Exhibit 10.3


 


 





WARRANT EXERCISE AGREEMENT


 


This Warrant Exercise
Agreement (this “Agreement”), dated as of December 16, 2019, is by and between Genius Brands International,
Inc., a Nevada corporation (the “Company”), and the undersigned holder (the “Holder”) of
warrants to purchase shares of the Company’s common stock, no par value (the “Common Stock”).


 








WHEREAS, the Holder
beneficially owns warrants to purchase shares of Common Stock at an exercise price of $3.00 per share that were issued in August
2018, as set forth on the Holder's signature page hereto (the “Original Warrants”).


 


WHEREAS, in order to
induce the Holder to exercise the Original Warrants, the Company and the Holder hereby agree to amend the Warrants to reduce the
exercise price thereof to $0.21 (the "Amended Exercise Price").


 


WHEREAS, the Holder
desires to exercise such Original Warrants in the amounts set forth on the applicable signature pages hereto using the Amended
Exercise Price and, immediately prior to such exercise and in consideration of the Holder’s exercise of such Original Warrants,
the Company has agreed to issue the Holder, in addition to the shares of Common Stock to which such exercising Holder is entitled
pursuant to the exercise of the Original Warrants, an equal number of new warrants as the number of Original Warrants being exercised
with an exercise price of $0.3004 per share in the form attached hereto as Exhibit A (the “New Warrants”). The
shares of Common Stock underlying the Original Warrants are referred to herein as the “Warrant Shares”. The
shares of Common Stock underlying the New Warrants are referred to herein as the "New Warrant Shares" and collectively
with the New Warrants and Warrant Shares, the "Securities".


 


NOW, THEREFORE, IN
CONSIDERATION of the mutual covenants contained in this Agreement, and for good and valuable consideration the receipt and adequacy
of which are hereby acknowledged, the Holder and the Company agree as follows:


 


ARTICLE I


DEFINITIONS


 


Section 1.1 Definitions. Capitalized
terms not defined in this Agreement shall have the meanings ascribed to such terms in the New Warrants.


 


ARTICLE II


EXERCISE OF ORIGINAL WARRANTS


 





Section 2.1 Exercise of Warrants.
Subject to the conditions in Section 2.3 below and the provisions of Section 2.5 below, by executing this Agreement, the Company
and the Holder hereby agree that the Holder shall be deemed to have exercised the number of Original Warrants set forth on the
signature page hereto for aggregate cash proceeds to the Company in the amount set forth on the Holder’s signature page
hereto, pursuant to the terms of the Original Warrants, except that the exercise price thereunder shall be the Amended Exercise
Price (as defined below). The Holder shall deliver the aggregate cash exercise price for such Original Warrants to the bank account
set forth on the Company’s signature page hereto within one Trading Day after the date hereof and the Company shall deliver
the Warrant Shares to the Holder via the Depository Trust Company Deposit or Withdrawal at Custodian system pursuant to the terms
of the Original Warrants, but (i) pursuant to DWAC instructions set forth on the Holder’s signature page hereto, and (ii)
with respect to the Original Warrants such that the Warrant Shares are delivered to the Holder no later than two (2) Trading Days
following the Closing Date. The date of the closing of the deemed exercise of the Original Warrants pursuant to this Section 2.1
shall be referred to as the “Closing Date”.


 


 


 






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Section 2.2 Issuance of New
Warrants. Within five Trading Days of the Closing Date, the Company shall deliver to the Holder the New Warrants to which the
Holder is entitled. The Holder shall be entitled to receive a New Warrant issuable for the identical number of shares of Common
Stock as the Holder is deemed to have exercised for cash pursuant to Section 2.1 above. Notwithstanding the foregoing, the Holder
will be deemed to have been issued the New Warrants as of the Closing Date, despite the fact that the New Warrant is only required
to be physically delivered within five Trading Days of the Closing Date.


 


Section 2.3 Legends; Restricted
Securities. (a) The Holder understands that the New Warrants and the shares of Common Stock underlying New Warrants are not,
and may never be, registered under the Securities Act of 1933, as amended (the “Securities Act”), or the securities
laws of any state and, accordingly, each certificate, if any, representing such securities shall bear a legend substantially similar
to the following:


 


“THIS
SECURITY HAS NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE
UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY,
MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE
EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH
APPLICABLE STATE SECURITIES LAWS. THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN ACCOUNT WITH A REGISTERED
BROKER-DEALER OR OTHER LOAN WITH A FINANCIAL INSTITUTION THAT IS AN “ACCREDITED INVESTOR” AS DEFINED IN RULE 501(a)
UNDER THE SECURITIES ACT OR OTHER LOAN SECURED BY SUCH SECURITIES.”


