Exhibit
10.1


 


SUBSCRIPTION
AGREEMENT


 


To
subscribe for Units in the private offering of


HOTH
THERAPEUTICS, INC.


 


		1.	On
                                         the Signature Page for the Subscription Agreement, Date and Fill in the number of
                                         units (the “Units”) that you wish to purchase at a price of
                                         $5.00 per Unit. Each Unit consists of (i) one (1) share of the Company’s common
                                         stock, par value $0.0001 per share (the “Common Stock”) and
                                         (ii) a Warrant (collectively, the “Warrants”) to purchase one-half
                                         (0.5) share of Common Stock (the Common Stock and Warrants in a Unit, and any Common
                                         Stock acquired pursuant to the exercise of a Warrant are collectively referred to below
                                         as the “Securities”). Then, Complete and Sign the Signature
                                         Page included in this Subscription Agreement.



 


		2.	Initial
                                         the Accredited Investor Certification attached to this Subscription Agreement.



 


		3.	Complete
                                         and Sign the Signature Page attached to this Subscription Agreement.



 


NOTICE:
Please note that by executing the attached Subscription Agreement, you will be deemed to have executed the Unit Purchase Agreement
(attached as Exhibit A to the Confidential Private Placement Memorandum (the “Memorandum”)), the Registration
Rights Agreement (attached as Exhibit C to the Memorandum) and have agreed to the terms of the Warrant (attached as Exhibit D
to the Memorandum) and to all exhibits, supplements and schedules to all of the foregoing, all as the same may be amended from
time to time (collectively the “Transaction Documents”), and will be treated for all purposes as if you did
review, approve and execute, if required, each such Transaction Document, even though you may not have physically signed the signature
pages to such documents.


 


		4.	Complete
and Sign the Purchaser Questionnaire, and, if applicable, the Wire Transfer Authorization attached to this Subscription Agreement.



 


		5.	Return
all forms to your account executive and then send all signed original documents with a check (if applicable) to:



 


Laidlaw
& Co. (UK) Ltd.


521 Fifth Avenue, 12th Floor


New York, NY 10175


 


		6.	Please
make your subscription payment payable to the order of “Signature Bank, as Escrow Agent for Hoth Therapeutics, Inc.”
Account No. 1503723669.



 


For
wiring funds directly to the escrow account, use the following instructions:


 


	 	Bank Name:	Signature Bank
	 	 	261 Madison
    Avenue 
	 	 	New York,
    NY 10016
	 	Acct. Name:	Signature Bank as Escrow Agent for Hoth Therapeutics,
    Inc.
	 	ABA Number:	026013576
    
	 	SWIFT Code:	SIGNUS33 
	 	A/C Number:	1503723669
	 	FBO:	Investor Name
	 	 	Social Security
    Number 
	 	 	Address



 



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Investors
will purchase the number of Units of Hoth Therapeutics, Inc., a Nevada corporation (the “Company”),
set forth on the signature page to the Subscription Agreement. The Securities are being offered (the “Offering”)
by the Company pursuant to the offering terms set forth in the Company’s Confidential Private Placement Memorandum, dated
June 27, 2019, as may be amended and/or supplemented from time to time (the “Memorandum”).


 


The
Securities are being offered on a “best efforts, all or none” basis with respect to the minimum offering of
$2,000,000 (the “Minimum Offering”) and thereafter on a “reasonable efforts” basis
up to the maximum offering of $5,000,000 (the “Maximum Offering”) at a purchase price per Unit of $5.00.
The Securities may be sold at one or more closings of the Offering (each a “Closing”, and, collectively,
the “Closings”), at any time during the Offering Period (defined hereafter); provided, however, that
no Closing may take place unless and until subscriptions for at least the Minimum Offering has been deposited in the Escrow Account
(defined hereafter). The minimum investment amount that may be purchased by an Investor is twenty-thousand (20,000) Units for
an aggregate minimum purchase price of $120,000 (the “Investor Minimum Investment”), unless the Company
and the Placement Agent (defined hereafter) waive such requirement in their sole discretion. The subscription for the Securities
will be made in accordance with and subject to the terms and conditions of the Subscription Agreement, the Memorandum and the
Transaction Documents.


