EX-10.3



 Exhibit 10.3 

APELLIS PHARMACEUTICALS, INC. 

2010 EQUITY INCENTIVE PLAN 

STOCK OPTION GRANT NOTICE 

Apellis Pharmaceuticals, Inc., a Delaware corporation (the “Company”), pursuant to its 2010 Equity Incentive Plan (the
“Plan”), hereby grants to the holder listed below (“Participant”), an option to purchase the number of shares of the Company’s common stock, $0.0001 par value (“Stock”), set forth below (the
“Option”). This Option is subject to all of the terms and conditions set forth herein and in the Stock Option Agreement attached hereto as Exhibit A (the “Stock Option Agreement”) and the Plan, which are
incorporated herein by reference. Unless otherwise defined herein, the terms defined in the Plan shall have the same defined meanings in this Grant Notice and the Stock Option Agreement. 

 

			
	 PARTICIPANT:
	  	
		
	 GRANT DATE:
	  	
		
	 EXERCISE PRICE PER SHARE:
	  	$                
		
	 TOTAL EXERCISE PRICE:
	  	$            
		
	 TOTAL NUMBER OF SHARES SUBJECT TO THE OPTION
	  	
	  
		
	 EXPIRATION DATE:
	  	
		
	 TYPE OF OPTION:
	  	 ̈ Incentive Stock Option
		  	x Non-Qualified Stock Option
		
	 VESTING SCHEDULE:
	  	Set forth on Exhibit B attached hereto.
		
	 CHANGE OF CONTROL:
	  	Set forth on Exhibit B attached hereto.

 By his or her signature, Participant agrees to be bound by the terms and conditions of the Plan, the Stock
Option Agreement and this Grant Notice. Participant has reviewed the Stock Option Agreement, the Plan and this Grant Notice in their entirety, has had an opportunity to obtain the advice of counsel prior to executing this Grant Notice and fully
understands all provisions of this Grant Notice, the Stock Option Agreement and the Plan. Participant hereby agrees to accept as binding, conclusive and final all decisions or interpretations of the Committee upon any questions arising under the
Plan or relating to the Option. Upon exercise of this Option, the Participant agrees to adopt and execute the Investor Rights Agreement, the Right of First Refusal and Co-Sale Agreement, the Voting Agreement or any similar agreements, as the Company
may request. 

  
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 IN WITNESS WHEREOF, the Company and the Participant have executed this Stock Option Grant Notice
as of the dates written below. 
  

			
	APELLIS PHARMACEUTICALS, INC.
		
	By	 	  

		 	Cedric Francois, President and CEO
	
	PARTICIPANT
	
	  

	[NAME]
	
	Date:                     
	
	Address:
	
	  

	  

	  




  
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 EXHIBIT A 

FORM OF STOCK OPTION AGREEMENT 

  
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 STOCK OPTION AGREEMENT 

Pursuant to the Stock Option Grant Notice (the “Grant Notice”) to which this Stock Option Agreement (this
“Agreement”) is attached, Apellis Pharmaceuticals, Inc., a Delaware corporation (the “Company”), has granted to Participant an option under the Company’s 2010 Equity Incentive Plan (the “Plan”)
to purchase the number of shares of Stock indicated in the Grant Notice. 
 ARTICLE I 

GENERAL 
 1.1
Defined Terms. Capitalized terms not specifically defined herein shall have the meanings specified in the Plan and the Grant Notice. 

1.2 Incorporation of Terms of Plan. The Option is subject to the terms and conditions of the Plan which are incorporated herein by
reference. 
 ARTICLE II 

GRANT OF OPTION 

2.1 Grant of Option. In consideration of Participant’s past and/or continued employment with or service to the Company or a Parent
or Subsidiary and for other good and valuable consideration, effective as of the Grant Date set forth in the Grant Notice (the “Grant Date”), the Company irrevocably grants to Participant the Option to purchase any part or all of an
aggregate of the number of shares of Stock set forth in the Grant Notice, upon the terms and conditions set forth in the Plan and this Agreement. Unless designated as a Non-Qualified Stock Option in the Grant Notice, the Option shall be an Incentive
Stock Option to the maximum extent permitted by law. 
 2.2 Exercise Price. The exercise price of the shares of Stock subject to the
Option shall be as set forth in the Grant Notice, without commission or other charge; provided, however, that the price per share of the shares subject to the Option shall not be less than one hundred percent (100%) of the Fair Market
Value of a share of Stock on the Grant Date. Notwithstanding the foregoing, if this Option is designated as an Incentive Stock Option and Participant owns (within the meaning of Section 424(d) of the Code) more than ten percent (10%) of
the total combined voting power of all classes of stock of the Company or any “subsidiary corporation” of the Company or any “parent corporation” of the Company (each within the meaning of Section 424 of the Code), the price
per share of the shares subject to the Option shall not be less than one hundred ten percent (110%) of the Fair Market Value of a share of Stock on the Grant Date. 