 


(b)       Certificates
evidencing shares of Common Stock underlying the New Warrants shall not contain any legend (including the legend set forth in Section
2.3(a) hereof), (i) while a registration statement covering the resale of such Common Stock is effective under the Securities Act,
(ii) following any sale of such Common Stock pursuant to Rule 144, (iii) if such Common Stock is eligible for sale under Rule 144,
without the requirement for the Company to be in compliance with the current public information required under Rule 144 as to such
Common Stock and without volume or manner-of-sale restrictions, (iv) if such Common Stock may be sold under Rule 144 and the
Company is then in compliance with the current public information required under Rule 144 as to such Common Stock, or (v) if such
legend is not required under applicable requirements of the Securities Act (including judicial interpretations and pronouncements
issued by the staff of the Securities and Exchange Commission (the “Commission”)). The Company shall cause its
counsel to issue a legal opinion to the transfer agent promptly after the Delegend Date (as defined below) if required by the Company
and/or the transfer agent to effect the removal of the legend hereunder, which opinion shall be in form and substance reasonably
acceptable to the Holder. If such Common Stock may be sold under Rule 144 without the requirement for the Company to be in compliance
with the current public information required under Rule 144 or if such legend is not otherwise required under applicable requirements
of the Securities Act (including judicial interpretations and pronouncements issued by the staff of the Commission) then such Common
Stock shall be issued free of all legends. The Company agrees that following the Delegend Date or at such time as such legend is
no longer required under this Section 2.3(b), it will, no later than two (2) Trading Days following the delivery by the Holder
to the Company or the transfer agent of a certificate representing the Common Stock underlying the New Warrants issued with a restrictive
legend (such second Trading Day, the “Legend Removal Date”), deliver or cause to be delivered to the Holder
a certificate representing such shares that is free from all restrictive and other legends or, at the request of the Holder shall
credit the account of the Holder’s prime broker with the Depository Trust Company System as directed by the Holder. The Company
may not make any notation on its records or give instructions to the transfer agent that enlarge the restrictions on transfer set
forth in this Section 2.3(b). “Delegend Date” means the earliest of the date that (a) a registration statement
with respect to the Common Stock has been declared effective by the Commission or (b) all of the Common Stock has been sold pursuant
to Rule 144 or may be sold pursuant to Rule 144 without the requirement for the Company to be in compliance with the current public
information required under Rule 144 and without volume or manner-of-sale restrictions or (c) following the six (6) month anniversary
of (I) the Closing Date if a New Warrant is exercised pursuant to a cashless exercise or (II) the date of the related cash exercise
of the New Warrants provided, in each case that the applicable holder of the New Warrants or the Common Stock, as the case may
be, is not an Affiliate of the Company, the Company is in compliance with the current public information required under Rule 144
(“Current Public Information Requirement”) and all such Common Stock may be sold pursuant to Rule 144 or an
exemption from registration under Section 4(a)(1) of the Securities Act without volume or manner-of-sale restrictions; provided,
further, however, that if the Company fails to comply with the Current Public Information Requirement at any time following the
applicable six (6) month anniversary set forth above and the one (1) year anniversary of the Closing Date, the Company shall promptly
provide notice to the Holder and the Holder undertakes not to sell such Common Stock pursuant to Rule 144 until the Company notifies
the Holder that it has regained compliance with the Current Public Information Requirement; and provided further, that if
a delegending is in effect solely as the result of the effectiveness of a registration statement covering the resale of any Common
Stock, the Holder undertakes not to sell any such Common Stock if the Holder is notified or otherwise becomes aware that such registration
statement has been withdrawn or suspended, contains a material misstatement or omission or has become stale. The Holder agrees
with the Company that the Holder will sell or transfer any New Warrants or shares of Common Stock underlying New Warrants pursuant
to either the registration requirements of the Securities Act, including any applicable prospectus delivery requirements, or an
exemption therefrom, and that if such securities are sold pursuant to a registration statement, they will be sold in compliance
with the plan of distribution set forth therein, and acknowledges that the removal of the restrictive legend from certificates
representing any such securities as set forth in this Section 2.3 or otherwise is predicated upon the Company’s reliance
upon this understanding.


