Name of Purchaser. Arena Special Opportunities (Offshore) Master, LP Signature of Authorized Signatory of Purchaser: Name of Authorized Signatory: Lawrence Cutler Title of Authorized Signatory: Authorized Signatory Email Address of Authorized Signatory: Facsimile Number of Authorized Signatory: Address for Notice to Purchaser: Arena Investors, LP 405 Lexington Avenue 59th Floor New York, NY 10174 Address for Delivery of Securities to Purchaser (if not same as address for notice): First Closing Subscription Amount: $401,070.68 First Closing Principal Amount: $445,634.04 First Closing Warrant Shares (subject to adjustment as set forth in the Warrant) Second Closing Subscription Amount: $641,713.08 Second Closing Principal Amount: $713,014.46 Second Closing Warrant Shares (subject to adjustment as set forth in the Warrant) Third Closing Subscription Amount: $641,713.08 Third Closing Principal Amount: $713,014.46 Third Closing Warrant Shares (subject to adjustment as set forth in the Warrant) Fourth Closing Subscription Amount: $641,713.08 Fourth Closing Principal Amount: $713,014.46 Fourth Closing Warrant Shares (subject to adjustment as set forth in the Warrant) Fifth Closing Subscription Amount: $641,713.08 Fifth Closing Principal Amount: $713,014.46 Fifth Closing Warrant Shares (subject to adjustment as set forth in the Warrant)
Name of Purchaser. SIGNATURE OF AUTHORIZED SIGNATORY OF PURCHASER: ________________________________ Name of Authorized Signatory: __________________________________________________ Title of Authorized Signatory: _________________________________________________ Email Address of Purchaser:_____________________________________________________ Address for Notice of Purchaser: Address for Delivery of Securities for Purchaser (if not same as above):
Name of Purchaser. Dated: -------------------------- -------------------------- By: ------------------------------ Name: Title: Aggregate principal amount of: Series [ ] Notes: $ -------------- Taxpayer identification number: ---------------- Address for notices: Wire transfer information for payments: Bank: -------------------------------- Address: Bank ABA#: -------------------------------- Account #: -------------------------------- Telephone: -------------------------------- Facsimile: -------------------------------- Attention: -------------------------------- Registered name: -------------------------- EXHIBIT A-3 TO ARG II BASE INDENTURE FORM OF TRANSFER CERTIFICATE FOR TEMPORARY GLOBAL NOTE OR PERMANENT GLOBAL NOTE TO RESTRICTED GLOBAL NOTE (TRANSFEROR) [Letterhead of Transferor] Reference is hereby made to the Amended and Restated Base Indenture, dated as of [ ], 2002 (the "BASE INDENTURE"), and the Series [ ] Supplement thereto, dated as of [ ] (the "SERIES [ ] SUPPLEMENT" and together with the Base Indenture, the "INDENTURE"), each between ARG II and The Bank of New York, as trustee. Capitalized terms used but not defined herein shall have the meanings assigned to them in the Indenture. Other terms shall have the meanings assigned to them in Rule 144A under the United States Securities Act of 1933, as amended (the "SECURITIES ACT"). This letter relates to U.S. $_________ principal amount of Series [ ] Notes (the "NOTES") of ARG II which are held in the registered name of [insert name of transferor] (the "TRANSFEROR"). The Transferor has requested a transfer of such Notes to [insert name of transferee]. In connection with such request, and in respect of such Notes, the Transferor does hereby certify that such Notes are being transferred in accordance with Rule 144A under the Securities Act to a transferee that the Transferor reasonably believes is purchasing the Notes for its own account or an account with respect to which the transferee exercises sole investment discretion and the transferee and any such account is a "qualified institutional buyer" within the meaning of Rule 144A, and such transferee is aware that the sale to it is being made in reliance upon Rule 144A, and any applicable securities laws of any state of the United States or any other jurisdiction. This letter and the statements contained herein are made for the benefit of ARG II and the Trustee. [TRANSFEROR] By: ----------------------------- Name: Title: Dated: ______________, _____ EXHIBIT A-4 TO...
Examples of Name of Purchaser in a sentence
Signature of Authorized Purchaser Print Name Here Title Date Streamlined Sales and Use Tax Agreement Certificate of Exemption Multistate Supplemental Name of Purchaser: STATE Reason for Exemption Identification Number (If Required) AR* GA IA IN KS KY MI MN NC ND NE NJ NV OH OK RI SD TN* UT VT WA WI WV WY *SSUTA Direct Mail provisions are not in effect for Arkansas and Tennessee.