2.3 Consideration to the Company. In consideration of the grant of the Option by the Company, Participant agrees to render faithful and
efficient services to the Company or any Parent or Subsidiary. Nothing in the Plan or this Agreement shall confer upon Participant any right to continue in the employ or service of the Company or any Parent or Subsidiary or shall


  
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interfere with or restrict in any way the rights of the Company and its Parents and Subsidiaries, which rights are hereby expressly reserved, to discharge or terminate the services of Participant
at any time for any reason whatsoever, with or without Cause, except to the extent expressly provided otherwise in a written agreement between the Company, a Parent or a Subsidiary and Participant. 

ARTICLE III 
 PERIOD
OF EXERCISABILITY 
 3.1 Commencement of Exercisability. 

(a) Subject to Sections 3.3 and 5.8, the Option shall become vested and exercisable in such amounts and at such times as are set forth in the
Grant Notice. 
 (b) No portion of the Option which has not become vested and exercisable at the date of Participant’s Termination of
Employment, Termination of Directorship or Termination of Consultancy shall thereafter become vested and exercisable, except as may be otherwise provided by the Committee or as set forth in a written agreement between the Company and Participant.

 3.2 Duration of Exercisability. The installments provided for in the vesting schedule set forth in the Grant Notice are
cumulative. Each such installment which becomes vested and exercisable pursuant to the vesting schedule set forth in the Grant Notice shall remain vested and exercisable until it becomes unexercisable under Section 3.3. 

3.3 Expiration of Option. The Option may not be exercised to any extent by anyone after the first to occur of the following events:

 (a) The expiration of ten (10) years from the Grant Date; 

(b) If this Option is designated as an Incentive Stock Option and Participant owned (within the meaning of Section 424(d) of the Code),
at the time the Option was granted, more than ten percent (10%) of the total combined voting power of all classes of stock of the Company or any “subsidiary corporation” of the Company or any “parent corporation” of the
Company (each within the meaning of Section 424 of the Code), the expiration of five (5) years from the Grant Date; 
 (c) The
expiration of one (1) year from the date of Participant’s Termination of Employment, Termination of Directorship or Termination of Consultancy, unless such termination occurs by reason of Participant’s discharge for Cause; 

(d) The time of Participant’s Termination of Employment, Termination of Directorship or Termination of Consultancy by the Company or any
Parent or Subsidiary by reason of Participant’s discharge for Cause; or 

  
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 (e) In connection with a Change of Control, the date and time provided under Article 11 of the
Plan. 
 Participant acknowledges that an Incentive Stock Option exercised more than three (3) months after Participant’s
Termination of Employment, other than by reason of death or Disability, will be taxed as a Non-Qualified Stock Option. 
 3.4 Special Tax
Consequences. Participant acknowledges that, to the extent that the aggregate Fair Market Value (determined as of the time the Option is granted) of all shares of Stock with respect to which Incentive Stock Options, including the Option, are
exercisable for the first time by Participant in any calendar year exceeds $100,000, the Option and such other options shall be Non-Qualified Stock Options to the extent necessary to comply with the limitations imposed by Section 422(d) of the
Code. Participant further acknowledges that the rule set forth in the preceding sentence shall be applied by taking the Option and other “incentive stock options” into account in the order in which they were granted, as determined under
Section 422(d) of the Code and the Treasury Regulations thereunder. 
 ARTICLE IV 

EXERCISE OF OPTION 

4.1 Person Eligible to Exercise. Except as provided in Sections 5.2(b) and 5.2(c), during the lifetime of Participant, only Participant
may exercise the Option or any portion thereof. After the death of Participant, any exercisable portion of the Option may, prior to the time when the Option becomes unexercisable under Section 3.3, be exercised by Participant’s personal
representative or by any person empowered to do so under the deceased Participant’s will or under the then applicable laws of descent and distribution. 

