展品99.3

SPA附件 B

授權書表格

[本證券或可行使本證券的證券均未根據修訂後的1933年《證券法》(以下簡稱《證券法》)的登記豁免而在任何 州的證券交易委員會或證券委員會登記,因此,除非根據《證券法》的有效登記聲明,或根據《證券法》的有效登記聲明,或根據《證券法》的登記要求和適用的州證券法,否則不得發行或出售該證券或證券。該證券及行使該證券時可發行的證券可與博納基金保證金賬户或該等證券擔保的其他貸款一起質押。]

普通股認購權證

美華國際醫療科技有限公司。

認股權證股份:_ 初步演習日期:2024年_

本普通股認購權證(“認股權證”) 證明,就收到的價值而言,_(紐約市時間)於2029年_(“終止日期”) 但此後不得認購美華國際醫療技術有限公司,該公司是開曼羣島豁免的 公司(“本公司”),最多_1 普通股(以下調整為“認股權證”)。本認股權證項下一股認股權證股份的收購價應等於第2(B)節所界定的行使價。

第1節定義。 本文中使用的大寫術語和未作其他定義的術語應具有本公司與各買方於2023年12月27日簽署的特定證券購買協議(“購買協議”)中所載的含義。

第二節鍛鍊。

A)行使擔保 。本認股權證所代表的購買權的全部或部分行使,可於初始行使日期或之後及終止日期或之前的任何時間或任何時間,以電子郵件(或電子郵件附件)的形式,以電子郵件(或電子郵件附件)形式提交正式簽署的行使通知的傳真副本 或.pdf副本(“行使通知”),送交本公司。在上述行使之日後的(I)兩(2)個交易日和(Ii)構成標準結算期間(如本文第2(D)(I)節所定義)的交易日數中較早的一個內,持有人應向 公司支付一筆款項,金額等於行權當日認股權證股票的有效行使價乘以適用的 美國銀行開出的電匯或本票行權通知中指定的認股權證股份數量(“行權總價”),除非適用的行權通知中規定了下文第2(C)節規定的無現金行權程序。不需要墨水原件的行使通知,也不需要對任何行使通知進行任何徽章擔保(或其他類型的擔保或公證)。儘管本協議有任何相反規定,在持有人購買了本協議項下所有的認股權證股票且認股權證已全部行使之前,持有人不應被要求向公司實際交出本認股權證。在此情況下,持有人應在最終行使通知送交本公司之日起三(3)個交易日內,將本認股權證交回本公司註銷。 部分行使本認股權證導致購買本認股權證可供認購股份總數的一部分, 將減少本認股權證可購買的已發行認股權證股份數目,其數額與適用認購認股權證股份數目相等於。持有人和公司應保存記錄,顯示所購買的認股權證股票數量和購買日期。公司應在收到任何行使通知的一(1)個工作日內遞交任何反對意見。在接受本認股權證後,持有人及任何受讓人確認並同意,由於本 段的規定,在購買部分本認股權證股份後,在任何給定時間,根據本認股權證可供購買的認股權證股份數目可能少於本認股權證票面所述的金額。

1每次成交50%的覆蓋率,計算方法為:(I)就首次成交而言,在購買協議日期的交易日,以每筆票據的面值除以VWAP;(Ii)在緊接適用成交前的 交易日,就任何後續成交而言,計算每筆票據的面值。

B)行使 價格。根據本認股權證,每股認股權證的行使價為_美元2, 可在本協議下進行調整(“行使價”)。

C)無現金鍛鍊。如果在行使時沒有有效的登記聲明登記,或其中包含的招股説明書不能供持有人轉售認股權證股份,則本認股權證也可在此時以無現金行使的方式全部或部分行使 ,在該行使方式中,持有人有權獲得相當於通過除法所得商數的認股權證股份 [(A-B)(X)](A),其中:

(A) =適用的:(I)在緊接適用的行權通知日期之前的交易日的VWAP,如果該行權通知是(1)在非交易日的交易日根據本合同第2條(A)籤立和交付,或(2)在該交易日“正常交易 小時”(根據根據聯邦證券法頒佈的NMS條例第600(B)(68)條的規定)開盤前的交易日同時根據本合同第2(A)條籤立和交付,(2) 根據持有人的選擇,(Y)緊接適用行使通知日期前一個交易日的VWAP 或(Z)Bloomberg L.P.(“Bloomberg”)報告的主要交易市場普通股在持有人籤立適用行使通知時的買入價,如果行使通知在交易日的“正常交易時間”內籤立,並在此後兩(2)小時內(包括至“正常交易”收盤後兩(2)小時內交付)如果行使通知的日期是交易日,且該行使通知是在該交易日的“正常交易時間”結束後根據第2(A)節的規定籤立和交付的,則(Iii)在適用的行使通知的日期 ,在適用的行使通知之日的VWAP;

