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[本证券或可行使本证券的证券均未根据修订后的1933年《证券法》(以下简称《证券法》)的登记豁免而在任何 州的证券交易委员会或证券委员会登记,因此,除非根据《证券法》的有效登记声明,或根据《证券法》的有效登记声明,或根据《证券法》的登记要求和适用的州证券法,否则不得发行或出售该证券或证券。该证券及行使该证券时可发行的证券可与博纳基金保证金账户或该等证券担保的其他贷款一起质押。]

普通股认购权证

美华国际医疗科技有限公司。

认股权证股份:_ 初步演习日期:2024年_

本普通股认购权证(“认股权证”) 证明,就收到的价值而言,_(纽约市时间)于2029年_(“终止日期”) 但此后不得认购美华国际医疗技术有限公司,该公司是开曼群岛豁免的 公司(“本公司”),最多_1 普通股(以下调整为“认股权证”)。本认股权证项下一股认股权证股份的收购价应等于第2(B)节所界定的行使价。

第1节定义。 本文中使用的大写术语和未作其他定义的术语应具有本公司与各买方于2023年12月27日签署的特定证券购买协议(“购买协议”)中所载的含义。

第二节锻炼。

A)行使担保 。本认股权证所代表的购买权的全部或部分行使,可于初始行使日期或之后及终止日期或之前的任何时间或任何时间,以电子邮件(或电子邮件附件)的形式,以电子邮件(或电子邮件附件)形式提交正式签署的行使通知的传真副本 或.pdf副本(“行使通知”),送交本公司。在上述行使之日后的(I)两(2)个交易日和(Ii)构成标准结算期间(如本文第2(D)(I)节所定义)的交易日数中较早的一个内,持有人应向 公司支付一笔款项,金额等于行权当日认股权证股票的有效行使价乘以适用的 美国银行开出的电汇或本票行权通知中指定的认股权证股份数量(“行权总价”),除非适用的行权通知中规定了下文第2(C)节规定的无现金行权程序。不需要墨水原件的行使通知,也不需要对任何行使通知进行任何徽章担保(或其他类型的担保或公证)。尽管本协议有任何相反规定,在持有人购买了本协议项下所有的认股权证股票且认股权证已全部行使之前,持有人不应被要求向公司实际交出本认股权证。在此情况下,持有人应在最终行使通知送交本公司之日起三(3)个交易日内,将本认股权证交回本公司注销。 部分行使本认股权证导致购买本认股权证可供认购股份总数的一部分, 将减少本认股权证可购买的已发行认股权证股份数目,其数额与适用认购认股权证股份数目相等于。持有人和公司应保存记录,显示所购买的认股权证股票数量和购买日期。公司应在收到任何行使通知的一(1)个工作日内递交任何反对意见。在接受本认股权证后,持有人及任何受让人确认并同意,由于本 段的规定,在购买部分本认股权证股份后,在任何给定时间,根据本认股权证可供购买的认股权证股份数目可能少于本认股权证票面所述的金额。

1每次成交50%的覆盖率,计算方法为:(I)就首次成交而言,在购买协议日期的交易日,以每笔票据的面值除以VWAP;(Ii)在紧接适用成交前的 交易日,就任何后续成交而言,计算每笔票据的面值。

B)行使 价格。根据本认股权证,每股认股权证的行使价为_美元2, 可在本协议下进行调整(“行使价”)。

C)无现金锻炼。如果在行使时没有有效的登记声明登记,或其中包含的招股说明书不能供持有人转售认股权证股份,则本认股权证也可在此时以无现金行使的方式全部或部分行使 ,在该行使方式中,持有人有权获得相当于通过除法所得商数的认股权证股份 [(A-B)(X)](A),其中:

(A) =适用的:(I)在紧接适用的行权通知日期之前的交易日的VWAP,如果该行权通知是(1)在非交易日的交易日根据本合同第2条(A)签立和交付,或(2)在该交易日“正常交易 小时”(根据根据联邦证券法颁布的NMS条例第600(B)(68)条的规定)开盘前的交易日同时根据本合同第2(A)条签立和交付,(2) 根据持有人的选择,(Y)紧接适用行使通知日期前一个交易日的VWAP 或(Z)Bloomberg L.P.(“Bloomberg”)报告的主要交易市场普通股在持有人签立适用行使通知时的买入价,如果行使通知在交易日的“正常交易时间”内签立,并在此后两(2)小时内(包括至“正常交易”收盘后两(2)小时内交付)如果行使通知的日期是交易日,且该行使通知是在该交易日的“正常交易时间”结束后根据第2(A)节的规定签立和交付的,则(Iii)在适用的行使通知的日期 ,在适用的行使通知之日的VWAP;