 


 


 






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Section 2.4      Filing of Form
8-K. Prior to 9:00 am ET on December 16, 2019, the Company shall issue a Current Report on Form 8-K, reasonably acceptable
to the Holder disclosing the material terms of the transactions contemplated hereby and pursuant to substantially similar agreements
with other Company warrant holders, which shall include this form of Agreement (the “8-K Filing”). From and
after the issuance of the 8-K Filing, the Company represents to the Holder that it shall not be in possession of any material,
nonpublic information received from the Company, any of its Subsidiaries or any of their respective officers, directors, employees
or agents, that is not disclosed in the 8-K Filing. In addition, effective upon the filing of the 8-K Filing, the Company acknowledges
and agrees that any and all confidentiality or similar obligations under any agreement, whether written or oral, between the Company,
any of its Subsidiaries or any of their respective officers, directors, employees or agents, on the one hand, and the Holder or
any of its affiliates, on the other hand, shall terminate. The Company shall not, and shall cause each of its Subsidiaries and
its and each of their respective officers, directors, employees and agents, not to, provide the Holder with any material, nonpublic
information regarding the Company or any of its Subsidiaries from and after the date hereof without the express prior written consent
of the Holder. To the extent that the Company, any of its Subsidiaries or any of their respective officers, directors, employees
or agents, delivers any material, non-public information to the Holder without the Holder’s consent, the Company hereby covenants
and agrees that the Holder shall not have any duty of confidentiality with respect to, or a duty not to trade on the basis of,
such material, non-public information.


 


Section 2.5.    Amendment to Exercise
Price in Original Warrants. The Company and the Holder hereby agree to amend and restate Section 2(b) of the Original Warrants
as follows: "b) Exercise Price. The exercise price per share of the Common Stock under this Warrant shall be $0.21,
subject to adjustment hereunder (the "Exercise Price")".


 


ARTICLE III


REPRESENTATIONS AND WARRANTIES


 


Section 3.1     Representations
and Warranties of the Company. The Company hereby makes the representations and warranties set forth below to the Holder that
as of the date of its execution of this Agreement:


 


(a)        Authorization;
Enforcement. The Company has the requisite corporate power and authority to enter into and to consummate the transactions contemplated
by this Agreement and otherwise to carry out its obligations hereunder and thereunder. The execution and delivery of this Agreement
by the Company and the consummation by it of the transactions contemplated hereby have been duly authorized by all necessary action
on the part of such Company and no further action is required by such Company, its board of directors or its stockholders in connection
therewith. This Agreement has been duly executed by the Company and, when delivered in accordance with the terms hereof will constitute
the valid and binding obligation of the Company enforceable against the Company in accordance with its terms except (i) as
limited by general equitable principles and applicable bankruptcy, insolvency, reorganization, moratorium and other laws of general
application affecting enforcement of creditors’ rights generally, (ii) as limited by laws relating to the availability
of specific performance, injunctive relief or other equitable remedies and (iii) insofar as indemnification and contribution
provisions may be limited by applicable law.


 


(b)        Organization.
The Company is a duly organized and validly existing corporation in good standing under the laws of the State of Nevada.


 


(c)        Registration
Statement. The Warrant Shares are registered for resale on a Form S-3 Registration Statement (the “Registration Statement”)
and the Company knows of no reasons why such Registration Statement shall not remain available for the resale by the Holder of
such Warrant Shares for the foreseeable future. The Company shall use commercially reasonable efforts to keep the Registration
Statement effective and available for the resale of the Warrant Shares underlying the Original Warrants until all Original Warrants
are exercised and the Warrant Shares are sold by the Holder. If the Company is unable to keep the Registration Statement effective
and available, the Holder may exercise the Original Warrants by means of a cashless exercise in accordance with the terms of the
Original Warrants, but using the Amended Exercise Price.