Signature of Authorized Purchaser Print Name Here Title Date 21999 (8/27/09) Streamlined Sales and Use Tax Agreement Certificate of Exemption Multi-state Supplemental Name of Purchaser STATE Reason for Exemption Identification Number (If Required) AR IA IN KS KY MI MN NC ND NE NJ NV OH OK RI SD TN UT VT WA WI WV WY SSUTA Direct Mail provisions are not in effect for Tennessee.
Signature of Authorized Purchaser Print Name Here Title Date Streamlined Sales and Use Tax Agreement Certificate of Exemption SSTGB Form F0003 Exemption Certificate (2/22/08) Multi-state Supplemental Name of Purchaser STATE Reason for Exemption Identification Number (If Required) AR IA IN KS KY MI MN NC ND NE NJ NV OH OK RI SD TN UT VT WA WV WY SSUTA Direct Mail provisions are not in effect for Tennessee.
If No Tax ID Number,Enter One of the Following: FEIN Driver’s License Number/State Issued ID Number State of Issue Number Foreign Diplomat Number Name of Purchaser Business Address City State Zip Code Purchaser’s Tax ID Number State of Issue Country of Issue Name of Seller From Whom You Are Purchasing, Leasing, or Renting Seller’s Address City State Zip Code Type of Business.
Signature Name Address Performance Security Bank Guarantee (unconditional) To : Tamilnadu Medical Services Corporation Limited (Name of Purchaser) Xx.000, Xxxxxxxx Xxxx, Xxxxxx, Xxxxxxx – 600 008.
More Definitions of Name of Purchaser
Name of Purchaser. Dated: ____ By: EXI-'CU"JJON Vf-RSION Name: Title: Aggregate Original Face Amount of: Class A Purchase Money Notes due August 24, 2018: $L_____j* *Inclusive of Purchase Money Notes Issuance Fee Exhibit C -1-2 CAD< :IRA DC Vt·nturc 2011-1 Strudured Transaniun ExhdlEI< 10 Custodoal and Paymg Agency A~7eemenr VerSloOl 3 I ,, EXECU liON VER>OION F:XHIBIT C-2 FORM OF CERTIFICATE FOR THE ACQUISITION OF REGULATIONS CERTIFICATE]) NOTES [Letterhead of Prospective Note Purchaser/Exchanger] CADC/RADC Venture 2011-1, LLC Xxxxx Fargo Bank, National Association, as Paying Agent 0000 Xxx Xxxxxxxxx Xxxx Xxxxxxxx, Xxxxxxxx 00000 Attention: Client Services Manager Reference: 2011-1 Structun E-Mail Addresses: Re: Purchase Money Notes due August 24, 2018 Ladies and Gentlemen: Reference is made to the Custodial and Paying Agency Agreement dated as of August 24, 2011 (as modified and supplemented ami in etfect from time to time, the "Custodial and Paving Agency Agreement") among CADC/RADC Venture 2011-1, LLC, as the Company, Acorn Loan Portfolio Private Owner VI, LLC, as the Private Owner, the Federal Deposit Insurance Corporation in its capacity as the Receiver, as the Initial Member and as the PMN Agent, and Xxxxx Fargo Bank, National Association, as the Custodian and Paying Agent. All capitalized terms used but not defined herein are used as defined in the Custodial and Paying Agency Agreement. In cormection with the tmdersigned's purchase of the Purchase Money Notes due August 24, 2018 (the "Purchase Money Notes"), as set forth below, the undersigned hereby represents, acknowledges and agrees as follows:
Name of Purchaser. Dated: By: Name: Title: Outstanding principal amount of [Class [A] [B] [C] [D] [E]] [[Senior][Junior] Subordinated] Notes: $__________
Name of Purchaser. AEFC FMFK Investment Corp. Address: AEFC FMFK Investment Corp. 311 S. Wacker Drive Xxxxx 0000 Chicago, IL 60601 Attn: Erhard Chorle Signature Xx: /x/ Xxxx E. Marks ----------------------------- Name: Joel E. Marks Titxx: Xxxxxxxxx Schedule 4.1 The company is qualified to do business in all fifty states. First Montauk Securities Corp, a New York corporation Montauk Insurance Services, Inc., a New Jersey corporation Schedule 5.3 None. EXHIBIT A Note EXHIBIT B Pledge Agreement EXHIBIT C Contingent Warrant EXHIBIT D Prepayment Warrant EXHIBIT 4.12 Form B-D EXHIBIT 4.15 Form ADV
Name of Purchaser. By: ___________________________ Name: Title: Aggregate Purchase Price (Subscription Amount): $ ___________________ Number of Shares to be Acquired: Underlying Shares Subject to Warrant: (25% of the number of Shares to be acquired) Tax ID No.: ____________________ Address for Notice: _______________________________ _______________________________ _______________________________ Telephone No.: ________________________ Facsimile No.: _________________________ E-mail Address: ________________________ Attention: ____________________________ Delivery Instructions: (if different than above) c/o ________________________ Street: ______________________ City/State/Zip: ________________ Attention: ___________________ Telephone No.: ______________ EXHIBITS:
Name of Purchaser. Date: Signature: Telephone: Address: DOB: Hearing Aid Specialist: Xxxxx Xxxxx-Xxxxxxxx, H.A.S. ACA Signature: License Number: HA4026 If the hearing aids are returned after the 30 day trial period the patient may be liable for fees related to the fittings and adjustments, restocking fee, and appointments provided by the hearing aid specialist. If you wish to inquire about these fees, please contact the office at 000-000-0000.