(B) =本認股權證的行使價,按以下規定調整;以及

(X) =根據本認股權證的 條款行使本認股權證時,如行使該認股權證時以現金行使而非無現金行使的方式,可發行的認股權證股份數目。

2等同於VWAP的120%(I)就首次成交而言,在購買協議日期的交易日,以及(Ii)在緊接適用成交之前的交易日 就任何後續成交而言。

2

如果在這種無現金行使中發行認股權證股票,雙方承認並同意,根據證券法第3(A)(9)條,認股權證股份應具有正在行使的認股權證的特徵,正在發行的認股權證股票的持有期可以 附加到本認股權證的持有期。本公司同意不採取任何與第2(C)條相反的立場。

“買入價” 指在任何日期由下列條款中的第一項確定的價格,該價格適用於:(A)如果普通股隨後在交易市場上市或報價,則為彭博社報道的普通股隨後在交易市場上市或報價的交易市場(或之前最近的日期)的買入價(根據交易日上午9:30開始計算)。(紐約時間 城市時間)至下午4:02(紐約時間)),(B)如果OTCQB或OTCQX不是交易市場,則為適用的OTCQB或OTCQX在該日期(或最近的前一日期)普通股的成交量加權平均價 ;(C)如果普通股沒有在OTCQB或OTCQX上市或報價,並且如果普通股的價格隨後在粉色公開市場(或繼承其報告價格職能的類似組織或機構)報告,則如此報告的普通股的最新每股買入價,或(D)在所有其他情況下,普通股的公允市值,由當時尚未償還且為公司合理接受的證券的大多數購買者真誠選擇的獨立評估師 選定,費用和開支由本公司支付。

“VWAP” 指於任何日期由下列第一項適用的價格釐定的價格:(A)如普通股當時在交易市場上市或報價,則指彭博報導的普通股於該日期(或最近的前一個日期)在交易市場掛牌或報價的每日成交量加權平均價(根據交易日上午9:30起計算)。(紐約市時間)至下午4:02(紐約市時間));(B)如果OTCQB或OTCQX不是交易市場,則為該日期(或最近的前一日期)普通股在OTCQB或OTCQX(視適用情況而定)的成交量加權平均價;(C)如果普通股當時沒有在場外交易市場或場外交易市場掛牌或報價,而普通股的價格隨後在平價公開市場(或接替其報告價格職能的類似組織或機構)報告,則為如此報告的普通股的最新每股買入價,或(D)在所有其他情況下,普通股的公平市值,由持有該證券多數權益的購買者真誠地選擇的獨立評估師確定,當時尚未發行且合理地為本公司接受。其費用和開支由公司支付。

3

儘管本協議有任何相反規定,本公司應於終止日期前三十(30)日向持有人發出通知,倘若本認股權證當時有效的行使價格 低於(I)緊接發出通知前的 交易日普通股在交易市場的正式收市價及(Ii)緊接發出通知前五(5)個交易日普通股在交易市場的平均收市價 。

D)鍛鍊的力學 。

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、行使時交付新權證 。如本認股權證已部分行使,本公司須應持有人的要求及於交回本認股權證證書後,於認股權證股份交付時,向持有人交付一份新的認股權證,證明持有人有權購買本認股權證所要求的未購買認股權證股份,而新認股權證在所有其他方面應與本認股權證完全相同。

4

三、撤銷 權利。如本公司未能安排轉讓代理於認股權證股份交割日前根據第2(D)(I)條 將認股權證股份轉讓予持有人,則持有人將有權撤銷該項行使。

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.沒有 零碎股份或Scrip。本認股權證行使後,不得發行任何零碎股份或代表零碎股份的股票。至於持有人於行使該權力後將有權購買的任何零碎股份,本公司將於其選擇時就該最後零碎股份支付現金調整,金額相等於該零碎股份乘以行使價,或向上舍入至下一個完整股份。

5

六、手續費, 税費。發行認股權證股票應免費向持有人收取與發行該等認股權證股份有關的任何發行或轉讓税或其他附帶費用,所有税項及開支均由本公司支付,而該等認股權證股份應以持有人的名義或按持有人指示的名稱發行;然而, 如認股權證股份以持有人以外的名義發行,則本認股權證於交回行使時,須附同由持有人正式簽署的轉讓表格,而本公司可要求支付一筆足以償還其所附帶的任何轉讓税的款項作為條件。本公司應支付當日處理任何行使通知所需的所有轉讓代理費用,以及當日以電子方式交付認股權證股份所需的所有費用予存託信託公司(或履行類似職能的另一間已成立結算公司)。

