EXHIBIT 10.28


 


	Void after November 15, 2018	Warrant No. ________


 


			This Warrant and any shares acquired upon the exercise of this Warrant have not been registered
under the Securities Act of 1933. This Warrant and such shares may not be sold or transferred in the absence of such registration
or an exemption therefrom under said Act. This Warrant and such shares may not be transferred except upon the conditions specified
in this Warrant, and no transfer of this Warrant or such shares shall be valid or effective unless and until such conditions shall
have been complied with.



 


NANOVIBRONIX, INC.


 


FORM OF COMMON STOCK PURCHASE WARRANT


 


NanoVibronix, Inc. (the “Company”), having
its principal office at 105 Maxess Road, Suite S124, Melville, NY 11747, hereby certifies that, for value received, _____________
(“Investor”), or assigns, is entitled, subject to the terms set forth below, to purchase from the Company at any time
on, or from time to time after, _____ ___, 2014 and before 5:00 P.M., New York City time, on November 15 , 2018, or as curtailed
in accordance with the terms hereof (the “Expiration Date”), ______________ fully paid and non-assessable shares
of Warrant Shares of the Company, at the Purchase Price per share of $___. The number and character of such shares of Warrant Shares
and the Purchase Price per share are subject to adjustment as provided herein.


  


As used herein, the following terms have the following respective
meanings:


 


“Warrant Shares” means the common stock of
the Company Stock, par value $0.001 per share, of the Company.


 


“Affiliate” means any person or entity that,
directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with a person
or entity, as such terms are used in and construed under Rule 144 under the Securities Act. With respect to a Holder, any investment
fund or managed account that is managed on a discretionary basis by the same investment manager as such Holder will be deemed to
be an Affiliate of such Holder.


 


“Business Day” means any day other than Saturday,
Sunday or other day on which commercial banks in the city of New York, New York are authorized or required by law to remain closed.


 


“Common Stock” means the common stock, par
value $0.001 per share, of the Company.


 


“Common Stock Equivalent” means any Convertible
Security or warrant, option or other right to subscribe for or purchase any additional shares of Common Stock or any Convertible
Security.


 






    	 



    	 



    

 


“Convertible Security” means any stock or
other security (other than options) that is at any time and under any circumstances, directly or indirectly, convertible into,
exercisable or exchangeable for, or which otherwise entitles the holder thereof to acquire, any shares of Common Stock.


 


“Exchange Act” means the
Securities Exchange Act of 1934 as the same shall be in effect at the time.


 


“Holder” means any record owner of this Warrant.


 


“Per Share Market Value” has the meaning
set forth in Section 2.3.


 


“Original Issue Date” means _____ ___, 2014.


 


“Other Securities” refers to any stock (other
than Warrant Shares) and other securities of the Company or any other entity which the Holder of this Warrant at any time shall
be entitled to receive, or shall have received, upon the exercise of this Warrant, in lieu of or in addition to Warrant Shares,
or which at any time shall be issuable or shall have been issued in exchange for or in replacement of Warrant Shares or Other Securities
pursuant to Section 5 or otherwise.


 


“Securities Act” means the Securities Act
of 1933 as the same shall be in effect at the time.


 


“Underlying Securities” means any Warrant
Shares or Other Securities issued or issuable upon exercise of this Warrant.


 


“Warrant” means, as applicable, this Warrant
or each right as set forth in this Warrant to purchase one share of Warrant Shares, as adjusted.


 


1.Sale or Exercise Without Registration. If,
at the time of any exercise, transfer or surrender for exchange of a Warrant or of Underlying Securities previously issued upon
the exercise of Warrants, such Warrant or Underlying Securities shall not be registered under the Securities Act, the Company may
require, as a condition of allowing such exercise, transfer or exchange, that the Holder or transferee of such Warrant or Underlying
Securities, as the case may be, furnish to the Company an opinion of counsel, reasonably satisfactory to the Company, to the effect
that such exercise, transfer or exchange may be made without registration under the Securities Act.


 


2.Exercise of Warrant.


