Exhibit 4.13


 


THE
REGISTERED HOLDER OF THIS PURCHASE WARRANT BY ITS ACCEPTANCE HEREOF, AGREES THAT IT WILL NOT SELL, TRANSFER OR ASSIGN THIS PURCHASE WARRANT
EXCEPT AS HEREIN PROVIDED AND THE REGISTERED HOLDER OF THIS PURCHASE WARRANT AGREES THAT IT WILL NOT SELL, TRANSFER, ASSIGN, PLEDGE OR
HYPOTHECATE THIS PURCHASE WARRANT FOR A PERIOD OF ONE HUNDRED EIGHTY DAYS FOLLOWING [●], 2021, WHICH IS THE COMMENCEMENT DATE OF
SALES IN THE OFFERING (THE “EFFECTIVE DATE”) TO ANYONE OTHER THAN (I) THE BENCHMARK COMPANY LLC, OR A SELECTED DEALER
IN CONNECTION WITH THE OFFERING FOR WHICH THIS PURCHASE WARRANT WAS ISSUED TO THE UNDERWRITER AS CONSIDERATION (THE “OFFERING”),
OR (II) THE OFFICERS OR PARTNERS, REGISTERED PERSONS OR AFFILIATES OF BENCHMARK COMPANY LLC.


 


THIS
PURCHASE WARRANT IS NOT EXERCISABLE PRIOR TO [●], 2022. VOID AFTER 5:00 P.M., EASTERN TIME, [●], 2026.


 


COMMON
STOCK PURCHASE WARRANT


 


For
the Purchase of [●] Shares of Common Stock


of


HeartBeam,
Inc.


 


1. Purchase
Warrant. THIS CERTIFIES THAT, in consideration of funds duly paid by or on behalf of [●] (“Holder”), as
registered owner of this Purchase Warrant, to HeartBeam, Inc., a Delaware corporation (the “Company”), Holder is entitled,
at any time or from time to time beginning [●], 2021 (the “Commencement Date”), and at or before 5:00 p.m.,
Eastern time, [●], 2026 (the “Expiration Date”), but not thereafter, to subscribe for, purchase and
receive, in whole or in part, up to [●] shares of common stock of the Company, par value $0.0001 per share (the “Shares”),
subject to adjustment as provided in Section 6 hereof. If the Expiration Date is a day on which banking institutions are authorized by
law to close, then this Purchase Warrant may be exercised on the next succeeding day which is not such a day in accordance with the terms
herein. During the period ending on the Expiration Date, the Company agrees not to take any action that would terminate this Purchase
Warrant. This Purchase Warrant is initially exercisable at $[●] per Share; provided, however, that upon the
occurrence of any of the events specified in Section 6 hereof, the rights granted by this Purchase Warrant, including the exercise price
per Share and the number of Shares to be received upon such exercise, shall be adjusted as therein specified. The term “Exercise
Price” shall mean the initial exercise price or the adjusted exercise price, depending on the context.


 


2. Exercise.


 


2.1 Exercise
Form. In order to exercise this Purchase Warrant, the exercise form attached hereto must be duly executed and completed and delivered
to the Company, together with this Purchase Warrant and payment of the Exercise Price for the Shares being purchased payable in cash
by wire transfer of immediately available funds to an account designated by the Company or by certified check or official bank check.
If the subscription rights represented hereby shall not be exercised at or before 5:00 p.m., Eastern time, on the Expiration Date, this
Purchase Warrant shall become and be void without further force or effect, and all rights represented hereby shall cease and expire.
Each exercise hereof shall be irrevocable.


 






     


     


    

 


2.2 Cashless
Exercise. In lieu of exercising this Purchase Warrant by payment of cash or check payable to the order of the Company pursuant
to Section 2.1 above, Holder may elect to receive the number of Shares equal to the value of this Purchase Warrant (or the portion thereof
being exercised), by surrender of this Purchase Warrant to the Company, together with the exercise form attached hereto, in which event
the Company will issue to Holder Shares in accordance with the following formula:


 


