Exhibit 10.1


 


 





STOCK FORFEITURE AND RELEASE


 


[ ], 2019


 


The undersigned stockholder
of Andover National Corporation, a Delaware corporation (the “Company”) is the holder of (i) [ ] shares (the “Class
A Shares”) of the Company’s Class A common stock, par value $.001 per share, and (ii) [ ] shares (the “Class
B Shares”) of the Company’s Class B common stock, par value $.001 per share. The undersigned desires to forfeit and
have the Company cancel [ ] Class A Shares and [ ] Class B Shares (collectively, the “Forfeited Shares”) effective
as of the date set forth above (the “Effective Date”).


 


NOW, THEREFORE,
the undersigned represents, warrants and agrees as follows:


		1.	On the Effective Date, the Forfeited Shares shall be cancelled and retired by the Company and shall
be of no further force or effect, and the undersigned agrees that no payment by the Company to the undersigned shall be made with
respect thereto.



		2.	The undersigned hereby acknowledges that the Company shall instruct the transfer agent to cancel
the Forfeited Shares on the books and records of the Company.



		3.	The undersigned represents and warrants to the Company that the undersigned holds good and valid
title to the Forfeited Shares, free and clear of all liens, encumbrances, pledges, interests, and adverse claims whatsoever.



		4.	The undersigned, on behalf of himself and all of the undersigned’s heirs, assigns, legal
representatives, successors in interest, or any person claiming through the undersigned, releases the Company and its direct or
indirect subsidiaries, parents and all other affiliated legal entities, as well as all of their respective current and former employees,
officers, directors, agents, members, managers, stockholders, attorneys, accountants, partners, insurers, advisors, assigns, successors,
heirs, predecessors in interest, joint venturers, and affiliated persons from all liabilities, causes of actions, charges, complaints,
suits, claims, obligations, costs, losses, damages, injuries, rights, judgments, attorney’s fees, expenses, bonds, bills,
penalties, fines, liens, and all other legal responsibilities of any form or nature whatsoever, whether known or unknown, suspected
or unsuspected, fixed or contingent, which they have or had or may claim to have by reason of any and all matters from the beginning
of time to and including the date hereof relating in any way to the Forfeited Shares or the undersigned’s acquisition, holding
or disposition of the Forfeited Shares (hereinafter “Released Claims”). The undersigned shall make no assignment of
any Released Claims, and the undersigned represents and warrants that no such assignment has been made. It is the intention of
the undersigned in executing this Stock Forfeiture and Release that this Stock Forfeiture and Release shall be effective as a full
and final release of all Released Claims. 



[Signature page follows]


 






     


     


    




IN WITNESS WHEREOF,
the undersigned has hereunto set his hand and seal as of the date first set forth above.


 


	 	By:	 	 
	 	 	Name:	 
	 	 	Title:	 
	 	 	 	 
	 	 	 	 
	 	 	 	 






 









Accepted and Acknowledged:


 


ANDOVER NATIONAL CORPORATION


 


 





	By:	 	 



 


 


 


 


 


 


 


 





[Signature Page to Stock Forfeiture and Release
Agreement]