CARDIMA, INC. SUBSCRIPTION AGREEMENT
Exhibit
4.1
CARDIMA,
INC.
The
undersigned (hereinafter “Subscriber”) hereby confirms
his/her/its subscription for the purchase of shares of common stock, par value
$0.001 per share, (“Shares”) of Cardima Inc.,
a
Delaware corporation (the “Company”), on the terms
described below.
In
connection with this subscription, Subscriber and the Company agree as
follows:
1.
Purchase and Sale
of
the Shares.
(a)
The Company hereby agrees to issue and to sell to Subscriber, and Subscriber
hereby agrees to purchase from the Company __________ Shares at a price equal
to
$0.50 per Share (the “Share
Price”) for the aggregate subscription amount set forth on the signature
page hereto. For every twenty (20) Shares purchased by Subscriber,
the Company will issue to Subscriber a warrant (“Warrant”) to purchase three (3)
shares of the common stock of the Company, par value $0.001 per share (“Warrant
Shares”). The exercise price of each Warrant shall be
$0.55. Each Warrant shall be exercisable commencing six (6) months
after the date of issuance and expiring on the Expiration Date, as more fully
described in the Warrant. Further, in accordance with the terms of
the Warrant, the number of Warrant Shares subject to purchase shall be
permanently reduced on a share-for-share basis by the number of shares of common
stock and other Company securities (including short sales and sales or purchases
of derivative securities) sold by Subscriber during such six (6) month period
after the date of issuance. The Warrants are subject to a forced
exercise by the Company at a price of $0.001 per Warrant Share upon notice
to
record holders of the Warrants, as more fully described in the Warrant and
accompanying documents. The Warrants are also subject to a mandatory
exchange or termination in the case of certain reorganizations, mergers, or
divestitures. The form of Warrant is as annexed hereto as Exhibit
A. Upon acceptance of this Subscription Agreement by the Company, the
Company shall issue and deliver to Subscriber a stock certificate and a Warrant
evidencing the applicable number of Shares and Warrant Shares subscribed for
against payment in U.S. Dollars of the Purchase Price (as defined
below).
(b)
Subscriber hereby agrees to pay the aggregate purchase price (the “Purchase Price”) set forth on
the signature page hereof required to purchase the Shares and Warrant subscribed
for hereunder, which amount has been paid in U.S. Dollars by cash, wire transfer
or check. The wiring instructions are set forth on the signature
pages.
(c)
Subscriber understands and acknowledges that this subscription is part of a
private placement by the Company of up to the maximum of 24,000,000 Shares
and
3,600,000 Warrant Shares (the “Maximum
Offering”). If this subscription is not accepted, whether in
whole or in part, or if the Company chooses to forego the private placement,
the
subscription funds held by the Company will be returned to the investor (in
whole or in part, as appropriate) without interest or deduction.
2.
Covenants,
Representations and Warranties of Subscriber. Subscriber
covenants with, represents and warrants to, the Company and the Placement Agent
as follows:
(a)
The Confidential Purchaser Questionnaire, in the form attached hereto as Exhibit
B, completed by the Subscriber and submitted to the Company is, as of the date
thereof, true, complete, and correct in all respects.
(b)
Subscriber is an “accredited investor” as defined by Rule 501 under the
Securities Act of 1933, as amended (the “Act”), and Subscriber
is
capable of evaluating the merits and risks of Subscriber’s investment in the
Company and has the capacity to protect Subscriber’s own interests.
(c)
Subscriber understands that the securities being subscribed to under this
Subscription Agreement (the “Securities”) are not presently registered, but
Subscriber is entitled to certain rights with respect to the registration of
the
Shares and Warrant Shares (see Section 4 below). Subscriber further
understands the Company may require the Subscriber (or holder of the Warrant)
to
exercise the Warrant at such time and upon the terms as described in the Warrant
and that the required exercise by the Company may occur at time when the
Subscriber (or holder of the Warrant) may be unable, due to his own personal
financial condition, to exercise the Warrant.
(d)
Subscriber acknowledges and understands that the Securities are being purchased
for investment purposes and not with a view to distribution or resale, nor
with
the intention of selling, transferring or otherwise disposing of all or any
part
thereof for any particular price, or at any particular time, or upon the
happening of any particular event or circumstances, except selling,
transferring, or disposing the Securities made in full compliance with all
applicable provisions of the Act, the rules and regulations promulgated by
the
Securities and Exchange Commission (“SEC”) thereunder, and applicable state
securities laws.
(e)
Subscriber acknowledges the Securities must be held indefinitely until
registered under the Act or unless an exemption from such registration is
available. Subscriber is aware of the provisions of Rule 144 promulgated under
the Act which permit limited resale of common stock purchased in a private
placement subject to the satisfaction of certain conditions, including, among
other things, the existence of a public market for the common stock, the
availability of certain current public information about the Company, the resale
occurring not less than one year after a party has purchased and paid for the
security to be sold, the sale being effected through a “broker’s transaction” or
in transactions directly with a “market maker” and the number of shares of
common stock being sold during any three-month period not exceeding specified
limitations.
(f)
Subscriber acknowledges that Subscriber has had the opportunity to ask questions
of, and receive answers from the Company or any person acting on its behalf
concerning the Company and its business and to obtain any additional
information, to the extent possessed by the Company (or to the extent it could
have been acquired by the Company without unreasonable effort or expense)
necessary to verify the accuracy of the information received by Subscriber.
In
connection therewith, Subscriber acknowledges that Subscriber has had the
opportunity to discuss the Company’s business, management and financial affairs
with the Company’s management or any person acting on its
behalf. Without limiting the generality of the foregoing, Subscriber
has been furnished with or has had the opportunity to acquire, and to review:
(i) copies of all of the Company’s publicly available documents, and (ii) all
information, both written and oral, it desires with respect to the Company’s
business, management, financial affairs and prospects. In determining
whether to make this investment, Subscriber has relied solely on Subscriber’s
own knowledge and understanding of the Company and its business based upon
Subscriber’s own due diligence investigations and the information furnished
pursuant to this paragraph. Subscriber understands that no person has
been authorized to give any information or to make any representations which
were not furnished pursuant to this paragraph and Subscriber has not relied
on
any other representations or information.
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(g) Subscriber
has all requisite legal and other power and authority to execute and deliver
this Subscription Agreement and to carry out and perform Subscriber’s
obligations under the terms of this Subscription Agreement. This
Subscription Agreement constitutes a valid and legally binding obligation of
Subscriber, enforceable in accordance with its terms, and subject to laws of
general application relating to bankruptcy, insolvency and the relief of debtors
and rules of law governing specific performance, injunctive relief or other
general principals of equity, whether such enforcement is considered in a
proceeding in equity or law.
(h)
Subscriber has carefully considered and has discussed with the Subscriber’s
professional legal, tax, accounting and financial advisors, to the extent
Subscriber has deemed necessary, the suitability of this investment and the
transactions contemplated by this Subscription Agreement for the Subscriber’s
particular federal, state, local and foreign tax and financial situation and
has
determined that this investment and the transactions contemplated by this
Subscription Agreement are a suitable investment for the
Subscriber. Subscriber relies solely on such advisors and not on any
statements or representations of the Company or any of its
agents. Subscriber understands that Subscriber (and not the Company)
shall be responsible for Subscriber’s own tax liabilities which may arise as a
result of this investment or the transactions contemplated by this Subscription
Agreement.
(i)
Neither this Subscription Agreement nor the Confidential Purchaser Questionnaire
contain any untrue statement of a material fact or omit any material fact
concerning Subscriber.
(j)
There are no actions, suits, proceedings or investigations pending against
Subscriber or Subscriber’s properties before any court or governmental agency
(nor, to Subscriber’s knowledge, is there any threat thereof) which would impair
in any way Subscriber’s ability to enter into and fully perform Subscriber’s
commitments and obligations under this Subscription Agreement or the
transactions contemplated hereby.
(k)
The execution, delivery and performance of and compliance with this Subscription
Agreement and the issuance of the Securities will not result in any material
violation of, or conflict with, or constitute a material default under, any
of
Subscriber’s articles of incorporation or bylaws, if applicable, or any of
Subscriber’s material agreements nor result in the creation of any mortgage,
pledge, lien, encumbrance or charge against any of the assets or properties
of
Subscriber or the Securities.
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(l) Subscriber
acknowledges the Securities are speculative and involve a high degree of risk
and that Subscriber can bear the economic risk of the purchase of the
Securities, including a total loss of his/her/its investment.
(m)
Subscriber recognizes that no federal, state or foreign agency has recommended
or endorsed the purchase of the Securities.
(n)
Subscriber is aware the Securities are and will be, when issued, “restricted
securities” as that term is defined in Rule 144 of the general rules and
regulations under the Act.
(o)
Subscriber understands any and all certificates representing the Securities
and
any and all securities issued in replacement thereof or in exchange therefore
shall bear the following legend or one substantially similar thereto, which
Subscriber has read and understands:
“THE
SECURITIES REPRESENTED HEREBY HAVE NOT BEEN REGISTERED UNDER THE SECURITIES
ACT
OF 1933, AS AMENDED, OR ANY STATE SECURITIES LAWS AND NEITHER THE SECURITIES
NOR
ANY INTEREST THEREIN MAY BE OFFERED, SOLD, TRANSFERRED, PLEDGED OR OTHERWISE
DISPOSED OF EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER SUCH
ACT OR SUCH LAWS OR AN EXEMPTION FROM REGISTRATION UNDER SUCH ACT AND SUCH
LAWS
WHICH, IN THE OPINION OF COUNSEL FOR THIS CORPORATION, IS
AVAILABLE.”