 


2.1.Exercise in Full.
Subject to the provisions hereof, this Warrant may be exercised in full by the Holder hereof by surrender of this Warrant, with
the form of subscription at the end hereof duly executed by such Holder, to the Company at its principal office accompanied by
payment, in cash or by certified or official bank check payable to the order of the Company, in the amount obtained by multiplying
the number of shares of Purchase Stock issuable upon exercise of this Warrant by the Purchase Price per share, after giving effect
to all adjustments through the date of exercise.


 






    	 



    	 



    

 


2.2.Partial Exercise.
Subject to the provisions hereof, this Warrant may be exercised in part by surrender of this Warrant in the manner and at the place
provided in Section 3.1 except that the amount payable by the Holder upon any partial exercise shall be the amount obtained by
multiplying (a) the number of shares of Warrant Shares (without giving effect to any adjustment therein) designated by the Holder
in the subscription at the end hereof, by (b) the Purchase Price per share. Upon any such partial exercise, the Company at its
expense will forthwith issue and deliver to or upon the order of the Holder hereof a new Warrant of like tenor, for the remaining
number of shares of Warrant Shares which may be purchased hereunder.


 


2.3 Cashless Exercise. In addition
to the method of payment set forth in Sections 2.1 and 2.2 and in lieu of any cash payment required thereunder, the Holder of the
Warrant shall have the right at any time and from time to time to exercise the Warrant in full or in part by surrendering this
Warrant in the manner and at the place specified in Section 3.1, specifying the number of shares for which this Warrant is being
exercised. The Company shall issue Holder the number of shares computed using the following formula:


 


	
         

        X=
	


 


	 	 	 
	where:	 	X = the number of Underlying Securities to be issued to Holder.
	 	 
	 	 	Y = the number of Underlying Securities for which this Warrant is being exercised.
	 	 
	 	 	A = the Purchase Price.
	 	 
	 	 	B = the Per Share Market Value of one share of Underlying Securities on the business day immediately preceding the date of such election


\


“Per
Share Market Value” means on any particular date (a) the closing sales price per share of the Underlying Securities
on such date on any registered national stock exchange on which the Underlying Securities is then listed, or if there is no such
closing sales price on such date, then the closing sales price on such exchange or quotation system on the date nearest preceding
such date, or (b) if the Underlying Securities is not then listed on a registered national stock exchange, the closing sales price
for a share of Underlying Securities in the over-the-counter market, as reported by the OTC Bulletin Board or the OTC Markets Group,
Inc. (or similar organization or agency succeeding to its functions of reporting prices) at the close of business on such date,
or (c) if the Underlying Securities is not then reported by the OTC Bulletin Board or the OTC Markets Group, Inc. (or similar organization
or agency succeeding to its functions of reporting prices), the fair market value of a share of Underlying Securities as determined
by the Board, acting in good faith. In determining the fair market value of any shares of Underlying Securities no consideration
shall be given to any restrictions on transfer of the Underlying Securities imposed by agreement or by federal or state securities
laws, or to the existence or absence of, or any limitations on, voting rights.


 






    	 



    	 



    

 


2.4.Certain Exercises.
If this Warrant is to be exercised in connection with a registered public offering or sale of the Company, such exercise may, at
the election of the Holder, be conditioned on the consummation of the public offering or sale of the Company, in which case such
exercise shall not be deemed effective until the consummation of such transaction.


 