4.2 Partial Exercise. Any exercisable portion of the Option or the entire Option, if then wholly exercisable, may be exercised in whole
or in part at any time prior to the time when the Option or portion thereof becomes unexercisable under Section 3.3. 
 4.3 Manner
of Exercise. The Option, or any exercisable portion thereof, may be exercised solely by delivery to the Secretary of the Company or the Secretary’s office of all of the following prior to the time when the Option or such portion thereof
becomes unexercisable under Section 3.3: 
 (a) An Exercise Notice (“Exercise Notice”) in writing signed by Participant or
any other person then entitled to exercise the Option or portion thereof, stating that the Option or portion thereof is thereby exercised, such notice complying with all applicable rules established by the Committee. Such Exercise Notice shall be
substantially in the form attached as Exhibit C to the Grant Notice (or such other form as is prescribed by the Committee); 
 (b)
The receipt by the Company of full payment for the shares with respect to which the Option or portion thereof is exercised, including payment of any applicable withholding tax, which may be in one or more of the forms of consideration permitted
under Section 4.4; 

  
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 (c) A bona fide written representation and agreement, in such form as is prescribed by the
Committee, signed by Participant or the other person then entitled to exercise such Option or portion thereof, stating that the shares of Stock are being acquired for Participant’s own account, for investment and without any present intention
of distributing or reselling said shares or any of them except as may be permitted under the Securities Act and then applicable rules and regulations thereunder and any other applicable law, and that Participant or other person then entitled to
exercise such Option or portion thereof will indemnify the Company against and hold it free and harmless from any loss, damage, expense or liability resulting to the Company if any sale or distribution of the shares by such person is contrary to the
representation and agreement referred to above. The Committee may take such additional actions it deems appropriate to ensure the observance and performance of such representation and agreement and to effect compliance with the Securities Act and
any other federal or state securities laws or regulations and any other applicable law. Without limiting the generality of the foregoing, the Committee may require an opinion of counsel acceptable to it to the effect that any subsequent transfer of
shares acquired on an Option exercise does not violate the Securities Act, and may issue stop-transfer orders covering such shares. Share certificates evidencing Stock issued on exercise of the Option shall bear an appropriate legend referring to
the provisions of this subsection (c) and the agreements herein. The written representation and agreement referred to in the first sentence of this subsection (c) shall, however, not be required if the shares to be issued pursuant to such
exercise have been registered under the Securities Act, and such registration is then effective in respect of such shares; and 
 (d) In
the event the Option or portion thereof shall be exercised pursuant to Section 4.1 by any person or persons other than Participant, appropriate proof of the right of such person or persons to exercise the Option. 

4.4 Method of Payment. Payment of the exercise price shall be by any of the following, or a combination thereof, at the election of the
Participant: 
 (a) cash; 

(b) check; 
 (c) with the
consent of the Committee, delivery of a notice that the Participant has placed a market sell order with a broker with respect to shares of Stock then issuable upon exercise of the Option, and that the broker has been directed to pay a sufficient
portion of the net proceeds of the sale to the Company in satisfaction of the aggregate exercise price; provided, that payment of such proceeds is then made to the Company upon settlement of such sale; 

(d) with the consent of the Committee, surrender of other shares of Stock which (A) in the case of shares of Stock acquired from the
Company, have been owned by the Participant for more than six (6) months on the date of surrender, and (B) have a Fair Market Value on the date of surrender equal to the aggregate exercise price of the shares with respect to which the
Option or portion thereof is being exercised; 

  
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 (e) with the consent of the Committee, surrendered shares of Stock issuable upon the exercise of
the Option having a Fair Market Value on the date of exercise equal to the aggregate exercise price of the shares with respect to which the Option or portion thereof is being exercised; or 

(f) with the consent of the Committee, property of any kind which constitutes good and valuable consideration. 

