Exhibit 4.1







 





 


 


FORM OF WARRANT


 


THE SECURITIES REPRESENTED BY THIS
CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS
OF ANY STATE AND MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER APPLICABLE FEDERAL
AND STATE SECURITIES LAWS OR PURSUANT TO AN APPLICABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS
OF THE ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR
TO SUCH EFFECT, WHICH OPINION SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.


 


 


	No. _______	______________, 2011


 


LABSTYLE INNOVATIONS CORP.


Common
Stock Purchase Warrant


_________________


 


THIS CERTIFIES THAT,
for value received, __________, or his/her/its registered assigns (the “Purchaser”), is entitled to subscribe for and
purchase from LabStyle Innovations Corp., a Delaware corporation (the “Company”), at any time prior to the fifth anniversary
of October 27, 2011 (the “Warrant Exercise Term”), the Shares at the Exercise Price (each as defined in Section 1 below).


 


This Warrant is issued
in connection with the Company’s private offering solely to accredited investors of units in accordance with, and subject
to, the terms and conditions described in the Subscription Agreement, dated as of August __, 2011 (the “Subscription Agreement”).


 


This Warrant is subject to the following
terms and conditions:


 


1.Shares.
The Purchaser has, subject to the terms set forth herein, the right to purchase, at any time during the Warrant Exercise Term,
up to [] shares (the “Shares”) of the Company’s common stock, par value $0.0001 (“Common Stock”),
at a per share exercise price of $1.50 (the “Exercise Price”). The Exercise Price is subject to adjustment as provided
in Section 3 hereof.


 


2.Exercise of
Warrant.


 


(a)Exercise.
This Warrant may be exercised by the Purchaser at any time during the Warrant Exercise Term, in whole or in part, by delivering
the notice of exercise attached as Exhibit A hereto (the “Notice of Exercise”), duly executed by the Purchaser
to the Company at its principal office, or at such other office as the Company may designate, accompanied by payment, in cash or
by wire transfer of immediately available funds or by check payable to the order of the Company, of the amount obtained by multiplying
the number of Shares designated in the Notice of Exercise by the Exercise Price (the “Purchase Price”). For purposes
hereof, “Exercise Date” shall mean the date on which all deliveries required to be made to the Company upon exercise
of this Warrant pursuant to this Section 2(a) shall have been made.


 






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(b)Issuance of
Certificates. As soon as practicable after the exercise of this Warrant, in whole or in part, in accordance with Section 2(a)
hereof, the Company, at its expense, shall cause to be issued in the name of and delivered to the Purchaser (i) a certificate or
certificates for the number of fully paid and non-assessable Shares to which the Purchaser shall be entitled upon such exercise
and, if applicable, (ii) a new warrant of like tenor to purchase all of the Shares that may be purchased pursuant to the portion,
if any, of this Warrant not exercised by the Purchaser. The Purchaser shall for all purposes hereof be deemed to have become the
Purchaser of record of such Shares on the date on which the Notice of Exercise and payment of the Purchase Price in accordance
with Section 2(a) hereof were delivered and made, respectively, irrespective of the date of delivery of such certificate or certificates,
except that if the date of such delivery, notice and payment is a date when the stock transfer books of the Company are closed,
such person shall be deemed to have become the holder of record of such Shares at the close of business on the next succeeding
date on which the stock transfer books are open.


 


(c)Taxes.
The issuance of the Shares upon the exercise of this Warrant, and the delivery of certificates or other instruments representing
such Shares, shall be made without charge to the Purchaser for any tax or other charge of whatever nature in respect of such issuance
and the Company shall bear any such taxes in respect of such issuance.


 


3.Adjustment
of Exercise Price and Number of Shares.


 