(p)
Because of the restrictions imposed on resale, Subscriber understands the
Company shall have the right to note stop-transfer instructions in its stock
transfer records to prohibit transfer in violation with this Subscription
Agreement or with applicable securities laws, and Subscriber has been informed
of the Company’s intention to do so. Any sales, transfers, or any
other dispositions of the Securities by Subscriber, if any, will be in
compliance with the Act.
(q)
Subscriber represents: (i) Subscriber is able to bear the economic risks of
an
investment in the Securities and to afford the complete loss of the investment,
and (ii) (A) Subscriber could be reasonably assumed to have the capacity to
protect his/her/its own interests in connection with this subscription; or
(B)
Subscriber has a pre-existing personal or business relationship with either
the
Company or any affiliate thereof of such duration and nature as would enable
a
reasonably prudent purchaser to be aware of the character, business acumen
and
general business and financial circumstances of the Company or such affiliate
and is otherwise personally qualified to evaluate and assess the risks, nature
and other aspects of this subscription.
(r)
Subscriber further represents the address set forth in the Confidential
Purchaser Questionnaire is his/her principal residence (or, if Subscriber is
a
company, partnership or other entity, the address of its principal place of
business); that Subscriber is purchasing the Securities for Subscriber’s own
account and not, in whole or in part, for the account of any other person;
and
Subscriber has not formed any entity for the purpose of purchasing the
Securities.
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(s)
Subscriber understands the Company shall have the unconditional right to accept
or reject each subscription, in whole or in part, for any reason or without
a
specific reason, in the sole and absolute discretion of the Company (even after
receipt and clearance of Subscriber’s funds). No subscription will be
binding upon any company until accepted by an authorized officer of the
Company. In the event the subscription is rejected, Subscriber’s
subscription funds will be returned without interest thereon or deduction
therefrom.
(t)
Subscriber represents that Subscriber is not subscribing for Securities as
a
result of or subsequent to any advertisement, article, notice or other
communication published in any newspaper, magazine or similar media or broadcast
over the Internet, television or radio or presented at any seminar or
meeting.
(u) Subscriber
has carefully read this Subscription Agreement and the Warrant, and Subscriber
has accurately completed the Confidential Purchaser Questionnaire which
accompanies this Subscription Agreement.
(v) Subscriber
represents and warrants, to the best of its knowledge, that other than the
placement agent, if any, no finder, broker, agent, financial advisor or other
intermediary, nor any purchaser representative or any broker-dealer acting
as a
broker, is entitled to any compensation in connection with the transactions
contemplated by this Subscription Agreement.
(w)
If Subscriber is a trust, this investment, together with all other securities
of
the Company held by the trust, does not exceed 10% of the trust
assets.
(x)
Regulation S. The
Subscriber is not acquiring the Securities for the account or benefit of,
directly or indirectly, any U.S. Person. The Subscriber is not a U.S.
Person. The Subscriber is acquiring the Securities for investment only and
not
with a view to resale or distribution and, in particular, it has no intention
to
distribute either directly or indirectly any of the Securities in the United
States or to U.S. Persons. The Subscriber acknowledges that the
Subscriber has not acquired the Securities as a result of, and will not itself
engage in, any "directed selling efforts" (as defined in Regulation S under
the
0000 Xxx) in the United States in respect of the Securities which would include
any activities undertaken for the purpose of, or that could reasonably be
expected to have the effect of, conditioning the market in the United States
for
the resale of the Securities; provided, however, that the Subscriber may sell
or
otherwise dispose of the Securities pursuant to registration of the Securities
pursuant to the 1933 Act and any applicable state and provincial securities
laws
or under an exemption from such registration requirements and as otherwise
provided herein.
3.
Covenants,
Representations and Warranties of the Company. The Company
covenants with, and represents and warrants to, Subscriber as
follows:
(a)
The Company is duly organized and validly exists as a corporation in good
standing under the laws of the State of Delaware.
(b)
The Company has all such corporate power and authority to enter into, deliver
and perform this Subscription Agreement and the Warrant.
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(c)
All necessary corporate action has been duly and validly taken by the Company
to
authorize the execution, delivery and performance of this Subscription Agreement
and the Warrant by the Company, and the issuance and sale of the Securities
to
be sold by the Company pursuant to this Subscription Agreement and the Warrant.
This Subscription Agreement and the Warrant have been duly and validly
authorized, executed and delivered by the Company and constitutes the legal,
valid and binding obligation of the Company enforceable against the Company
in
accordance with its terms, except as the enforceability thereof may be limited
by bankruptcy, insolvency, reorganization, moratorium or other similar laws
affecting the enforcement of creditors’ rights generally and by general
equitable principles.
(d)
To its best knowledge, the Company has not infringed, is not infringing, nor
has
received notice of any claim that the Company has infringed with respect to
asserted intellectual property rights (including, without limitation, copyright,
patent, trademark, trade dress, service xxxx and any other intellectual property
rights) of others. To the best knowledge of the Company, none of the patents,
patent applications, trademarks, service marks, trade names and copyrights,
and
licenses and rights to the foregoing presently owned or held by the Company,
materially infringe upon any like right of any other person or entity. The
Company: (i) owns or has the right to use, free and clear of all liens, charges,
claims, encumbrances, pledges, security interests, defects or other restrictions
of any kind whatsoever, sufficient patents, trademarks, service marks, trade
names, copyrights, licenses and rights with respect to the foregoing, , and
(ii)
is not obligated or under any liability whatsoever to make any payments by
way
of royalties, fees or otherwise to any owner or licensee of, or other claimant
to, any patent, trademark, service xxxx, trade name, copyright, know-how,
technology or other intangible asset, with respect to the use thereof or in
connection with the conduct of its business as now conducted or otherwise.
The
Company has direct ownership of title to all its intellectual property
(including all United States and foreign patent applications and patents),
other
proprietary rights, confidential information and know-how; owns all the rights
to its intangibles assets as are currently used in or have potential for use
in
its business.
(e)
The Shares and Warrant Shares to be issued and sold to the undersigned as
provided in this Subscription Agreement have been duly authorized and when
issued and delivered against payment therefor, will be validly issued, fully
paid and non-assessable. The Warrants are exercisable for shares of the common
stock of the Company, par value $0.001 per share, and these shares of common
stock issuable upon exercise of the Warrants have been duly authorized and
when
issued and delivered upon exercise and due payment therefor will be validly
issued, fully paid and non-assessable and there are no preemptive or other
rights to subscribe for or to purchase, no encumbrances or liens, nor any
restriction upon the voting or transfer of, any shares of common stock issuable
to Subscriber (whether issued directly as part of the Shares or upon exercise
of
the Warrants) pursuant to the Company's certificate of incorporation or by-laws
or any agreement or other outstanding instrument to which the Company is a
party
or is otherwise known to the Company. The Company has reserved sufficient shares
of Common Stock to be issued upon exercise of the Warrants.
(f) The
Company shall provide for the transfer, upon request of the Subscriber, or
removal of any legends on the Securities, all as may be allowed in accordance
with SEC Rule 144, and provide any required opinions of counsel to the Company’s
transfer agents, at no cost to Subscriber.
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(g) As
of the date of this Subscription Agreement, the Company’s authorized capital
stock consists of (a) 300,000,000 shares of common stock of which 98,316,311
shares are issued and outstanding and (b) 10,000,000 shares of Preferred Stock,
par value $0.001 per share, of which 10,000,000 shares are designated Series
A
Participating Preferred Stock, of which 5,000,000 shares are issued and
outstanding. All 98,316,311 shares of common stock of the Company
outstanding have been duly authorized and validly issued and are fully paid
and
non-assessable.
(h) The
Company has not taken any action inconsistent with the treatment of the sale
of
the Shares and Warrants as a private placement exempt from the registration
requirements of the Act pursuant to the provisions of Section 4(2) thereof
and
Regulation D thereunder or under Regulation S. Assuming the accuracy
of each Subscriber’s representations and warranties, the offer, sale, and
issuance by the Company of the Shares and Warrants to the Subscribers as
contemplated herein constitute transactions exempt from the registration
requirements of Section 5 of the Act.
(i) All
Company filings with the SEC, including, without limitation, annual reports
on
Form 10-KSB, quarterly reports on Form 10-QSB and reports by the Company on
Form
8-K (the “SEC Documents”), conform in all material respects to the requirements
of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), as
applicable, and the rules, regulations and instructions of the SEC
thereunder. The SEC Documents did not as of their dates contain any
untrue statement of a material fact or omit to state a material fact required
to
be stated therein or necessary to make the statements made therein, in light
of
the circumstances in which they were made, not misleading. The
financial statements of the Company included in the SEC Documents (the
“Financial Statements”) comply as to form in all material respects with
applicable accounting requirements and with the published rules and regulations
of the SEC with respect thereto. Except as may be indicated in the
notes to the Financial Statements, the Financial Statements have been prepared
in accordance with generally accepted accounting principles consistently applied
and fairly present, in all material respects, the financial position of the
Company at the dates thereof and the results of its operations, stockholders’
equity and cash flows for the periods then ended (subject, in the case of
unaudited statements, to normal, recurring adjustments).
(j) Except
as set forth in the SEC Documents, (i) the Company has not incurred any
liabilities or obligations, contingent or otherwise, that are material in the
aggregate to the Company taken as a whole, except in the ordinary course of
business, (ii) there has been no material adverse change in the condition or
results of operations, financial or otherwise, of the Company, taken as a whole;
and (iii) there are no material legal proceedings to which the Company is a
party or of which property of the Company is the subject and, to the Company’s
knowledge, no such proceedings are contemplated by governmental authorities
or
others.
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4.
Registration Rights.
