Exhibit
4.1


 


2015
NOTE SUBSCRIPTION AGREEMENT


 


This
2015 Note Subscription Agreement, dated as of ________________, 2021 (this “Agreement”), is entered into by and between
HeartBeam, Inc., a Delaware corporation (the “Company”), and the person or entity listed on the signature page hereto
(the “Investor”).


 


RECITALS



 


A.
On the terms and subject to the conditions set forth herein, the Investor is willing to purchase from the Company, and the Company is
willing to sell to such Investor, a 2015 convertible promissory note in the form of Exhibit A hereto (a “Note”)
in the principal amount set forth opposite such Investor’s name on the signature page hereto.


 


B.
The Company may, in its sole discretion, issue and sell additional 2015 convertible promissory notes in a form substantially similar
to the Note (each, also a “Note” and together with all other Notes, the “Notes”) to certain other
investors identified by the Company from time to time (each, also an “Investor” and together with all other Investors,
the “Investors”) pursuant to a 2015 note subscription agreement in a form substantially similar to this Agreement
(each, also an “Agreement” and together with all other Agreements, the “Agreements”), provided
the aggregate amount of Note principal issued and sold pursuant to all such Agreements does not exceed $5,000,000.


 


C.
Capitalized terms not otherwise defined herein shall have the meaning set forth in the Note.


 


AGREEMENT


 


NOW
THEREFORE, in consideration of the foregoing, and the representations, warranties, and conditions set forth below, the parties hereto,
intending to be legally bound, hereby agree as follows:


 


1.
The Note.


 


(a)
Issuance of Note. Subject to all of the terms and conditions hereof, the Company agrees to issue and sell to the Investor, and
the Investor agrees to purchase from the Company, a Note in the principal amount set forth opposite such Investor’s name on the
signature page hereto.


 


(b)
Delivery. The sale and purchase of the Note shall take place at a closing (the “Closing”) to be held on the
date of this Agreement (the “Closing Date”). At the Closing, the Company will deliver to the Investor the Note to
be purchased by such Investor, against receipt by the Company of the corresponding purchase price set forth on the signature page hereto
(the “Purchase Price”). The Note will be registered in such Investor’s name in the Company’s records.


 


(c)
Use of Proceeds. The proceeds of the sale and issuance of the Note shall be used for general corporate purposes.


 


2.
Representations and Warranties of the Company. The Company represents and warrants to the Investor that:


 


(a)
Due Incorporation, Qualification, etc. The Company (i) is a corporation duly incorporated, validly existing and in good standing
under the laws of the State of Delaware; (ii) has the power and authority to own, lease and operate its properties and carry on
its business as now conducted; and (iii) is duly qualified, licensed to do business and in good standing as a foreign corporation
in each jurisdiction where the failure to be so qualified or licensed could reasonably be expected to have a material adverse effect
on the Company.


 






    


     


    

 


(b)
Authority. The execution, delivery and performance by the Company of each Transaction Document to be executed by the Company and
the consummation of the transactions contemplated thereby (i) are within the power of the Company and (ii) have been duly authorized
by all necessary actions on the part of the Company, its officers, directors and stockholders.


 


(c)
Enforceability. Each Transaction Document executed, or to be executed, by the Company has been, or will be, duly executed and
delivered by the Company and constitutes, or will constitute, a legal, valid and binding obligation of the Company, enforceable against
the Company in accordance with its terms, except as limited by bankruptcy, insolvency or other laws of general application relating to
or affecting the enforcement of creditors’ rights generally and general principles of equity.


 


(d)
Compliance with Other Instruments. Neither the authorization, execution and delivery of this Agreement, nor the issuance and delivery
of the Note, will constitute or result in a material default or violation of any law or regulation applicable to the Company or any material
term or provision of the Company's current Certificate of Incorporation or bylaws or any material agreement or instrument by which it
is bound or to which its properties or assets are subject.