(B) =本认股权证的行使价,按以下规定调整;以及

(X) =根据本认股权证的 条款行使本认股权证时,如行使该认股权证时以现金行使而非无现金行使的方式,可发行的认股权证股份数目。

2等同于VWAP的120%(I)就首次成交而言,在购买协议日期的交易日,以及(Ii)在紧接适用成交之前的交易日 就任何后续成交而言。

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如果在这种无现金行使中发行认股权证股票,双方承认并同意,根据证券法第3(A)(9)条,认股权证股份应具有正在行使的认股权证的特征,正在发行的认股权证股票的持有期可以 附加到本认股权证的持有期。本公司同意不采取任何与第2(C)条相反的立场。

“买入价” 指在任何日期由下列条款中的第一项确定的价格,该价格适用于:(A)如果普通股随后在交易市场上市或报价,则为彭博社报道的普通股随后在交易市场上市或报价的交易市场(或之前最近的日期)的买入价(根据交易日上午9:30开始计算)。(纽约时间 城市时间)至下午4:02(纽约时间)),(B)如果OTCQB或OTCQX不是交易市场,则为适用的OTCQB或OTCQX在该日期(或最近的前一日期)普通股的成交量加权平均价 ;(C)如果普通股没有在OTCQB或OTCQX上市或报价,并且如果普通股的价格随后在粉色公开市场(或继承其报告价格职能的类似组织或机构)报告,则如此报告的普通股的最新每股买入价,或(D)在所有其他情况下,普通股的公允市值,由当时尚未偿还且为公司合理接受的证券的大多数购买者真诚选择的独立评估师 选定,费用和开支由本公司支付。

“VWAP” 指于任何日期由下列第一项适用的价格厘定的价格:(A)如普通股当时在交易市场上市或报价,则指彭博报导的普通股于该日期(或最近的前一个日期)在交易市场挂牌或报价的每日成交量加权平均价(根据交易日上午9:30起计算)。(纽约市时间)至下午4:02(纽约市时间));(B)如果OTCQB或OTCQX不是交易市场,则为该日期(或最近的前一日期)普通股在OTCQB或OTCQX(视适用情况而定)的成交量加权平均价;(C)如果普通股当时没有在场外交易市场或场外交易市场挂牌或报价,而普通股的价格随后在平价公开市场(或接替其报告价格职能的类似组织或机构)报告,则为如此报告的普通股的最新每股买入价,或(D)在所有其他情况下,普通股的公平市值,由持有该证券多数权益的购买者真诚地选择的独立评估师确定,当时尚未发行且合理地为本公司接受。其费用和开支由公司支付。

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尽管本协议有任何相反规定,本公司应于终止日期前三十(30)日向持有人发出通知,倘若本认股权证当时有效的行使价格 低于(I)紧接发出通知前的 交易日普通股在交易市场的正式收市价及(Ii)紧接发出通知前五(5)个交易日普通股在交易市场的平均收市价 。

D)锻炼的力学 。

i. Delivery of Warrant Shares Upon Exercise. The Company shall cause the Warrant Shares purchased hereunder to be transmitted by the Transfer Agent to the Holder by crediting the account of the Holder’s or its designee’s balance account with The Depository Trust Company through its Deposit or Withdrawal at Custodian system (“DWAC”) if the Company is then a participant in such system and either (A) there is an effective registration statement permitting the issuance of the Warrant Shares to or resale of the Warrant Shares by the Holder or (B) the Warrant Shares are eligible for resale by the Holder without volume or manner-of-sale limitations pursuant to Rule 144 (assuming cashless exercise of the Warrants), and otherwise by physical delivery of a certificate, registered in the Company’s share register in the name of the Holder or its designee, for the number of Warrant Shares to which the Holder is entitled pursuant to such exercise to the address specified by the Holder in the Notice of Exercise by the date that is the earliest of (i) two (2) Trading Days after the delivery to the Company of the Notice of Exercise, (ii) one (1) Trading Day after delivery of the Aggregate Exercise Price to the Company and (iii) the number of Trading Days comprising the Standard Settlement Period after the delivery to the Company of the Notice of Exercise (such date, the “Warrant Share Delivery Date”). Upon delivery of the Notice of Exercise, the Holder shall be deemed for all corporate purposes to have become the holder of record of the Warrant Shares with respect to which this Warrant has been exercised, irrespective of the date of delivery of the Warrant Shares, provided that payment of the Aggregate Exercise Price (other than in the case of a cashless exercise) is received within the earlier of (i) two (2) Trading Days and (ii) the number of Trading Days comprising the Standard Settlement Period following delivery of the Notice of Exercise. If the Company fails for any reason to deliver to the Holder the Warrant Shares subject to a Notice of Exercise by the Warrant Share Delivery Date, the Company shall pay to the Holder, in cash, as liquidated damages and not as a penalty, for each US$1,000 of Warrant Shares subject to such exercise (based on the VWAP of the Ordinary Shares on the date of the applicable Notice of Exercise), US$5 per Trading Day for each Trading Day after such Warrant Share Delivery Date until such Warrant Shares are delivered or Holder rescinds such exercise. The Company agrees to maintain a transfer agent that is a participant in the FAST program so long as this Warrant remains outstanding and exercisable. As used herein, “Standard Settlement Period” means the standard settlement period, expressed in a number of Trading Days, on the Company’s primary Trading Market with respect to the Ordinary Shares as in effect on the date of delivery of the Notice of Exercise.