4.5 Conditions to Issuance of Stock Certificates. The shares of Stock deliverable upon the exercise of the Option, or any portion
thereof, may be either previously authorized but unissued shares or issued shares which have then been reacquired by the Company. Such shares shall be fully paid and nonassessable. The Company shall not be required to issue or deliver any shares of
Stock purchased upon the exercise of the Option or portion thereof prior to fulfillment of all of the following conditions: 
 (a) The
admission of such shares to listing on all stock exchanges on which such Stock is then listed; 
 (b) The completion of any registration or
other qualification of such shares under any state or federal law or under rulings or regulations of the Securities and Exchange Commission or of any other governmental regulatory body, which the Committee shall, in its reasonable discretion, deem
necessary or advisable; 
 (c) The obtaining of any approval or other clearance from any state or federal governmental agency which the
Committee shall, in its reasonable discretion, determine to be necessary or advisable; 
 (d) The receipt by the Company of full payment
for such shares, including payment of any applicable withholding tax, which may be in one or more of the forms of consideration permitted under Section 4.4; 

(e) The lapse of such reasonable period of time following the exercise of the Option as the Committee may from time to time establish for
reasons of administrative convenience; and 
 (f) The adoption and execution of any agreement among the holders of the Company’s
Stock, as may be amended from time to time, or any similar agreement as the Company may request. 
 4.6 Rights as Stockholder. The
holder of the Option shall not be, nor have any of the rights or privileges of, a stockholder of the Company in respect of any shares purchasable upon the exercise of any part of the Option unless and until such shares shall have been issued by the
Company to such holder (as evidenced by the appropriate entry on the books of the Company or 

  
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of a duly authorized transfer agent of the Company). No adjustment will be made for a dividend or other right for which the record date is prior to the date the shares are issued, except as
provided in Article 11 of the Plan. 
 ARTICLE V 

OTHER PROVISIONS 

5.1 Administration. The Committee shall have the power to interpret the Plan and this Agreement and to adopt such rules for the
administration, interpretation and application of the Plan as are consistent therewith and to interpret, amend or revoke any such rules. All actions taken and all interpretations and determinations made by the Committee in good faith shall be final
and binding upon Participant, the Company and all other interested persons. No member of the Committee shall be personally liable for any action, determination or interpretation made in good faith with respect to the Plan, this Agreement or the
Option. In its absolute discretion, the Board may at any time and from time to time exercise any and all rights and duties of the Committee under the Plan and this Agreement. 

5.2 Option Not Transferable. 

(a) Subject to Section 5.2(b), the Option may not be sold, pledged, assigned or transferred in any manner other than by will or the laws
of descent and distribution, unless and until the shares underlying the Option have been issued, and all restrictions applicable to such shares have lapsed. Neither the Option nor any interest or right therein shall be liable for the debts,
contracts or engagements of Participant or his or her successors in interest or shall be subject to disposition by transfer, alienation, anticipation, pledge, encumbrance, assignment or any other means whether such disposition be voluntary or
involuntary or by operation of law by judgment, levy, attachment, garnishment or any other legal or equitable proceedings (including bankruptcy), and any attempted disposition thereof shall be null and void and of no effect, except to the extent
that such disposition is permitted by the preceding sentence or otherwise in Section 10.3 of the Plan. 
 (b) Notwithstanding any
other provision in this Agreement, with the consent of the Committee and to the extent the Option is not intended to qualify as an Incentive Stock Option, the Option may be transferred to one or more Permitted Transferees, subject to the terms and
conditions set forth in Section 10.3 of the Plan. 
 (c) Unless transferred to a Permitted Transferee in accordance with
Section 5.2(b), during the lifetime of Participant, only Participant may exercise the Option or any portion thereof. Subject to such conditions and procedures as the Committee may require, a Permitted Transferee may exercise the Option or any
portion thereof during Participant’s lifetime. After the death of Participant, any exercisable portion of the Option may, prior to the time when the Option becomes unexercisable under Section 3.3, be exercised by Participant’s
personal representative or by any person empowered to do so under the deceased Participant’s will or under the then applicable laws of descent and distribution. 

  
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 5.3 Restrictive Legends and Stock Transfer Orders. 