(a)Adjustment
for Reclassification, Consolidation or Merger. If while this Warrant, or any portion hereof, remains outstanding and unexpired
there shall be (i) a reorganization or recapitalization (other than a combination, reclassification, exchange or subdivision of
shares otherwise provided for herein), (ii) a merger or consolidation of the Company with or into another corporation or other
entity in which the Company shall not be the surviving entity, or a reverse merger in which the Company shall be the surviving
entity but the shares of the Company’s capital stock outstanding immediately prior to the merger are converted by virtue
of the merger into other property, whether in the form of securities, cash or otherwise, or (iii) a sale or transfer of the Company’s
properties and assets as, or substantially as, an entirety to any other corporation or other entity in one transaction or a series
of related transactions, then, as a part of such reorganization, recapitalization, merger, consolidation, sale or transfer, unless
otherwise directed by the Purchaser, all necessary or appropriate lawful provisions shall be made so that the Purchaser shall thereafter
be entitled to receive upon exercise of this Warrant, during the period specified herein and upon payment of the Exercise Price
then in effect, the greatest number of shares of capital stock or other securities or property that a holder of the Shares deliverable
upon exercise of this Warrant would have been entitled to receive in such reorganization, recapitalization, merger, consolidation,
sale or transfer if this Warrant had been exercised immediately prior to such reorganization, recapitalization, merger, consolidation,
sale or transfer, all subject to further adjustment as provided in this Section 3. If the per share consideration payable to the
Purchaser for Shares in connection with any such transaction is in a form other than cash or marketable securities, then the value
of such consideration shall be determined in good faith by the Company’s Board of Directors (the “Board of Directors”).
The foregoing provisions of this paragraph shall similarly apply to successive reorganizations, recapitalizations, mergers, consolidations,
sales and transfers and to the capital stock or securities of any other corporation that are at the time receivable upon the exercise
of this Warrant. In all events, appropriate adjustment shall be made in the application of the provisions of this Warrant with
respect to the rights and interests of the Purchaser after the transaction, to the end that the provisions of this Warrant shall
be applicable after that event, as near as reasonably may be, in relation to any shares or other property deliverable or issuable
after such reorganization, recapitalization, merger, consolidation, sale or transfer upon exercise of this Warrant.


 






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(b)Adjustments
for Split, Subdivision or Combination of Shares. If the Company shall at any time subdivide (by any stock split, stock dividend,
recapitalization, reorganization, reclassification or otherwise) the shares of Common Stock subject to acquisition hereunder, then,
after the date of record for effecting such subdivision, the Exercise Price in effect immediately prior to such subdivision will
be proportionately reduced and the number of shares of Common Stock subject to acquisition upon exercise of the Warrant will be
proportionately increased. If the Company at any time combines (by reverse stock split, recapitalization, reorganization, reclassification
or otherwise) the shares of Common Stock subject to acquisition hereunder, then, after the record date for effecting such combination,
the Exercise Price in effect immediately prior to such combination will be proportionately increased and the number of shares of
Common Stock subject to acquisition upon exercise of the Warrant will be proportionately decreased.


 


(c)Adjustments
for Dividends in Stock or Other Securities or Property. If while this Warrant, or any portion hereof, remains outstanding and
unexpired, the holders of any class of securities as to which purchase rights under this Warrant exist at the time shall have received
or, on or after the record date fixed for the determination of eligible stockholders, shall have become entitled to receive, without
payment therefor, other or additional stock or other securities or property (other than cash) of the Company by way of dividend,
then and in each case, this Warrant shall represent the right to acquire, in addition to the number of shares of such class of
security receivable upon exercise of this Warrant, and without payment of any additional consideration therefor, the amount of
such other or additional stock or other securities or property (other than cash) of the Company that such holder would hold on
the date of such exercise had it been the holder of record of the class of security receivable upon exercise of this Warrant on
the date hereof and had thereafter, during the period from the date hereof to and including the date of such exercise, retained
such shares and/or all other additional stock available to it as aforesaid during said period, giving effect to all adjustments
called for during such period by the provisions of this Section 3.


 


(d)Adjustment
of Exercise Price Upon Issuance of Additional Shares of Common Stock. If while this Warrant, or any portion hereof, remains
outstanding and unexpired, the Company shall issue Additional Shares of Common Stock (as hereinafter defined) without consideration
or for a consideration per share less than the then-applicable Exercise Price, then and in such event, such Exercise Price shall
be reduced, concurrently with such issue, to a price (calculated to the nearest cent) determined by multiplying the then-applicable
Exercise Price by a fraction, (i) the numerator of which shall be the number of shares of Common Stock issued and outstanding immediately
prior to such issuance plus the quotient obtained by dividing (x) the aggregate consideration received by the Company for the total
number of Additional Common Stock so issued by (y) the Exercise Price, and (ii) the denominator of which shall be the number
of shares of the Common Stock issued and outstanding immediately prior to such issuance plus the number of Additional Shares of
Common Stock so issued.