	X	=	Y(A-B)	 
	A	 
	Where,	 	 	 
	 	X	=	The
    number of Shares to be issued to Holder;
	 	Y	=	The
    number of Shares for which the Purchase Warrant is being exercised if such exercise were by means of a cash exercise rather than
    a cashless exercise;
	 	A	=	as
    applicable: (i) the VWAP on the Trading Day immediately preceding  the date of the applicable exercise form if such exercise
    form is (1) both executed and delivered pursuant to Section 2.2 hereof on a day that is not a Trading Day or (2) both executed and
    delivered pursuant to Section 2.2 hereof on a Trading Day prior to the opening of “regular trading hours” (as defined
    in Rule 600(b)(68) of Regulation NMS promulgated under the federal securities laws) on such Trading Day, (ii) at the option of the
    Holder, either (y) the VWAP on the Trading Day immediately preceding the date of the applicable Exercise Form or (z) the Bid Price
    of the Common Stock on the principal Trading Market as reported by Bloomberg L.P. as of the time of the Holder’s execution
    of the applicable Exercise Form if such Exercise Form is executed during “regular trading hours” on a Trading Day and
    is delivered within two (2) hours thereafter (including until two (2) hours after the close of “regular trading hours”
    on a Trading Day) pursuant to Section 2.2 hereof, which Bid Price shall be shown on supporting documents provided by the Holder to
    the Company within two Trading Days of delivery of the exercise form, or (iii) the VWAP on the date of the applicable exercise form
    if the date of such exercise form is a Trading Day and such exercise form is both executed and delivered pursuant to Section 2.2
    hereof after the close of “regular trading hours” on such Trading Day; and
	 	B	=	The
    Exercise Price.
	 	 	 	 	 	 	 	 	 





“Bid
Price” means, for any date, the price determined by the first of the following clauses that applies: (a) if the Common Stock
is then listed or quoted on a Trading Market, the bid price of the Common Stock for the time in question (or the nearest preceding date)
on the Trading Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading Day from 9:30
a.m. (New York City time) to 4:02 p.m. (New York City time)), (b) if OTCQB or OTCQX is not a Trading Market, the volume weighted average
price of the Common Stock for such date (or the nearest preceding date) on OTCQB or OTCQX as applicable, (c) if the Common Stock is not
then listed or quoted for trading on OTCQB or OTCQX and if prices for the Common Stock are then reported in the “Pink Sheets”
published by OTC Markets Group, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the most
recent bid price per share of the Common Stock so reported, or (d) in all other cases, the fair market value of a share of Common Stock
as determined by an independent appraiser selected in good faith by the Holder and reasonably acceptable to the Company, the fees and
expenses of which shall be paid by the Company.


 


“VWAP”
means, for any date, the price determined by the first of the following clauses that applies: (a) if the Common Stock is then listed
or quoted on a Trading Market, the daily volume weighted average price of the Common Stock for such date (or the nearest preceding date)
on the Trading Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading Day from 9:30
a.m. (New York City time) to 4:02 p.m. (New York City time)), (b) if OTCQB or OTCQX is not a Trading Market, the volume weighted average
price of the Common Stock for such date (or the nearest preceding date) on OTCQB or OTCQX as applicable, (c) if the Common Stock is not
then listed or quoted for trading on OTCQB or OTCQX and if prices for the Common Stock are then reported in the “Pink Sheets”
published by OTC Markets Group, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the daily
volume weighted average price of the Common Stock for such date (or the nearest preceding date), or (d) in all other cases, the fair
market value of a share of Common Stock as determined by an independent appraiser selected in good faith by the Holder and reasonably
acceptable to the Company, the fees and expenses of which shall be paid by the Company.


 






    2


     


    

 


“Trading
Day” means a day on which the New York Stock Exchange is open for trading.


 


“Trading
Market” means any of the following markets or exchanges on which the Common Stock is listed or quoted for trading on the date
in question: the NYSE American, the Nasdaq Capital Market, the Nasdaq Global Market, the Nasdaq Global Select Market, or the New York
Stock Exchange (or any successors to any of the foregoing).


 


3. Transfer.


 


3.1 General
Restrictions. The registered Holder of this Purchase Warrant agrees by his, her or its acceptance hereof, that such Holder will not:
(a) sell, transfer, assign, pledge or hypothecate this Purchase Warrant for a period of one hundred eighty (180) days following the Effective
Date to anyone other than: (i) Benchmark Company LLC (“Benchmark”) or an underwriter or a selected dealer participating
in the Offering, or (ii) the officers or partners, registered persons or affiliates of Benchmark or of any such underwriter or selected
dealer, in each case in accordance with FINRA Conduct Rule 5110(e), and (b) cause this Purchase Warrant or the securities issuable hereunder
to be the subject of any hedging, short sale, derivative, put or call transaction that would result in the effective economic disposition
of this Purchase Warrant or the securities hereunder, except as provided for in FINRA Rule 5110(e)(2). After 180 days after the Effective
Date, transfers to others may be made subject to compliance with or exemptions from applicable securities laws. In order to make any
permitted assignment, the Holder must deliver to the Company the assignment form attached hereto duly executed and completed, together
with the Purchase Warrant and payment of all transfer taxes, if any, payable in connection therewith. The Company shall within five (5)
Business Days transfer this Purchase Warrant on the books of the Company and shall execute and deliver a new Purchase Warrant or Purchase
Warrants of like tenor to the appropriate assignee(s) expressly evidencing the right to purchase the aggregate number of Shares purchasable
hereunder or such portion of such number as shall be contemplated by any such assignment.