(a) The share certificate or certificates evidencing the shares of Stock purchased hereunder shall be endorsed with any legends that may be
required by state or federal securities laws, and shall also be endorsed with a legend substantially as follows: 
 THE SALE, PLEDGE, HYPOTHECATION OR
TRANSFER OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE IS SUBJECT TO, AND IN CERTAIN CASES PROHIBITED BY, THE TERMS AND CONDITIONS OF A CERTAIN RIGHT OF FIRST REFUSAL CONTAINED IN A CERTAIN STOCK OPTION GRANT AGREEMENT BY AND BETWEEN THE
STOCKHOLDER AND THE CORPORATION. COPIES OF SUCH AGREEMENT MAY BE OBTAINED UPON WRITTEN REQUEST TO THE SECRETARY OF THE CORPORATION. 
 (b)
Participant agrees that, in order to ensure compliance with the restrictions referred to herein, the Company may issue appropriate “stop transfer” instructions to its transfer agent, if any, and that, if the Company transfers its own
securities, it may make appropriate notations to the same effect in its own records. 
 (c) The Company shall not be required: (i) to
transfer on its books any shares of Stock that have been sold or otherwise transferred in violation of any of the provisions of this Agreement, or (ii) to treat as owner of such shares of Stock or to accord the right to vote or pay dividends to
any purchaser or other transferee to whom such shares shall have been so transferred. 
 5.4 Shares to Be Reserved. The Company shall
at all times during the term of the Option reserve and keep available such number of shares of Stock as will be sufficient to satisfy the requirements of this Agreement. 

5.5 Notices. Any notice to be given under the terms of this Agreement to the Company shall be addressed to the Company in care of the
Company’s Chief Executive Officer at the Company’s principal office, and any notice to be given to Participant shall be addressed to Participant at the address given beneath Participant’s signature on the Grant Notice. By a notice
given pursuant to this Section 5.5, either party may hereafter designate a different address for notices to be given to that party. Any notice which is required to be given to Participant shall, if Participant is then deceased, be given to the
person entitled to exercise his or her Option pursuant to Section 4.1 by written notice under this Section 5.5. Any notice shall be deemed duly given when sent via email or when sent by certified mail (return receipt requested) and
deposited (with postage prepaid) in a post office or branch post office regularly maintained by the United States Postal Service. 
 5.6
Titles. Titles are provided herein for convenience only and are not to serve as a basis for interpretation or construction of this Agreement. 

5.7 Governing Law; Severability. This Agreement shall be administered, interpreted and enforced under the laws of the State of
Delaware, without regard to the conflicts of law principles thereof. Should any provision of this Agreement be determined by a court of law to be illegal or unenforceable, the other provisions shall nevertheless remain effective and shall remain
enforceable. 

  
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 5.8 Conformity to Securities Laws. Participant acknowledges that the Plan is intended to
conform to the extent necessary with all provisions of the Securities Act and the Exchange Act and any and all regulations and rules promulgated by the Securities and Exchange Commission thereunder, and state securities laws and regulations.
Notwithstanding anything herein to the contrary, the Plan shall be administered, and the Option is granted and may be exercised, only in such a manner as to conform to such laws, rules and regulations. To the extent permitted by applicable law, the
Plan and this Agreement shall be deemed amended to the extent necessary to conform to such laws, rules and regulations. The Company may restrict the transfer of the shares subject to this Option in such manner as it deems advisable, defer the
effectiveness of an exercise of this Option or require that the Participant make such reasonable covenants, agreements and representations, to ensure the availability of any exemption from registration or qualification under, and to otherwise comply
with, Federal and state securities laws, regulations, rules and requirements. 
 5.9 Amendments. This Agreement may not be modified,
amended or terminated except by an instrument in writing, signed by Participant or such other person as may be permitted to exercise the Option pursuant to Section 4.1 and by a duly authorized representative of the Company. 

5.10 Successors and Assigns. The Company may assign any of its rights under this Agreement to single or multiple assignees, and this
Agreement shall inure to the benefit of the successors and assigns of the Company. Subject to the restrictions on transfer herein set forth in Section 5.2, this Agreement shall be binding upon Participant and his or her heirs, executors,
administrators, successors and assigns. 
 5.11 Notification of Disposition. If this Option is designated as an Incentive Stock
Option, Participant shall give prompt notice to the Company of any disposition or other transfer of any shares of Stock acquired under this Agreement if such disposition or transfer is made (a) within two years from the Grant Date with respect
to such shares or (b) within one year after the transfer of such shares to him. Such notice shall specify the date of such disposition or other transfer and the amount realized, in cash, other property, assumption of indebtedness or other
consideration, by Participant in such disposition or other transfer. 
 5.12 Limitations Applicable to Section 16 Persons.
Notwithstanding any other provision of the Plan or this Agreement, if Participant is subject to Section 16 of the Exchange Act, the Plan, the Option and this Agreement shall be subject to any additional limitations set forth in any applicable
exemptive rule under Section 16 of the Exchange Act (including any amendment to Rule 16b-3 of the Exchange Act) that are requirements for the application of such exemptive rule. To the extent permitted by applicable law, this Agreement shall be
deemed amended to the extent necessary to conform to such applicable exemptive rule. 