Name of Purchaser. Dated: By: Name: Title: Aggregate principal amount of: 26 Insert as appropriate Purchase Money Notes due [February 25, 2012]: $ Purchase Money Notes due [February 25, 2013]: $ Purchase Money Notes due [February 25, 2014]: $ EXHIBIT C-5 FORM OF CERTIFICATE FOR TRANSFER OR EXCHANGE OF GLOBAL NOTE TO CERTIFICATED NOTE Multibank 2009-1 CML-ADC Venture, LLC c/o Wells Fargo Bank, N.A., as Paying Agent 0xx Xxxxxx & Xxxxxxxxx Xxxxxx Xxxxxxxxxxx, XX 00000 Attn: Corporate Trust Services Transfer Agent Department Re: Purchase Money Notes due [February 25, 2012][February 25, 2013][February 25, 2014]27 Ladies and Gentlemen:
Name of Purchaser. Del Mar Master Fund, Ltd. Signature of Authorized Signatory of Purchaser: /s/ Xxxxx X. Xxxxxxxx Name of Authorized Signatory: Xxxxx X. Xxxxxxxx Title of Authorized Signatory: Managing Member Email Address of Authorized Signatory: Facsimile Number of Authorized Signatory: Address for Notice to Purchaser: Address for Delivery of Securities to Purchaser (if not same as address for notice): Subscription Amount: $2,420,000 Shares: 1,512,500 EIN Number: [Provided Separately] [PURCHASER SIGNATURE PAGES CONTINUE] DISCLOSURE SCHEDULES The Company Disclosure Schedule (the “Disclosure Schedule”) is being delivered in connection with that certain Securities Purchase Agreement (the “Agreement”) dated as of December 24, 2013, by and among DS Healthcare Group, Inc. (the “Company”) and the Purchasers identified on the signature page to the Agreement. Capitalized terms used, but not otherwise defined, in this Disclosure Schedule shall have the meanings ascribed to them in the Agreement. The Disclosure Schedule is qualified in its entirety by reference to the specific provisions of the Agreement. In addition, information set forth in this Disclosure Schedule modifies, supplements, qualifies or limits the representations and warranties made by the Company in the Agreement. The Disclosure Schedule is arranged in sections corresponding to the sections contained in the Agreement, but the disclosure of an item in one section of this Disclosure Schedule shall be deemed adequately disclosed in each other section of this Disclosure Schedule. The headings contained in this Disclosure Schedule are included for convenience only, and shall not be deemed to constitute a part of this Disclosure Schedule or a part of the Agreement. The specification of any dollar amount in this Disclosure Schedule is not intended and shall not be deemed to be an admission or acknowledgment of the materiality of such amounts or items, nor shall the same be used in any dispute or controversy between the parties to determine whether any obligation, item or matter (whether or not described herein or included in any schedule) is or is not material for purposes of the Agreement. Schedule 3.1(a) Subsidiaries · DS Laboratories Inc. · Sigma Development and Holding Co., Inc. · Polaris Labs, Inc. · Nutra Origin, Inc. · Velocity Storage and Packaging, LLC (Variable Interest Entity – the Company’s variable interest relates to a financing arrangement whereby all operational expenses, including labor costs, facility cos...