 


(e)
No “Bad Actor” Disqualification. The Company has exercised reasonable care, in accordance with Securities and Exchange
Commission rules and guidance, to determine whether any Covered Person (as defined below) is subject to any of the “bad actor”
disqualifications described in Rule 506(d)(1)(i) through (viii) under the Securities Act (“Disqualification Events”).
To the Company’s knowledge, no Covered Person is subject to a Disqualification Event, except for a Disqualification Event covered
by Rule 506(d)(2) or (d)(3) under the Securities Act. The Company has complied, to the extent applicable, with any disclosure obligations
under Rule 506(e) under the Securities Act. “Covered Persons” are those persons specified in Rule 506(d)(1)
under the Securities Act, including the Company; any predecessor or affiliate of the Company; any director, executive officer, other
officer participating in the offering, general partner or managing member of the Company; any beneficial owner of 20% or more of the
Company’s outstanding voting equity securities, calculated on the basis of voting power; any promoter (as defined in Rule 405
under the Securities Act) connected with the Company in any capacity at the time of the sale of the Note; and any person that has been
or will be paid (directly or indirectly) remuneration for solicitation of purchasers in connection with the sale of the Note (a “Solicitor”),
any general partner or managing member of any Solicitor, and any director, executive officer or other officer participating in the offering
of any Solicitor or general partner or managing member of any Solicitor.


 


3.
Representations and Warranties of the Investor. The Investor represents and warrants to the Company upon the acquisition
of a Note as follows:


 


(a)
Binding Obligation. The Investor has full legal capacity, power and authority to execute and deliver this Agreement and to perform
its obligations hereunder. This Agreement constitutes a valid and binding obligation of such Investor, enforceable in accordance with
its terms, except as limited by bankruptcy, insolvency or other laws of general application relating to or affecting the enforcement
of creditors’ rights generally and general principles of equity.


 


(b)
Securities Law Compliance. The Investor has been advised that the Note and the underlying securities have not been registered
under the Securities Act of 1933, as amended (the “Securities Act”), or any state securities laws and, therefore,
cannot be resold unless they are registered under the Securities Act and applicable state securities laws or unless an exemption from
such registration requirements is available. Such Investor is aware that the Company is under no obligation to effect any such registration
with respect to the Note or the underlying securities or to file for or comply with any exemption from registration. Such Investor has
not been formed solely for the purpose of making this investment and is purchasing the Note to be acquired by such Investor hereunder
for its own account for investment, not as a nominee or agent, and not with a view to, or for resale in connection with, the distribution
thereof, and Investor has no present intention of selling, granting any participation in, or otherwise distributing the same. Such Investor
has such knowledge and experience in financial and business matters that such Investor is capable of evaluating the merits and risks
of such investment, is able to incur a complete loss of such investment without impairing such Investor’s financial condition and
is able to bear the economic risk of such investment for an indefinite period of time. Such Investor is an “accredited investor”
as such term is defined in Rule 501 of Regulation D under the Securities Act and shall submit to the Company such further assurances
of such status as may be reasonably requested by the Company. The residency of the Investor (or, in the case of a partnership or corporation,
such entity’s principal place of business) is correctly set forth beneath such Investor’s name on the signature page hereto.


 






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(c)
Access to Information. The Investor acknowledges that the Company has given such Investor access to the corporate records and
accounts of the Company and to all information in its possession relating to the Company, has made its officers and representatives available
for interview by such Investor, and has furnished such Investor with all documents and other information required for such Investor to
make an informed decision with respect to the purchase of the Note.


 


(d)
No “Bad Actor” Disqualification Events. Neither (i)  Investor, (ii) any of its directors, executive officers,
other officers that may serve as a director or officer of any company in which it invests, general partners or managing members, nor
(iii) any beneficial owner of any of the Company’s voting equity securities (in accordance with Rule 506(d) of the Securities
Act) held by such Investor is subject to any Disqualification Event (as defined in Section 2(e)), except for Disqualification Events
covered by Rule 506(d)(2) or (d)(3) under the Securities Act and disclosed reasonably in advance of the Closing in writing in reasonable
detail to the Company.


 


4.
Miscellaneous.


 


(a)
Waivers and Amendments. Any provision of this Agreement and the Note may be amended, waived or modified only upon the written
consent of the Company and the Investors representing a majority of all principal then owing pursuant to outstanding Notes issued pursuant
to the Agreements (a “Majority in Interest of Investors”). Any amendment or waiver effected in accordance with this
paragraph shall be binding upon all of the Investors with respect to their Notes.