 






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For the purposes hereof
“Additional Shares of Common Stock” shall mean all shares of Common Stock, or options, rights, warrants to subscribe
for Common Stock, or securities convertible into or exchangeable for shares of Common Stock, actually issued by the Company on
or after the date hereof, other than shares of Common Stock or securities convertible into shares of Common Stock issued at any
time:


 


(i)upon
exercise of the Warrants;


 


(ii)pursuant to
the exercise of options, warrants or other common stock purchase rights issued (or to be issued) to employees, officers or directors
of, or consultants or advisors to, or any strategic ally of or investor in, the Company pursuant to any stock purchase or stock
option plan or other arrangement approved by the Board of Directors;


 


(iii)pursuant to
the exercise of options, warrants or any evidence of indebtedness, shares of capital stock (other than Common Stock) or other securities
convertible into or exchangeable for Common Stock (“Convertible Securities”) outstanding as of the date of the issuance
of this Warrant;


 


(iv)in connection
with the acquisition of all or part of another entity by stock acquisition, merger, consolidation or other reorganization, or by
the purchase of all or part of the assets of such other entity (including securities issued to persons formerly employed by such
other entity and subsequently hired by the Company and to any brokers or finders in connection therewith) where the Company or
its stockholders own more than fifty percent (50%) of the voting power of the acquired, surviving, combined or successor company;
or


 


(v)to financial
institutions, strategic or institutional investors or bona fide commercial partners, or lessors in connection with credit arrangements,
equipment financings or similar transactions approved by the Board of Directors.


 


Upon each adjustment
of the Exercise Price pursuant to the provisions of this Section 3(d), the number of Shares issuable upon exercise of this Warrant
shall be adjusted by multiplying a number equal to the Exercise Price in effect immediately prior to such adjustment by the number
of Shares issuable upon exercise of this Warrant immediately prior to such adjustment and dividing the product so obtained by the
adjusted Exercise Price.


 


(e)Notice of Adjustments.
Upon any adjustment of the Exercise Price and any increase or decrease in the number of Shares purchasable upon the exercise of
this Warrant, then, and in each such case, the Company, within 30 days thereafter, shall give written notice thereof to the Purchaser
at the address of such Purchaser as shown on the books of the Company, which notice shall state the Exercise Price as adjusted
and, if applicable, the increased or decreased number of Shares purchasable upon the exercise of this Warrant, setting forth in
reasonable detail the method of calculation of each.


 






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4.Notices.
All notices, requests, consents and other communications required or permitted under this Warrant shall be in writing and shall
be deemed delivered (i) three business days after being sent by registered or certified mail, return receipt requested, postage
prepaid or (ii) one business day after being sent via a reputable nationwide overnight courier service guaranteeing next business
day delivery or (iii) on the business day of delivery if send by facsimile transmission, in each case to the intended recipient
as set forth below:


 


If to the Company
to:


 


LabStyle Innovations Corp.


350 Fifth Avenue, 59th Floor


New York, New York 10018


Attention: Oren Fuerst


Facsimile: (646) 349-3180


 


With a copy (that shall
not constitute notice) to:


 


Ellenoff Grossman & Schole
LLP


150 East 42 Street, 11th Floor


New York, New York 10017


Attention: Lawrence A. Rosenbloom,
Esq.


Facsimile: (646) 895-7204


 


If to the Purchaser
at its address as furnished in the Subscription Agreement.


 


Either party may give
any notice, request, consent or other communication under this Warrant using any other means (including personal delivery, messenger
service, facsimile transmission, first class mail or electronic mail), but no such notice, request, consent or other communication
shall be deemed to have been duly given unless and until it is actually received by the party for whom it is intended. Either party
may change the address to which notices, requests, consents or other communications hereunder are to be delivered by giving the
other party notice in the manner set forth in this Section 4.


 


5.Legends.
Each certificate evidencing the Shares issued upon exercise of this Warrant shall be stamped or imprinted with a legend substantially
in the following form:


 


THE SECURITIES REPRESENTED BY
THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES
LAWS OF ANY STATE AND MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER APPLICABLE FEDERAL
AND STATE SECURITIES LAWS OR PURSUANT TO AN APPLICABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS
OF THE ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR
TO SUCH EFFECT, WHICH OPINION SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.


 






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6.Removal of
Legend. Upon request of a holder of a certificate with the legends required by Section 5 hereof, the Company shall issue to
such holder a new certificate therefor free of any transfer legend, if, with such request, the Company shall have received an opinion
of counsel satisfactory to the Company in form and substance to the effect that any transfer by such holder of the Shares evidenced
by such certificate will not violate the Act or any applicable state securities laws.


 


7.Fractional
Shares. No fractional Shares will be issued in connection with any exercise hereunder. Instead, the Company shall round up,
as nearly as practicable to the nearest whole Share, the number of Shares to be issued.