 


Certain
of the subscription funds will be held in a non-interest bearing escrow account (the “Escrow Account”)
in the Company’s name at Signature Bank, 261 Madison Avenue, New York, New York 10016 (the “Escrow Agent”),
or with such other escrow agent as may be appointed by Laidlaw & Company (UK) Ltd. (“Laidlaw” or
the “Placement Agent”) and the Company.


 


The
Securities will be offered through August 15, 2019 commencing on the date of the Memorandum (the “Initial Offering
Period”), which period may be extended by the Company and Laidlaw in their sole discretion, without further notice
to prospective investors to a date not later than August 23, 2019 (the “Final Termination Date”, with
this additional period, together with the Initial Offering Period, being referred to herein as the “Offering Period”).
In the event that (i) subscriptions for the Offering are rejected in whole (at the sole discretion of the Company or the Placement
Agent), (ii) a Closing does not occur prior to the Final Termination Date or (iii) the Offering is otherwise terminated by the
Company, then the Escrow Agent will refund all subscription funds held in the Escrow Account to the persons who submitted such
funds, without interest, penalty or deduction. If a subscription is rejected in part (at the sole discretion of the Company or
the Placement Agent) and the Company accepts the portion not so rejected, the funds for the rejected portion of such subscription
will be returned without interest, penalty, expense or deduction.


 


The
Company reserves the right (but is not obligated) to have its employees, agents, officers, directors and affiliates purchase Securities
in the Offering and all such purchases will be counted towards the Maximum Offering amount.


 


The
terms of the Offering are more completely described in the Memorandum and such terms are incorporated herein in their entirety.
Certain capitalized terms used, but not otherwise defined herein, will have the respective meanings provided in the Memorandum.


 


Questions
regarding completion of the subscription documents should be directed to your account executive at (212) 953-4900.


 


ALL
SUBSCRIPTION DOCUMENTS MUST BE FILLED IN AND SIGNED EXACTLY AS SET FORTH WITHIN.


 




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SUBSCRIPTION
AGREEMENT FOR


 


HOTH
THERAPEUTICS, INC.


 


__,
2019


 


Hoth
Therapeutics, Inc.


c/o
Laidlaw & Company (UK), Ltd. 521


Fifth
Avenue, 12th Floor


New
York, NY 10175


 


Ladies and Gentlemen:


 


1. Subscription.
The undersigned (the “Purchaser”) will purchase the number of units (the “Units”),
each unit consisting of (a) one (1) share of common stock, par value $0.0001 per share (the “Common Stock”)
and (b) a warrant to purchase one-half (0.5) share of Common Stock (“Warrant”) (the Common Stock and
Warrants in a Unit, and any Common Stock acquired pursuant to the exercise of a Warrant (the “Warrant Shares”)
are collectively referred to below as the “Securities”) of Hoth Therapeutics, Inc., a Nevada corporation
(the “Company”), set forth on the signature page to the Subscription Agreement. The Securities are being
offered (the “Offering”) by the Company pursuant to the offering terms set forth in the Company’s
Confidential Private Placement Memorandum, dated June 27, 2019, as may be amended and/or supplemented from time to time (the “Memorandum”).


 


The
Securities are being offered on a “best efforts, all or none” basis with respect to the Minimum Offering of
$2,000,000 (the “Minimum Offering”) and thereafter on a “reasonable efforts” basis
up to the maximum of $5,000,000 (the “Maximum Offering”) at a purchase price per Unit of $5.00. The
Securities may be sold at one or more closings of the Offering (each a “Closing”, and, collectively,
the “Closings”), at any time during the Offering Period (defined hereafter); provided, however, that
no Closing may take place unless and until subscriptions for at least the Minimum Offering has been deposited in the Escrow Account
(defined hereafter). The minimum investment amount that may be purchased by an Investor is 20,000 Units at a purchase price of
$120,000 (the “Investor Minimum Investment”). The subscription for the Securities will be made in accordance
with and subject to the terms and conditions of this Subscription Agreement, the Memorandum and the Transaction Documents (defined
hereafter).