七.正在關閉 本圖書。本公司不會以任何妨礙根據本條款及時行使本認股權證的方式關閉其股東賬簿或記錄。

E)持有者的運動限制。本公司不得行使本認股權證,持有人亦無權根據第2條或其他規定行使本認股權證的任何部分,條件是持有人(連同持有人的聯營公司,以及與持有人或持有人的任何聯營公司(該等人士,“出讓方”)作為一個集團行事的任何其他人士,在行使適用的行使通知所載的行使權利後, 將實益擁有超過實益擁有權限額(定義如下)的權證。就前述句子而言, 持有人及其關聯公司和出資方實益擁有的普通股數量應包括因行使本認股權證而可發行的普通股數量,但不包括因(I)持有人或其任何關聯公司或出讓方實益擁有的剩餘未行使部分,以及(Ii)行使或轉換本公司任何其他證券(包括但不限於,任何其他普通股等價物),但須受 轉換或行使類似於本協議所載限制的限制,該等限制由持有人或其任何聯屬公司或授權方實益擁有。除上一句所述外,就本第2(E)條而言,實益所有權應根據《交易所法案》第13(D)節及據此頒佈的規則和條例計算, 持有人確認本公司並未向持有人表示該計算符合《交易所法案》第13(D)條的規定 ,並由持有人獨自負責根據該條款提交的任何時間表。在第2(E)款中包含的限制適用的範圍內,確定本認股權證是否可行使(與持有人與任何關聯方和出資方共同擁有的其他證券有關)以及本認股權證的哪一部分可行使,應由持有人自行決定,提交行使通知應視為持有人決定是否可行使本認股權證(與持有人與任何關聯方和出資方共同擁有的其他證券有關) 以及本認股權證的哪部分可行使。在每種情況下,本公司均受實益所有權限制,且本公司無義務核實或確認該等決定的準確性。此外,上述關於任何集團地位的決定應根據《交易所法案》第13(D)節及其頒佈的規則和條例來確定。就本第2(E)條而言,在釐定已發行普通股數目時,持有人可依據(A)本公司向監察委員會提交的最新定期或年度報告(視屬何情況而定)、(B)本公司較新的公告或(C)本公司或轉讓代理較新發出的書面通知所反映的已發行普通股數量。應持有人的書面或口頭要求,本公司應在一個交易日內向持有人口頭和書面確認當時已發行的普通股數量。在任何情況下,已發行普通股數量應由持有人或其關聯公司或出資方自報告該等已發行普通股數量之日起,於轉換或行使本公司證券(包括本認股權證)後確定。 “實益擁有權限額”應為緊接 行使本認股權證後發行可發行普通股數量的4.99%。持有人在通知本公司後,可增加或減少本第2(E)節的實益擁有權限制條文,但在任何情況下,實益擁有權限制不得超過緊隨持有人行使本認股權證而發行普通股後已發行普通股數目的9.99%,而本第2(E)節的規定將繼續適用。對受益所有權限制的任何增加將在該通知送達本公司後的第61天內生效。本款條款 的解釋和實施方式不應嚴格符合第2(E)款的條款 ,以糾正本款(或其任何部分)可能存在缺陷或與本文所載的預期受益所有權限制 不一致的地方,或者做出必要或適當的更改或補充以適當地實施此類限制。本段包含的限制 應適用於本認股權證的每一位繼任者。

6

第3條某些調整

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.

7

C)後續 配股。除根據上述第3(A)條進行的任何調整外,如果公司在任何時間向任何 類別普通股的記錄持有人按比例授予、發行或出售任何普通股等價物或購買股票、認股權證、證券或其他財產的權利(“購買權”),則持有人將有權根據適用於該等購買權的條款,獲得持有人假若持有在完全行使本認股權證後可獲得的普通股數量的情況下可獲得的總購買權(不受行使本認股權證的任何限制,包括但不限於, 實益所有權限制)緊接在授予、發行或出售此類購買權的記錄日期之前 ,或者,如果沒有記錄,則為確定普通股記錄持有人授予、發行或出售此類購買權的日期(但前提是,如果持有人蔘與任何此類購買權的權利會導致持有人超出實益所有權限制,則持有人無權參與該等購買權(或因該購買權而對該等普通股的實益擁有權),而該購買權將在可能的範圍內由持有人暫時擱置,直至其權利不會導致持有人超過實益擁有權限制的時間(如有的話)。