二、行使时交付新权证 。如本认股权证已部分行使,本公司须应持有人的要求及于交回本认股权证证书后,于认股权证股份交付时,向持有人交付一份新的认股权证,证明持有人有权购买本认股权证所要求的未购买认股权证股份,而新认股权证在所有其他方面应与本认股权证完全相同。

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三、撤销 权利。如本公司未能安排转让代理于认股权证股份交割日前根据第2(D)(I)条 将认股权证股份转让予持有人,则持有人将有权撤销该项行使。

iv. Compensation for Buy-In on Failure to Timely Deliver Warrant Shares Upon Exercise. In addition to any other rights available to the Holder, if the Company fails to cause the Transfer Agent to transmit to the Holder the Warrant Shares in accordance with the provisions of Section 2(d)(i) above pursuant to an exercise on or before the Warrant Share Delivery Date, and if after such date the Holder is required by its broker to purchase (in an open market transaction or otherwise) or the Holder’s brokerage firm otherwise purchases, Ordinary Shares to deliver in satisfaction of a sale by the Holder of the Warrant Shares which the Holder anticipated receiving upon such exercise (a “Buy-In”), then the Company shall (A) pay in cash to the Holder the amount, if any, by which (x) the Holder’s total purchase price (including brokerage commissions, if any) for the Ordinary Shares so purchased exceeds (y) the amount obtained by multiplying (1) the number of Warrant Shares that the Company was required to deliver to the Holder in connection with the exercise at issue times (2) the price at which the sell order giving rise to such purchase obligation was executed, and (B) at the option of the Holder, either reinstate the portion of the Warrant and equivalent number of Warrant Shares for which such exercise was not honored (in which case such exercise shall be deemed rescinded) or deliver to the Holder the number of Ordinary Shares that would have been issued had the Company timely complied with its exercise and delivery obligations hereunder. For example, if the Holder purchases Ordinary Shares having a total purchase price of US$11,000 to cover a Buy-In with respect to an attempted exercise of Ordinary Shares with an aggregate sale price giving rise to such purchase obligation of US$10,000, under clause (A) of the immediately preceding sentence the Company shall be required to pay the Holder US$1,000. The Holder shall provide the Company with written notice indicating the amounts payable to the Holder in respect of the Buy-In and, upon request of the Company, provide evidence of the amount of such loss. Nothing herein shall limit a Holder’s right to pursue any other remedies available to it hereunder, at law or in equity including, without limitation, a decree of specific performance and/or injunctive relief with respect to the Company’s failure to timely deliver Ordinary Shares upon exercise of the Warrant as required pursuant to the terms hereof.