 


3.2
 Restrictions Imposed by the Act. The securities evidenced by this Purchase Warrant shall
not be transferred unless and until: (i) if required by applicable law, the Company has received the opinion of counsel for the Company
that the securities may be transferred pursuant to an exemption from registration under the Act and applicable state securities laws,
or (ii) a registration statement or a post-effective amendment to the Registration Statement relating to the offer and sale of such securities
has been filed by the Company and declared effective by the U.S. Securities and Exchange Commission (the ”Commission”)
and compliance with applicable state securities law has been established.


 


4. Reserved.


 


5. New
Purchase Warrants to be Issued.


 


5.1 Partial
Exercise or Transfer. This Purchase Warrant may be exercised or assigned in whole or in part. In the event of the exercise or assignment
hereof in part only, upon surrender of this Purchase Warrant for cancellation, together with the duly executed exercise or assignment
form, the Company shall cause to be delivered to the Holder without charge a new Purchase Warrant of like tenor to this Purchase Warrant
in the name of the Holder evidencing the right of the Holder to purchase the number of Shares purchasable hereunder as to which this
Purchase Warrant has not been exercised or assigned.


 


5.2
 Lost Certificate. Upon receipt by the Company of evidence satisfactory to it of the
loss, theft, destruction or mutilation of this Purchase Warrant and of reasonably satisfactory indemnification or the posting of a bond,
determined in the sole discretion of the Company, the Company shall execute and deliver a new Purchase Warrant of like tenor and date.
Any such new Purchase Warrant executed and delivered as a result of such loss, theft, mutilation or destruction shall constitute a substitute
contractual obligation on the part of the Company.


 






    3


     


    

 





6. Adjustments.


 


6.1 Adjustments
to Exercise Price and Number of Securities. The Exercise Price and the number of Shares underlying the Purchase Warrant shall be
subject to adjustment from time to time as hereinafter set forth:



 


6.1.1 Share
Dividends; Split Ups. If, after the date hereof, and subject to the provisions of Section 6.3 below, the number of outstanding Shares
is increased by a stock dividend payable in Shares or by a split up of Shares or other similar event, then, on the effective day thereof,
the number of Shares purchasable hereunder shall be increased in proportion to such increase in outstanding Shares, and the Exercise
Price shall be proportionately decreased.


 


6.1.2
 Aggregation of Shares. If, after the date hereof, and subject to the provisions of Section
6.3 below, the number of outstanding Shares is decreased by a consolidation, combination or reclassification of Shares or other similar
event, then, on the effective date thereof, the number of Shares purchasable hereunder shall be decreased in proportion to such decrease
in outstanding Shares, and the Exercise Price shall be proportionately increased.


 


6.1.3
 Replacement of Securities upon Reorganization, etc. In case of any reclassification
or reorganization of the outstanding Shares other than a change covered by Section 6.1.1 or 6.1.2 hereof or that solely affects the par
value of such Shares, or in the case of any share reconstruction or amalgamation or consolidation or merger of the Company with or into
another corporation (other than a consolidation or share reconstruction or amalgamation or merger in which the Company is the continuing
corporation and that does not result in any reclassification or reorganization of the outstanding Shares), or in the case of any sale
or conveyance to another corporation or entity of the property of the Company as an entirety or substantially as an entirety in connection
with which the Company is dissolved, the Holder of this Purchase Warrant shall have the right thereafter (until the expiration of the
right of exercise of this Purchase Warrant) to receive upon the exercise hereof, for the same aggregate Exercise Price payable hereunder
immediately prior to such event, the kind and amount of shares of stock or other securities or property (including cash) receivable upon
such reclassification, reorganization, share reconstruction or amalgamation, or consolidation, or upon a dissolution following any such
sale or transfer, by a Holder of the number of Shares of the Company obtainable upon exercise of this Purchase Warrant immediately prior
to such event; and if any reclassification also results in a change in Shares covered by Section 6.1.1 or 6.1.2, then such adjustment
shall be made pursuant to Sections 6.1.1, 6.1.2 and this Section 6.1.3. The provisions of this Section 6.1.3 shall similarly apply to
successive reclassifications, reorganizations, share reconstructions or amalgamations, or consolidations, sales or other transfers.


