EX-10.4





 Exhibit 10.4 

DECIBEL THERAPEUTICS, INC. 

INCENTIVE STOCK OPTION AGREEMENT 

GRANTED UNDER 2015 STOCK INCENTIVE PLAN 

1. Grant of Option. 
 This Incentive Stock
Option Agreement (the “Agreement”) evidences the grant by Decibel Therapeutics, Inc. a Delaware corporation (the “Company”), on [________ __, 20__] (the “Grant Date”) to [___________], an employee
of the Company (the “Participant”), of an option to purchase, in whole or in part, on the terms provided herein and in the Company’s 2015 Stock Incentive Plan (the “Plan”), a total of [_________] shares (the
“Shares”) of common stock, $0.001 par value per share, of the Company (“Common Stock”) at $[_______] per Share. Unless earlier terminated, this option shall expire at 5:00 p.m., Eastern time, on [_______ __,
20__] [date is ten years minus one day from grant date] (the “Final Exercise Date”). 
 It is intended that the
option evidenced by this Agreement shall be an incentive stock option as defined in Section 422 of the Internal Revenue Code of 1986, as amended, and any regulations promulgated thereunder (the “Code”). Except as otherwise
indicated by the context, the term “Participant”, as used in this option, shall be deemed to include any person who acquires the right to exercise this option validly under its terms. 

 

	2.	 Vesting Schedule. 



(a) Option Vesting Schedule. Subject to subsection (c) below, this option will become exercisable (“vest”) as to
25% of the original number of Shares on the first anniversary of the Vesting Commencement Date (as defined below) and as to an additional 2.0833% of the original number of Shares at the end of each successive month following the first
anniversary of the Vesting Commencement Date until the fourth anniversary of the Vesting Commencement Date. On the fourth anniversary of the Vesting Commencement Date, this option will be exercisable as to all Shares. For purposes of this Agreement,
“Vesting Commencement Date” shall mean [__________________]. 
 For purposes of this Agreement and the Restricted Stock
Agreement (as defined below), any Shares that have vested in accordance with this Section 2(a) are referred to as “Vested Shares.” To the extent there are unvested Shares under this option, with regard to which an exercise has
not yet been made, and unvested Shares under any Restricted Stock Agreement, vesting shall apply first to those unvested Shares that are subject to a Restricted Stock Agreement. To the extent there is any ambiguity in which of the Shares, whether
under this option, with regard to which an exercise has not yet been made, or under a Restricted Stock Agreement, are vested, the determination of which of the Shares are vested shall be made by the Board of Directors of the Company in its sole
discretion. 
 (b) Cumulative Exercise. The right of exercise shall be cumulative so that to the extent the option is not exercised
in any period to the maximum extent permissible it shall continue to be exercisable, in whole or in part, with respect to all Shares for which it is vested until the earlier of the Final Exercise Date or the termination of this option under
Section 3 hereof or the Plan. 












 (c) Early Exercise Alternative. Notwithstanding the vesting schedule set forth in
Section 2(a), the Participant may elect to exercise this option as to the unvested Shares (in addition to the Vested Shares) if simultaneously with such exercise the Participant enters into a Restricted Stock Agreement with the Company, with
respect to the unvested Shares, in the form attached hereto as Exhibit A (the “Restricted Stock Agreement”). The Restricted Stock Agreement provides, among other things, that the unvested Shares shall be subject to a right of
repurchase in favor of the Company in the event that the Participant ceases to be an Eligible Participant (as defined below). 
 (d)
Issuance of Shares. Upon any exercise of this option, of the Shares to be issued in connection with such exercise, the Company shall first issue Vested Shares not theretofore issued, up to the lesser of (i) the number of Shares to be
issued on such exercise and (ii) the number of Vested Shares not theretofore issued. Any additional Shares being issued shall be unvested Shares and shall be subject to a Restricted Stock Agreement. 

 

	3.	 Exercise of Option. 



(a) Form of Exercise. Each election to exercise this option shall be accompanied by a completed Notice of Stock Option Exercise in the
form attached hereto as Exhibit B, signed by the Participant, and received by the Company at its principal office, accompanied by this Agreement, and payment in full in the manner provided in the Plan. The Participant may purchase less than
the number of Shares covered hereby, provided that no partial exercise of this option may be for any fractional share or for fewer than ten whole shares. 

(b) Continuous Relationship with the Company Required. Except as otherwise provided in this Section 3, this option may not be
exercised unless the Participant, at the time he or she exercises this option, is, and has been at all times since the Grant Date, an employee or officer of, or consultant or advisor to, the Company or any parent or subsidiary of the Company as
defined in Section 424(e) or (f) of the Code (an “Eligible Participant”). 
 (c) Termination of Relationship
with the Company. If the Participant ceases to be an Eligible Participant for any reason, then, except as provided in paragraphs (d) and (e) below, the right to exercise this option shall terminate three months after such
cessation (but in no event after the Final Exercise Date), provided that this option shall be exercisable only to the extent that the Participant was entitled to exercise this option on the date of such cessation. Notwithstanding the
foregoing, if the Participant, prior to the Final Exercise Date, violates the non-competition or confidentiality provisions of any employment contract, confidentiality and nondisclosure agreement or other
agreement between the Participant and the Company, the right to exercise this option shall terminate immediately upon such violation. 
 (d)
Exercise Period Upon Death or Disability. If the Participant dies or becomes disabled (within the meaning of Section 22(e)(3) of the Code) prior to the Final Exercise Date while he or she is an Eligible Participant and the Company has not terminated
such relationship for “cause” as specified in paragraph (e) below, this option shall be exercisable, within the period 

  
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of one year following the date of death or disability of the Participant, by the Participant (or in the case of death by an authorized transferee), provided that this option shall
be exercisable only to the extent that this option was exercisable by the Participant on the date of his or her death or disability, and further provided that this option shall not be exercisable after the Final Exercise Date. 