 


The
Securities will be offered through August 15, 2019 commencing on the date of the Memorandum (the “Initial Offering
Period”), which period may be extended by the Company and Laidlaw & Company (UK) Ltd. (“Laidlaw”
or the “Placement Agent”)) in their sole discretion, without further notice to prospective investors
by the Company to a date not later than August 23, 2019 (the “Final Termination Date”), with this additional
period, together with the Initial Offering Period, being referred to herein as the “Offering Period”.
In the event that (i) subscriptions for the Offering are rejected in whole (at the sole discretion of the Company or Placement
Agent), (ii) a Closing does not occur prior to the expiration of the Initial Offering Period or, if extended, prior to the Final
Termination Date or (iii) the Offering is otherwise terminated by the Company, then the Escrow Agent (as defined below) will refund
all subscription funds held in the Escrow Account (as defined below) to the persons who submitted such funds, without interest,
penalty or deduction. If a subscription is rejected in part (at the sole discretion of the Company or the Placement Agent) and
the Company accepts the portion not so rejected, the funds for the rejected portion of such subscription will be returned without
interest, penalty, expense or deduction.


 


The
terms of the Offering are more completely described in the Memorandum and such terms are incorporated herein in their entirety.
Certain capitalized terms used, but not otherwise defined herein, will have the respective meanings provided in the Memorandum.


 



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2. Payment.
The Purchaser encloses herewith either a check payable to, or will immediately make a wire transfer payment to, “Signature
Bank, as Escrow Agent for Hoth Therapeutics, Inc.,” in the full amount of the purchase price of the Securities being
subscribed for. Together with the check for or wire transfer of the full purchase price, the Purchaser is delivering a completed
and executed Signature Page to this Subscription Agreement along with a completed and executed Accredited Investor Certification,
which are annexed hereto. Please note that by executing the attached Subscription Agreement, you will be deemed to have executed
the Unit Purchase Agreement (attached as Exhibit A to the Confidential Private Placement Memorandum (the “Memorandum”)),
the Registration Rights Agreement (attached as Exhibit C to the Memorandum) and have agreed to the terms of the Warrant (attached
as Exhibit D to the Memorandum) and to all exhibits, supplements and schedules to all of the foregoing, all as the same may be
amended from time to time (collectively the “Transaction Documents”), and will be treated for all purposes
as if you did review, approve and execute, if required, each such Transaction Document, even though you may not have physically
signed the signature pages to such documents.


 


3. Deposit
of Funds. All payments made as provided in Section 2 hereof by Purchasers subscribing pursuant to the Memorandum will
be deposited by the Purchaser as soon as practicable with Signature Bank, as escrow agent (the “Escrow Agent”),
or such other escrow agent appointed by Laidlaw and the Company, in a non-interest bearing escrow account (the “Escrow
Account”). In the event that the Company does not effect a Closing during the Offering Period, the Escrow Agent
will refund all subscription funds, without deduction and/or interest accrued thereon, and the Company will return the subscription
documents to each Purchaser. If the Company rejects a subscription, either in whole or in part (at the sole discretion of the
Company or Placement Agent), the rejected subscription funds or the rejected portion thereof will be returned promptly to such
Purchaser without interest, penalty, expense or deduction.