2.5.Holder’s Exercise
Limitations. The Company shall not affect any exercise of this Warrant, and a Holder shall not have the right to exercise any
portion of this Warrant, pursuant to Section 2 or otherwise, to the extent that after giving effect to such issuance after exercise
as set forth on the applicable Exercise Notice, the Holder (together with the Holder’s Affiliates, and any other Persons
acting as a group together with the Holder or any of the Holder’s Affiliates), would beneficially own in excess of the Beneficial
Ownership Limitation (as defined below). For purposes of the foregoing sentence, the number of shares of Common Stock beneficially
owned by the Holder and its Affiliates shall include the number of shares of Common Stock issuable upon exercise of this Warrant
with respect to which such determination is being made, but shall exclude the number of shares of Common Stock which would be issuable
upon (i) exercise of the remaining, nonexercised portion of this Warrant beneficially owned by the Holder or any of its affiliates
and (ii) exercise or conversion of the unexercised or nonconverted portion of any other securities of the Company (including, without
limitation, any other  Common Stock Equivalents) subject to a limitation on conversion or exercise analogous to the limitation
contained herein beneficially owned by the Holder or any of its Affiliates.  Except as set forth in the preceding sentence,
for purposes of this Section 2.5, beneficial ownership shall be calculated in accordance with Section 13(d) of the Exchange Act
and the rules and regulations promulgated thereunder, it being acknowledged by the Holder that the Company is not representing
to the Holder that such calculation is in compliance with Section 13(d) of the Exchange Act and the Holder is solely responsible
for any schedules required to be filed in accordance therewith.   To the extent that the limitation contained in
this Section 2.5 applies, the determination of whether this Warrant is exercisable (in relation to other securities owned by the
Holder together with any Affiliates) and of which portion of this Warrant is exercisable shall be in the sole discretion of the
Holder, and the submission of a form of subscription shall be deemed to be the Holder’s determination of whether this Warrant
is exercisable (in relation to other securities owned by the Holder together with any Affiliates) and of which portion of this
Warrant is exercisable, in each case subject to the Beneficial Ownership Limitation, and the Company shall have no obligation to
verify or confirm the accuracy of such determination.   In addition, a determination as to any group status as contemplated
above shall be determined in accordance with Section 13(d) of the Exchange Act and the rules and regulations promulgated thereunder.  For
purposes of this Section 2.5, in determining the number of outstanding shares of Common Stock, a Holder may rely on the number
of outstanding shares of Common Stock as reflected in (A) the Company’s most recent periodic or annual report filed with
the Commission, as the case may be, (B) a more recent public announcement by the Company or (C) a more recent written notice by
the Company or the transfer agent setting forth the number of shares of Common Stock outstanding.  Upon the written or oral
request of a Holder, the Company shall within two Business Days confirm orally and in writing to the Holder the number of shares
of Common Stock then outstanding.  In any case, the number of outstanding shares of Common Stock shall be determined after
giving effect to the conversion or exercise of securities of the Company, including this Warrant, by the Holder or its Affiliates
since the date as of which such number of outstanding shares of Common Stock was reported.  The “Beneficial
Ownership Limitation” shall be 9.99% of the number of shares of the Common Stock outstanding immediately after giving
effect to the issuance of shares of Common Stock issuable upon exercise of this Warrant. The Holder, upon not less than 61 days’
prior written notice to the Company, may increase or decrease the Beneficial Ownership Limitation provisions of this Section 2.5,
provided that the Beneficial Ownership Limitation in no event exceeds 9.99% of the number of shares of the Common Stock outstanding
immediately after giving effect to the issuance of shares of Common Stock upon exercise of this Warrant held by the Holder and
the provisions of this Section 2.5 shall continue to apply.  Any such increase or decrease will not be effective until
the 61st day after such written notice is delivered to the Company. The provisions of this paragraph shall be construed and implemented
in a manner otherwise than in strict conformity with the terms of this Section 2.5 to correct this paragraph (or any portion hereof)
which may be defective or inconsistent with the intended Beneficial Ownership Limitation herein contained or to make changes or
supplements necessary or desirable to properly give effect to such limitation. The limitations contained in this paragraph shall
apply to a successor holder of this Warrant. The Beneficial Ownership Limitation provisions of this Section 2.5 may be waived at
the election of the Holder upon not less than 61 days’ prior written notice to the Company. Any such waiver will not be effective
and the provisions of this paragraph shall continue to apply until the 61st day (or later, if stated in the notice) after such
notice of waiver is delivered to the Company. Unless earlier waived, the provisions of this Section 25 shall expire and be of no
further force or effect as of November 14, 2018.


 






    	 



    	 



    

 


3.Delivery of Stock Certificates, etc., on Exercise.
As soon as practicable after the exercise of this Warrant in full or in part, the Company at its own expense (including the payment
by it of any applicable issue taxes) will cause to be issued in the name of and delivered to the Holder hereof, or as such Holder
(upon payment by such Holder of any applicable transfer taxes) may direct, a certificate or certificates for the number of fully
paid and non-assessable shares of Warrant Shares or Other Securities to which such Holder shall be entitled upon such exercise,
plus, in lieu of any fractional share to which such Holder would otherwise be entitled, cash equal to such fraction multiplied
by the then-current Market Price of one full share, together with any other stock or other securities and property (including cash,
where applicable) to which such Holder is entitled upon such exercise pursuant to Section 4 or otherwise.