(e) Termination for Cause. If, prior to the Final Exercise Date, the Participant’s employment is terminated by the Company for
Cause (as defined below), the right to exercise this option shall terminate immediately upon the effective date of such termination of employment. If, prior to the Final Exercise Date, the Participant is given notice by the Company of the
termination of his or her employment by the Company for Cause, and the effective date of such employment termination is subsequent to the date of delivery of such notice, the right to exercise this option shall be suspended from the time of the
delivery of such notice until the earlier of (i) such time as it is determined or otherwise agreed that the Participant’s employment shall not be terminated for Cause as provided in such notice or (ii) the effective date of such
termination of employment (in which case the right to exercise this option shall, pursuant to the preceding sentence, terminate upon the effective date of such termination of employment). If the Participant is party to an employment or severance
agreement with the Company that contains a definition of “cause” for termination of employment, “Cause” shall have the meaning ascribed to such term in such agreement. Otherwise, “Cause” shall mean willful misconduct by
the Participant or willful failure by the Participant to perform his or her responsibilities to the Company (including, without limitation, breach by the Participant of any provision of any employment, consulting, advisory, nondisclosure, non-competition or other similar agreement between the Participant and the Company), as determined by the Company, which determination shall be conclusive. The Participant’s employment shall be considered to
have been terminated for Cause if the Company determines, within 30 days after the Participant’s resignation, that termination for Cause was warranted. 
  

	4.	 Company Right of First Refusal. 



(a) Notice of Proposed Transfer. If the Participant proposes to sell, assign, transfer, pledge, hypothecate or otherwise dispose of, by
operation of law or otherwise (collectively, “transfer”) any Shares acquired upon exercise of this option, then the Participant shall first give written notice of the proposed transfer (the “Transfer Notice”) to the
Company. The Transfer Notice shall name the proposed transferee and state the number of such Shares the Participant proposes to transfer (the “Offered Shares”), the price per share and all other material terms and conditions of the
transfer. 
 (b) Company Right to Purchase. For 30 days following its receipt of such Transfer Notice, the Company shall have the
option to purchase all or part of the Offered Shares at the price and upon the terms set forth in the Transfer Notice. In the event the Company elects to purchase all or part of the Offered Shares, it shall give written notice of such election to
the Participant within such 30-day period. Within 10 days after his or her receipt of such notice, the Participant shall tender to the Company at its principal offices the certificate or certificates
representing the Offered Shares to be purchased by the Company, duly endorsed in blank by the Participant or with duly endorsed stock powers attached thereto, all in a form suitable for transfer of the Offered Shares to the Company. Promptly
following receipt of such certificate or certificates, 

  
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the Company shall deliver or mail to the Participant a check in payment of the purchase price for such Offered Shares; provided that if the terms of payment set forth in the
Transfer Notice were other than cash against delivery, the Company may pay for the Offered Shares on the same terms and conditions as were set forth in the Transfer Notice; and provided further that any delay in making such payment
shall not invalidate the Company’s exercise of its option to purchase the Offered Shares. 
 (c) Shares Not Purchased By
Company. If the Company does not elect to acquire all of the Offered Shares, the Participant may, within the 30-day period following the expiration of the option granted to the Company under subsection
(b) above, transfer the Offered Shares which the Company has not elected to acquire to the proposed transferee, provided that such transfer shall not be on terms and conditions more favorable to the transferee than those contained
in the Transfer Notice. Notwithstanding any of the above, all Offered Shares transferred pursuant to this Section 4 shall remain subject to the right of first refusal set forth in this Section 4 and such transferee shall, as a condition to
such transfer, deliver to the Company a written instrument confirming that such transferee shall be bound by all of the terms and conditions of this Section 4. 

(d) Consequences of Non-Delivery. After the time at which the Offered Shares are required to be
delivered to the Company for transfer to the Company pursuant to subsection (b) above, the Company shall not pay any dividend to the Participant on account of such Offered Shares or permit the Participant to exercise any of the privileges or
rights of a stockholder with respect to such Offered Shares, but shall, insofar as permitted by law, treat the Company as the owner of such Offered Shares. 

(e) Exempt Transactions. The following transactions shall be exempt from the provisions of this Section 4: 

(1) any transfer of Shares to or for the benefit of any spouse, child or grandchild of the Participant, or to a trust for their benefit; 

(2) any transfer pursuant to an effective registration statement filed by the Company under the Securities Act of 1933, as amended (the
“Securities Act”); and 
 (3) the sale of all or substantially all of the outstanding shares of capital stock of the
Company (including pursuant to a merger or consolidation); 
 provided, however, that in the case of a transfer pursuant to clause
(1) above, such Shares shall remain subject to the right of first refusal set forth in this Section 4. 
 (f) Assignment of
Company Right. The Company may assign its rights to purchase Offered Shares in any particular transaction under this Section 4 to one or more persons or entities. 

(g) Termination. The provisions of this Section 4 shall terminate upon the earlier of the following events:


  
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 (1) the closing of the sale of shares of Common Stock in an underwritten public offering
pursuant to an effective registration statement filed by the Company under the Securities Act; or 
 (2) the sale of all or substantially
all of the outstanding shares of capital stock, assets or business of the Company, by merger, consolidation, sale of assets or otherwise (other than a merger or consolidation in which all or substantially all of the individuals and entities who were
beneficial owners of the Company’s voting securities immediately prior to such transaction beneficially own, directly or indirectly, more than 75% (determined on an as-converted basis) of the outstanding
securities entitled to vote generally in the election of directors of the resulting, surviving or acquiring corporation in such transaction). 

(h) No Obligation to Recognize Invalid Transfer. The Company shall not be required (1) to transfer on its books any of the Shares
which shall have been sold or transferred in violation of any of the provisions set forth in this Section 4, or (2) to treat as owner of such Shares or to pay dividends to any transferee to whom any such Shares shall have been so sold or
transferred. 
 (i) Legends. The certificate representing Shares shall bear a legend substantially in the following form (in addition
to, or in combination with, any legend required by applicable federal and state securities laws and agreements relating to the transfer of the Company securities): 

“The shares represented by this certificate are subject to a right of first refusal in favor of the Company, as
provided in a certain stock option agreement with the Company.” 
 The certificates representing unvested Shares shall bear such legends as shall be
required by the Restricted Stock Agreement. 
  

	5.	 Agreement in Connection with Initial Public Offering. 



The Participant agrees, in connection with the initial underwritten public offering of the Common Stock pursuant to a registration statement under the
Securities Act, (i) not to (a) offer, pledge, announce the intention to sell, sell, contract to sell, sell any option or contract to purchase, purchase any option or contract to sell, grant any option, right or warrant to purchase, or
otherwise transfer or dispose of, directly or indirectly, any shares of Common Stock or any other securities of the Company or (b) enter into any swap or other agreement that transfers, in whole or in part, any of the economic consequences of
ownership of shares of Common Stock or other securities of the Company, whether any transaction described in clause (a) or (b) is to be settled by delivery of securities, in cash or otherwise, during the period beginning on the date of the
filing of such registration statement with the Securities and Exchange Commission and ending 180 days after the date of the final prospectus relating to the offering (plus up to an additional 34 days to the extent requested by the managing
underwriters for such offering in order to address NASD Rule 2711(f)(4) or NYSE Rule 472(f)(4) or any similar successor provision), and (ii) to execute any agreement reflecting clause (i) above as may be requested by the Company or the
managing underwriters at the time of such offering. The Company may impose stop-transfer instructions with respect to the shares of Common Stock or other securities subject to the foregoing restriction until the end of the “lock-up” period. 

