Exhibit 4.1


 


FORM OF WARRANT


 


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


 


	Warrant No. _____	[            ], 2013


 


LABSTYLE INNOVATIONS CORP.


Common
Stock Purchase Warrant


 


THIS CERTIFIES THAT,
for value received, [              ] (the “Holder”),
is entitled to subscribe for and purchase, at the Exercise Price (as defined below), from LabStyle Innovations Corp., a Delaware
corporation (the “Company”), shares of the Company’s common stock, par value $0.0001 (the “Common
Stock”), at any time prior to three (3) year anniversary of the First Closing (as defined below) (the “Warrant
Exercise Term”).


 


This Warrant is issued
in connection with the Company’s private offering solely to accredited investors of units in accordance with, and subject
to, the terms and conditions described in the Subscription Agreement between the initial Holder and the Company (the “Subscription
Agreement”) in connection with the private placement offering of the Company (the “Offering”) described
in that certain Confidential Private Placement Memorandum, dated March 28, 2013, as the same may be amended and supplemented from
time to time (the “Memorandum”).


 


The term “First
Closing” means the date that the Company and the Placement Agent may conduct a first closing once the Escrow Account
contains at least the Minimum Offering and other conditions to closing are satisfied.


 


The term “Minimum
Offering” means the $1,000,000 minimum aggregate amount of the Offering.


 


This Warrant is subject to the following
terms and conditions:


 


1.         Shares.
The Holder has, subject to the terms set forth herein, the right to purchase up to an aggregate of [                    
] shares (the “Shares”) of Common Stock at a per share exercise price of $5.00 (the “Exercise Price”).


 




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		2.	Exercise of Warrant.



 


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


 


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


 


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


 


		3.	Adjustment of Exercise Price.



 


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


 




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


 


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


 


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


 


4.         Notices.
Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be mailed by certified
mail, return receipt requested, or delivered by facsimile transmission or by e-mail transmission, or delivered against receipt
to the party to whom it is to be given (a) if to the Company, at the address provided to the Holder, or (b) if to the Holder, at
the address set forth in the Company’s records (or, in either case, to such other address as the party shall have furnished
in writing in accordance with the provisions of this Section 4). Any notice or other communication given by certified mail shall
be deemed given at the time of receipt thereof.


 




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


 


THIS SECURITY HAS NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR THE SECURITIES
LAWS OF ANY STATE AND MAY NOT BE TRANSFERRED OR OTHERWISE SOLD UNLESS IT HAS BEEN REGISTERED UNDER SUCH ACT AND ALL SUCH APPLICABLE
STATE SECURITIES LAWS OR PURSUANT TO AN OPTION OF COUNSEL REASONABLY SATISFACTORY TO THE ISSUER THAT APPLICABLE REGISTRATION REQUIREMENTS
OF SUCH ACT AND SUCH LAWS IS AVAILABLE.”


 


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


 


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


 


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


 


9.         No
Transfer. This Warrant is not assignable or transferable, except to Permitted Transferees of the Holder. The term “Permitted
Transferee” means (a) a spouse, child, step child, descendants or the lineal ancestors of such Holder or such Holder’s
spouse; (b) the custodian, executor, heirs, receiver, liquidator or trustee of the Holder or such Holder’s estate upon (i)
the death of such Holder for purposes of administration of such Holder’s estate, or (ii) upon the incompetence of such Holder
for purposes of the protection and management of such Holder’s assets; (c) a family limited partnership or limited liability
company in which all interests are held by the Holder, the Holder’s spouse, and/or the lineal ancestors, step children, siblings,
nieces, nephews or descendants of such Holder or such Holder’s spouse; provided, that control of such partnership or limited
liability company by virtue of voting power resides with such Holder, his spouse, or a combination of both; (d) a trust, all of
the beneficiaries of which are a Holder, the Holder’s spouse and/or the lineal ancestors, step children, siblings, nieces,
nephews or descendants of such Holder or such Holder’s spouse; provided, that control of such partnership or limited liability
company by virtue of voting power resides with such Holder, such Holder’s spouse, or a combination of both; (e) a limited
liability company or other entity provided that the majority interest in such entity is and continues to be owned or controlled
by the Holder; (f) with respect to any Holder that is a trust, all of the beneficiaries of such trust, and the spouse, children,
step children, nieces, nephews, descendants or the lineal ancestors of such beneficiaries, or (g) with respect to any Holder that
is a non-natural person, to a person that is controlled by, or is under common control with such person; provided, that the transferor
shall remain liable for the obligations of such Permitted Transferee. Any transfer of this Warrant to a Permitted Transferee shall
be effective upon delivery of this Warrant and the form of assignment attached hereto as Exhibit B, accompanied by an (i) investment
letter in form and substance satisfactory to the Company and (ii) such other assurances reasonably required by the Company to ensure
that such transfer does not violate applicable securities laws.


 




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10.         Miscellaneous.


 


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


 


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


 


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


 


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


 


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


 


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


 


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


 


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


 


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


 


	 	LABSTYLE INNOVATIONS CORP.
	 	 	 
	 	By:	 
	 	 	Name: 
	 	 	Title:


  




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Exhibit A


NOTICE OF EXERCISE


 


		TO:	LabStyle Innovations Corp.



Attention: President


 


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


 


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


 


	 
	(Name)
	 
	 
	(Address)


 


The undersigned
hereby represents and warrants the following:


 


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


 


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


 


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


 


(d)         It
has no present need for liquidity in its investment in the Shares; and


 


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


 


	 	 	 
	 	(Signature and Date)	 


  




    	 



    	 



    

  


Exhibit B


 


FORM OF ASSIGNMENT


 


FOR VALUE RECEIVED,
___________________________________ hereby sells, assigns and transfers to each assignee set forth below all of the rights of the
undersigned under the Warrant (as defined in and evidenced by the attached Warrant) to acquire the number of Shares set opposite
the name of such assignee below and in and to the foregoing Warrant with respect to said acquisition rights and the shares issuable
upon exercise of the Warrant:


 





	Name of Assignee	 	 	Address	 	 	Number of Shares	 
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 












If the total of the
Shares are not all of the Shares evidenced by the foregoing Warrant, the undersigned requests that a new Warrant evidencing the
right to acquire the Shares not so assigned be issued in the name of and delivered to the undersigned.


 


	 	Name of Holder (print): ________________________
	 	(Signature): ___________________________________
	 	(By:)  _________________________________________
	 	(Title:) ________________________________________
	 	Dated: ________________________________________