JOHN PAPPAJOHN WARRANT TO PURCHASE SHARES
THIS
WARRANT AND THE SECURITIES ISSUABLE UPON THE EXERCISE HEREOF HAVE NOT BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. THEY MAY NOT
BE SOLD, OFFERED FOR SALE, PLEDGED, HYPOTHECATED, OR OTHERWISE TRANSFERRED
EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT
OF 1933, AS AMENDED OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT
REGISTRATION IS NOT REQUIRED.
Void
after
________,
2017
XXXX
XXXXXXXXX
WARRANT TO PURCHASE
SHARES
This
Warrant is issued to Xx. Xxxx Xxxxxxxxx (“Investor”) by CNS Response,
Inc., a Delaware corporation (the “Company”), pursuant to the
terms of that certain Bridge Note and Warrant Purchase Agreement (the “Agreement”), dated June 3,
2010. All capitalized terms not defined in this Warrant shall have
the meaning ascribed to them in the Agreement.
(i) the
surrender of the Warrant, together with a notice of exercise in substantially
the form attached hereto as Exhibit A to the
Secretary of the Company at its principal offices; and
(ii) the
payment to the Company of an amount equal to the aggregate Exercise Price for
the number of Shares being purchased, either in cash (through a check payable to
the Company or by wire transfer to an account designated by the Company) or as
provided in Section 4 below.
Y (A -
B)
X
= A
Where
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X
—
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The
number of Shares to be issued to the holder of this
Warrant.
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Y
—
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The
number of Shares purchasable under this
Warrant.
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A
—
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The
fair market value of one Share.
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B
—
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The
Exercise Price (as adjusted to the date of such
calculations).
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For
purposes of this Section 4, the fair market value of a Share shall mean the
closing price of the Shares quoted in the over-the-counter market or any
exchange on which the Shares are listed, whichever is applicable, as published
in The Wall Street
Journal on the date of determination of fair market value. If
the Shares are not traded on the over-the-counter market or on an exchange, the
fair market value shall be the price per Share that the Company could obtain
from a willing buyer for Shares sold by the Company from authorized but unissued
Shares, as such prices shall be determined in good faith by the Company’s Board
of Directors.
The
Shares (unless registered under the Securities Act of 1933, as amended (the
"Act")) shall
be stamped or imprinted with a legend in substantially the following
form:
THE
SHARES REPRESENTED BY THIS CERTIFICATE HAVE BEEN ACQUIRED FOR INVESTMENT AND NOT
WITH A VIEW TO, OR IN CONNECTION WITH, THE SALE OR DISTRIBUTION THEREOF, AND
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED. SUCH SHARES MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF
SUCH REGISTRATION OR AN EXEMPTION THEREFROM UNDER THE ACT AND ANY APPLICABLE
STATE SECURITIES LAWS. COPIES OF THE AGREEMENT COVERING THE PURCHASE
OF THESE SHARES AND RESTRICTING THEIR TRANSFER MAY BE OBTAINED AT NO COST BY
WRITTEN REQUEST MADE BY THE HOLDER OF RECORD OF THIS CERTIFICATE TO THE
SECRETARY OF THE COMPANY AT THE PRINCIPAL EXECUTIVE OFFICES OF THE
COMPANY.
THE SALE
OF SECURITIES WHICH ARE THE SUBJECT OF THIS AGREEMENT HAS NOT BEEN QUALIFIED
WITH THE COMMISSIONER OF CORPORATIONS OF THE STATE OF CALIFORNIA AND THE
ISSUANCE OF THE SECURITIES OR THE PAYMENT OR RECEIPT OF ANY PART OF THE
CONSIDERATION THEREFOR PRIOR TO THE QUALIFICATION IS UNLAWFUL, UNLESS THE SALE
OF SECURITIES IS EXEMPT FROM THE QUALIFICATION BY SECTION 25100, 25102 OR 25105
OF THE CALIFORNIA CORPORATIONS CODE. THE RIGHTS OF ALL PARTIES TO
THIS AGREEMENT ARE EXPRESSLY CONDITIONED UPON THE QUALIFICATION BEING OBTAINED
UNLESS THE SALE IS SO EXEMPT.
15. Governing
Law. This Warrant and all actions arising out of or in
connection with this Agreement shall be governed by and construed in accordance
with the laws of the State of California, without regard to the conflicts of law
provisions of the State of California or of any other state.
[Signature
Page Follows]
Issued
this ___ day of _____, 2010.
By:
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Name: Xxxxxx
Xxxxxxxxx
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Its: Chief
Executive
Officer
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Address:
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85
Enterprise, Xxxxx 000
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Xxxxx
Xxxx, XX 00000
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Accepted
and agreed:
Xx.
Xxxx Xxxxxxxxx
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Address:
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000
Xxxxxx Xxxxxx
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Xxxxx
0000
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Xxx
Xxxxxx, XX 00000
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EXHIBIT A
TO:
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Attention:
Chief Executive
Officer
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1. The
undersigned hereby elects to purchase __________ Shares of _____________
pursuant to the terms of the attached Warrant.
2. Method
of Exercise (Please initial the applicable blank):
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___
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The
undersigned elects to exercise the attached Warrant by means of a cash
payment, and tenders herewith payment in full for the purchase price of
the shares being purchased, together with all applicable transfer taxes,
if any.
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___
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The
undersigned elects to exercise the attached Warrant by means of the net
exercise provisions of Section 4 of the
Warrant.
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3. Please
issue a certificate or certificates representing said Shares in the name of the
undersigned or in such other name as is specified below:
(Name)
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(Address)
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4. The
undersigned hereby represents and warrants that the aforesaid Shares are being
acquired for the account of the undersigned for investment and not with a view
to, or for resale, in connection with the distribution thereof, and that the
undersigned has no present intention of distributing or reselling such shares
and all representations and warranties of the undersigned set forth in
Section 10 of the attached Warrant are true and correct as of the date
hereof.
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(Signature)
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(Name)
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(Date)
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(Title)
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FORM
OF TRANSFER
(To be
signed only upon transfer of Warrant)
FOR VALUE
RECEIVED, the undersigned hereby sells, assigns and transfers unto
______________________the right represented by the attached Warrant to purchase
____________ shares of ________________________ of CNS Response, Inc.
to which the attached Warrant relates, and appoints ______________ Attorney to
transfer such right on the books of __________, with full power of substitution
in the premises.
Dated:
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(Signature
must conform in all respects to name of Holder as specified on the face of
the Warrant)
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Address:
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Signed
in the presence of:
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