在採取任何會導致本認股權證可行使的認股權證股份數目或行使價調整的行動前,本公司 應獲得任何公共監管機構或具有司法管轄權的 機構的所有授權或豁免或同意。

8

E)管轄權。 有關本保證書的解釋、有效性、執行和解釋的所有問題均應根據《採購協議》的規定確定。

9

F)限制。 持有人承認,在行使本認股權證時獲得的認股權證股票,如果未登記,且持有人未使用無現金行使,則在轉售時將受到州和聯邦證券法的限制。

G)不放棄 和費用。持有人的任何交易過程或任何延誤或未能行使本協議項下的任何權利,均不得視為放棄該權利或以其他方式損害持有人的權利、權力或補救。在不限制本認股權證或購買協議的任何其他規定的情況下,如果本公司故意及明知不遵守本認股權證的任何條款,導致持有人遭受任何重大損害,本公司應向持有人支付足以支付持有人因收取根據本協議到期或以其他方式執行其在本協議項下的任何權利、權力或補救措施而招致的任何費用和開支的金額,包括但不限於合理的律師費,包括上訴訴訟費用。

H)通知。 本公司要求或允許向持有人發出或交付的任何通知、請求或其他文件應按照購買協議的通知條款交付。

I)責任限制。在持有人未採取任何肯定行動以行使本認股權證以購買認股權證 股份的情況下,本協議任何條文均不會導致持有人就購買任何普通股的價格或作為本公司的股東而承擔任何責任,不論該等責任是由本公司或本公司的債權人主張的。

10

J)補救措施。 持有人除了有權行使法律授予的所有權利,包括追討損害賠償外,還有權具體 履行其在本認股權證項下的權利。本公司同意,金錢賠償不足以補償因其違反本認股權證規定而蒙受的任何損失,因此,本公司同意放棄且不在任何針對具體履約的訴訟中提出法律補救即已足夠的抗辯理由。

K)繼承人 和分配人。在適用證券法的規限下,本認股權證及其所證明的權利及義務,對本公司的繼承人及獲準受讓人以及持有人的繼承人及準許受讓人具有約束力。 本認股權證的規定旨在不時為本認股權證的任何持有人的利益而設,並可由認股權證股份持有人或持有人強制執行。

L)修訂。 經本公司及持有人書面同意,本認股權證可予修改或修訂,或放棄本認股權證的規定。

M)可分割性。 在可能的情況下,本保證書的每一條款均應解釋為在適用法律下有效和有效,但如果本保證書的任何條款根據適用法律被禁止或無效,則該條款應在該禁止或無效的範圍內無效,但不會使該等條款的其餘部分或本保證書的其餘條款無效。

N)標題。 本授權書中使用的標題僅供參考,不得出於任何目的被視為本授權書的一部分。

(簽名頁如下)

11

茲證明,自上述日期起,公司已由其正式授權的高級職員簽署本認股權證。

美華國際醫療科技有限公司。

發信人:

姓名:

標題:

行使通知

致:美華國際醫療技術有限公司

12

(1)在此簽署的 選擇根據所附認股權證的條款購買_

(2)付款 應採用以下形式(勾選適用框):

☐ 美國合法貨幣;或

☐ 如獲準按照第(br}2(C)款規定的公式註銷所需數量的認股權證股份,則根據第2(C)款規定的無現金行使程序 可購買的最大認股權證股份數行使本認股權證。

(3)請 以以下籤署人的名義或以下指定的其他名稱發行上述認股權證股票:

認股權證股票應交付給以下DWAC帳户 編號:

(4)認可的 投資者。以下籤署人是根據修訂後的1933年證券法頒佈的法規D所界定的“認可投資者” 。

13

持有人簽名

投資主體名稱:________________________________________________________

投資主體授權簽署人:_

授權簽字人姓名:___________________________________________________

授權簽字人名稱:____________________________________________________

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

日期:_

14

附件B

作業表
(要轉讓上述認股權證,請執行此表格並提供所需的 信息。請勿使用此表格購買股票。)
對於收到的價值,前述認股權證和由此證明的所有權利在此轉讓給
姓名:

15

(請打印)

地址:

(請打印)

電話:

電子郵件地址:

日期:_

持有人簽名:_

_______________________________

持有人簽名:_

_______________________________

_______________________________

_______________________________

(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: ________________________________________________________________________

16

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: _____________________

17