  
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	6.	 Tax Matters. 



(a) Withholding. No Shares will be issued pursuant to the exercise of this option unless and until the Participant pays to the Company,
or makes provision satisfactory to the Company for payment of, any federal, state or local withholding taxes required by law to be withheld in respect of this option. 

(b) Disqualifying Disposition. If the Participant disposes of Shares acquired upon exercise of this option within two years from the
Grant Date or one year after such Shares were acquired pursuant to exercise of this option, the Participant shall notify the Company in writing of such disposition. 
  

	7.	 Transfer Restrictions. 



(a) This option may not be sold, assigned, transferred, pledged or otherwise encumbered by the Participant, either voluntarily or by operation
of law, except by will or the laws of descent and distribution, and, during the lifetime of the Participant, this option shall be exercisable only by the Participant.  

(b) The Participant agrees that he or she will not transfer any Shares issued pursuant to the exercise of this option unless the transferee,
as a condition to such transfer, delivers to the Company a written instrument confirming that such transferee shall be bound by all of the terms and conditions of Section 4 and Section 5; provided that such a written confirmation shall not
be required with respect to (1) Section 4 after such provision has terminated in accordance with Section 4(g) or (2) Section 5 after the completion of the lock-up period in connection
with the Company’s initial underwritten public offering. 
  

	8.	 Provisions of the Plan. 



This option is subject to the provisions of the Plan (including the provisions relating to amendments to the Plan), a copy of which is
furnished to the Participant with this option. 
 [Remainder of Page Intentionally Left Blank] 

  
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 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
first above written. The Participant hereby accepts the foregoing option and agrees to the terms and conditions thereof. The Participant hereby acknowledges receipt of a copy of the Company’s 2015 Stock Incentive Plan. 

 

			
	 COMPANY:
  

DECIBEL THERAPEUTICS, INC.

		
	 By:
	 	 
		 	Name:                                     
                                         
   
		 	Title:                                    
                                         
      


  

			
	PARTICIPANT:
		
	 By:
	 	 
		 	Name:                                     
                                         
   


  

			
	Address:	 	  [                                   
                                         
  ]
		 	  [                                   
                                         
  ]


  

			
	SPOUSAL CONSENT1:
		
	 By:
	 	 
		 	Name:                                     
                                         
   


  

			
	Address:	 	  [                                   
                                         
  ]
		 	  [                                   
                                         
  ]


  

	1 	 If the Participant resides in a community property state, it is desirable to have the Participant’s spouse
also accept the option. The following are community property states: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, and Washington. Although Wisconsin is not formally a community property state, it has laws governing the division
of marital property similar to community property states and it may be desirable to have a Wisconsin Participant’s spouse accept the option. 



  
 SIGNATURE PAGE TO
INCENTIVE STOCK OPTION AGREEMENT 













 EXHIBIT A 

FORM OF RESTRICTED STOCK AGREEMENT 

DECIBEL THERAPEUTICS, INC. 

RESTRICTED STOCK AGREEMENT 

GRANTED UNDER 2015 STOCK INCENTIVE PLAN 

This Restricted Stock Agreement (the “Agreement”) is made this [____] day of [_____________], 20[ ], between Decibel
Therapeutics, Inc., a Delaware corporation (the “Company”), and [________________________] (the “Participant”). 

For valuable consideration, receipt of which is acknowledged, the parties hereto agree as follows: 

1. Purchase of Shares. The Company has, on the date of this Agreement, issued to the Participant an aggregate of [number of
unvested Shares] shares (the “Shares”) of the Common Stock, $0.001 par value per share (“Common Stock”) of the Company at a price of [____] per share (the “Option Price”) upon exercise by
the Participant of an incentive stock option grant pursuant to an Incentive Stock Option Agreement, dated [_______] (the “Option Agreement”). The Participant agrees that the Shares shall be subject to the Purchase Option set forth
in Section 3 of this Agreement and the restrictions on transfer set forth in Section 5 of this Agreement. 
 2. Certain
Definitions. 
 (a) “Change in Control” shall mean the sale of all or substantially all of the outstanding shares of
capital stock, assets or business of the Company, by merger, consolidation, sale of assets or otherwise (other than a merger or consolidation in which all or substantially all of the individuals and entities who were beneficial owners of the
Company’s voting securities immediately prior to such transaction beneficially own, directly or indirectly, more than 75% (determined on an as-converted basis) of the outstanding securities entitled to
vote generally in the election of directors of the resulting, surviving or acquiring corporation in such transaction). 
 (b) Eligible
Participant” shall mean an employee or officer of, or consultant or advisor to, the Company or any parent or subsidiary of the Company as defined in Section 424(e) or (f) of the Internal Revenue Code of 1986, as amended. 

(c) “Vesting Commencement Date” shall mean [_________________]. 

3. Purchase Option. 
 (a)
In the event that the Participant ceases to be an Eligible Participant for any reason or no reason, with or without cause, prior to [Insert final Vesting Date under Option Agreement], the Company shall have the right and option (the
“Purchase Option”) to purchase from the Participant, for a sum equal to the Option Price per share, any Shares that have not become Vested Shares pursuant to the vesting schedule and provisions set forth in Section 2 of the
Option Agreement. 












 (b) This Agreement is subject to the provisions of the Option Agreement. 

4. Exercise of Purchase Option and Closing. 

(a) The Company may exercise the Purchase Option by delivering or mailing to the Participant (or the Participant’s estate), within 180
days after the termination of the Service of the Participant, a written notice of exercise of the Purchase Option. Such notice shall specify the number of Shares to be purchased. If and to the extent the Purchase Option is not so exercised by the
giving of such a notice within such 180-day period, the Purchase Option shall automatically expire and terminate effective upon the expiration of such 180-day period.