 


6.1.4
 Changes in Form of Purchase Warrant. This form of Purchase Warrant need not be changed
because of any change pursuant to this Section 6.1, and Purchase Warrants issued after such change may state the same Exercise Price
and the same number of Shares as are stated in the Purchase Warrants initially issued pursuant to this Agreement. The acceptance by any
Holder of the issuance of new Purchase Warrants reflecting a required or permissive change shall not be deemed to waive any rights to
an adjustment occurring after the Commencement Date or the computation thereof.


 


6.2
 Substitute Purchase Warrant. In case of any consolidation of the Company with, or share
reconstruction or amalgamation or merger of the Company with or into, another corporation (other than a consolidation or share reconstruction
or amalgamation or merger which does not result in any reclassification or change of the outstanding Shares), the corporation formed
by such consolidation or share reconstruction or amalgamation shall execute and deliver to the Holder a supplemental Purchase Warrant
providing that the holder of each Purchase Warrant then outstanding or to be outstanding shall have the right thereafter (until the stated
expiration of such Purchase Warrant) to receive, upon exercise of such Purchase Warrant, the kind and amount of shares of stock and other
securities and property receivable upon such consolidation or share reconstruction or amalgamation, by a holder of the number of Shares
of the Company for which such Purchase Warrant might have been exercised immediately prior to such consolidation, share reconstruction
or amalgamation or merger, sale or transfer. Such supplemental Purchase Warrant shall provide for adjustments which shall be identical
to the adjustments provided for in this Section 6. The above provision of this Section shall similarly apply to successive consolidations
or share reconstructions or amalgamations or mergers.


 


6.3
 Elimination of Fractional Interests. The Company shall not be required to issue certificates
representing fractions of Shares upon the exercise of the Purchase Warrant, nor shall it be required to issue scrip or pay cash in lieu
of any fractional interests, it being the intent of the parties that all fractional interests shall be eliminated by rounding any fraction
up or down, as the case may be, to the nearest whole number of Shares or other securities, properties or rights.


 


7.
 Reservation. The Company shall at all times reserve and keep available out of its authorized
Shares, solely for the purpose of issuance upon exercise of the Purchase Warrants, such number of Shares or other securities, properties
or rights as shall be issuable upon the exercise thereof. The Company covenants and agrees that, upon exercise of the Purchase Warrants
and payment of the Exercise Price therefor, in accordance with the terms hereby, all Shares and other securities issuable upon such exercise
shall be duly and validly issued, fully paid and non-assessable and not subject to preemptive rights of any shareholder.


 






    4


     


    

 


8. Certain
Notice Requirements.


 


8.1 Holder’s
Right to Receive Notice. Nothing herein shall be construed as conferring upon the Holders the right to vote or consent or to receive
notice as a shareholder for the election of directors or any other matter, or as having any rights whatsoever as a shareholder of the
Company. If, however, at any time prior to the expiration of the Purchase Warrants and their exercise, any of the events described in
Section 8.2 shall occur, then, in one or more of said events, the Company shall deliver to each Holder a copy of each notice relating
to such events given to the other shareholders of the Company at the same time and in the same manner that such notice is given to the
shareholders.


 


8.2
 Events Requiring Notice. The Company shall be required to give the notice described
in this Section 8 upon one or more of the following events: (i) if the Company shall take a record of the holders of its Shares for the
purpose of entitling them to receive a dividend or distribution payable otherwise than in cash, or a cash dividend or distribution payable
otherwise than out of retained earnings, as indicated by the accounting treatment of such dividend or distribution on the books of the
Company, or (ii) the Company shall offer to all the holders of its Shares any additional shares of capital stock of the Company or securities
convertible into or exchangeable for shares of capital stock of the Company, or any option, right or warrant to subscribe therefor.


 


8.3
 Notice of Change in Exercise Price. The Company shall, promptly after an event requiring
a change in the Exercise Price pursuant to Section 6 hereof, send notice to the Holders of such event and change (“Price Notice”).
The Price Notice shall describe the event causing the change and the method of calculating same.