The Company shall use its best efforts to secure effectiveness of, as
soon as reasonably practicable after the issuance and delivery of the Shares
and
Warrants, a registration statement on Form SB-2 (the “Registration Statement”)
with the SEC pursuant to the Securities Act to register the resale of the Shares
and the Warrant Shares (the “Registrable Securities”). In no case,
however, shall the filing of the Registration Statement with the SEC occur
later
than forty-five (45) calendar days after the issuance and delivery of the Shares
and Warrants under this Subscription Agreement;
(a) Registration
Expenses . The
Company shall pay all Registration Expenses (as defined below) in connection
with any registration, qualification or compliance hereunder, and each holder
of
Registrable Securities (a “Holder;” collectively, the “Holders”) shall pay all
Selling Expenses related to such Holder’s sale of Registrable Securities and
other expenses that are not Registration Expenses relating to the Registrable
Securities resold by such Holder. “Registration Expenses” shall mean
all expenses, except for Selling Expenses, incurred by the Company in complying
with the registration provisions herein described, including, without
limitation, all registration, qualification and filing fees, printing expenses,
fees and disbursements of counsel for the Company, blue sky fees and expenses
and the expense of any special audits incident to or required by any such
registration. “Selling Expenses” shall mean all selling commissions,
underwriting fees and stock transfer taxes applicable to the Registrable
Securities and all fees and disbursements of counsel for any Holder, not to
exceed $25,000 in the aggregate.
(b) Providing
Information . Each
Holder of Registrable Securities shall furnish to the Company such information
regarding such Holder and the distribution proposed by such Holder as the
Company may reasonably request in writing and as shall be reasonably required
in
connection with any registration, qualification or compliance described
herein. Such Holder shall represent that such information is true and
complete.
(c) Additional
Company Obligations
(1) In
the case of any registration effected by the Company pursuant to these
registration provisions, the Company will use its best efforts to: (i) keep
such
registration effective until two years after the Closing Date (or such earlier
date as all of the Registrable Securities have been sold or may be sold under
Rule 144(k); (ii) prepare and file with the SEC such amendments and supplements
to the Registration Statement and the prospectus used in connection with the
Registration Statement as may be necessary to comply with the provisions of
the
Act with respect to the disposition of the Registrable Securities; (iii) furnish
such number of prospectuses and other documents incident thereto, including
any
amendment of or supplement to the prospectus, as a Holder from time to time
may
reasonably request; (iv) cause all such Registrable Securities registered as
described herein to be listed on each securities exchange and quoted on each
quotation service on which similar securities issued by the Company are then
listed or quoted; (v) provide a transfer agent and registrar for all Registrable
Securities registered pursuant to the Registration Statement and a CUSIP number
for all such Registrable Securities; (vi) use its reasonable efforts to comply
with all applicable rules and regulations of the SEC and (vii) notify Holders
of
the happening of any event as a result of which the prospectus included in
the
Registration Statement, as then in effect, includes an untrue statement of
a
material fact or omits to state a material fact required to be stated therein
or
necessary to make the statements therein not misleading in light of the
circumstances then existing; and (viii) file the documents required of the
Company and otherwise use its best efforts to maintain requisite blue sky
clearance in (A) all jurisdictions in which any of the Registrable Securities
are originally sold and (B) all other states specified in writing by a Holder
as
may reasonably be required to sell such Holder’s Registrable Securities,
provided as to clause (B), however, that the Company shall not be required
to
qualify to do business or consent to service of process in any state in which
it
is not now so qualified or has not so consented.
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(2) With
a view to make available to the Subscribers or Holders the benefits of Rule
144
promulgated under the Act and any other rule or regulation of the SEC that
may
at any time permit a Subscriber or Holder to sell Securities to the public
without registration or pursuant to a registration, the Company will covenant
and agree to: (i) make and keep public information available, as those terms
are
understood and defined in Rule 144, at all times; (ii) file with the SEC in
a
timely manner all reports and other documents required of the Company under
the
Exchange Act; and (iii) furnish to any Subscriber or Holder, so long as the
Subscriber or Holder owns any Securities forthwith upon request, (A) a written
statement by the Company that it has complied with the reporting requirements
of
Rule 144, the Act and the Exchange Act, (B) a copy of the most recent annual
or
quarterly report of the Company, and (C) such other information as may be
reasonably requested in order to avail any Subscriber or Holder of any rule
or
regulation of the SEC that permits the selling of any such Securities without
registration.
5.
Indemnification.
(a) Indemnification
by the Company. The Company
agrees to indemnify and hold harmless each Holder from and against any losses,
claims, damages or liabilities (or actions or proceedings in respect thereof)
to
which such Holder may become subject (under the Act or otherwise) insofar as
such losses, claims, damages or liabilities (or actions or proceedings in
respect thereof) arise out of, or are based upon, any claim by a third party
asserting any untrue statement of a material fact contained in the Registration
Statement, on the effective date thereof, or arise out of any failure by the
Company to fulfill any undertaking included in the Registration Statement,
and
the Company will, as incurred, reimburse such Holder for any legal or other
expenses reasonably incurred in investigating, defending or preparing to defend
any such action, proceeding or claim; provided,
however,
that the Company shall not be liable
in any such case to the extent that such loss, claim, damages or liability
arises out of, or is based upon (i) an untrue statement or alleged untrue
statement made in such Registration Statement in reliance upon and in conformity
with written information furnished to the Company by or on behalf of such Holder
specifically for use in preparation of the Registration Statement or (ii))
any
untrue statement in any prospectus that is corrected in any subsequent
prospectus that was delivered to the Holder prior to the pertinent sale or
sales
by the Holder.
(b) Indemnification
by Holder. Each
Holder, severally and not jointly, agrees to indemnify and hold harmless the
Company from and against any losses, claims, damages or liabilities (or actions
or proceedings in respect thereof) to which the Company may become subject
(under the Securities Act or otherwise) insofar as such losses, claims, damages
or liabilities (or actions or proceedings in respect thereof) arise out of,
or
are based upon any claim by a third party asserting (i) an untrue statement
made
in such Registration Statement in reliance upon and in conformity with written
information furnished to the Company by or on behalf of such Holder specifically
for use in preparation of the Registration Statement, provided, however,
that no
Holder shall be liable in any such case for any untrue statement included in
any
prospectus which statement has been corrected, in writing, by such Holder and
delivered to the Company at least three business days before the sale from
which
such loss occurred or (ii) any untrue statement in any prospectus that is
corrected in any subsequent prospectus that was delivered to the Holder prior
to
the pertinent sale or sales by the Holder, and each Holder, severally and not
jointly, will, as incurred, reimburse the Company for any legal or other
expenses reasonably incurred in investigating, defending or preparing to defend
any such action, proceeding or claim.
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(c) Controlling
Persons Indemnified. The
obligations of the Company and the Holders under this Section 5 shall be in
addition to any liability which the Company and the respective Holders may
otherwise have and shall extend, upon the same terms and conditions, to each
person, if any, who controls the Company or any Holder within the meaning of
the
Act.
6.
Patriot Act
Compliance. (Terms used in this section are defined in paragraph (d)
below.)
To
induce
the Company to accept the undersigned’s investment, the undersigned hereby makes
the following representations, warranties and covenants to the
Company:
(a) The
undersigned represents and warrants that no holder of any beneficial interest
in
the undersigned’s equity securities of the Company (each a “Beneficial Interest Holder”)
and, no Related Person (in the case the undersigned is an entity) is or will
be:
(1)
|
A
person or entity whose name appears on the list of specially designated
nationals and blocked persons maintained by the Office of Foreign
Asset
Control from time to time;
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(2)
|
A
Foreign Shell Bank; or
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(3)
|
A
person or entity resident in or whose subscription funds are transferred
from or through an account in a Non-Cooperative
Jurisdiction.
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(b) The
undersigned represents that the bank or other financial institution (the “Wiring Institution”) from
which the undersigned’s funds will be wired is located in a FATF
Country.
(c) The
undersigned represents that:
(1)
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Neither
it, any Beneficial Interest Holder nor any Related Person (in the
case of
the undersigned is an entity) is a Senior Foreign Political Figure,
any
member of a Senior Foreign Political Figure’s Immediate Family or any
Close Associate of a Senior Foreign Political Figure;
or
|
(2)
|
Neither
it, any Beneficial Interest Holder nor any Related Person (in the
case the
undersigned is an entity) is resident in, or organized or chartered
under
the laws of, a jurisdiction designated by the Secretary of the Treasury
under Section 311 or 312 of the USA PATRIOT Act as warranting special
measures due to money laundering
concerns.
|
10
(3)
|
Its
investment funds do not originate from, nor will they be routed through,
an account maintained at a Foreign Shell Bank, an “offshore bank,” or a
bank organized or chartered under the laws of a Non-Cooperative
Jurisdiction.
|
(d)
Definitions:
Close
Associate: With
respect to a Senior Foreign Political Figure, a person who is widely and
publicly known internationally to maintain an unusually close relationship
with
the Senior Foreign Political Figure, and includes a person who is in a position
to conduct substantial domestic and international financial transactions on
behalf of the Senior Foreign Political Figure.
FATF:
The Financial
Action Task Force on Money Laundering.
FATF
Country: A
country that is a member of FATF. As of September 1, 2003, the
countries which are members of FATF are: Argentina; Australia; Austria; Belgium;
Brazil; Canada; Denmark; Finland; France; Germany; Greece; Hong Kong; Iceland;
Ireland; Italy; Japan; Luxembourg; Mexico; Kingdom of the Netherlands; New
Zealand; Norway; Portugal; Singapore; South Africa; Spain; Sweden; Switzerland;
Turkey; United Kingdom and United States. For a current list of FATF
members see xxxx://xxx0.xxxx.xxx/xxxx/Xxxxxxx_xx.xxx.