 (b) Within ten (10) days after delivery to the Participant of the Company’s notice of the exercise of the Purchase Option
pursuant to subsection (a) above, the Participant (or the Participant’s estate) shall, pursuant to the provisions of the Joint Escrow Instructions referred to in Section 8 below, tender to the Company at its principal offices the
certificate or certificates representing the Shares that the Company has elected to purchase in accordance with the terms of this Agreement, duly endorsed in blank or with duly endorsed stock powers attached thereto, all in form suitable for the
transfer of such Shares to the Company. Promptly following its receipt of such certificate or certificates, the Company shall pay to the Participant the aggregate Option Price for such Shares (provided that any delay in making such payment shall not
invalidate the Company’s exercise of the Purchase Option with respect to such Shares). 
 (c) After the time at which any Shares are
required to be delivered to the Company for transfer to the Company pursuant to subsection (b) above, the Company shall not pay any dividend to the Participant on account of such Shares or permit the Participant to exercise any of the
privileges or rights of a stockholder with respect to such Shares, but shall, in so far as permitted by law, treat the Company as the owner of such Shares. 

(d) The Option Price may be payable, at the option of the Company, in cancellation of all or a portion of any outstanding indebtedness of the
Participant to the Company or in cash (by check) or both. 
 (e) The Company shall not purchase any fraction of a Share upon exercise of the
Purchase Option, and any fraction of a Share resulting from a computation made pursuant to Section 3 of this Agreement shall be rounded to the nearest whole Share (with any one-half Share being rounded
upward). 
 (f) The Company may assign its Purchase Option to one or more persons or entities. 












 5. Restrictions on Transfer. 

(a) The Participant shall not sell, assign, transfer, pledge, hypothecate or otherwise dispose of, by operation of law or otherwise
(collectively “transfer”) any Shares, or any interest therein, that are subject to the Purchase Option, except that the Participant may transfer such Shares (i) to or for the benefit of any spouse, children, parents, uncles,
aunts, siblings, grandchildren and any other relatives approved by the Board of Directors (collectively, “Approved Relatives”) or to a trust established solely for the benefit of the Participant and/or Approved Relatives,
provided that such Shares shall remain subject to this Agreement (including without limitation the restrictions on transfer set forth in this Section 5, the Purchase Option and the right of first refusal set forth in Section 6) and
such permitted transferee shall, as a condition to such transfer, deliver to the Company a written instrument confirming that such transferee shall be bound by all of the terms and conditions of this Agreement or (ii) as part of the sale of all
or substantially all of the shares of capital stock of the Company (including pursuant to a merger or consolidation), provided that, in accordance with the Plan, the securities or other property received by the Participant in connection with
such transaction shall remain subject to this Agreement. 
 (b) The Participant shall not transfer any Shares, or any interest therein, that
are no longer subject to the Purchase Option, except in accordance with Section 6 below. 
 6. Right of First Refusal. 

(a) If the Participant proposes to transfer any Shares that are no longer subject to the Purchase Option (either because they are free from the
Purchase Option pursuant to Section 3 or because the Purchase Option expired unexercised pursuant to Section 4), then the Participant shall first give written notice of the proposed transfer (the “Transfer Notice”) to the
Company. The Transfer Notice shall name the proposed transferee and state the number of such Shares the Participant proposes to transfer (the “Offered Shares”), the price per share and all other material terms and conditions of the
transfer. 
 (b) For 30 days following its receipt of such Transfer Notice, the Company shall have the option to purchase all or part of the
Offered Shares at the price and upon the terms set forth in the Transfer Notice. In the event the Company elects to purchase all or part of the Offered Shares, it shall give written notice of such election to the Participant within such 30-day period. Within 10 days after the Participant’s receipt of such notice, the Participant shall tender to the Company at its principal offices the certificate or certificates representing the Offered Shares
to be purchased by the Company, duly endorsed in blank by the Participant or with duly endorsed stock powers attached thereto, all in a form suitable for transfer of the Offered Shares to the Company. Promptly following receipt of such certificate
or certificates, the Company shall deliver or mail to the Participant a check in payment of the purchase price for such Offered Shares; provided that if the terms of payment set forth in the Transfer Notice were other than cash against
delivery, the Company may pay for the Offered Shares on the same terms and conditions as were set forth in the Transfer Notice; and provided further that any delay in making such payment shall not invalidate the Company’s exercise
of its option to purchase the Offered Shares. 
 (c) If the Company does not elect to acquire all of the Offered Shares, the Participant
may, within the 30-day period following the expiration of the option granted to the Company under subsection (b) above, transfer the Offered Shares which the Company has not elected to acquire to the proposed transferee, provided that such transfer
shall not be on terms and conditions more favorable to the transferee than those contained in the Transfer Notice. 












 
Notwithstanding any of the above, all Offered Shares transferred pursuant to this Section 6 shall remain subject to this Agreement (including without limitation the restrictions on transfer
set forth in Section 5 and the right of first refusal set forth in this Section 6) and such transferee shall, as a condition to such transfer, deliver to the Company a written instrument confirming that such transferee shall be bound by
all of the terms and conditions of this Agreement. 
 (d) After the time at which the Offered Shares are required to be delivered to the
Company for transfer to the Company pursuant to subsection (b) above, the Company shall not pay any dividend to the Participant on account of such Offered Shares or permit the Participant to exercise any of the privileges or rights of a
stockholder with respect to such Offered Shares, but shall, insofar as permitted by law, treat the Company as the owner of such Offered Shares. 

(e) The following transactions shall be exempt from the provisions of this Section 6: 

(1) a transfer of Shares to or for the benefit of any Approved Relatives, or to a trust established solely for the benefit of the Participant
and/or Approved Relatives; 
 (2) any transfer pursuant to an effective registration statement filed by the Company under the Securities
Act of 1933, as amended (the “Securities Act”); and 
 (3) the sale of all or substantially all of the outstanding shares
of capital stock of the Company (including pursuant to a merger or consolidation); 
 provided, however, that in the case of a transfer pursuant to
clause (1) above, such Shares shall remain subject to this Agreement (including without limitation the restrictions on transfer set forth in Section 5 and the right of first refusal set forth in this Section 6) and such transferee
shall, as a condition to such transfer, deliver to the Company a written instrument confirming that such transferee shall be bound by all of the terms and conditions of this Agreement. 