 


8.Rights of
Stockholders. Except as expressly provided in Section 3(c) hereof, the Purchaser, as such, shall not be entitled to vote or
receive dividends or be deemed the holder of the Shares or any other securities of the Company that may at any time be issuable
on the exercise hereof for any purpose, nor shall anything contained herein be construed to confer upon the Purchaser, as such,
any of the rights of a stockholder of the Company or any right to vote for the election of directors or upon any matter submitted
to stockholders at any meeting thereof, or to give or withhold consent to any corporate action (whether upon any recapitalization,
issuance of stock, reclassification of stock, change of par value, consolidation, merger, conveyance, or otherwise) or to receive
notice of meetings, or otherwise until this Warrant shall have been exercised and the Shares purchasable upon the exercise hereof
shall have been issued, as provided herein.


 


9.Miscellaneous.


 


(a)This Warrant
and disputes arising hereunder shall be governed by and construed and enforced in accordance with the laws of the State of Delaware
applicable to agreements made and to be performed wholly within such State, without regard to its conflict of law rules.


 


(b)The headings
in this Warrant are for purposes of reference only, and shall not limit or otherwise affect any of the terms hereof.


 


(c)The covenants
of the respective parties contained herein shall survive the execution and delivery of this Warrant.


 


(d)The terms of
this Warrant shall be binding upon and shall inure to the benefit of any successors or permitted assigns of the Company and of
the Purchaser and of the Shares issued or issuable upon the exercise hereof.


 






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(e)This Warrant
and the other documents delivered pursuant hereto constitute the full and entire understanding and agreement between the parties
with regard to the subject hereof.


 


(f)The Company
shall not, by amendment of the Certificate of Incorporation or Bylaws, or through any other means, directly or indirectly, avoid
or seek to avoid the observance or performance of any of the terms of this Warrant and shall at all times in good faith assist
in the carrying out of all such terms and in the taking of all such action as may be necessary or appropriate in order to protect
the rights of the Purchaser contained herein against impairment.


 


(g)Upon receipt
of evidence reasonably satisfactory to the Company of the loss, theft, destruction or mutilation of this Warrant and, in the case
of any such loss, theft or destruction, upon delivery of an indemnity agreement reasonably satisfactory in form and amount to the
Company, or, in the case of any such mutilation, upon surrender and cancellation of such Warrant, the Company, at its expense,
will execute and deliver to the Purchaser, in lieu thereof, a new Warrant of like date and tenor.


 


(h)This Warrant
and any provision hereof may be amended, waived or terminated only by an instrument in writing signed by the Company and the Purchaser.


 


IN WITNESS WHEREOF, the Company has caused
this Warrant to be signed by its duly authorized officer.


 


LABSTYLE INNOVATIONS CORP.


 


 


 


By:                                                                       


Name: Oren Fuerst


Title: Chief Executive Officer


 






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Exhibit A


NOTICE OF EXERCISE


 


TO:LabStyle Innovations Corp.


Attention: President


 


The undersigned hereby
elects to purchase _______________ shares (the “Shares”) of Common Stock of LabStyle Innovations Corp. (the “Company”)
pursuant to the terms of this Warrant, and tenders herewith payment of the purchase price of such Shares in full.


 


Please issue a certificate
or certificates representing said shares in the name of the undersigned or in such other name as is specified below:


 


	
                                                                               




        (Name)

	                                                                       
	
                                                                               

        (Address)



 


The undersigned
hereby represents and warrants the following:


 


(a) He/she/it (i)
has such knowledge and experience in financial and business affairs that he/she/it is capable of evaluating the merits and risks
involved in purchasing the Shares, (ii) is able to bear the economic risks involved in purchasing the Shares, and (iii) is an “accredited
investor,” as defined in Rule 501(a) of Regulation D promulgated under the Securities Act of 1933, as amended;


 


(b)In making the
decision to purchase the Shares, he/she/it has relied solely on independent investigations made by him/her/it and has had the opportunity
to ask questions of, and receive answers from, the Company concerning the Shares, the financial condition, prospective business
and operations of the Company and has otherwise had an opportunity to obtain any additional information, to the extent that the
Company possess such information or could acquire it without unreasonable effort or expense;


 


(c) His/her/its
overall commitment to investments that are not readily marketable is not disproportionate to his/her/its net worth and income,
and the purchase of the Shares will not cause such overall commitment to become disproportionate; he/she/it can afford to bear
the loss of the purchase price of the Shares;


 


(d)He/she/it has
no present need for liquidity in his/her/its investment in the Shares; and


 


(e)He/she/it acknowledges
that the transaction contemplated in connection with the purchase of the Shares has not been reviewed or approved by the Securities
and Exchange Commission or by any administrative agency charged with the administration of the securities laws of any state, and
that no such agency has passed on or made any recommendation or endorsement of any of the securities contemplated hereby.


 


________________


(Signature and Date)


 






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