Foreign
Bank: An
organization which (i) is organized under the laws of a country outside the
United States; (ii) engages in the business of banking; (iii) is recognized
as a
bank by the bank supervisory or monetary authority of the country of its
organization or principal banking operations; (iv) receives deposits to a
substantial extent in the regular course of its business; and (v) has the power
to accept demand deposits, but does not include the U.S. branches or agencies
of
a foreign bank.
Foreign
Shell Bank: A
Foreign Bank without a Physical Presence in any country, but does not include
a
Regulated Affiliate.
Government
Entity:
Any government or any state, department or other political subdivision thereof,
or any governmental body, agency, authority or instrumentality in any
jurisdiction exercising executive, legislative, regulatory or administrative
functions of or pertaining to government.
Immediate
Family:
With respect to a Senior Foreign Political Figure, typically includes the
political figure’s parents, siblings, spouse, children and in-laws.
Non-Cooperative
Jurisdiction: Any foreign country or territory that has been designated
as non-cooperative with international anti-money laundering principles or
procedures by an intergovernmental group or organization, such as FATF, of
which
the United States is a member and with which designation the United States
representative to the group or organization continues to concur. See
xxxx://xxx0.xxxx.xxx/xxxx/XXXX_xx.xxx for FATF’s list of non-cooperative
countries and territories.
Physical
Presence: A
place of business maintained by a Foreign Bank and is located at a fixed
address, other than solely a post office box or an electronic address, in a
country in which the Foreign Bank is authorized to conduct banking activities,
at which location the Foreign Bank: (a) employs one or more individuals on
a
full-time basis; (b) maintains operating records related to its banking
activities; and (c) is subject to inspection by the banking authority that
licensed the Foreign Bank to conduct banking activities.
11
Publicly
Traded
Company: An entity whose securities are listed on a recognized securities
exchange or quoted on an automated quotation system in the U.S. or country
other
than a Non-Cooperative Jurisdiction or a wholly-owned subsidiary of such an
entity.
Qualified
Plan: A tax
qualified pension or retirement plan in which at least 100 employees participate
that is maintained by an employer organized in the U.S. or is a U.S. Government
Entity.
Regulated
Affiliate:
A Foreign Shell Bank that: (a) is an affiliate of a depository institution,
credit union or Foreign Bank that maintains a Physical Presence in the U.S.
or a
foreign country, as applicable; and (b) is subject to supervision by a banking
authority in the country regulating such affiliated depository institution,
credit union or Foreign Bank.
Related
Person: With
respect to any entity, any interest holder, director, senior officer, trustee,
beneficiary or grantor of such entity; provided that in the case of an entity
that is a Publicly Traded Company or a Qualified Plan, the term “Related Person”
shall exclude any interest holder holding less than 5% of any class of
securities of such Publicly Traded Company and beneficiaries of such Qualified
Plan.
Senior
Foreign Political
Figure: A senior official in the executive, legislative, administrative,
military or judicial branches of a non-U.S. government (whether elected or
not),
a senior official of a major non-U.S. political party, or a senior executive
of
a non-U.S. government-owned corporation. In addition, a Senior
Foreign Political Figure includes any corporation, business or other entity
that
has been formed by, or for the benefit of, a Senior Foreign Political
Figure.
USA
PATRIOT Act: The
Uniting and Strengthening America by Providing Appropriate Tools Required to
Intercept and Obstruct Terrorism (USA PATRIOT Act) Act of 2001 (Pub. L.
No. 107-56).
7.
Independent Nature
of
Investor’s Obligations and Rights. The obligations of the
Subscriber under this Agreement and any other documents delivered in connection
herewith and therewith (collectively, the “Transaction Documents”) are several
and not joint with the obligations of any other purchaser of Shares, and the
Subscriber is not responsible in any way for the performance of the obligations
of any other purchaser of Shares under any Transaction Document. The
decision of the Subscriber to purchase Shares pursuant to the Transaction
Documents has been made by the Subscriber independently of any other purchaser
of Shares. Nothing contained herein or in any Transaction Document,
and no action taken by any purchaser of Shares pursuant thereto, shall be deemed
to constitute such purchasers as a partnership, an association, a joint venture,
or any other kind of entity, or create a presumption that the purchasers of
Shares are in any way acting in concert or as a group with respect to such
obligations or the transactions contemplated by the Transaction
Documents. The Subscriber acknowledges that no other purchaser of
Shares has acted as agent for the Subscriber in connection with making its
investment hereunder and that no other purchaser of Shares will be acting as
agent of the Subscriber in connection with monitoring its investment in the
Shares or enforcing its rights under the Transaction Documents. The
Subscriber shall be entitled to independently protect and enforce its rights,
including without limitation the rights arising out of this Agreement or out
of
the other Transaction Documents, and it shall not be necessary for any other
purchaser of Shares to be joined as an additional party in any proceeding for
such purpose.
12
8.
Miscellaneous.
(a)
Subscriber agrees not to transfer or assign this Subscription Agreement or
any
of Subscriber’s interest herein and further agrees that the transfer or
assignment of the Securities acquired pursuant hereto shall be made only in
accordance with all applicable laws.
(b)
Subscriber agrees that Subscriber cannot cancel, terminate or revoke this
Subscription Agreement or any agreement of Subscriber made hereunder, and this
Subscription Agreement shall survive the death or legal disability of Subscriber
and shall be binding upon Subscriber’s heirs, executors, administrators,
successors and permitted assigns.
(c)
Subscriber has read and accurately completed this entire Subscription
Agreement
(d)
This Subscription Agreement constitutes the entire agreement among the parties
hereto with respect to the subject matter hereof and may be amended only by
a
written execution by all parties.
(e)
Subscriber acknowledges it has been advised to consult with his/her/its own
attorney regarding this subscription and Subscriber has done so to the extent
that Subscriber deems appropriate. Subscriber understands and agrees that
Subscriber has not been represented in this transaction by counsel to the
Company or the Placement Agent.
(f)
Any notice or other document required or permitted to be given or delivered
to
the Subscriber shall be in writing and sent: (i) by registered or certified
mail
with return receipt requested (postage prepaid) or (ii) by a recognized
overnight delivery service (with charges prepaid).
If
to the
Company, at:
00000
Xxxxxxx Xxxxxx
Xxxxxxx,
XX 00000
(000)
000-0000
Attn.:
Xxxxx Xxx, Chief Financial Officer
If to the Subscriber, at its address set forth on the signature page to this
Subscription Agreement or such other address as it shall have specified to
the
Company in writing.
(g)
Failure of the Company to exercise any right or remedy under this Subscription
Agreement or any other agreement between the Company and the Subscriber, or
otherwise, or delay by the Company in exercising such right or remedy, will
not
operate as a waiver thereof. No waiver by the Company will be effective unless
and until it is in writing and signed by the Company.
13
(h)
This Subscription Agreement shall be enforced; governed and construed in all
respects in accordance with the laws of the State of California as such laws
are
applied to agreements between California residents entered into and to be
performed entirely within California. The Subscriber hereby irrevocably submits
to the jurisdiction of any State or United States Federal court sitting in
Alameda or San Francisco counties in the State of California over any action
or
proceeding arising out of or relating to this Subscription Agreement or any
agreement contemplated hereby, and the Purchaser hereby irrevocably agrees
that
all claims in respect of such action or proceeding may be heard and determined
in such State or Federal court. The Subscriber further waives any objection
to
venue in such State and any objection to an action or proceeding in such State
on the basis of a non-convenient forum. The Subscriber further agrees that
any
action or proceeding brought against the Company shall be brought only in the
State or United States Federal courts sitting in Alameda or San Francisco
counties in the State of California. The Subscriber agrees to waive its right
to
a jury trial on any claim or cause of action based upon or arising out of this
Subscription Agreement or any document or agreement contemplated
hereby.
(i)
If any provision of this Subscription Agreement is held to be invalid or
unenforceable under any applicable statute or rule of law, then such provision
shall be deemed modified to conform to such statute or rule of law. Any
provision hereof that may prove invalid or unenforceable under any law shall
not
affect the validity or enforceability of any other provisions
hereof.
(j)
The parties understand and agree money damages would not be a sufficient remedy
for any breach of the Subscription Agreement by the Company or the Subscriber
and that the party against which such breach is committed shall be entitled
to
equitable relief, including injunction and specific performance, as a remedy
for
any such breach. Such remedies shall not be deemed to be the exclusive remedies
for a breach by either party of the Subscription Agreement but shall be in
addition to all other remedies available at law or equity to the party against
which such breach is committed.
(k)
All pronouns and any variations thereof used herein shall be deemed to refer
to
the masculine, feminine, singular or plural, as identity of the person or
persons may require.
(l)
This Subscription Agreement may be executed in counterparts and by facsimile,
each of which shall be deemed an original, but all of which shall constitute
one
and the same instrument.
[Signature
Pages Follow]
14
Signature
Page for Individuals:
IN
WITNESS WHEREOF, Subscriber has
caused this Subscription Agreement to be executed as of the date indicated
below.