 


4. Acceptance
of Subscription. The Purchaser understands and agrees that the Company, in its sole discretion, reserves the right to accept
this or any other subscription for the Securities, in whole or in part, notwithstanding prior receipt by the Purchaser of notice
of acceptance of this or any other subscription. The Company will have no obligation hereunder until the Company executes and
delivers to the Purchaser an executed copy of the Transaction Documents. If Purchaser’s subscription is rejected in whole
(at the sole discretion of the Company), the Offering is terminated or the Minimum Offering is not subscribed for and accepted,
all funds received from the Purchaser will be returned without interest, penalty, expense or deduction, and this Subscription
Agreement will thereafter be of no further force or effect. If Purchaser’s subscription is rejected in part (at the sole
discretion of the Company) and the Company accepts the portion not so rejected, the funds for the rejected portion of such subscription
will be returned without interest, penalty, expense or deduction, and this Subscription Agreement will continue in full force
and effect to the extent such subscription was accepted. The Purchaser may revoke its subscription and obtain a return of the
subscription amount paid to the Escrow Account at any time before the date of the initial Closing. The Purchaser may not revoke
this subscription or obtain a return of the subscription amount paid to the Escrow Agent on or after the date of the initial Closing.
Any subscription received after the initial Closing but prior to the close of the Offering Period shall be irrevocable.


 


5. Representations
and Warranties of the Purchaser. The Purchaser hereby acknowledges, represents, warrants, and agrees as follows:


 


(a) None
of the Securities are registered under the Securities Act of 1933, as amended (the “Securities Act”),
or any state securities laws. The Purchaser understands that the offering and sale of the Securities is intended to be exempt
from registration under the Securities Act, by virtue of Section 4(a)(2) thereof and the provisions of Regulation D promulgated
thereunder, based, in part, upon the representations, warranties and agreements of the Purchaser contained in this Subscription
Agreement and the Unit Purchase Agreement;


 



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(b) The
Purchaser and the Purchaser’s attorney, accountant, purchaser representative and/or tax advisor, if any (collectively, “Advisors”),
have received and have carefully reviewed the Memorandum, this Subscription Agreement, the Transaction Documents and all other
documents requested by the Purchaser or its Advisors, if any, and understand the information contained therein, prior to the execution
of this Subscription Agreement;


 


(c) Neither
the Securities and Exchange Commission (the “Commission”) nor any state securities commission has approved
or disapproved of the Securities or passed upon or endorsed the merits of the Offering or confirmed the accuracy or determined
the adequacy of the Memorandum. The Memorandum has not been reviewed by any federal, state or other regulatory authority. Any
representation to the contrary may be a criminal offense;


 


(d) All
documents, records, and books pertaining to the investment in the Securities including, but not limited to, all information regarding
the Company and the Securities, have been made available for inspection and reviewed by the Purchaser and its Advisors, if any;


 


(e) The
Purchaser and its Advisors, if any, have reviewed the Company’s filings with the Commission, including, but not limited
to, the Company’s Quarterly Report on Form 10-Q’s for the period ended March 31, 2019 and the Company’s Annual
Report on Form 10-K for the fiscal year ended December 31, 2018;


 


(f) The
Purchaser and its Advisors, if any, have had a reasonable opportunity to ask questions of and receive answers from the Company’s
officers and any other persons authorized by the Company to answer such questions, concerning, among other related matters, the
Offering, the Securities, the Transaction Documents and the business, financial condition, results of operations and prospects
of the Company and all such questions have been answered by the Company to the full satisfaction of the Purchaser and its Advisors,
if any;


 


(g) In
evaluating the suitability of an investment in the Company, the Purchaser has not relied upon any representation or other information
(oral or written) other than as stated in the Memorandum, the Transaction Documents or as contained in documents so furnished
to the Purchaser or its Advisors, if any, by the Company in writing;


 


(h)
 The Purchaser has taken no action which would give rise to any claim by any person for brokerage commissions, finders’
fees or the like relating to this Subscription Agreement or the transactions contemplated hereby (other than fees to be paid by
the Company to Laidlaw, as described in the Memorandum);


 