(f) The Company may assign its rights to purchase Offered Shares in any particular transaction under this Section 6 to one or more
persons or entities. 
 (g) The provisions of this Section 6 shall terminate upon the earlier of the following events: 

(1) the closing of the sale of shares of Common Stock in an underwritten public offering pursuant to an effective registration statement
filed by the Company under the Securities Act; or 
 (2) a Change in Control. 

(h) The Company shall not be required (1) to transfer on its books any of the Shares which shall have been sold or transferred in
violation of any of the provisions set forth in this Agreement, or (2) to treat as owner of such Shares or to pay dividends to any transferee to whom any such Shares shall have been so sold or transferred. 












 7. Agreement in Connection with Initial Public Offering. 

The Participant agrees, in connection with the initial underwritten public offering of the Common Stock pursuant to a registration statement
under the Securities Act, (i) not to (a) offer, pledge, announce the intention to sell, sell, contract to sell, sell any option or contract to purchase, purchase any option or contract to sell, grant any option, right or warrant to
purchase, or otherwise transfer or dispose of, directly or indirectly, any shares of Common Stock or any securities convertible into or exercisable or exchangeable for shares of Common Stock or (b) enter into any swap or other agreement that
transfers, in whole or in part, any of the economic consequences of ownership of shares of Common Stock, whether any transaction described in clause (a) or (b) is to be settled by delivery of shares of Common Stock or other securities, in cash
or otherwise, during the period beginning on the date of the filing of such registration statement with the Securities and Exchange Commission and ending 180 days from the date of the final prospectus relating to the offering (plus up to an
additional 34 days to the extent requested by the managing underwriters for such offering in order to address NASD Rule 2711(f)(4) or NYSE Rule 472(f)(4) or any similar successor provision), and (ii) to execute any agreement reflecting clause
(i) above as may be requested by the Company or the managing underwriters at the time of such offering. The Company may impose stop-transfer instructions with respect to the shares of Common Stock or other securities subject to the foregoing
restriction until the end of the “lock-up” period. 
 8. Escrow. 

The Participant shall, upon the execution of this Agreement, execute Joint Escrow Instructions in the form attached to this Agreement as
Exhibit A. The Joint Escrow Instructions shall be delivered to the Secretary of the Company, as escrow agent thereunder. The Participant shall deliver to such escrow agent a stock assignment duly endorsed in blank, in the form attached to
this Agreement as Exhibit B, and hereby instructs the Company to deliver to such escrow agent, on behalf of the Participant, the certificate(s) evidencing the Shares issued hereunder. Such materials shall be held by such escrow agent pursuant
to the terms of such Joint Escrow Instructions. 
 9. Restrictive Legends. 

All certificates representing Shares shall have affixed thereto legends in substantially the following form, in addition to any other legends
that may be required under federal or state securities laws: 
 “The shares of stock represented by this certificate
are subject to restrictions on transfer and an option to purchase set forth in a certain Restricted Stock Agreement between the corporation and the registered owner of these shares (or such owner’s predecessor in interest), and such Agreement
is available for inspection without charge at the office of the Secretary of the corporation.” 
 “The shares
represented by this certificate have not been registered under the Securities Act of 1933, as amended, and may not be sold, transferred or otherwise disposed of in the absence of an effective registration statement under such Act or an opinion of
counsel satisfactory to the corporation to the effect that such registration is not required.” 












 10. Provisions of the Plan. 

This Agreement is subject to the provisions of the Plan, a copy of which is furnished to the Participant with this Agreement. 

11. Investment Representations. 

The Participant represents, warrants and covenants as follows: 

(a) The Participant is purchasing the Shares for Participant’s own account for investment only, and not with a view to, or for sale in
connection with, any distribution of the Shares in violation of the Securities Act, or any rule or regulation under the Securities Act. 

(b) The Participant has had such opportunity as Participant has deemed adequate to obtain from representatives of the Company such information
as is necessary to permit him to evaluate the merits and risks of Participant’s investment in the Company. 
 (c) The Participant has
sufficient experience in business, financial and investment matters to be able to evaluate the risks involved in the purchase of the Shares and to make an informed investment decision with respect to such purchase. 

(d) The Participant can afford a complete loss of the value of the Shares and is able to bear the economic risk of holding such Shares for an
indefinite period. 
 (e) The Participant understands that (i) the Shares have not been registered under the Securities Act and are
“restricted securities” within the meaning of Rule 144 under the Securities Act; (ii) the Shares cannot be sold, transferred or otherwise disposed of unless they are subsequently registered under the Securities Act or an
exemption from registration is then available; (iii) in any event, the exemption from registration under Rule 144 will not be available for at least one year and even then will not be available unless a public market then exists for the
Common Stock, adequate information concerning the Company is then available to the public, and other terms and conditions of Rule 144 are complied with; and (iv) there is now no registration statement on file with the Securities and
Exchange Commission with respect to any stock of the Company and the Company has no obligation or current intention to register the Shares under the Securities Act. 

12. Withholding Taxes; Section 83(b) Election. 

(a) The Participant acknowledges and agrees that the Company has the right to deduct from payments of any kind otherwise due to the Participant
any federal, state or local taxes of any kind required by law to be withheld with respect to the purchase of the Shares by the Participant or the lapse of the Purchase Option. 












 (b) The Participant has reviewed with the Participant’s own tax advisors the federal,
state, local and foreign tax consequences of this investment and the transactions contemplated by this Agreement. The Participant is relying solely on such advisors and not on any statements or representations of the Company or any of its agents.
The Participant understands that the Participant (and not the Company) shall be responsible for the Participant’s own tax liability that may arise as a result of this investment or the transactions contemplated by this Agreement. The
Participant understands that it may be beneficial in many circumstances to elect to be taxed at the time the Shares are granted by the Company rather than when and as the Company’s Purchase Option expires by filing an election under
Section 83(b) of the Internal Revenue Code of 1986 with the I.R.S. within 30 days from the date of grant by the Company. 
 THE
PARTICIPANT ACKNOWLEDGES THAT IT IS SOLELY THE PARTICIPANT’S RESPONSIBILITY AND NOT THE COMPANY’S TO FILE TIMELY THE ELECTION UNDER SECTION 83(b), EVEN IF THE PARTICIPANT REQUESTS THE COMPANY OR ITS REPRESENTATIVES TO MAKE THIS FILING ON
THE PARTICIPANT’S BEHALF. 
 13. Miscellaneous. 