V.没有 零碎股份或Scrip。本认股权证行使后,不得发行任何零碎股份或代表零碎股份的股票。至于持有人于行使该权力后将有权购买的任何零碎股份,本公司将于其选择时就该最后零碎股份支付现金调整,金额相等于该零碎股份乘以行使价,或向上舍入至下一个完整股份。

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六、手续费, 税费。发行认股权证股票应免费向持有人收取与发行该等认股权证股份有关的任何发行或转让税或其他附带费用,所有税项及开支均由本公司支付,而该等认股权证股份应以持有人的名义或按持有人指示的名称发行;然而, 如认股权证股份以持有人以外的名义发行,则本认股权证于交回行使时,须附同由持有人正式签署的转让表格,而本公司可要求支付一笔足以偿还其所附带的任何转让税的款项作为条件。本公司应支付当日处理任何行使通知所需的所有转让代理费用,以及当日以电子方式交付认股权证股份所需的所有费用予存托信托公司(或履行类似职能的另一间已成立结算公司)。

七.正在关闭 本图书。本公司不会以任何妨碍根据本条款及时行使本认股权证的方式关闭其股东账簿或记录。

E)持有者的运动限制。本公司不得行使本认股权证,持有人亦无权根据第2条或其他规定行使本认股权证的任何部分,条件是持有人(连同持有人的联营公司,以及与持有人或持有人的任何联营公司(该等人士,“出让方”)作为一个集团行事的任何其他人士,在行使适用的行使通知所载的行使权利后, 将实益拥有超过实益拥有权限额(定义如下)的权证。就前述句子而言, 持有人及其关联公司和出资方实益拥有的普通股数量应包括因行使本认股权证而可发行的普通股数量,但不包括因(I)持有人或其任何关联公司或出让方实益拥有的剩余未行使部分,以及(Ii)行使或转换本公司任何其他证券(包括但不限于,任何其他普通股等价物),但须受 转换或行使类似于本协议所载限制的限制,该等限制由持有人或其任何联属公司或授权方实益拥有。除上一句所述外,就本第2(E)条而言,实益所有权应根据《交易所法案》第13(D)节及据此颁布的规则和条例计算, 持有人确认本公司并未向持有人表示该计算符合《交易所法案》第13(D)条的规定 ,并由持有人独自负责根据该条款提交的任何时间表。在第2(E)款中包含的限制适用的范围内,确定本认股权证是否可行使(与持有人与任何关联方和出资方共同拥有的其他证券有关)以及本认股权证的哪一部分可行使,应由持有人自行决定,提交行使通知应视为持有人决定是否可行使本认股权证(与持有人与任何关联方和出资方共同拥有的其他证券有关) 以及本认股权证的哪部分可行使。在每种情况下,本公司均受实益所有权限制,且本公司无义务核实或确认该等决定的准确性。此外,上述关于任何集团地位的决定应根据《交易所法案》第13(D)节及其颁布的规则和条例来确定。就本第2(E)条而言,在厘定已发行普通股数目时,持有人可依据(A)本公司向监察委员会提交的最新定期或年度报告(视属何情况而定)、(B)本公司较新的公告或(C)本公司或转让代理较新发出的书面通知所反映的已发行普通股数量。应持有人的书面或口头要求,本公司应在一个交易日内向持有人口头和书面确认当时已发行的普通股数量。在任何情况下,已发行普通股数量应由持有人或其关联公司或出资方自报告该等已发行普通股数量之日起,于转换或行使本公司证券(包括本认股权证)后确定。 “实益拥有权限额”应为紧接 行使本认股权证后发行可发行普通股数量的4.99%。持有人在通知本公司后,可增加或减少本第2(E)节的实益拥有权限制条文,但在任何情况下,实益拥有权限制不得超过紧随持有人行使本认股权证而发行普通股后已发行普通股数目的9.99%,而本第2(E)节的规定将继续适用。对受益所有权限制的任何增加将在该通知送达本公司后的第61天内生效。本款条款 的解释和实施方式不应严格符合第2(E)款的条款 ,以纠正本款(或其任何部分)可能存在缺陷或与本文所载的预期受益所有权限制 不一致的地方,或者做出必要或适当的更改或补充以适当地实施此类限制。本段包含的限制 应适用于本认股权证的每一位继任者。

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第3条某些调整

a) Stock Dividends and Splits. If the Company, at any time while this Warrant is outstanding: (i) pays a stock dividend or otherwise makes a distribution or distributions on its Ordinary Shares or any other equity or equity equivalent securities payable in Ordinary Shares (which, for avoidance of doubt, shall not include any Ordinary Shares issued by the Company upon exercise of this Warrant), (ii) subdivides outstanding Ordinary Shares into a larger number of shares, (iii) combines (including by way of reverse stock split) outstanding Ordinary Shares into a smaller number of shares, or (iv) issues by reclassification of Ordinary Shares any shares of capital stock of the Company, then in each case the Exercise Price shall be multiplied by a fraction of which the numerator shall be the number of Ordinary Shares (excluding treasury shares, if any) outstanding immediately before such event and of which the denominator shall be the number of Ordinary Shares outstanding immediately after such event, and the number of shares issuable upon exercise of this Warrant shall be proportionately adjusted such that the Aggregate Exercise Price of this Warrant shall remain unchanged. Any adjustment made pursuant to this Section 3(a) shall become effective immediately after the record date for the determination of stockholders entitled to receive such dividend or distribution and shall become effective immediately after the effective date in the case of a subdivision, combination or re-classification.