(i)
 The Purchaser, either alone or together with its Advisors, if any, has such knowledge and experience in financial, tax, and
business matters, and, in particular, investments in securities, so as to enable it to utilize the information made available
to it in connection with the Offering to evaluate the merits and risks of an investment in the Securities and the Company and
to make an informed investment decision with respect thereto;


 


(j) The
Purchaser is not relying on the Company, Laidlaw or any of their respective employees or agents with respect to the legal, tax,
economic and related considerations of an investment in any of the Securities and the Purchaser has relied on the advice of, or
has consulted with, only its own Advisors;


 


(k) The
Purchaser is acquiring the Securities solely for such Purchaser’s own account for investment and not with a view to resale
or distribution thereof, in whole or in part. The Purchaser has no agreement or arrangement, formal or informal, with any person
to sell or transfer all or any part of any of the Securities and the Purchaser has no plans to enter into any such agreement or
arrangement;


 



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(l) The
Purchaser understands and agrees that purchase of the Securities is a high risk investment and the Purchaser is able to afford
an investment in a speculative venture having the risks and objectives of the Company, including a risk of total loss of such
investment. The Purchaser must bear the substantial economic risks of the investment in the Securities indefinitely because none
of the Securities may be sold, hypothecated or otherwise disposed of unless subsequently registered under the Securities Act and
applicable state securities laws or an exemption from such registration is available. Legends will be placed on the certificates
representing the Securities to the effect that such securities have not been registered under the Securities Act or applicable
state securities laws and appropriate notations thereof will be made in the Company’s books. The Purchaser understands that
there is no public market for the Warrants to be issued in the Offering and the Company has no intentions of seeking an active
trading market for these securities;


 


(m) The
Purchaser has adequate means of providing for such Purchaser’s current financial needs and foreseeable contingencies and
has no need for liquidity from its investment in the Securities for an indefinite period of time;


 


(n) The
Purchaser is aware that an investment in the Securities involves a number of very significant risks and has carefully read and
considered the matters set forth in the Memorandum and, in particular, the matters under the caption “Risk Factors”
therein and understands any of such risk may materially adversely affect the Company’s operations and future prospects;


 


(o) At
the time such Purchaser was offered the Securities, it was, and as of the date hereof it is, and on each date on which it exercises
any Warrants, it will be, an “accredited investor” within the meaning of Regulation D, Rule 501(a), promulgated by
the Commission under the Securities Act and has truthfully and accurately completed the Purchaser Questionnaire attached to this
Subscription Agreement and will submit to the Company such further assurances of such status as may be reasonably requested by
the Company;


 


(p) The
Purchaser: (i) if a natural person, represents that the Purchaser has reached the age of 21 and has full power and authority to
execute and deliver this Subscription Agreement and all other related agreements or certificates and to carry out the provisions
hereof and thereof; (ii) if a corporation, partnership, or limited liability company, or association, joint stock company, trust,
unincorporated organization or other entity, represents that such entity was not formed for the specific purpose of acquiring
the Securities, such entity is duly organized, validly existing and in good standing under the laws of the state of its organization,
the consummation of the transactions contemplated hereby is authorized by, and will not result in a violation of state law or
its charter or other organizational documents, such entity has full power and authority to execute and deliver this Subscription
Agreement and all other related agreements or certificates and to carry out the provisions hereof and thereof and to purchase
and hold the Securities, the execution and delivery of this Subscription Agreement has been duly authorized by all necessary action,
this Subscription Agreement has been duly executed and delivered on behalf of such entity and is a legal, valid and binding obligation
of such entity; or (iii) if executing this Subscription Agreement in a representative or fiduciary capacity, represents that it
has full power and authority to execute and deliver this Subscription Agreement in such capacity and on behalf of the subscribing
individual, ward, partnership, trust, estate, corporation, or limited liability company or partnership, or other entity for whom
the Purchaser is executing this Subscription Agreement, and such individual, partnership, ward, trust, estate, corporation, or
limited liability company or partnership, or other entity has full right and power to perform pursuant to this Subscription Agreement
and make an investment in the Company, and represents that this Subscription Agreement constitutes a legal, valid and binding
obligation of such entity. The execution and delivery of this Subscription Agreement will not violate or be in conflict with any
order, judgment, injunction, agreement or controlling document to which the Purchaser is a party or by which it is bound;