 


 


 






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(d)        No
Conflicts. The execution, delivery and performance of this Agreement by the Company and the consummation by the Company of
the transactions contemplated hereby do not and will not: (i) conflict with or violate any provision of the Company’s
certificate or articles of incorporation, bylaws or other organizational or charter documents, or (ii) conflict with, or constitute
a default (or an event that with notice or lapse of time or both would become a default) under, result in the creation of any lien
upon any of the properties or assets of the Company, or give to others any rights of termination, amendment, acceleration or cancellation
(with or without notice, lapse of time or both) of, any material agreement, credit facility, debt or other material instrument
(evidencing Company debt or otherwise) or other material understanding to which the Company is a party or by which any property
or asset of the Company is bound or affected which have not been waived, or (iii) conflict with or result in a violation of
any law, rule, regulation, order, judgment, injunction, decree or other restriction of any court or governmental authority to which
the Company is subject (including federal and state securities laws and regulations), or by which any property or asset of the
Company is bound or affected.


 


(e)        Disclosure.
Except with respect to the material terms and conditions of the transactions contemplated by this Agreement and substantially
similar agreements with other Company warrant holders, the Company confirms that neither it nor any other Person acting on its
behalf has provided any of Holder or their agents or counsel with any information that it believes constitutes or might constitute
material, non-public information. The Company understands and confirms that the Holder will rely on the foregoing representation
in effecting transactions in securities of the Company. All of the disclosure furnished by or on behalf of the Company to the Holder
regarding the Company and its Subsidiaries, their respective businesses and the transactions contemplated hereby, including but
not limited to the disclosure set forth in the SEC Reports, is true and correct and does not contain any untrue statement of a
material fact or omit to state any material fact necessary in order to make the statements made therein, in light of the circumstances
under which they were made, not misleading. As used herein, “SEC Reports” means all reports, schedules, forms,
statements and other documents required to be filed by the Company with the Commission pursuant to the reporting requirements of
the 1934 Act, including all exhibits included therein and financial statements, notes and schedules thereto and documents incorporated
by reference therein.


 


(f)        Issuance
of Securities. The issuance of the New Warrants are duly authorized and, upon issuance in accordance with the terms of this
Agreement, the New Warrants shall be validly issued and free from all preemptive or similar rights (except for those which have
been validly waived prior to the date hereof), taxes, liens and charges and other encumbrances with respect to the issue thereof.
As of the Closing Date, a number of shares of Common Stock shall have been duly authorized and reserved for issuance which equals
or exceeds the maximum number of Warrant Shares issuable upon exercise of the New Warrants (without taking into account any limitations
on the exercise of the New Warrants set forth therein). Upon exercise of the New Warrants in accordance with the New Warrants,
the Warrant Shares when issued will be validly issued, fully paid and non-assessable and free from all preemptive or similar rights,
taxes, liens, charges and other encumbrances with respect to the issue thereof, with the holders being entitled to all rights accorded
to a holder of Common Stock. Assuming the accuracy of each of the representations and warranties set forth in Section 3.2 of this
Agreement, the offer and issuance by the Company of the New Warrants is exempt from registration under the 1933 Act.


 


(g)        No
General Solicitation. Neither the Company, nor any of its Subsidiaries or affiliates, nor any Person acting on its or their
behalf, has engaged in any form of general solicitation or general advertising (within the meaning of Regulation D) in connection
with the offer or sale of the New Warrants.


 


(h)       
No Integrated Offering. None of the Company, its Subsidiaries or any of their affiliates, nor any Person acting on their
behalf has, directly or indirectly, made any offers or sales of any security or solicited any offers to buy any security, under
circumstances that would require registration of the issuance of any of the New Warrants or the shares of Common Stock underlying
the New Warrants (collectively, the “Securities”) under the 1933 Act, whether through integration with prior
offerings or otherwise, or cause this offering of the Securities to require approval of shareholders of the Company for purposes
of the 1933 Act or any applicable shareholder approval provisions, including, without limitation, under the rules and regulations
of any exchange or automated quotation system on which any of the securities of the Company are listed or designated for quotation.
None of the Company, its Subsidiaries, their affiliates nor any Person acting on their behalf will take any action or steps that
would require registration of the issuance of any of the Securities under the 1933 Act or cause the offering of any of the Securities
to be integrated with other offerings for purposes of any such applicable shareholder approval provisions.