(a) No Rights to Employment. The Participant acknowledges and agrees that the vesting of the Shares pursuant to Section 3 hereof is
earned only by the Participant’s continuous Service (not through the act of being hired or purchasing the Shares hereunder). The Participant further acknowledges and agrees that the transactions contemplated hereunder and the vesting schedule
set forth herein do not constitute an express or implied promise of continued engagement as an employee or consultant for the vesting period, for any period, or at all. 

(b) Severability. The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability
of any other provision of this Agreement, and each other provision of this Agreement shall be severable and enforceable to the extent permitted by law. 

(c) Waiver. Any provision for the benefit of the Company contained in this Agreement may be waived, either generally or in any
particular instance, by the Board of Directors of the Company. 
 (d) Binding Effect. This Agreement shall be binding upon and inure
to the benefit of the Company and the Participant and their respective heirs, executors, administrators, legal representatives, successors and assigns, subject to the restrictions on transfer set forth in Sections 5 and 6 of this Agreement.

 (e) Notice. All notices required or permitted hereunder shall be in writing and deemed effectively given upon personal delivery or
five days after deposit in the United States Post Office, by registered or certified mail, postage prepaid, addressed to the other party hereto at the address shown beneath his or her or its respective signature to this Agreement, or at such other
address or addresses as either party shall designate to the other in accordance with this Section 13(e). 












 (f) Pronouns. Whenever the context may require, any pronouns used in this Agreement
shall include the corresponding masculine, feminine or neuter forms, and the singular form of nouns and pronouns shall include the plural, and vice versa. 

(g) Entire Agreement. This Agreement and the Plan constitute the entire agreement between the parties, and supersedes all prior
agreements and understandings, relating to the subject matter of this Agreement. 
 (h) Amendment. This Agreement may be amended or
modified only by a written instrument executed by both the Company and the Participant. 
 (i) Governing Law. This Agreement shall be
construed, interpreted and enforced in accordance with the internal laws of the State of Delaware without regard to any applicable conflict of law principles. 

(j) Participant’s Acknowledgments. The Participant acknowledges that he or she: (i) has read this Agreement; (ii) has
been represented in the preparation, negotiation, and execution of this Agreement by legal counsel of the Participant’s own choice or has voluntarily declined to seek such counsel; (iii) understands the terms and consequences of this
Agreement; (iv) is fully aware of the legal and binding effect of this Agreement; and (v) understands that the law firm of WilmerHale is acting as counsel to the Company in connection with the transactions contemplated by the Agreement,
and is not acting as counsel for the Participant. 
 [Remainder of Page Intentionally Left Blank] 












 IN WITNESS WHEREOF, the parties hereto have executed the Restricted Stock Agreement as of
the date and year first above written. The Participant hereby agrees to the terms and conditions thereof. The Participant hereby acknowledges receipt of a copy of the Company’s 2015 Stock Incentive Plan. 

 

			
	 COMPANY:
  

DECIBEL THERAPEUTICS, INC.

		
	 By:
	 	 
		 	Name:                                     
                                         
   
		 	Title:                                    
                                         
      


  

			
	Address:	 	 1325 Boylston Street

Suite 500
 Boston, MA
02115



  

			
	PARTICIPANT:
		
	 By:
	 	 
		 	Name:                                     
                                         
   


  

			
	Address:	 	  [                                   
                                         
  ]
		 	  [                                   
                                         
  ]


  

			
	SPOUSAL CONSENT:
		
	 By:
	 	 
		 	Name:                                     
                                         
   


  

			
	Address:	 	  [                                   
                                         
  ]
		 	  [                                   
                                         
  ]














 EXHIBIT A 

JOINT ESCROW INSTRUCTIONS 












 DECIBEL THERAPEUTICS, INC. 

JOINT ESCROW INSTRUCTIONS 

[___________, 20__] 
 Decibel Therapeutics, Inc.

 1325 Boylston Street 
 Suite 500 

Boston, MA 02115 
 Attention: Secretary 

Dear Secretary: 
 As Escrow Agent for Decibel
Therapeutics, Inc., a Delaware corporation (the “Company”), and its successors in interest under the Restricted Stock Agreement (the “Agreement”) of even date herewith, to which a copy of these Joint Escrow
Instructions is attached, and the undersigned person (“Holder”), you are hereby authorized and directed to hold the documents delivered to you pursuant to the terms of the Agreement in accordance with the following instructions:

 1. Appointment. Holder irrevocably authorizes the Company to deposit with you any certificates evidencing Shares (as defined in
the Agreement) to be held by you hereunder and any additions and substitutions to said Shares. For purposes of these Joint Escrow Instructions, “Shares” shall be deemed to include any additional or substitute property. Holder does
hereby irrevocably constitute and appoint you as his or her attorney-in-fact and agent for the term of this escrow to execute with respect to such Shares all documents
necessary or appropriate to make such Shares negotiable and to complete any transaction herein contemplated. Subject to the provisions of this Section 1 and the terms of the Agreement, Holder shall exercise all rights and privileges of a
stockholder of the Company while the Shares are held by you. 
 2. Closing of Purchase. 

(a) Upon any purchase by the Company of the Shares pursuant to the Agreement, the Company shall give to Holder and you a written notice
specifying the number of Shares to be purchased, the purchase price for the Shares, as determined pursuant to the Agreement, and the time for a closing hereunder (the “Closing”) at the principal office of the Company. Holder and the
Company hereby irrevocably authorize and direct you to close the transaction contemplated by such notice in accordance with the terms of said notice. 

(b) At the Closing, you are directed (i) to date the stock assignment form or forms necessary for the transfer of the Shares,
(ii) to fill in on such form or forms the number of Shares being transferred, and (iii) to deliver the same, together with the certificate or certificates evidencing the Shares to be transferred, to the Company against the simultaneous
delivery to you of the purchase price for the Shares being purchased pursuant to the Agreement. 
 3. Withdrawal. The Holder shall
have the right to withdraw from this escrow any Shares as to which the Purchase Option (as defined in the Agreement) has terminated or expired. 












 4. Duties of Escrow Agent. 

(a) Your duties hereunder may be altered, amended, modified or revoked only by a writing signed by all of the parties hereto. 