$______________________($0.50
per
Share)
|
______________________________________________________________________
|
Purchase
Price
|
Number
of
Shares
|
______________________________________________________________________
|
|
Entitled
to Warrants for Number of
Warrant Shares
|
|
______________________________________________________________________
|
______________________________________________________________________
|
Print
or Type
Name
|
Print
or Type Name
(Joint-owner)
|
______________________________________________________________________
|
______________________________________________________________________
|
Signature
|
Signature
(Joint-owner)
|
___________________________________
|
__________________________________
|
Date
|
Date
(Joint-owner)
|
____________________________________
|
___________________________________
|
IRS
Taxpayer Identification
Number
|
IRS
Taxpayer Identification Number
(Joint-owner)
|
___________________________________
|
____________________________________
|
Address
|
Address
(Joint-owner)
|
___________________________________
|
____________________________________
|
Telephone
Number
|
Telephone
Number
|
___________________________________
|
____________________________________
|
Fax
Number
|
Fax
Number
|
___________________________________
|
____________________________________
|
E-mail
Address
|
E-mail
Address
|
Type
of
Ownership
|
Individual
|
|
Tenants
in common
|
|
Joint
tenants with right of survivorship
|
|
Community
property (check only if resident of community property state)
|
Other (please specify:____________________)
15
Wiring
Instructions:
TO: | SILICON VALLEY BANK |
0000 XXXXXX XXXXX | |
XXXXX XXXXX, XX 00000 | |
ROUTING & TRANSIT: | 000000000 |
FOR CREDIT OF: | CARDIMA |
CREDIT ACCOUNT #: | 0272686670 |
BY ORDER OF: | NAME OF SENDER} |
16
Partnerships,
Corporations or Other Entities:
IN
WITNESS WHEREOF, Subscriber has
caused this Subscription Agreement to be executed as of the date indicated
below.
$
______________________($0.50 per
Share)
_____________________________
Total
Purchase
Price
Number of Shares
____________________________________________
Entitled to Warrants for Number of Warrant Shares
Entitled to Warrants for Number of Warrant Shares
_____________________________________________________________________________
Print
or
Type Name of Entity
______________________________________________________________________________
Address
______________________________
Telephone
Number
______________________________
Fax
Number
______________________________
Email
Address
____________________________________
____________________________________
Taxpayer
I.D. No. (if
applicable)
Date
By:
____________________________________ ____________________________________
Signature:
Name: Print
or Type Name and Indicate
Title:
Title or Position with Entity
____________________________________
____________________________________
Signature
(other authorized
signatory)
Print or Type Name and Indicate
Title or Position with Entity
Type
of
Ownership
|
Individual
|
|
Tenants
in common
|
|
Joint
tenants with right of survivorship
|
|
Community
property (check only if resident of community property state)
|
Other (please specify:____________________)
17
All
subscriptions from partnerships, corporations, trusts or limited liability
companies must be accompanied by resolutions of the appropriate corporate
authority (board of directors, trustee or managing partner or members, as
applicable) and trust documents evidencing the authorization and power to make
the subscription.
Wiring
Instructions:
TO: | SILICON VALLEY BANK |
0000 XXXXXX XXXXX | |
XXXXX XXXXX, XX 00000 | |
ROUTING & TRANSIT: | 000000000 |
FOR CREDIT OF: | CARDIMA |
CREDIT ACCOUNT #: | 0272686670 |
BY ORDER OF: | NAME OF SENDER} |
18
SUBSCRIPTION
ACCEPTANCE BY CARDIMA, INC.
IN
WITNESS WHEREOF, the Company has
caused this Subscription Agreement to be executed, and the foregoing
subscription accepted, as of the date indicated below.
_______________________________________
By: __________________________________
Name: _____________________________
Title: _______________________________
Date:
_______________________, 20__
19
EXHIBIT
A
[Warrant
No. _______________
THE
SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE BEEN ACQUIRED FOR INVESTMENT
AND
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE
“SECURITIES ACT”). THE SECURITIES MAY NOT BE SOLD, TRANSFERRED,
ASSIGNED OR HYPOTHECATED UNLESS REGISTERED UNDER THE SECURITIES ACT AND
QUALIFIED UNDER APPLICABLE STATE SECURITIES LAWS OR UNLESS SUCH SALE, TRANSFER,
ASSIGNMENT OR HYPOTHECATION IS EXEMPT FROM THE REGISTRATION REQUIREMENTS OF
THE
SECURITIES ACT AND THE QUALIFICATION REQUIREMENTS OF APPLICABLE STATE SECURITIES
LAWS AND THE COMPANY RECEIVES AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY
THAT SUCH REGISTRATION AND QUALIFICATION ARE NOT REQUIRED. THE
SECURITIES REPRESENTED BY THIS CERTIFICATE AND THE RIGHTS OF HOLDERS THEREOF
ARE
SUBJECT TO CERTAIN RESTRICTIONS ON TRANSFER AND OTHER RESTRICTIONS, AND THE
HOLDER OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE (INCLUDING ANY FUTURE
HOLDERS) IS BOUND BY THE TERMS OF A SUBSCRIPTION AGREEMENT BETWEEN THE ORIGINAL
PURCHASER AND THE COMPANY (COPIES OF WHICH MAY BE OBTAINED FROM THE
COMPANY).
REDEEMABLE
WARRANT TO PURCHASE SHARES
OF
COMMON STOCK OF CARDIMA, INC.
This
certifies that _________________ (the “Holder”), for value received is entitled
to purchase from Cardima, Inc., a Delaware corporation (the “Company”),
________________ (________)1
fully paid and nonassessable shares of the
Company’s Common Stock (the “Warrant Shares”) at a price of $ 0.55 [which
exercise price shall be equal to 110% of the Purchase Price] per share (the
“Stock Purchase Price”) at any time or from time to time on or after the
Commencement Date (as defined below) up to and including 5:00 p.m. (Pacific
time) on the Expiration Date (as defined below), upon surrender to the Company
at its principal office at 00000 Xxxxxxx Xxxxxx, Xxxxxxx, Xxxxxxxxxx 00000
(or
at such other location as the Company may advise Holder in writing) of this
Warrant properly endorsed with the Form of Subscription attached hereto duly
filled in and signed and upon payment by cash, cashier’s check or wire transfer
of immediately available funds of the aggregate Stock Purchase Price for the
number of shares for which this Warrant is being exercised determined in
accordance with the provisions hereof, such exercise to be conditioned upon
the
accuracy of all representations and warranties contained in such Form of
Subscription. The Stock Purchase Price and the number of shares
purchasable hereunder are subject to adjustment as provided in Section 3 of
this
Warrant. “Commencement Date” means the date which is six (6) months
after the date of issuance of this Warrant and “Expiration Date” means the
earlier of (i) five (5) years from the date hereof, (ii) the occurrence of
an
event, proposal of which is described in subsection (d) of Section 3.4 which
causes termination of this Warrant under Section 3.4, or (iii) on the date
specified in the Notice of Redemption (as defined below) pursuant to Section
7. This Warrant is issued pursuant to the Subscription Agreement
between the Company and Holder dated as of the date hereof (the “Subscription
Agreement”).
20
This
Warrant is subject to the following terms and conditions:
1.
Exercise of
Warrant
. This
Warrant is exercisable at the option of Holder at any time or from time to
time
on or after the Commencement Date and prior to or on the Expiration Date for
all
or a portion of the shares of Warrant Shares which may be purchased hereunder
but if this Warrant is to be exercised only in part, not for less than the
greater of (a) twenty-five (25%) of the number of Warrant Shares which may
initially be purchased hereunder or (b) one thousand (1,000) Warrant Shares
(in
either case as adjusted for any stock dividend, split, combination,
recapitalization or the like with respect to such shares). The
Company agrees that the Warrant Shares purchased under this Warrant shall be
and
are deemed to be issued to Holder as the record 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. Subject to the provisions of
Section 2, certificates for the Warrant Shares so purchased, together with
any
other securities or property to which Holder is entitled upon such exercise,
shall be delivered to Holder by the Company’s transfer agent at the Company’s
expense within a reasonable time after this Warrant has been
exercised. Each stock certificate so delivered shall be in such
denominations of Warrant Shares as may be requested by Holder and shall be
registered in the name of Holder or such other name as shall be designated
by
Holder, subject to the limitations contained in Section 2. If, upon
exercise of this Warrant, fewer than all of the Warrant Shares evidenced by
this
Warrant are purchased prior to the date of expiration of this Warrant, one
or
more new warrants substantially in the form of, and on the terms in, this
Warrant will be issued for the remaining number of Warrant Shares not purchased
upon exercise of this Warrant.
1.2
Payment
. Payment
of the Stock Purchase Price shall be made by surrender to the Company of this
Warrant properly endorsed with the Form of Subscription attached hereto duly
filled in and signed and payment by cash, cashier’s check or wire transfer of
immediately available funds and specifying the number of Warrant Shares to
be
purchased, during normal business hours on any day that is not a Saturday or
Sunday or a day on which banks are required or permitted to be closed in the
State of California.
21
2.
Shares to be Fully
Paid; Reservation of Shares
. The
Company covenants and agrees that all Warrant Shares which 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 free from
all
preemptive rights of any stockholder and free of all taxes, liens and charges
with respect to the issue thereof. The Company further covenants and
agrees that during the period within which the rights represented by this
Warrant may be exercised, the Company will use its best efforts to at all times
have authorized and reserved, for the purpose of issue or transfer upon exercise
of this Warrant, a sufficient number of shares of authorized but unissued Common
Stock. When and as required to provide for the exercise of the rights
represented by this Warrant, the Company will take all such action as may be
necessary to assure that such shares of Common Stock may be issued as provided
herein without violation of any applicable law or regulation, or of any
requirements of any domestic securities exchange or automated quotation system
upon which the Common Stock may be listed.
3.
Adjustment of Stock
Purchase Price; Number of Shares
. The
Stock Purchase Price and the number of shares of Warrant Shares purchasable
upon
the exercise of this Warrant shall be subject to adjustment from time to time
upon the occurrence of certain events described in this Section 3.