 


(q) The
Purchaser and its Advisors, if any, have had the opportunity to obtain any additional information, to the extent the Company had
such information in its possession or could acquire it without unreasonable effort or expense, necessary to verify the accuracy
of the information contained in the Memorandum, including, but not limited to, the terms and conditions of the Securities as set
forth therein, and the Transaction Documents and all other related documents received or reviewed in connection with the purchase
of the Securities and have had the opportunity to have representatives of the Company provide them with such additional information
regarding the terms and conditions of this particular investment and the financial condition, results of operations, business
and prospects of the Company deemed relevant by the Purchaser or its Advisors, if any, and all such requested information, to
the extent the Company had such information in its possession or could acquire it without unreasonable effort or expense, has
been provided by the Company in writing to the full satisfaction of the Purchaser and its Advisors, if any;


 



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(r) The
Purchaser represents to the Company that any information which the undersigned has heretofore furnished or is furnishing herewith
to the Company is complete and accurate and may be relied upon by the Company in determining the availability of an exemption
from registration under federal and state securities laws in connection with the Offering of the Securities as described in the
Memorandum;


 


(s) The
Purchaser has significant prior investment experience, including investment in non-listed and non-registered securities. The Purchaser
has a sufficient net worth to sustain a loss of its entire investment in the Company in the event such a loss should occur. The
Purchaser’s overall commitment to investments which are not readily marketable is not excessive in view of the Purchaser’s
net worth and financial circumstances and the purchase of the Securities will not cause such commitment to become excessive. This
investment is a suitable one for the Purchaser;


 


(t) The
Purchaser is satisfied that it has received adequate information with respect to all matters which it or its Advisors, if any,
consider material to its decision to make this investment;


 


(u) The
Purchaser acknowledges that any and all estimates or forward-looking statements or projections provided to the Purchaser by the
Company and included in the Transaction Documents were prepared in good faith, but that the attainment of any such projections,
estimates or forward-looking statements cannot be guaranteed, will not be updated by the Company and should not be relied upon;


 


(v) No
oral or written representations have been made, or oral or written information furnished, to the Purchaser or its Advisors, if
any, in connection with the offering of the Securities which are in any way inconsistent with the information contained in the
Memorandum;


 


(w) Within
two (2) days after receipt of a request from the Company, the Purchaser will provide such information and deliver such documents
as may reasonably be necessary to comply with any and all laws and ordinances to which the Company is subject;


 


(x) THE
PURCHASER ACKNOWLEDGES THAT SECURITIES OFFERED HEREBY HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OR THE SECURITIES LAWS
OF CERTAIN STATES AND ARE BEING OFFERED AND SOLD IN RELIANCE ON EXEMPTIONS FROM THE REGISTRATION REQUIREMENTS OF SAID ACT AND
SUCH LAWS. THE SECURITIES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY AND RESALE AND MAY NOT BE TRANSFERRED OR RESOLD EXCEPT
AS PERMITTED UNDER SAID ACT AND SUCH LAWS PURSUANT TO REGISTRATION OR EXEMPTION THEREFROM. THE SECURITIES HAVE NOT BEEN APPROVED
OR DISAPPROVED BY THE COMMISSION, ANY STATE SECURITIES COMMISSION OR ANY OTHER REGULATORY AUTHORITY, NOR HAVE ANY OF THE FOREGOING
AUTHORITIES PASSED UPON OR ENDORSED THE MERITS OF THIS OFFERING OR THE ACCURACY OR ADEQUACY OF THE MEMORANDUM. ANY REPRESENTATION
TO THE CONTRARY IS UNLAWFUL;