(b) You shall be obligated only for the performance of such duties as are specifically set forth herein and may rely and shall be protected in
relying or refraining from acting on any instrument reasonably believed by you to be genuine and to have been signed or presented by the proper party or parties. You shall not be personally liable for any act you may do or omit to do hereunder as
Escrow Agent or as attorney-in-fact of Holder while acting in good faith and in the exercise of your own good judgment, and any act done or omitted by you pursuant to
the advice of your own attorneys shall be conclusive evidence of such good faith. 
 (c) You are hereby expressly authorized to disregard
any and all warnings given by any of the parties hereto or by any other person or entity, excepting only orders or process of courts of law, and are hereby expressly authorized to comply with and obey orders, judgments or decrees of any court. If
you are uncertain of any actions to be taken or instructions to be followed, you may refuse to act in the absence of an order, judgment or decrees of a court. In case you obey or comply with any such order, judgment or decree of any court, you shall
not be liable to any of the parties hereto or to any other person or entity, by reason of such compliance, notwithstanding any such order, judgment or decree being subsequently reversed, modified, annulled, set aside, vacated or found to have been
entered without jurisdiction. 
 (d) You shall not be liable in any respect on account of the identity, authority or rights of the parties
executing or delivering or purporting to execute or deliver the Agreement or any documents or papers deposited or called for hereunder. 

(e) You shall be entitled to employ such legal counsel and other experts as you may deem necessary properly to advise you in connection with
your obligations hereunder and may rely upon the advice of such counsel. 
 (f) Your rights and responsibilities as Escrow Agent hereunder
shall terminate if (i) you cease to be Secretary of the Company or (ii) you resign by written notice to each party. In the event of a termination under clause (i), your successor as Secretary shall become Escrow Agent hereunder; in
the event of a termination under clause (ii), the Company shall appoint a successor Escrow Agent hereunder. 
 (g) If you reasonably
require other or further instruments in connection with these Joint Escrow Instructions or obligations in respect hereto, the necessary parties hereto shall join in furnishing such instruments. 

(h) It is understood and agreed that if you believe a dispute has arisen with respect to the delivery and/or ownership or right of possession
of the securities held by you hereunder, you are authorized and directed to retain in your possession without liability to anyone all or any part of said securities until such dispute shall have been settled either by mutual written agreement of the
parties concerned or by a final order, decree or judgment of a court of competent jurisdiction after the time for appeal has expired and no appeal has been perfected, but you shall be under no duty whatsoever to institute or defend any such
proceedings. 












 (i) These Joint Escrow Instructions set forth your sole duties with respect to any and all
matters pertinent hereto and no implied duties or obligations shall be read into these Joint Escrow Instructions against you. 
 (j) The
Company shall indemnify you and hold you harmless against any and all damages, losses, liabilities, costs, and expenses, including attorneys’ fees and disbursements, (including without limitation the fees of counsel retained pursuant to
Section 4(e) above, for anything done or omitted to be done by you as Escrow Agent in connection with this Agreement or the performance of your duties hereunder, except such as shall result from your gross negligence or willful misconduct. 

5. Notice. Any notice required or permitted hereunder shall be given in writing and shall be deemed effectively given upon personal
delivery or upon deposit in the United States Post Office, by registered or certified mail with postage and fees prepaid, addressed to each of the other parties thereunto entitled at the following addresses, or at such other addresses as a party may
designate by ten days’ advance written notice to each of the other parties hereto. 
  

			
	 COMPANY:
	  	Notices to the Company shall be sent to the address set forth in the salutation hereto, Attn: President
		
	 HOLDER:
	  	Notices to Holder shall be sent to the address set forth below Holder’s signature below.
		
	 ESCROW AGENT:
	  	Notices to the Escrow Agent shall be sent to the address set forth in the salutation hereto.

 6. Miscellaneous. 

By signing these Joint Escrow Instructions, you become a party hereto only for the purpose of said Joint Escrow Instructions, and you do not
become a party to the Agreement. 
 This instrument shall be binding upon and inure to the benefit of the parties hereto and their
respective successors and permitted assigns. 
 [Remainder of Page Intentionally Left Blank] 












 IN WITNESS WHEREOF, the parties hereto have executed these Joint Escrow Instructions as of
the day and year first above written. 

			
	 Very truly yours,
  

	 COMPANY:
  

DECIBEL THERAPEUTICS, INC.

		
	 By:
	 	 
		 	Name:                                     
                                         
   
		 	Title:                                    
                                         
      


  

			
	HOLDER:
		
	 By:
	 	 
		 	Name:                                     
                                         
   


  

			
	Address:	 	  [                                   
                                         
  ]
		 	  [                                   
                                         
  ]


  

			
	ESCROW AGENT:
		
	 By:
	 	 
		 	Name:                                     
                                         
   
		 	Title: Secretary


  












 EXHIBIT B 

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE













 STOCK ASSIGNMENT SEPARATE FROM
CERTIFICATE 
 FOR VALUE RECEIVED, I hereby sell, assign and transfer unto __________________ __________________
(_________) shares of Common Stock, $0.001 par value per share, of Decibel Therapeutics, Inc. (the “Corporation”) standing in my name on the books of the Corporation represented by Certificate(s) Number __________ herewith, and do
hereby irrevocably constitute and appoint Wilmer Cutler Pickering Hale and Dorr LLP attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises. 

 

			
		
	Dated:	 	 

  

	
	PARTICIPANT:
	
	 
	[Name]
	
	 
	Name of Spouse (if any):


 Instructions to Participant: Please do not fill in any blanks other than the signature line(s). The
purpose of the Stock Assignment Separate from Certificate is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or
Participant’s spouse, if any. The signature(s) to this assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. 












 NOTICE ON 83(B)
ELECTIONS 
 IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. 

THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. 

YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE
COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. 

The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your
tax returns. See www.irs.gov. 












 SECTION 83(B) ELECTION 

The undersigned hereby makes an election pursuant to Section 83(b) of the Internal Revenue Code of 1986, as amended, with respect to the property
described below and supplies the following information in accordance with Treas. Reg. § 1.83-2: 
  

	 	1.	 The name, address, and taxpayer identification number of the undersigned are: 



[Name] 
 [Address] 

[City, State Zip] 
 Taxpayer
Identification Number:
                                        

  

	 	2.	 The property with respect to which this election is being made is [______] shares of common stock, $0.001 par
value per share, of Decibel Therapeutics, Inc., a Delaware corporation (the “Company”). 


  

	 	3.	 The date on which the property was transferred or the date on which the restrictions on such property were
imposed, whichever is later, is ____________ _____, 20[__] and the taxable year for which this election is being made is the calendar year 20[__]. 


  

	 	4.	 The property is subject to vesting provisions and may be forfeited under the terms of a stock restriction
agreement executed between the undersigned and the Company. 