 


8.4
 Transmittal of Notices. All notices, requests, consents and other communications under
this Purchase Warrant shall be in writing and shall be deemed to have been duly made when hand delivered, or mailed by express mail or
private courier service: (i) if to the registered Holder of the Purchase Warrant, to the address of such Holder as shown on the books
of the Company, or (ii) if to the Company, to following address or to such other address as the Company may designate by notice to the
Holders:


 


If
to the Holder:


 


Benchmark
Company LLC


150
E. 58th Street, 17th floor


New
York, NY 10155


Attention:
President


 


with
a copy (which shall not constitute notice) to:




Schiff Hardin LLP


901
K Street, NW, Suite 700


Washington,
DC 20001


Attn:
Ralph V. De Martino, Esq.


Fax
No.:  (202) 778-6460


 


If
to the Company:


 


HeartBeam,
Inc.


2118
Walsh Avenue, Suite 210


Santa
Clara, CA 95050


Attention:
[●]


 


With
copies to (which shall not constitute notice):


 


Lucosky
Brookman LLP


101
Wood Avenue South, 5th Floor


Woodbridge,
NJ 08830


jlucosky@lucbro.com


Attention:
Joseph M. Lucosky, Esq.


 






    5


     


    

 


9. Miscellaneous.


 


9.1 Amendments.
The Company and Benchmark may from time to time supplement or amend this Purchase Warrant without the approval of any of the Holders
in order to cure any ambiguity, to correct or supplement any provision contained herein that may be defective or inconsistent with any
other provisions herein, or to make any other provisions in regard to matters or questions arising hereunder that the Company and Benchmark
may deem necessary or desirable and that the Company and Benchmark deem shall not adversely affect the interest of the Holders. All other
modifications or amendments shall require the written consent of and be signed by (i) the Company and (ii) the Holder(s) of Purchase
Warrants then-exercisable for at least a majority of the Shares then-exercisable pursuant to all then-outstanding Purchase Warrants.


 


9.2
 Headings. The headings contained herein are for the sole purpose of convenience of reference,
and shall not in any way limit or affect the meaning or interpretation of any of the terms or provisions of this Purchase Warrant.


 


9.3.
 Entire Agreement. This Purchase Warrant (together with the other agreements and documents
being delivered pursuant to or in connection with this Purchase Warrant) constitutes the entire agreement of the parties hereto with
respect to the subject matter hereof, and supersedes all prior agreements and understandings of the parties, oral and written, with respect
to the subject matter hereof.


 


9.4
 Binding Effect. This Purchase Warrant shall inure solely to the benefit of and shall
be binding upon, the Holder and the Company and their permitted assignees, respective successors, legal representative and assigns, and
no other person shall have or be construed to have any legal or equitable right, remedy or claim under or in respect of or by virtue
of this Purchase Warrant or any provisions herein contained.


 


9.5
 Governing Law; Submission to Jurisdiction; Trial by Jury. This Purchase Warrant shall
be governed by and construed and enforced in accordance with the laws of the State of New York, without giving effect to conflict of
laws principles thereof. The Company hereby agrees that any action, proceeding or claim against it arising out of, or relating in any
way to this Purchase Warrant shall be brought and enforced in the courts located in New York, New York, or in the United States District
Court located in New York, New York, and irrevocably submits to such jurisdiction, which jurisdiction shall be exclusive. The Company
hereby waives any objection to such exclusive jurisdiction and that such courts represent an inconvenient forum. Any process or summons
to be served upon the Company may be served by transmitting a copy thereof by registered or certified mail, return receipt requested,
postage prepaid, addressed to it at the address set forth in Section 8 hereof. Such mailing shall be deemed personal service and shall
be legal and binding upon the Company in any action, proceeding or claim. The Company and the Holder agree that the prevailing party(ies)
in any such action shall be entitled to recover from the other party(ies) all of its reasonable attorneys’ fees and expenses relating
to such action or proceeding and/or incurred in connection with the preparation therefor. The Company (on its behalf and, to the extent
permitted by applicable law, on behalf of its stockholders and affiliates) and the Holder hereby irrevocably waive, to the fullest extent
permitted by applicable law, any and all right to trial by jury in any legal proceeding arising out of or relating to this Agreement
or the transactions contemplated hereby.