 


 


 


 






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(i)         No
Disqualification Events. With respect to Securities to be offered and sold hereunder in reliance on Rule 506(b) under the 1933
Act ("Regulation D Securities"), none of the Company, any of its predecessors, any affiliated issuer, any director,
executive officer, other officer of the Company participating in the offering hereunder, any beneficial owner of 20% or more of
the Company's outstanding voting equity securities, calculated on the basis of voting power, nor any promoter (as that term is
defined in Rule 405 under the 1933 Act) connected with the Company in any capacity at the time of sale (each, an "Issuer
Covered Person" and, together, "Issuer Covered Persons") is subject to any of the "Bad Actor"
disqualifications described in Rule 506(d)(1)(i) to (viii) under the 1933 Act (a "Disqualification Event"), except
for a Disqualification Event covered by Rule 506(d)(2) or (d)(3). The Company has exercised reasonable care to determine whether
any Issuer Covered Person is subject to a Disqualification Event. The Company has complied, to the extent applicable, with its
disclosure obligations under Rule 506(e), and has furnished to the Holder a copy of any disclosures provided thereunder.


 


Section 3.2     Representations
and Warranties of the Holder. The Holder hereby makes the representations and warranties set forth below to the Company that
as of the date of its execution of this Agreement.


 


(a)        Due
Authorization. The Holder represents and warrants that (i) the execution and delivery of this Agreement by it and the
consummation by it of the transactions contemplated hereby have been duly authorized by all necessary action on its behalf and
(ii) this Agreement has been duly executed and delivered by the Holder and constitutes the valid and binding obligation of
the Holder, enforceable against it in accordance with its terms.


 


(b)        No
Conflicts. The Holder represents and warrants that the execution, delivery and performance of this Agreement by the Holder
and the consummation by the Holder of the transactions contemplated hereby do not and will not: (i) conflict with or violate
any provision of the Holder’s organizational or charter documents, or (ii) conflict with or result in a violation of
any agreement, law, rule, regulation, order, judgment, injunction, decree or other restriction of any court or governmental authority
which would interfere with the ability of the Holder to perform its obligations under this Agreement.


 


(c)        Access
to Information. The Holder acknowledges that it has had the opportunity to review this Agreement and the SEC Reports and has
been afforded (i) the opportunity to ask such questions as it has deemed necessary of, and to receive answers from, representatives
of the Company concerning the terms and conditions of the exercise of the Original Warrants and the merits and risks of investing
in the Warrant Shares; (ii) access to information about the Company and its financial condition, results of operations, business,
properties, management and prospects sufficient to enable it to evaluate its investment; and (iii) the opportunity to obtain
such additional information that the Company possesses or can acquire without unreasonable effort or expense that is necessary
to make an informed investment decision with respect to the investment. The Holder acknowledges and agrees that neither Bradley
Woods & Co., Ltd. (the “Advisor”) nor any Affiliate of the Advisor has provided the Holder with any information
or advice with respect to the Securities nor is such information or advice necessary or desired. Neither the Advisor nor any
Affiliate has made or makes any representation as to the Company or the quality of the securities issued and issuable hereunder
and the Advisor and any Affiliate may have acquired non-public information with respect to the Company which the Holder agrees
need not be provided to it. In connection with the issuance of the securities hereunder to the Holder, neither the Advisor
nor any of its Affiliates has acted as a financial advisor or fiduciary to the Holder.


 


(d)        Holder
Status. The Holder represents and warrants that is an “accredited investor” as defined in Rule 501 under the Securities
Act.


 


(e)        Knowledge. The Holder, either alone or together with its representatives,
has such knowledge, sophistication and experience in business and financial matters so as to be capable of evaluating the merits
and risks of the prospective investment in the Warrant Shares, and has so evaluated the merits and risks of such investment. The
Holder is able to bear the economic risk of an investment in the Warrant Shares and, at the present time, is able to afford a
complete loss of such investment.


 


 






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ARTICLE IV


MISCELLANEOUS


 


Section 4.1     Notices.
Any and all notices or other communications or deliveries required or permitted to be provided hereunder shall be made by email
to the email address of the Holder set forth on Holders’ signature page.


 


Section 4.2     Survival. All
warranties and representations (as of the date such warranties and representations were made) made herein or in any certificate
or other instrument delivered by it or on its behalf under this Agreement shall be considered to have been relied upon by the
parties hereto and shall survive the issuance of the New Warrants. This Agreement shall inure to the benefit of and be binding
upon the successors and permitted assigns of each of the parties; provided however that no party may assign this Agreement or
the obligations and rights of such party hereunder without the prior written consent of the other parties hereto.


