company shall not be required to pay any tax that may be payable in respect of
any transfer involved in the issuance and delivery of any certificate in a name
other than that of the then holder of the Warrant being exercised.
5. NO VOTING OR DIVIDEND RIGHTS; LIMITATION OF LIABILITY. Nothing
contained in this Warrant shall be construed as conferring upon Holder the right
to vote or to consent or to receive notice as a stockholder in respect of
meetings of stockholders for the election of directors of the Company or any
other matters or any rights whatsoever as a stockholder of the Company, until,
and only to the extent that, this Warrant shall have been exercised. Except as
provided in Section 3.1 in the event of a dividend on the Common Stock payable
in shares of Common Stock, no dividends or interest shall be payable or accrued
in respect of this Warrant or the interest represented hereby or the Warrant
Shares purchasable hereunder until, and only to the extent that, this Warrant
shall have been exercised. The Company covenants, however, that until the
Termination Date, for so long as this Warrant remains at least partially
unexercised, it will furnish the Holder with copies of all reports and
communications furnished to the stockholders of the Company. No provisions
hereof, in the absence of affirmative action by Xxxxxx to purchase Warrant
Shares, and no mere enumeration herein of the rights or privileges of
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Holder shall give rise to any liability of Holder for the Exercise Price or as a
stockholder of the Company whether such liability is asserted by the Company or
by its creditors.
6. MODIFICATION AND WAIVER. This Warrant and any provision hereof may be
changed, waived, discharged or terminated only by an instrument in writing
signed by the party against which enforcement of the same is sought.
7. NOTICES. Any notice required or permitted under this Warrant shall be
in writing and either delivered personally, telegraphed or telecopied or sent by
certified or registered mail, postage prepaid, and shall be deemed to be given,
dated and received when so delivered personally, telegraphed or telecopied or,
if mailed, five (5) business days after the date of mailing to the following
address or facsimile number, or to such other address or addresses as such
person may subsequently designate by notice given hereunder.
If to the Company: Premier Laser Systems, Inc.
Attention: Secretary
0 Xxxxxx
Xxxxxx, Xxxxxxxxxx 00000
Facsimile: 000 000-0000
with a copy to: Xxxx, Xxxxxxxx, Xxxxxxxx & Xxxxxx LLP
Attention: Xxxxx X. Xxxxxxxx, Esq.
000 Xxxx Xxxxxx Xxxxx, 00xx Xxxxx
Xxxxx Xxxx, Xxxxxxxxxx 00000-1924
Facsimile: 000 000-0000
If to Holder: As Xxxxxx's address appears
on a register of Warrants
maintained by the Company's
transfer agent.
8. BINDING EFFECT ON SUCCESSORS. This Warrant shall be binding upon any
corporation succeeding the Company by merger, consolidation or acquisition of
all or substantially all of the Company's assets. All of the obligations of the
Company relating to the Common Stock issuable upon the exercise of this Warrant
shall survive the exercise and termination of this Warrant. All of the
covenants and agreements of the Company shall inure to the benefit of the
successors and assigns of the Holder.
9. DESCRIPTIVE HEADINGS AND GOVERNING LAW. The descriptive headings of
the several sections and paragraphs of this Warrant are inserted for convenience
only and do not constitute a part of this Warrant. This Warrant shall be
construed and enforced in
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accordance with, and the rights of the parties shall be governed by, the laws of
the State of California.
10. EXCHANGE, ASSIGNMENT, COMBINATION AND REPLACEMENT OF WARRANTS.
(a) This Warrant is exchangeable, without expense other than as
provided in this Section 10, at the option of the Holder upon the reasonable
request, presentation and surrender hereof to the Company for other Warrants of
different denominations entitling the Holder thereof to acquire in the aggregate
the same number of Warrant Shares that may be acquired hereunder.
(b) All of the covenant and provisions of this Warrant by or for the
benefit of the Holder shall be binding upon and shall inure to the benefit of,
its successors and permitted assigns hereunder. This Warrant and all rights
hereunder are transferrable and may be sold, transferred, assigned, or
hypothecated upon surrender of this Warrant to the Company, together with a duly
executed assignment in the form attached hereto as Exhibit B (the "Assignment
Form"), whereupon the Company shall, without charge, execute and deliver a new
Warrant containing the same terms and conditions of this Warrant in the name of
the assignee as named in the Assignment Form, and this Warrant shall be canceled
at that time. This Warrant, if properly assigned, may be exercised by a new
Holder without first having the new Warrant issued.
(c) This Warrant may be delivered or combined with other Warrants
that carry the same rights upon the reasonable request, presentation and
surrender of this Warrant at the office of the Company, together with a written
notice signed by the Holder, specifying the names and denominations in which new
Warrants are to be issued.