b) Subsequent Equity Sales. If the Company, the Company’s controlling shareholder or any Subsidiary thereof, as applicable, at any time while this Warrant is outstanding, shall sell, enter into an agreement to sell, or grant any option to purchase, or sell or grant any right to reprice, or otherwise dispose of or issue (or announce any offer, sale, grant or any option to purchase or other disposition) any Ordinary Shares or Ordinary Share Equivalents, at an effective price per share less than the Exercise Price then in effect (such lower price, the “Base Share Price” and such issuances collectively, a “Dilutive Issuance”) (it being understood and agreed that if the holder of the Ordinary Shares or Ordinary Share Equivalents so issued shall at any time, whether by operation of purchase price adjustments, reset provisions, floating conversion, exercise or exchange prices or otherwise, or due to warrants, options or rights per share which are issued in connection with such issuance, be entitled to receive Ordinary Shares at an effective price per share that is less than the Exercise Price, such issuance shall be deemed to have occurred for less than the Exercise Price on such date of the Dilutive Issuance at such effective price), then simultaneously with the consummation (or, if earlier, the announcement) of each Dilutive Issuance the Exercise Price shall be reduced and only reduced to equal the Base Share Price, and the number of Warrant Shares issuable hereunder shall be proportionately increased such that the aggregate Exercise Price payable hereunder by the Holder hereof, after taking into account such decrease in the Exercise Price to the Base Share Price, shall be equal to the aggregate Exercise Price payable hereunder by the Holder hereof on the date on which this Warrant was initially issued pursuant to the Purchase Agreement. Notwithstanding the foregoing, no adjustments shall be made, paid or issued under this Section 3(b) in respect of an Exempt Issuance. For issuances other than an Exempt Issuance (in which case no notice shall be required), the Company shall notify the Holder, in writing, no later than the Trading Day following the issuance or deemed issuance of any Ordinary Shares or Ordinary Share Equivalents subject to this Section 3(b), indicating therein the applicable issuance price, or applicable reset price, exchange price, conversion price and other pricing terms (such notice, the “Dilutive Issuance Notice”). For purposes of clarification, whether or not the Company provides a Dilutive Issuance Notice pursuant to this Section 3(b), upon the occurrence of any Dilutive Issuance, the Holder is entitled to receive a number of Warrant Shares based upon the Base Share Price regardless of whether the Holder accurately refers to the Base Share Price in the Notice of Exercise. If the Company enters into a Variable Rate Transaction, the Company shall be deemed to have issued Ordinary Shares or Ordinary Share Equivalents at the lowest possible price, conversion price or exercise price at which such securities may be issued, converted or exercised.

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C)后续 配股。除根据上述第3(A)条进行的任何调整外,如果公司在任何时间向任何 类别普通股的记录持有人按比例授予、发行或出售任何普通股等价物或购买股票、认股权证、证券或其他财产的权利(“购买权”),则持有人将有权根据适用于该等购买权的条款,获得持有人假若持有在完全行使本认股权证后可获得的普通股数量的情况下可获得的总购买权(不受行使本认股权证的任何限制,包括但不限于, 实益所有权限制)紧接在授予、发行或出售此类购买权的记录日期之前 ,或者,如果没有记录,则为确定普通股记录持有人授予、发行或出售此类购买权的日期(但前提是,如果持有人参与任何此类购买权的权利会导致持有人超出实益所有权限制,则持有人无权参与该等购买权(或因该购买权而对该等普通股的实益拥有权),而该购买权将在可能的范围内由持有人暂时搁置,直至其权利不会导致持有人超过实益拥有权限制的时间(如有的话)。

在采取任何会导致本认股权证可行使的认股权证股份数目或行使价调整的行动前,本公司 应获得任何公共监管机构或具有司法管辖权的 机构的所有授权或豁免或同意。

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E)管辖权。 有关本保证书的解释、有效性、执行和解释的所有问题均应根据《采购协议》的规定确定。