3.1
Adjustment
of Purchase Price
. In
the event that the Company at any time or from time to time after the issuance
of this Warrant shall declare or pay, without consideration, any dividend on
the
Common Stock payable in Common Stock or in any right to acquire Common Stock
for
no consideration, or shall effect a subdivision of the outstanding shares of
Common Stock into a greater number of shares of Common Stock (by stock split,
reclassification or otherwise than by payment of a dividend in Common Stock
or
in any right to acquire Common Stock), or in the event the outstanding shares
of
Common Stock shall be combined or consolidated, by reclassification or
otherwise, into a lesser number of shares of Common Stock, then the Stock
Purchase Price in effect immediately prior to such event shall, concurrently
with the effectiveness of such event, be proportionately decreased or increased,
as appropriate. In the event that the Company shall declare or pay,
without consideration, any dividend on the Common Stock payable in any right
to
acquire Common Stock for no consideration, then the Company shall be deemed
to
have made a dividend payable in Common Stock in an amount of shares equal to
the
maximum number of shares issuable upon exercise of such rights to acquire Common
Stock. Upon each adjustment of the Stock Purchase Price pursuant to
this Section 3.1, the holder of this Warrant shall thereafter be entitled to
purchase, at the Stock Purchase Price resulting from such adjustment, the number
of shares of Common Stock obtained by multiplying the Stock Purchase Price
in
effect immediately prior to such adjustment by the number of shares of Common
Stock purchasable pursuant hereto immediately prior to such adjustment, and
dividing the product thereof by the Stock Purchase Price resulting from such
adjustment.
3.2
Adjustments
for Reclassification and Reorganization
. If
the Common Stock shall be changed into the same or a different number of shares
of any other class or classes of stock, whether by capital reorganization,
reclassification or otherwise (other than a subdivision or combination of shares
provided for in Section 3.1), the Stock Purchase Price then in effect shall,
concurrently with the effectiveness of such reorganization or reclassification,
be proportionately adjusted so that this Warrant shall represent the right
to
purchase, in lieu of the number of shares of Common Stock which this Warrant
would otherwise represent the right to purchase, a number of shares of such
other class or classes of stock equivalent to the number of shares of Common
Stock which this Warrant would have otherwise entitled the holder to purchase
immediately before that change.
3.3
Notice
of Adjustment
. Upon
any adjustment of the Stock Purchase Price or any increase or decrease in the
number of shares of Common Stock purchasable upon the exercise of this Warrant,
the Company shall within five business days give written notice thereof, by
first class mail, postage prepaid, (or by international delivery service, for
international addresses) addressed to the registered holder of this Warrant
at
the address of such holder as shown on the books of the Company. The
notice shall be signed by the Company’s chief financial officer and shall state
the Stock Purchase Price resulting from such adjustment and the increase or
decrease, if any, in the number of shares purchasable at such price upon the
exercise of this Warrant, setting forth in reasonable detail the method of
calculation and the facts upon which such calculation is based.
22
3.4
Certain
Termination Events; Other Notices
. If
at any time the Company shall propose to:
(a)
declare any cash dividend upon its Common Stock;
(b)
declare or make any dividend or other distribution to the holders of its Common
Stock, whether in cash, property or other securities;
(c)
effect any reorganization or reclassification of the capital stock of the
Company or any consolidation or merger of the Company with or into another
corporation or any sale, lease or conveyance of all or substantially all of
the
property of the Company; or
(d)
effect a voluntary or involuntary dissolution, liquidation or winding-up of
the
Company;
then,
in
any one or more of said cases, the Company shall give, by certified or
registered mail, postage prepaid, or international delivery service for
international deliveries, addressed to the holder of this Warrant at the address
of such holder as shown on the books of the Company, (i) at least fifteen (15)
business 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 or distribution
or for determining rights to vote in respect of any such reorganization,
reclassification, consolidation, merger, sale, lease, conveyance, dissolution,
liquidation or winding up, and (ii) in the case of any such reorganization,
reclassification, consolidation, merger, sale, lease, conveyance, dissolution,
liquidation or winding up, at least fifteen (15) business days’ written notice
of the date when the same shall take place. Any notice given in
accordance with clause (i) above shall also specify, in the case of any such
dividend or distribution, the record date for such dividend or distribution,
if
after the Commencement Date. Any notice given in accordance with
clause (ii) above 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, if any, deliverable upon such reorganization, reclassification,
consolidation/merger, sale, lease, conveyance, dissolution, liquidation or
winding up, as the case may be and in connection with the occurrence of an
event
described in clause (d) above such notice shall specify the anticipated net
equity value that will accrue to Common Stock holders so that the Holder can
make an informed decision whether or not to exercise this Warrant. In
the event that the Holder of the Warrant does not exercise this Warrant prior
to
the occurrence of an event described in clause (a) or (b) above, the Holder
shall not be entitled to receive the benefits accruing to existing holders
of
the Common Stock in such event. Upon the occurrence of an event
described in clause (c) in which the holders of the Company’s voting securities
of the Company immediately prior to the event do not hold at least fifty percent
(50%) of the voting securities of the Company or the surviving entity (in a
sale
of assets, the Company shall be the surviving entity) resulting from such event
immediately after such event, this Warrant shall terminate unless the Company
has negotiated (which it is under no obligation to do) for the assumption of
this Warrant. Upon the occurrence of an event described in clause (c)
and, subject to the immediately preceding sentence, the Holder shall be entitled
thereafter, upon payment of the Stock Purchase Price in effect immediately
prior
to such action, to receive upon exercise of this Warrant the class and number
of
shares which the Holder would have been entitled to receive after the occurrence
of such event had this Warrant been exercised immediately prior to such
event. In connection with the transactions described in clause (c)
and provided that this Warrant does not terminate as provided in the second
sentence immediately preceding this sentence, the Company will require each
person (other than the Company) that may be required to deliver any cash, stock,
securities or other property upon the exercise of this Warrant as provided
herein to assume, by written instrument delivered to the Holder of this Warrant
(x) the obligations of the Company under this Warrant and (y) the obligation
to
deliver to such Holder such cash, stock, securities or other property as such
Holder may be entitled to receive in accordance with the provisions of this
Section 3. Upon the occurrence of an event the proposal of which is described
in
clause (d), this Warrant shall terminate. Notwithstanding any other
provision hereof, no Holder shall have the right to obtain an injunction or
restraining order or otherwise interfere with or prevent the occurrence of
any
of the actions described in (a) - (d) above.
23
3.5
Adjustment
of Number of Warrant Shares
. The
number of Warrant Shares purchasable hereunder shall be reduced on a one-for-one
basis by the number of shares of Common Stock (or Common Stock equivalents)
sold
directly or indirectly, including, without limitation, any short sale, third
party short sales or holdings of a “put equivalent position” (as defined in Rule
16a-1 of the 1934 Act), of the Company’s Common Stock by the Holder from the
date hereof until the Commencement Date. Prior to or simultaneously
with the first exercise of this Warrant by the Holder (or the transfer of this
Warrant), the Holder shall provide the Company with an affidavit and other
reasonable supporting materials as to the foregoing.
4.
Issue
Tax
. The
issuance of certificates for the Warrant Shares upon the exercise of the Warrant
shall be made without charge to the Holder of the Warrant for any issue tax
in
respect thereof; provided, however, that the Company shall not be required
to
pay any tax which 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 the Holder
hereof 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. Except for the adjustment to the Stock Purchase Price
pursuant to 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 shares
purchasable hereunder until, and only to the extent that, this Warrant shall
have been exercised. No provisions hereof, in the absence of
affirmative action by the Holder to purchase shares of Warrant Shares, and
no
mere enumeration herein of the rights or privileges of the Holder hereof, shall
give rise to any liability of such Holder for the Stock Purchase Price or as
a
stockholder of the Company whether such liability is asserted by the Company
or
by its creditors.
24
6.
Restrictions on
Transferability of Securities: Compliance with Securities
Act
6.1
Restrictions
on Transferability
. The
Warrant and the Warrant Shares (collectively, the “Securities”) shall not be
transferable except upon the conditions specified in the Subscription Agreement,
which conditions are intended to insure compliance with the provisions of the
Securities Act and applicable “blue sky” law.
6.2
Restrictive
Legend
. Each
certificate representing the Securities or any other securities issued in
respect of the Securities upon any stock split, stock dividend,
recapitalization, merger, consolidation or similar event, shall (unless
otherwise permitted by the provisions of the Subscription Agreement) be stamped
or otherwise imprinted with a legend substantially in the following form (in
addition to any legend required under applicable state securities
laws):
THE
SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE BEEN ACQUIRED FOR INVESTMENT
AND
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE
“SECURITIES ACT”). THE SECURITIES MAY NOT BE SOLD, TRANSFERRED,
ASSIGNED OR HYPOTHECATED UNLESS REGISTERED UNDER THE SECURITIES ACT AND
QUALIFIED UNDER APPLICABLE STATE SECURITIES LAWS OR UNLESS SUCH SALE, TRANSFER,
ASSIGNMENT OR HYPOTHECATION IS EXEMPT FROM THE REGISTRATION REQUIREMENTS OF
THE
SECURITIES ACT AND THE QUALIFICATION REQUIREMENTS OF APPLICABLE STATE SECURITIES
LAWS AND THE COMPANY RECEIVES AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY
THAT SUCH REGISTRATION AND QUALIFICATION ARE NOT REQUIRED. THE
SECURITIES REPRESENTED BY THIS CERTIFICATE AND THE RIGHTS OF HOLDERS THEREOF
ARE
SUBJECT TO CERTAIN RESTRICTIONS ON TRANSFER AND OTHER RESTRICTIONS, AND THE
HOLDER OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE (INCLUDING ANY FUTURE
HOLDERS) IS BOUND BY THE TERMS OF A SUBSCRIPTION AGREEMENT BETWEEN THE ORIGINAL
PURCHASER AND THE COMPANY (COPIES OF WHICH MAY BE OBTAINED FROM THE
COMPANY).