 


9.6
 Waiver, etc. The failure of the Company or the Holder to at any time enforce any of
the provisions of this Purchase Warrant shall not be deemed or construed to be a waiver of any such provision, nor to in any way affect
the validity of this Purchase Warrant or any provision hereof or the right of the Company or any Holder to thereafter enforce each and
every provision of this Purchase Warrant. No waiver of any breach, non-compliance or non-fulfillment of any of the provisions of this
Purchase Warrant shall be effective unless set forth in a written instrument executed by the party or parties against whom or which enforcement
of such waiver is sought; and no waiver of any such breach, non-compliance or non-fulfillment shall be construed or deemed to be a waiver
of any other or subsequent breach, non-compliance or non-fulfillment.


 


9.7
 Exchange Agreement. As a condition of the Holder’s receipt and acceptance of this
Purchase Warrant, Holder agrees that, at any time prior to the complete exercise of this Purchase Warrant by Holder, if the Company and
Benchmark enter into an agreement (“Exchange Agreement”) pursuant to which they agree that all outstanding Purchase
Warrants will be exchanged for securities or cash or a combination of both, then Holder shall agree to such exchange and become a party
to the Exchange Agreement.


 


[Signature
Page Follows]





 






    6


     


    

 


IN
WITNESS WHEREOF, the Company has caused this Purchase Warrant to be signed by its duly authorized officer as of the [●] day of
[●], 2021.


 


HeartBeam, Inc.


 


	By: 	 	 
	 	Name:	Richard Brounstein	 
	 	Title:	 Chief Financial Officer	 


 






    7


     


    

 


[Form
to be used to exercise Purchase Warrant]


 


Date:
__________, 20___


 


The
undersigned hereby elects irrevocably to exercise the Purchase Warrant for ______ shares of common stock, par value $0.0001 per share
(the “Shares”), of HeartBeam, Inc., a Delaware corporation (the “Company”), and hereby makes payment
of $____ (at the rate of $____ per Share) in payment of the Exercise Price pursuant thereto. Please issue the Shares as to which this
Purchase Warrant is exercised in accordance with the instructions given below and, if applicable, a new Purchase Warrant representing
the number of Shares for which this Purchase Warrant has not been exercised.


 


or


 


The
undersigned hereby elects irrevocably to convert its right to purchase ___ Shares of the Company under the Purchase Warrant for ______
Shares, as determined in accordance with the following formula:


 


	 	X	=	Y(A-B)	 
	A	 
	Where,	 	 	 
	 	X	=	The
    number of Shares to be issued to Holder;
	 	Y	=	The
    number of Shares for which the Purchase Warrant is being exercised;
	 	A	=	The
    fair market value of one Share which is equal to $_____; and
	 	B	=	The
    Exercise Price which is equal to $______ per share
	 	 	 	 	 	 	 





The
undersigned agrees and acknowledges that the calculation set forth above is subject to confirmation by the Company and any disagreement
with respect to the calculation shall be resolved by the Company in its sole discretion.


 


Please
issue the Shares as to which this Purchase Warrant is exercised in accordance with the instructions given below and, if applicable, a
new Purchase Warrant representing the number of Shares for which this Purchase Warrant has not been converted.


 


Signature
____________________________________________


 


Signature
Guaranteed ___________________________________


 






    8


     


    

 


	INSTRUCTIONS FOR REGISTRATION OF SECURITIES
	 	 
	Name:	         	 
	(Print in Block Letters) 	 
	 	 
	Address:	 	 
	 	 	 
	 	 	 






 


NOTICE:
The signature to this form must correspond with the name as written upon the face of the Purchase Warrant without alteration or enlargement
or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership
on a registered national securities exchange.


 






    9


     


    

 





[Form
to be used to assign Purchase Warrant]


 


ASSIGNMENT


 


(To
be executed by the registered Holder to effect a transfer of the within Purchase Warrant):


 


FOR
VALUE RECEIVED, __________________ does hereby sell, assign and transfer unto the right to purchase shares of Common Stock, par value
$0.0001 per share, of HeartBeam, Inc., a Delaware corporation (the “Company”), evidenced by the Purchase Warrant and
does hereby authorize the Company to transfer such right on the books of the Company.


 


Dated:
__________, 20__


 


Signature
_____________________________________


 


Signature
Guaranteed ____________________________


 


NOTICE:
The signature to this form must correspond with the name as written upon the face of the within Purchase Warrant without alteration or
enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm
having membership on a registered national securities exchange.


 


 






    10