  
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 5.13 Entire Agreement. The Participant acknowledges and agrees that the Plan and this
Agreement (including all Exhibits hereto) constitute the entire agreement of the parties and supersede in their entirety all prior undertakings and agreements of the Company and Participant with respect to the subject matter hereof. 

[END OF TEXT] 

  
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 IN WITNESS WHEREOF, the Company and the Participant have executed this Stock Option Agreement as
of the dates written below. 
  

			
	APELLIS PHARMACEUTICALS, INC.
		
	By	 	  

		 	Cedric Francois, President and CEO
	
	PARTICIPANT
	
	  

	[NAME]
	
	Date:                     



  
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 EXHIBIT B 

Vesting Schedule 
 [Subject to the terms and
conditions of the Option Agreement, one-fourth (25%) of the shares of Stock stated on the Grant Notice (the “Shares”) shall vest and become exercisable on the attainment of the date that is 12 months after the date of the Grant
Notice. Thereafter, 1/48th (or 2.0833%) of the Shares shall vest and become exercisable on the first day of each of the following 36 months]; provided, however, one-fourth
(25%) of the Shares shall vest and become exercisable immediately upon the occurrence of a Change of Control. 
 The Participant shall be
allowed to exercise the Option on a “cashless exercise” basis as set forth in Sections 4.4(d) and (e). 







 EXHIBIT C 

FORM OF EXERCISE NOTICE 







 FORM OF EXERCISE NOTICE 

Effective as of today,
                    , the undersigned (“Participant”) hereby elects to exercise Participant’s option to purchase the number of
shares of common stock specified below (the “Shares”) of Apellis Pharmaceuticals, Inc., a Delaware corporation (the “Company”), under and pursuant to the Apellis Pharmaceuticals, Inc. 2010 Equity Incentive Plan (the
“Plan”) and the Stock Option Grant Notice and Stock Option Agreement dated as of (the “Option Agreement”). Capitalized terms used herein without definition shall have the meanings given in the Plan and, if not
defined in the Plan, the Option Agreement. 
  

					
	 GRANT DATE:
	  		  	
			
	 NUMBER OF SHARES AS TO WHICH OPTION IS EXERCISED:
	  		  	
			
	 EXERCISE PRICE PER SHARE:
	  	$            	  	
			
	 TOTAL EXERCISE PRICE:
	  	$            	  	
			
	 CERTIFICATE TO BE ISSUED IN NAME OF:
	  		  	
		
	 PAYMENT DELIVERED HEREWITH:
	  	$             (Representing the full exercise price for the Shares, as well as any applicable withholding tax)
			
	 FORM OF PAYMENT
	  	  
	  	
		  	(Please specify)
		
	 TYPE OF OPTION:
	  	 ̈ Incentive Stock Option
		  	 ̈ Non-Qualified Stock Option

 Participant acknowledges that Participant has received, read and understood the Plan and the Option Agreement.
Participant agrees to abide by and be bound by their terms and conditions. Participant understands that Participant may suffer adverse tax consequences as a result of Participant’s purchase or disposition of the Shares. Participant represents
that Participant has consulted with any tax consultants Participant deems advisable in connection with the purchase or disposition of the Shares and that Participant is not relying on the Company for any tax advice. The Plan and Option Agreement are
incorporated herein by reference. This Agreement, the Plan and the Option Agreement constitute the entire agreement of the parties and supersede in their entirety all prior undertakings and agreements of the Company and Participant with respect to
the subject matter hereof. 







 
			
	SUBMITTED BY:
	
	PARTICIPANT
	
	  

	Print Name:	 	  

	Address:	 	  

		 	  

		 	  



  

			
	ACCEPTED BY:
	
	APELLIS PHARMACEUTICALS, INC.
		 	
	By	 	  

	Name:	 	  

	Title:	 	  



Date:                      

  
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