25
6.3
Exchange
of
Warrant
. Subject
to the terms and conditions hereof, including the restrictions on transfer
in
this Section 6 and in the Subscription Agreement, upon surrender of this Warrant
to the Company with a duly executed Assignment Form in the form attached hereto
and funds sufficient to pay any transfer tax, the Company shall, without charge,
execute and deliver a new Warrant or Warrants of like tenor in the name of
the
assignee named in such Assignment Form and this Warrant shall promptly be
canceled; provided, however, that if the transfer is for less than all of this
Warrant, the transferor shall pay all reasonable costs of the Company in
connection with a transfer of Warrants to purchase less than the greater of
(a)
twenty-five percent (25%) of the Warrant Shares which may initially be purchased
hereunder or (b) one thousand (1,000) Warrant Shares (in either case as adjusted
for any stock dividend, split, combination, recapitalization or the like with
respect to such shares). The term “Warrant” as used herein shall be
deemed to include any Warrants issued in exchange for this Warrant.
6.4
Ownership
of
Warrant
. The
Company may deem and treat the person in whose name this Warrant is registered
as the holder and owner hereof (notwithstanding any notations of ownership
or
writing hereon made by anyone other than the Company) for all purposes and
shall
not be affected by any notice to the contrary, until presentation of this
Warrant for registration of transfer as provided in
Section 6.3.
7.
Forced Exercise
by the
Company.
At the option of the Company, the Company may force the Holder to exercise
the
Warrant at a price per share equal to $0.55, provided that (i) the average
closing bid price of the Company’s Common Stock as reported by the National
Association of Securities Dealers Automated Quotation or the OTC Bulletin board
shall have been equal to or greater than $1.00 for a period of fifteen (15)
consecutive trading days ending on the date preceding the date on which the
Holder receives a notice from the Company in which it announces its intention
to
force the exercise of the Warrants and (ii) a registration statement is in
effect with respect to the Warrant Shares. Upon Holder receipt of
said notice, the Holder shall have fifteen (15) Trading Days [This term is
not
defined] to submit to the Company a completed Form of Subscription, together
with a check for full payment in accordance with the provisions of this
Warrant. If the Company does not receive payment within said time
period, this Warrant shall expire immediately and the Holder shall have no
further rights hereunder.
8.
Modification and
Waiver
. Except
as otherwise provided herein, 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.
9.
Notices
. Except
as otherwise provided herein, any notices and other communications required
or
permitted hereunder shall be in writing and shall be deemed effectively given
(a) upon personal delivery to the party to be notified, (b) upon electronic
confirmation of successful facsimile transmission, (c) three (3) days after
deposit with the United States mail, by registered or certified mail, postage
prepaid, or (d) one (1) business day after timely delivery to an overnight
air
courier for next business day delivery, in each case addressed (i) if to the
Subscriber, at the address set forth on the signature to the Subscription
Agreement or at such other address as the Subscriber shall have furnished the
Company in writing, or (ii) if to the Company, at its address set forth in
the
Subscription Agreement, or at such other address as the Company shall have
furnished to the Subscriber in writing.
26
10.
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 accordance
with, and the rights of the parties shall be governed by, the laws of the State
of California (without regard to its conflicts of law
provisions). The Holder hereby irrevocably submits to the
jurisdiction of any State or United States Federal court sitting in the Alameda
or San Francisco counties in the State of California over any action or
proceeding arising out of or relating to this Warrant or any agreement
contemplated hereby, and the Holder irrevocably agrees that all claims in
respect of such action or proceeding may be heard and determined in such State
or Federal court. The Holder further waives any objection to venue in
such State and any objection to an action or proceeding in such State based
on
non-convenient forum. The Holder further agrees that any action or
proceeding brought against the Company shall be brought in the State or United
States Federal courts sitting in Alameda or San Francisco counties in the State
of California. The Holder agrees to waive its rights to a jury trial or any
claim for cause of action based upon or arising out of this Warrant or any
document or agreement contemplated hereby.
11.
Lost Warrants or
Stock
Certificates
. The
Company represents and warrants to Holder that upon receipt of evidence
reasonably satisfactory to the Company of the loss, theft, destruction, or
mutilation of any Warrant or stock certificate and, in the case of any such
loss, theft or destruction, upon receipt of an indemnity and, if requested,
bond
reasonably satisfactory to the Company, or, in the case of any such mutilation,
upon surrender and cancellation of such Warrant or stock certificate, the
Company at its expense will make and deliver a new Warrant or stock certificate,
of like tenor, in lieu of the lost, stolen, destroyed or mutilated Warrant
or
stock certificate.
12.
Amendment
. This
Warrant is one of a series of warrants (the “Warrant Series”) to purchase in the
aggregate up to three million six hundred thousand (3,600,000) shares of the
Company’s Common Stock. This Warrant may be amended only with the
written approval of the Company and (i) the Holder of this Warrant or (ii)
the
holders of warrants representing a majority of the Warrant Shares; provided,
however, that any amendment affected pursuant to (ii) above shall be made in
the
same manner to all warrants in the Warrant Series.
13.
Binding Effect;
Benefits
. This
Warrant shall inure to the benefit of and shall be binding upon the Company
and
the Holder and their respective heirs, legal representatives, successors and
assigns. Nothing in this Warrant, expressed or implied, is intended
to or shall confer on any person other than the Company and the Holder, or
their
respective heirs, legal representatives, successors or assigns, any rights,
remedies, obligations or liabilities under or by reason of this
Warrant.
14.
Fractional
Shares
. No
fractional shares shall be issued upon exercise of this Warrant. The
Company shall, in lieu of issuing any fractional share, pay the Holder entitled
to such fraction a sum in cash equal to such fraction multiplied by the market
price of the Common Stock on such exercise date, which shall be, on such date,
the closing price for the Common Stock or the closing bid if no sales were
reported, as quoted on the exchange or market that is the primary trading market
for the Company.
27
IN
WITNESS WHEREOF, the Company has caused this Warrant to be executed by its
officers, thereunto duly authorized this ____ day of ____, 2007.
CARDIMA,
INC., a Delaware corporation
By:
Name:
____________________________
Title:
_____________________________
28
FORM
OF
SUBSCRIPTION
(To
be
signed only upon exercise of Warrant)
To:
Cardima, Inc.
The
undersigned, the holder of the
within Warrant, hereby irrevocably elects to exercise such Warrant for, and
to
purchase thereunder, ________________ (________) shares of Common Stock of
[_____________] Inc. (the “Company”), and herewith makes payment in the amount
of $________ therefor. The certificates for such shares should be
issued in the name of, and delivered to, ________________ whose address is
________________________________ __________________________________________________________.
The
undersigned represents, unless the exercise of this Warrant has been registered
under the Securities Act of 1933, as amended (the “Securities Act”), that (i)
the undersigned is acquiring such Common Stock for his or its own account for
investment and not with a view to or for sale in connection with any
distribution thereof (except for any resale pursuant to a registration statement
under the Securities Act), (ii) the undersigned has such knowledge and
experience in financial and business matters as to be capable of evaluating
the
merits and risks of the undersigned’s investment in the shares of Common Stock,
(iii) the undersigned has received all of the information the undersigned
requested from the Company and the undersigned considers necessary or
appropriate for deciding whether to purchase the shares, (iv) the undersigned
has the ability to bear the economic risks of the undersigned’s prospective
investment and (v) the undersigned is able, without materially impairing his
financial condition, to hold the shares of Common Stock for an indefinite period
of time and to suffer complete loss on the undersigned’s
investment.
The
undersigned is an “accredited investor” as defined in Regulation D of the
Securities and Exchange Commission on the date hereof.
DATED:
_______________________________________
(Signature
must conform in all respects to name of holder as specified on the face of
the
Warrant)
_______________________________________
_______________________________________
(Address)
29
THIS
WARRANT AND ANY SHARES ACQUIRED UPON THE EXERCISE OF THIS WARRANT HAVE NOT
BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AND MAY NOT BE SOLD
OR
OTHERWISE TRANSFERRED EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
FILED UNDER SUCH ACT OR PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER SUCH
ACT.
ASSIGNMENT
FORM
(To
be
executed only upon transfer of this Warrant)
For
value
received, the undersigned registered holder of the within Warrant hereby sells,
assigns and transfers unto ____________________ (the “Assignee”) the right
represented by such Warrant to purchase __________ Warrant Shares and all other
rights of the Holder with respect thereto under the within Warrant, and appoints
_________________ as Attorney to make such transfer on the books of Cardima,
Inc. maintained for such purpose, with full power of substitution in the
premises.
The
undersigned also represents that, by assignment hereof, the Assignee
acknowledges that this Warrant and the Warrant Shares to be issued upon exercise
hereof are being acquired for investment and that the Assignee will not offer,
sell or otherwise dispose of this Warrant or any Warrant Shares to be issued
upon exercise hereof except under circumstances that will not result in a
violation of the Securities Act of 1933, as amended, or any state securities
laws. Further, the Assignee has acknowledged that upon exercise of
this Warrant, the Assignee shall, if requested by the Company, confirm in
writing, in a form satisfactory to the Company, that the Warrant Shares so
purchased are being acquired for investment and not with a view toward
distribution or resale.
Dated: ____________________.
[MEDALLION
GUARANTEE]
|
______________________________
|
(Signature)
______________________________
(Print
Name)
______________________________
(Xxxxxx
Xxxxxxx)
______________________________
(City) (State) (Zip
Code)
30
EXHIBIT
B
CONFIDENTIAL
PURCHASER QUESTIONNAIRE
CONFIDENTIAL
PURCHASER QUESTIONNAIRE
THIS
QUESTIONNAIRE WILL BE USED IN CONNECTION WITH VARIOUS INVESTMENTS MADE BY THE
UNDERSIGNED FROM TIME TO TIME, WHICH SUCH INVESTMENTS SHALL BE BROUGHT TO THE
UNDERSIGNED BY, AND MADE THROUGH, SMH CAPITAL
THE
COMPANY SHALL HAVE THE RIGHT TO FULLY RELY ON THE REPRESENTATIONS AND WARRANTIES
CONTAINED HEREIN UNTIL SUCH TIME AS THE UNDERSIGNED HAS FURNISHED AN AMENDED
CONFIDENTIAL PURCHASER QUESTIONNAIRE.