 


4.Adjustment for Dividends in Other Stock, Property,
etc.; Reclassification, etc. In case at any time or from time to time after the Original Issue Date, the holders of Warrant
Shares (or, if applicable, Other Securities) shall have received, or (on or after the record date fixed for the determination of
stockholders eligible to receive) shall have become entitled to receive, without payment therefor


 






    	 



    	 



    

 


(a)other or additional
stock or other securities or property (other than cash) by way of dividend, or


 


(b)any cash paid or payable
(including, without limitation, by way of dividend), or


 


(c)other or additional
stock or other securities or property (including cash) by way of spin-off, split-up, reclassification, recapitalization, combination
of shares or similar corporate rearrangement,


 


then, and in each such case the Holder of this Warrant, upon
the exercise hereof as provided in Section 2, shall be entitled to receive the amount of stock and other securities and property
(including cash in the cases referred to in subdivisions (b) and (c) of this Section 4) which such Holder would hold on the date
of such exercise if on the Original Issue Date such Holder had been the Holder of record of the number of shares of Warrant Shares
called for on the face of this Warrant and had thereafter, during the period from the Original Issue Date to and including the
date of such exercise, retained such shares and all such other or additional stock and other securities and property (including
cash in the cases referred to in subdivisions (b) and (c) of this Section 4) receivable by such Holder as aforesaid during such
period, giving effect to all adjustments called for during such period by Section 5 hereof. If the number of shares of Warrant
Shares outstanding at any time after the date hereof is decreased by a combination or reverse stock split of the outstanding shares
of common stock, the Purchase Price per share shall be increased, and the number of shares of Warrant Shares purchasable under
this Warrant shall be decreased in proportion to such decrease in outstanding shares of Warrant Shares.


 


5.Reorganization, Consolidation, Merger, etc.
In case the Company after the Original Issue Date shall (a) effect a reorganization, (b) consolidate with or merge into any other
entity or (c) transfer all or substantially all of its properties or assets to any other entity under any plan or arrangement contemplating
the dissolution of the Company, then, in each such case, the Holder of this Warrant, upon the exercise hereof as provided in Section
3 at any time after the consummation of such reorganization, consolidation or merger or the effective date of such dissolution,
as the case may be, shall be entitled to receive (and the Company shall be entitled to deliver), in lieu of the Underlying Securities
issuable upon such exercise prior to such consummation or such effective date, the stock and other securities and property (including
cash) to which such Holder would have been entitled upon such consummation or in connection with such dissolution, as the case
may be, if such Holder had so exercised this Warrant immediately prior thereto, all subject to further adjustment thereafter as
provided in this Section 5; provided that if the sole consideration to which such Holder would have been entitled upon such consummation
or in connection with such dissolution, as the case may be, if such Holder had so exercised this Warrant immediately prior thereto,
is cash, the Warrant shall be terminated upon such consummation or dissolution. The Company shall not effect any such reorganization,
consolidation, merger or sale, unless prior to or simultaneously with the consummation thereof, the successor corporation resulting
from such consolidation or merger or the corporation purchasing such assets or the appropriate corporation or entity shall assume,
by written instrument, the obligation to deliver to each Holder the shares of stock, cash, other securities or assets to which,
in accordance with the foregoing provisions, each Holder may be entitled to and all other obligations of the Company under this
Warrant. In any such case, if necessary, the provisions set forth in this Section 5 with respect to the rights thereafter of the
Holders shall be appropriately adjusted so as to be applicable, as nearly as may reasonably be, to any Other Securities or assets
thereafter deliverable on the exercise of the Warrants.


 






    	 



    	 



    

 


6.Further Assurances. The Company will take all
such action as may be necessary or appropriate in order that the Company may validly and legally issue fully paid and non-assessable
shares of stock upon the exercise of all Warrants from time to time outstanding.


 


7.Officer's Certificate as to Adjustments. In
each case of any adjustment or readjustment in the shares of Warrant Shares (or Other Securities) issuable upon the exercise of
the Warrants, the Company will issue a certificate setting forth such adjustment or readjustment and the basis therefor.