  

	 	5.	 The fair market value of the property at the time of the transfer or the date on which the restrictions on such
property were imposed, whichever is later, (determined without regard to any lapse restriction, as defined in Treas. Reg. § 1.83-3(i)) is $[__________], equal to a fair market value of
$[__________] per share. 


  

	 	6.	 The amount paid for the property by the undersigned is $[__________]23, equal to a purchase price of $[__________] per share. 



 

	 	7.	 This statement is executed on ____________ _____, 20[__]. 



In accordance with Treas. Reg. § 1.83-2(d) & (e)(7), a copy of this statement has been furnished to the
Company. 
  

	2 	 If restrictions are being added to previously unrestricted stock, the following language is to be used:
“[_____________] shares of the Company, having a fair market value of $[______________],” 



	3 	 If the shares were issued in exchange for an assignment of intellectual property rights, the following language
is to be used: “Intellectual property having a fair market value of $[______________],” 















					
			
	   
	 		 	   

	Signature of Taxpayer	 		 	Signature of Spouse (if any)













 SECTION 83(B) ELECTION 

BACKGROUND INFORMATION 

Section 83(b) of the Internal Revenue Code permits persons who receive restricted property, such as restricted stock, in connection with
the performance of services to include the value of such property in their gross income for the year the property is received. Such persons who purchase stock of the company subject to a stock restriction agreement providing for the vesting of such
stock over a period of time are entitled to make this election. Any person who makes a timely Section 83(b) election will recognize compensation income on the date of grant (the date listed in item 3 of the election form) equal to the
difference, if any, between the fair market value of the stock and the amount paid for the stock. A person who pays taxes in connection with an election and subsequently forfeits the stock, however, will not receive a refund or other tax benefit for
the taxes previously paid. 
 Any person who does not make the election will be required to include the value of the stock in gross income
in the year in which the stock vests. In particular, when the stock vests, the person will recognize compensation income in an amount equal to the difference between the fair market value of the stock on the vesting date and the amount paid for the
stock. As a result, if the value of the stock increases, a person who does not make a timely Section 83(b) election will have compensation income at the time each installment of stock vests. 

Each person should consult with his or her tax or legal advisor regarding the advisability and timing of filing the election. The original,
signed and dated Section 83(b) election must be filed within 30 days of the grant date but may be filed prior to the grant date. The election should be filed by certified mail, return receipt requested, with the Internal
Revenue Service at the service center where the electing person ordinarily files his or her annual tax return. A copy of the Section 83(b) election, as filed, must be returned to the company. A copy of the Section 83(b) election must also
be included with the person’s federal income tax return for the year of grant (each person should check with his or her tax preparer regarding this and any state, local, foreign or other filing requirements). 

Please also note that the certified mailing receipt for the Section 83(b) election should be retained. This receipt is essential if
the Internal Revenue Service does not receive the Section 83(b) election and challenges the election. 












 EXHIBIT B 

NOTICE OF STOCK OPTION EXERCISE 

[DATE]1 

Decibel Therapeutics, Inc. 
 1325 Boylston Street 

Suite 500 
 Boston, MA 02115 

Attention: Treasurer 
 Dear Sir or Madam: 

I am the holder of an Incentive Stock Option granted to me under the Decibel Therapeutics, Inc. (the “Company”) 2015 Stock
Incentive Plan on [__________]2 for the purchase of [__________]3 shares of Common Stock of the Company at a purchase price of $[__________]4 per share. 
 I hereby exercise my option to purchase [_________]5 shares of Common Stock (the “Shares”), for which I have enclosed [__________]6 in the amount of [________]7. Please register my stock certificate as follows: 
  

					
	 Name (s):
	  	                                      
              8 	  	
		  	                                      
              	  	
	 Address:
	  	                                      
              	  	
		  	                                      
              	  	

 I represent, warrant and covenant as follows: 

 
  

	1 	 Enter date of exercise. 



	2 	 Enter the date of grant. 



	3 	 Enter the total number of shares of Common Stock for which the option was granted. 



	4 	 Enter the option exercise price per share of Common Stock. 



	5 	 Enter the number of shares of Common Stock to be purchased upon exercise of all or part of the option.




	6 	 Enter “cash”, “personal check” or if permitted by the option or Plan, “stock
certificates No. XXXX and XXXX”. 



	7 	 Enter the dollar amount (price per share of Common Stock times the number of shares of Common Stock to be
purchased), or the number of shares tendered. Fair market value of shares tendered, together with cash or check, must cover the purchase price of the shares issued upon exercise. 



	8 	 Enter name(s) to appear on stock certificate in one of the following formats: (a) your name only (i.e., John
Doe); (b) your name and other name (i.e., John Doe and Jane Doe, Joint Tenants with Right to Survivorship); or for Nonstatutory Stock Options only, (c) a child’s name, with you as custodian (i.e. Jane Doe, Custodian for Tommy Doe). Note: There
may be income and/or gift tax consequences for registering shares in a child’s name. 














 6. I am purchasing the Shares for my own account for investment only, and not with a view to, or for sale in
connection with, any distribution of the Shares in violation of the Securities Act of 1933 (the “Securities Act”), or any rule or regulation under the Securities Act. 

7. I have had such opportunity as I have deemed adequate to obtain from representatives of the Company such information as is necessary to permit me to
evaluate the merits and risks of my investment in the Company. 
 8. I have sufficient experience in business, financial and investment matters to be able
to evaluate the risks involved in the purchase of the Shares and to make an informed investment decision with respect to such purchase. 
 9. I can afford a
complete loss of the value of the Shares and am able to bear the economic risk of holding such Shares for an indefinite period. 
 10. I understand that
(i) the Shares have not been registered under the Securities Act and are “restricted securities” within the meaning of Rule 144 under the Securities Act, (ii) the Shares cannot be sold, transferred or otherwise disposed of unless
they are subsequently registered under the Securities Act or an exemption from registration is then available; (iii) in any event, the exemption from registration under Rule 144 will not be available for at least one year and even then will not
be available unless a public market then exists for the Common Stock, adequate information concerning the Company is then available to the public, and other terms and conditions of Rule 144 are complied with; and (iv) there is now no
registration statement on file with the Securities and Exchange Commission with respect to any stock of the Company and the Company has no obligation or current intention to register the Shares under the Securities Act. 

 

	
	 Very truly yours,

	
	   

	 [Name]



  
 -8-