(d) The Company will execute and deliver to the Holder a new Warrant
of like tenor and date upon receipt by the Company of evidence reasonably
satisfactory to it of the loss, theft, destruction, or mutilation of this
Warrant; provided, that (i) in the case of loss, theft, or destruction, the
Company receives a reasonably satisfactory indemnity or bond, or (ii) in the
case of mutilation, the Holder shall provide and surrender this Warrant to the
Company for cancellation.
(e) Any new Warrant executed and delivered by the Company in
substitution or replacement of this Warrant shall constitute a contractual
obligation of the Company regardless of whether this Warrant was lost, stolen,
destroyed or mutilated, and shall be enforceable by any Holder thereof.
(f) The Holder shall pay all transfer and excise taxes applicable to
any issuance of new Warrants under this Section 10.
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11. FRACTIONAL SHARES. No fractional shares shall be issued upon exercise
of this Warrant. The Company shall, in lieu of issuing any fractional share,
round such fractional shares to the nearest whole share.
12. BEST EFFORTS. The Company covenants that it will not, by amendment of
its Articles of Incorporation or bylaws, or through any reorganization, transfer
of assets, consolidation, merger, dissolution, reissue or sale of securities, or
any other voluntary action, avoid or seek to avoid the observation or
performance for any term of this Warrant, but will at all times in good faith
assist in carrying out all those terms and in taking all action necessary or
appropriate to protect the rights of the Holder against dilution or other
impairment.
13. FURTHER ASSURANCES. The Company will take all such action as may be
necessary or appropriate in order that the Company may validly and legally
issue, duly authorized fully paid and nonassessable Warrants and Common Stock
and other securities issuable upon exercise of this Warrant from time to time
and not in violation of any pre-emptive rights.
(Signature page follows.)
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IN WITNESS WHEREOF, the Company has caused this Warrant to be executed by
its duly authorized officer effective as of ___________, 1998.
PREMIER LASER SYSTEMS, INC.
By: ________________________________________
Xxxxxxx Xxxxxx, Ph.D.
Chief Executive Officer
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EXHIBIT A
PREMIER LASER SYSTEMS, INC.
COMMON STOCK WARRANT
FORM OF SUBSCRIPTION AGREEMENT
(TO BE SIGNED AND DELIVERED
UPON EXERCISE OF WARRANT)
PREMIER LASER SYSTEMS, INC.
0 Xxxxxx
Xxxxxx, Xxxxxxxxxx 00000
Attention: Secretary
The undersigned, the holder of the within Warrant, hereby irrevocably
elects to exercise the purchase right represented by such Warrant for, and to
purchase thereunder, _______________ shares of Common Stock (the "Stock") of
Premier Laser Systems, Inc. (the "Company") and herewith makes payment of
__________________________ Dollars ($________) therefor and requests that the
certificates for such shares be issued in the name of, and delivered to,
______________, whose address is ____________________________________. A copy
of the Exercise Notice (as defined in the Warrant) evidencing that the Warrant
is exercisable for at least the number of shares covered by this agreement is
attached.
The address set forth below is the true and correct address of the
undersigned.
_____________________________________________
(Name)
_____________________________________________
(Adress)
_____________________________________________
_____________________________________________
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If said number of shares shall not be all the shares exercisable or
purchasable under the within Warrant, a new Warrant is to be issued in the name
of the undersigned for the balance remaining of the Warrants.
DATED:________________________
__________________________________________________
Name of holder must conform in all respects to
name of holder as specified on the face of the
Warrant or with the name of the assignee appearing
on the assignment form attached hereto.)
__________________________________________________
(signature)
_________________________________________________
(print name)
__________________________________________________
(print title)
A-1
EXHIBIT B
ASSIGNMENT FORM
FOR VALUE RECEIVED, the receipt and adequacy of which are each hereby
confirmed, the undersigned,_____________________, hereby sells, assigns and
transfers unto___________________ all of the undersigned's right, title and
interest in and to an aggregate of __________ (___) warrants to purchase shares
of the Common Stock of Premier Laser Systems, Inc. (the "Corporation) standing
in the name of the undersigned on the books of the Corporation and evidenced by
that certain Class C Warrant, dated ________ __, ___ (the "Warrant"), and does
hereby irrevocable constitute and appoint __________________ as attorney-in-fact
to effect the reissue of the Warrant as necessary and the transfer of said
Warrant on the books of the Corporation with full power of substitution upon
presentation to the Corporation of this Assignment Form together with the
Warrant.
Dated: ____________ __, ___
Signature: ___________________________
Printed Name: ___________________________
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