THIS
QUESTIONNAIRE MUST BE ANSWERED FULLY AND RETURNED TO SMH CAPITAL
THE
INFORMATION SUPPLIED IN THIS QUESTIONNAIRE WILL BE HELD IN STRICT
CONFIDENCE. NO INFORMATION WILL BE DISCLOSED EXCEPT TO THE EXTENT
THAT SUCH DISCLOSURE IS REQUIRED BY LAW OR REGULATION, OTHERWISE DEMANDED BY
PROPER LEGAL PROCESS OR IN LITIGATION INVOLVING THE COMPANY IN WHICH YOU ARE
INVESTING AND ITS CONTROLLING PERSONS.
(1)
The undersigned represents and warrants that he, she or it comes within at
least
one category marked below, and that for any category marked, he, she or it
has
truthfully set forth, where applicable, the factual basis or reason the
undersigned comes within that category. The undersigned agrees to furnish any
additional information which any issuer of securities deems necessary in
order to verify the answers set forth below.
Category
A
|
The
undersigned is an individual (not a partnership, corporation, etc.)
whose
individual net worth, or joint net worth with his or her spouse,
presently
exceeds $1,000,000.
|
Explanation:
In calculating net worth you may include equity in personal property and real
estate, including your principal residence, cash, short-term investments, stock
and securities. Equity in personal property and real estate should be
based on the fair market value of such property less debt secured by such
property.
Category
B
|
The
undersigned is an individual (not a partnership, corporation, etc.)
who
had an income in excess of $200,000 in each of the two most recent
years,
or joint income with his or her spouse in excess of $300,000 in each
of
those years (in each case including foreign income, tax exempt income
and
full amount of capital gains and losses but excluding any income
of other
family members and any unrealized capital appreciation) and has a
reasonable expectation of reaching the same income level in the current
year.
|
31
Category
C
|
The
undersigned is a director or executive officer of the company which
is
issuing and selling the Securities.
|
Category
D
|
The
undersigned is (i) a bank, as defined in Section 3(a)(2) of the
Securities Act of 1933, as amended (the “Act”); (ii) a savings and loan
association or other institution as defined in
Section 3(a)(5)(A) of the Act, whether acting in its individual or
fiduciary capacity; (iii) an insurance company as defined in
Section 2(13) of the Act; (iv) an investment company registered under
the Investment Company Act of 1940 or a business development company
as
defined in Section 2(a)(48) of that Act; (v) a Small Business
Investment Company (SBIC) licensed by the U.S. Small Business
Administration under Section 301(c) or (d) of the Small Business
Investment Act of 1958; or (vi) a plan established and maintained
by a
state, its political subdivisions, or any agency or instrumentality
of a
state or its political subdivisions, for the benefit of its employees,
if
such plan has total assets in excess of $5,000,000;
|
Category
E ___
|
The
undersigned is an (i) employee benefit plan within the meaning of
the
Employee Retirement Income Security Act of 1974 if the investment
decision
is made by a plan fiduciary, as defined in Section 3(21) of such act,
which is either a bank, savings and loan association, insurance company,
or registered investment advisor, (ii) an employee benefit plan with
total
assets in excess of $5,000,000, or (iii) a self-directed employee
benefit
plan (including a self-directed individual retirement account or
XXX,
Xxxxxx or SEP plan) with investment decisions made solely by persons
that
are accredited investors (describe entity).
|
Category
F
|
The
undersigned is a private business development company as defined
in
section 202(a) (22) of the Investment Advisors Act of 1940 (describe
entity)
|
32
Category
G
|
The
undersigned is either a corporation, limited liability company,
partnership, Massachusetts business trust, or non-profit organization
within the meaning of Section 501(c)(3) of the Internal Revenue Code,
in each case not formed for the specific purpose of acquiring the
Securities and with total assets in excess of $5,000,000. (describe entity)
|
Category
H
|
The
undersigned is a trust with total assets in excess of $5,000,000, not
formed for the specific purpose of acquiring the Securities, where
the
purchase is directed by a “sophisticated investor” as defined in
Regulation 506(b)(2)(ii) under the Act. (must also answer
Question 5
below).
|
Category
I
|
The
undersigned is an entity (other than a trust) in which all of the
equity
owners are “accredited investors” within one or more of the above
categories. If relying upon this category alone, each equity
owner must complete a separate copy of this Purchaser
Questionnaire. (describe entity
below)
|
The
undersigned agrees that the undersigned will notify SMH Capital at any time
in
the event that the representations and warranties in this Purchaser
Questionnaire shall cease to be true, accurate and complete.
(2)
Suitability (please answer each question)
|
(a)
|
For
an individual, please describe your current employment, including
the
company by which you are employed and its principal business:
|
|
(b)
|
For
an individual, please describe any college or graduate degrees held
by
you:
|
(c)
For all subscribers, please list types of prior investments:
33
|
(d)
|
For
all subscribers, please state whether you have you participated in
other
private
placements before:
|
YES
|
NO
|
|
(e)
|
If
your answer to question (d) above was “YES”, please indicate frequency of
such prior participation in private
placements of:
|
Public
Companies
|
Private
Companies
|
|
Frequently
|
||
Occasionally
|
||
Never
|
|
(f)
|
For
individuals, do you expect your current level of income to significantly
decrease in the foreseeable future?
|
YES
|
NO
|
|
(g)
|
For
trust, corporate, partnership and other institutional subscribers,
do you
expect your total assets to significantly decrease in the foreseeable
future?
|
YES
|
NO
|
|
(h)
|
For
all subscribers, do you have any other investments or contingent
liabilities which you reasonably anticipate could cause you to need
sudden
cash requirements in excess of cash readily available to you?
|
YES
|
NO
|
|
(i)
|
For
all subscribers, are you familiar with the risk aspects and the
non-liquidity of investments such as the Securities for which you
seek to
purchase?
|
YES
|
NO
|
|
(j)
|
For
all subscribers, do you understand that there is no guarantee of
financial
return on this investment and that you run the risk of losing your
entire
investment?
|
34
YES
|
NO
|
(3)
Manner in which title is to be held: (circle one)
(a)
Individual Ownership
(b)
Community Property
(c)
Joint Tenant with Right of Survivorship (both parties must sign)
(d)
Partnership
(e)
Tenants in Common
(f)
Limited Liability Company
(g)
Corporation
(h)
Trust
(i)
Other
(4)
NASD Affiliation.
Are
you
affiliated or associated with an NASD member firm (please check
one):
YES
|
NO
|
If
Yes,
please describe:
_________________________________________________________
_________________________________________________________
_________________________________________________________
*If
subscriber is a Registered Representative with an NASD member firm, have the
following acknowledgment signed by the appropriate party:
The
undersigned NASD member firm acknowledges receipt of the notice required by
the
NASD Conduct Rules.
_________________________________
Name
of
NASD Member Firm
By:
______________________________
Authorized
Officer
Date:
____________________________
(5)
For Trust Subscribers
A.
Certain trusts generally may not qualify as accredited investors except under
special circumstances. Therefore, if you intend to hold securities in
whole or in part through a trust, please answer each of the following
questions.
35
Is
the trustee of the trust a national
or state bank that is acting in its fiduciary capacity in making the investment
on behalf of the trust?
Yes
o
No o
B.
If the
trust is a revocable
trust, please complete Question 1 below. If the trust is an irrevocable trust, please
complete Question 2 below.
1.
REVOCABLE
TRUSTS
Can
the trust be amended or revoked at
any time by its grantors:
Yes
o
No o
If
yes,
please answer the following questions relating to each
grantor (please add sheets if necessary):
Grantor
Name: _________________________
Net
worth of grantor (including spouse,
if applicable), including home, home furnishings and automobiles exceeds
$1,000,000?
Yes
o
No o
OR
Income
(exclusive of any income attributable to spouse) was in excess of $200,000
for
the prior two taxable years and is reasonably expected to be in excess of
$200,000 for the current taxable year?
Yes
o
No o
OR
Income
(including income attributable to spouse) was in excess of $300,000 for the
prior two taxable years and is reasonably expected to be in excess of $300,000
for the current taxable year?
Yes
o
No o
36
2.
IRREVOCABLE
TRUSTS
If
the
trust is an irrevocable trust, please answer the following
questions:
Please
provide the name of each
trustee:
Trustee
Name: ________________________________________
Trustee
Name: ________________________________________
Does
the trust have assets greater than
$5 million?
Yes
o
No o
Indicate
how often you invest in:
Marketable
Securities
Often
o
Occasionally
o
Seldom o
Never o
Restricted
Securities
Often
o
Occasionally
o
Seldom o
Never o
Venture
Capital Companies
Often
o
Occasionally
o
Seldom o
Never o
This
completes the questions applicable to Trust Investors. Please sign
below.
37
The
undersigned has been informed of the significance of the foregoing
representations and answers contained in this Confidential Purchaser
Questionnaire and such representations and answers have been provided with
the
understanding that all companies in which you are purchasing securities through
the placement agent, will rely on them.
Individual
Date:
________________________
_______________________________
Name
of Individual
(Please
type or print)
_______________________________
Signature
of Individual
_______________________________
Name
of Joint Owner
(Please
type or print)
_______________________________
Signature
(Joint Owner)
Partnership,
Corporation
or
Other
Entity
Date:
________________________ _______________________________
Print
or Type Entity Name
By:
_______________________
Name:
Title:
________________________________
Signature
(other authorized signatory, if any)
38