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F)限制。 持有人承认,在行使本认股权证时获得的认股权证股票,如果未登记,且持有人未使用无现金行使,则在转售时将受到州和联邦证券法的限制。

G)不放弃 和费用。持有人的任何交易过程或任何延误或未能行使本协议项下的任何权利,均不得视为放弃该权利或以其他方式损害持有人的权利、权力或补救。在不限制本认股权证或购买协议的任何其他规定的情况下,如果本公司故意及明知不遵守本认股权证的任何条款,导致持有人遭受任何重大损害,本公司应向持有人支付足以支付持有人因收取根据本协议到期或以其他方式执行其在本协议项下的任何权利、权力或补救措施而招致的任何费用和开支的金额,包括但不限于合理的律师费,包括上诉诉讼费用。

H)通知。 本公司要求或允许向持有人发出或交付的任何通知、请求或其他文件应按照购买协议的通知条款交付。

I)责任限制。在持有人未采取任何肯定行动以行使本认股权证以购买认股权证 股份的情况下,本协议任何条文均不会导致持有人就购买任何普通股的价格或作为本公司的股东而承担任何责任,不论该等责任是由本公司或本公司的债权人主张的。

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J)补救措施。 持有人除了有权行使法律授予的所有权利,包括追讨损害赔偿外,还有权具体 履行其在本认股权证项下的权利。本公司同意,金钱赔偿不足以补偿因其违反本认股权证规定而蒙受的任何损失,因此,本公司同意放弃且不在任何针对具体履约的诉讼中提出法律补救即已足够的抗辩理由。

K)继承人 和分配人。在适用证券法的规限下,本认股权证及其所证明的权利及义务,对本公司的继承人及获准受让人以及持有人的继承人及准许受让人具有约束力。 本认股权证的规定旨在不时为本认股权证的任何持有人的利益而设,并可由认股权证股份持有人或持有人强制执行。

L)修订。 经本公司及持有人书面同意,本认股权证可予修改或修订,或放弃本认股权证的规定。

M)可分割性。 在可能的情况下,本保证书的每一条款均应解释为在适用法律下有效和有效,但如果本保证书的任何条款根据适用法律被禁止或无效,则该条款应在该禁止或无效的范围内无效,但不会使该等条款的其余部分或本保证书的其余条款无效。

N)标题。 本授权书中使用的标题仅供参考,不得出于任何目的被视为本授权书的一部分。

(签名页如下)

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兹证明,自上述日期起,公司已由其正式授权的高级职员签署本认股权证。

美华国际医疗科技有限公司。

发信人:

姓名:

标题:

行使通知

致:美华国际医疗技术有限公司

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(1)在此签署的 选择根据所附认股权证的条款购买_

(2)付款 应采用以下形式(勾选适用框):

☐ 美国合法货币;或

☐ 如获准按照第(br}2(C)款规定的公式注销所需数量的认股权证股份,则根据第2(C)款规定的无现金行使程序 可购买的最大认股权证股份数行使本认股权证。

(3)请 以以下签署人的名义或以下指定的其他名称发行上述认股权证股票:

认股权证股票应交付给以下DWAC帐户 编号:

(4)认可的 投资者。以下签署人是根据修订后的1933年证券法颁布的法规D所界定的“认可投资者” 。

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持有人签名

投资主体名称:________________________________________________________

投资主体授权签署人:_

授权签字人姓名:___________________________________________________

授权签字人名称:____________________________________________________

********************

日期:_

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附件B

作业表
(要转让上述认股权证,请执行此表格并提供所需的 信息。请勿使用此表格购买股票。)
对于收到的价值,前述认股权证和由此证明的所有权利在此转让给
姓名:

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(请打印)

地址:

(请打印)

电话:

电子邮件地址:

日期:_

持有人签名:_

_______________________________

持有人签名:_

_______________________________

_______________________________

_______________________________

(4) Accredited Investor. The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended.

[SIGNATURE OF HOLDER]

Name of Investing Entity: ________________________________________________________

Signature of Authorized Signatory of Investing Entity: _________________________________

Name of Authorized Signatory: ___________________________________________________

Title of Authorized Signatory: ____________________________________________________

Date: ________________________________________________________________________

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EXHIBIT B

ASSIGNMENT FORM

(To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.)

FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to

Name: __________________________________________
(Please Print)
Address: __________________________________________
(Please Print)
Phone: __________________________________________
Email Address: __________________________________________
Dated:______________ ___, _______
Holder’s Signature:_____________________
Holder’s Signature: _____________________

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