 


(b)
Governing Law. This Agreement and all actions arising out of or in connection with this Agreement shall be governed by and construed
in accordance with the laws of the State of California, without regard to the conflicts of law provisions of the State of California
or of any other state.


 


(c)
Survival. The representations, warranties, covenants and agreements made herein shall survive the execution and delivery of this
Agreement.


 


(d)
Successors and Assigns. The rights and obligations of the Company and the Investor shall be binding upon and benefit the successors,
assigns, heirs, administrators and transferees of the parties.


 


(e)
Entire Agreement. This Agreement together with the Note constitute and contain the entire agreement between the Company and Investor
and supersedes any and all prior agreements, negotiations, correspondence, understandings and communications among the parties, whether
written or oral, respecting the subject matter hereof.


 


(f)
Notices. All notices, requests, demands, consents, instructions or other communications required or permitted hereunder shall
in writing and faxed, mailed or delivered to each party as follows: (i) if to the Investor, at such Investor’s address or
facsimile number set forth on the signature page hereto, or at such other address as such Investor shall have furnished the Company in
writing, or (ii) if to the Company, Attn: President, 2118 Walsh Ave., Suite 210, Santa Clara, CA 95050, or at such other address
as the Company shall have furnished to the Investor in writing. All such notices and communications will be deemed effectively given
the earlier of (i) when received, (ii) when delivered personally, (iii) one business day after being delivered by facsimile
(with receipt of appropriate confirmation), (iv) one business day after being deposited with an overnight courier service of recognized
standing or (v) four days after being deposited in the U.S. mail, first class with postage prepaid.


 






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(g)
Counterparts. This Agreement may be executed in one or more counterparts, each of which will be deemed an original, but all of
which together will constitute one and the same agreement. Facsimile copies of signed signature pages will be deemed binding originals.


 


(h)
Waiver of Potential Conflicts of Interest.  Each of the Investors and the Company acknowledges that Wilson Sonsini Goodrich
& Rosati, Professional Corporation (“WSGR”) may have represented and may currently represent certain of the Investors.
In the course of such representation, WSGR may have come into possession of confidential information relating to Investor. The Investor
and the Company acknowledge that WSGR is representing only the Company in this transaction. The Investor and the Company understands
that an affiliate of WSGR may also be an Investor under this Agreement. Pursuant to Rule 3-310 of the Rules of Professional Conduct promulgated
by the State Bar of California, an attorney must avoid representations in which the attorney has or had a relationship with another party
interested in the representation without the informed written consent of all parties affected. By executing this Agreement, each of the
Investors and the Company hereby waives any actual or potential conflict of interest which may arise as a result of WSGR’s representation
of such persons and entities, WSGR’s possession of such confidential information and the participation by WSGR’s affiliate
in the financing. Each of the Investors and the Company represents that it has had the opportunity to consult with independent counsel
concerning the giving of this waiver.


 


(Signature
Page Follows)


 




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The
foregoing 2015 Note Subscription Agreement is hereby confirmed and accepted by the Company as of ____________, 2021.


 


	 	HeartBeam,
    Inc.
	 	 	 
	 	By:	                      
	 	Name:	Richard Brounstein
	 	Title:	CFO
	 	 	 
	 	2118
    Walsh Avenue, Suite 210
	 	Santa
    Clara, CA 95050



 


 


	Note
    Amount:		 
	 	 	           
	 $                    		(Signature)
	 	 	 
	 	 	         
	 	 	(Print Name)
	 	 	 
	 	 	          
	 	 	(Name as it
    should appear on the Note,
	 	 	if different
    than above)
	 	 	 
	 	 	          
	 	 	(Address)
	 	 	 
	 	 	         
	 	 	(Address, cont.)
	 	 	 
	 	 	         
	 	 	(Email)



 





[Signature page for 2015 Note Subscription Agreement]

 







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Exhibit
A


 


FORM
OF 2015 CONVERTIBLE PROMISSORY NOTE