 


Section 4.3     Execution.
This Agreement may be executed in two or more counterparts, all of which when taken together shall be considered one and the same
agreement and shall become effective when counterparts have been signed by each party and delivered to the other party, it being
understood that both parties need not sign the same counterpart. In the event that any signature is delivered by facsimile transmission,
such signature shall create a valid and binding obligation of the party executing (or on whose behalf such signature is executed)
with the same force and effect as if such facsimile signature page were an original thereof.


 


Section 4.4     Severability.
If any provision of this Agreement is held to be invalid or unenforceable in any respect, the validity and enforceability of the
remaining terms and provisions of this Agreement shall not in any way be affected or impaired thereby and the parties will attempt
to agree upon a valid and enforceable provision that is a reasonable substitute therefor, and upon so agreeing, shall incorporate
such substitute provision in this Agreement.


 


Section 4.5     Governing Law.
All questions concerning the construction, validity, enforcement and interpretation of this Agreement shall be determined pursuant
to the Governing Law provision of the New Warrants.


 


Section 4.6     Entire Agreement.
The Agreement, together with the exhibits and schedules thereto, contain the entire understanding of the parties with respect to
the subject matter hereof and supersede all prior agreements and understandings, oral or written, with respect to such matters,
which the parties acknowledge have been merged into such documents, exhibits and schedules.


 


Section 4.7     Construction.
The headings herein are for convenience only, do not constitute a part of this Agreement and shall not be deemed to limit or affect
any of the provisions hereof. The language used in this Agreement will be deemed to be the language chosen by the parties to express
their mutual intent, and no rules of strict construction will be applied against any party.


 


Section 4.8     Fees and Expenses.
Except as expressly set forth herein, each party shall pay the fees and expenses of its advisers, counsel, accountants and other
experts, if any, and all other expenses incurred by such party incident to the negotiation, preparation, execution, delivery and
performance of this Agreement. The Company shall pay all transfer agent fees, stamp taxes and other taxes and duties levied in
connection with the delivery of any Warrant Shares.


 








Section 4.9    Prospectus Supplement.
On or prior to the Closing Date, the Company shall file with the Commission a supplement (the "Supplement") to the prospectus
supplement dated November 1, 2018 pursuant to the Rule 424(b)(3) as part of the Registration Statement on S-3 (registration number
333-227349) to give effect to the Amended Exercise Price.


 


 


 






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IN WITNESS WHEREOF, the undersigned
have executed this Warrant Exercise Agreement as of the date first written above.


COMPANY:


GENIUS BRANDS INTERNATIONAL, INC.


 


 


By:  _______________________________


Name:   ____________________________


Title:  ______________________________


 




Bank Account and Wire Instructions


 


[insert]


 


WARRANT HOLDER:


[NAME OF WARRANT HOLDER]


 


_________________________


 


By:  _______________________________


Name:   ____________________________


Title:  ______________________________


 


 


 


 


 






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[HOLDER SIGNATURE PAGES TO GNUS 


WARRANT EXERCISE AGREEMENT] 


 


IN WITNESS WHEREOF, the undersigned have caused this Agreement
to be duly executed by their respective authorized signatories as of the date first indicated above.


 


	 	 	 
	Name of Holder:	 	
 




 


	 	 	 
	Signature of Authorized Signatory of Holder:	 	
 




 


	 	 	 
	Name of Authorized Signatory:	 	
 




 


	 	 	 
	Title of Authorized Signatory:	 	
 




 


	 	 	 
	Email Address of Holder:	 	
 




 


	 	 	 
	Number of Original Warrants held: 	 	
 


	
         

        Number of Original Warrants deemed exercised:
	 	
 




 


 


 


 





	Aggregate Exercise
Price of Warrants deemed Exercised:	 



 


 





Warrant Shares underlying Warrants deemed Exercised:                                                        



 


Instructions for Warrant Shares
to be issued upon initial exercise of Original Warrants: _________________


 


Number of New Warrants to be issued to Holder upon deemed Exercise:                             


 





Address for Delivery of New Warrants for Holder: _______________________________________________



 






 


DWAC Instructions:




 


 


 


 


 






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