 


8.Notices of Record Date, etc. In the event of


 


(a)any taking by the Company
of a record of its stockholders for the purpose of determining the stockholders thereof who are entitled to receive any dividend
or other distribution, or any right to subscribe for, purchase or otherwise acquire any shares of stock of any class or any other
securities or property, or to receive any other right, or for the purpose of determining stockholders who are entitled to vote
in connection with any proposed capital reorganization of the Company, any reclassification or recapitalization of the capital
stock of the Company or any transfer of all or substantially all the assets of the Company to or consolidation or merger of the
Company with or into any other person, or


 


(b)any voluntary or involuntary
dissolution, liquidation or winding-up of the Company, or


 


(c)any proposed issue
or grant by the Company of any common stock, or any other securities, or any right or option to subscribe for, purchase or otherwise
acquire any shares of stock of any class or any other securities (other than the issue of common stock on the exercise of the Warrants),


 


then and in each such event the Company will mail or cause to
be mailed to each Holder of a Warrant a notice specifying (i) the date on which any such record is to be taken for the purpose
of such dividend, distribution or right, and stating the amount and character of such dividend, distribution or right, (ii) the
date on which any such reorganization, reclassification, recapitalization, transfer, consolidation, merger, dissolution, liquidation
or winding-up is to take place, and the time, if any, as of which the Holders of record of Underlying Securities shall be entitled
to exchange their shares of Underlying Securities for securities or other property deliverable upon such reorganization, reclassification,
recapitalization, transfer, consolidation, merger, dissolution, liquidation or winding-up and (iii) the amount and character of
any stock or other securities, or rights or options with respect thereto, proposed to be issued or granted, the date of such proposed
issue or grant and the persons or class of persons to whom such proposed issue or grant and the persons or class of persons to
whom such proposed issue or grant is to be offered or made. Such notice shall be given at least 10 days prior to the date therein
specified.


 






    	 



    	 



    

 


9.Reservation of Stock, etc., Issuable on Exercise
of Warrants. The Company will at all times reserve and keep available, solely for issuance and delivery upon the exercise of
the Warrants, all shares of Warrant Shares (or Other Securities) from time to time issuable upon the exercise of the Warrants.


 


10.Notices, etc. All notices and other communications
from the Company to the Holder of this Warrant shall be delivered by fax or courier, at such address as may have been furnished
to the Company in writing by such Holder, or, until an address is so furnished, to and at the address of the last Holder of this
Warrant who has so furnished an address to the Company.


 


11.Miscellaneous. This Warrant and any term hereof
may be changed, waived, discharged or terminated only by an instrument in writing signed by the Company and the Holder or as otherwise
provided in the Subscription Agreement. This Warrant shall be governed by and construed and enforced in accordance with the General
Corporation Law of the State of Delaware without regard to principles of conflicts of law. Each party hereby irrevocably consents
and submits to the jurisdiction of any New York State or United States Federal Court sitting in the State of New York, County of
New York, over any action or proceeding arising out of or relating to this Agreement and irrevocably consents to the service of
any and all process in any such action or proceeding by registered mail addressed to such party at its address specified herein
(or as otherwise noticed to the other party). Each party further waives any objection to venue in New York and any objection to
an action or proceeding in such state and county on the basis of forum non conveniens. Each party also waives any right
to trial by jury.


 


	Dated: __________ __, 2014	 	NANOVIBRONIX, INC.
	 	 	 	By:  	 
	 	 	 	Name:	 
	Attest:   	 	 	Title:	 


 






    	 



    	 



    

  


FORM OF SUBSCRIPTION


(To be signed only upon exercise of Warrant)


 


To: NANOVIBRONIX, INC.


 


The undersigned, the Holder of the within
Warrant, hereby irrevocably elects to exercise the purchase right represented by such Warrant for, and to purchase thereunder,
_________ shares of Warrant Shares of NanoVibronix, Inc., and herewith makes payment therefor


 


(i) of $_____________ or


 


(ii) by surrender of the number of Warrants included
in the within Warrant required for full exercise pursuant to Section 2.3 of the Warrant,


and requests that the certificates for such shares be issued
in the name of, and delivered to, ___________________, whose address is _______________________.


 


Dated:


 


	 	 
	 	(Signature must conform in all respects to name of Holder as specified on the face of the Warrant)
	 	 
	 	 
	 	(Address)