(y) The
Purchaser acknowledges that the Securities have not been recommended by any federal or state securities commission or regulatory
authority. In making an investment decision, investors must rely on their own examination of the Company and the terms of the
Offering, including the merits and risks involved. Furthermore, the foregoing authorities have not confirmed the accuracy or determined
the adequacy of this Subscription Agreement or the other Transaction Documents. Any representation to the contrary is a criminal
offense. The Securities are subject to restrictions on transferability and resale and may not be transferred or resold except
as permitted under the Securities Act and the applicable state securities laws or pursuant to registration or exemption therefrom.
Investors should be aware that they will be required to bear the financial risks of this investment for an indefinite period of
time;


 



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(z) (For
ERISA plans only) The fiduciary of the ERISA plan (the “Plan”) represents that such fiduciary
has been informed of and understands the Company’s investment objectives, policies and strategies, and that the decision
to invest “plan assets” (as such term is defined in ERISA) in the Company is consistent with the provisions of ERISA
that require diversification of plan assets and impose other fiduciary responsibilities. The Purchaser or Plan fiduciary (a) is
responsible for the decision to invest in the Company; (b) is independent of the Company and any of its affiliates; (c) is qualified
to make such investment decision; and (d) in making such decision, the Purchaser or Plan fiduciary has not relied on any advice
or recommendation of the Company or any of its affiliates;


 


(aa) The
Purchaser has read in its entirety the Memorandum and the Transaction Documents and all exhibits, annexes and schedules thereto,
including, but not limited to, all information relating to the Company and the Securities, and understands to its full satisfaction
all information included in the Transaction Documents and the Memorandum, including, but not limited to, the section entitled
“Risk Factors” in the Memorandum;


 


(bb) The
Purchaser represents that (i) the Purchaser was contacted regarding the sale of the Securities by the Company or the Placement
Agent (or another person whom the Purchaser believed to be an authorized agent or representative thereof) with whom the Purchaser
had a prior substantial pre-existing relationship and (ii) it did not learn of the offering of the Securities by means of any
form of general solicitation or general advertising, and in connection therewith, the Purchaser did not (A) receive or review
any advertisement, article, notice or other communication published in a newspaper or magazine or similar media or broadcast over
television or radio, whether closed circuit, or generally available, or over the Internet; or (B) attend any seminar meeting or
industry investor conference whose attendees were invited by any general solicitation or general advertising or did not become
aware of the Offering as a result of any solicitation of a subscription by, a person not previously known to the Purchaser in
connection with investments in securities generally;


 


(cc) The
Purchaser consents to the placement of a legend on any certificate or other document evidencing the Securities and, when issued,
the Warrant Shares, and that such securities have not been registered under the Securities Act or any state securities or “blue
sky” laws and setting forth or referring to the restrictions on transferability and sale thereof contained in this Agreement.
The Purchaser is aware that the Company will make a notation in its appropriate records with respect to the restrictions on the
transferability of such Securities. The legend to be placed on each certificate shall be in form substantially similar to the
following:


 


“[NEITHER]
THIS SECURITY [NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE] [HAS NOT] [HAVE NOT BEEN] REGISTERED UNDER THE UNITED
STATES SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) OR ANY STATE SECURITIES OR “BLUE SKY LAWS,” AND
MAY NOT BE OFFERED, SOLD, TRANSFERRED, ASSIGNED, PLEDGED OR HYPOTHECATED ABSENT AN EFFECTIVE REGISTRATION THEREOF UNDER SUCH ACT
OR COMPLIANCE WITH RULE 144 PROMULGATED UNDER SUCH ACT, OR UNLESS THE COMPANY HAS RECEIVED AN OPINION OF COUNSEL, REASONABLY SATISFACTORY
TO THE COMPANY AND ITS COUNSEL, THAT SUCH REGISTRATION IS NOT REQUIRED.”


 



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(dd) The
Purchaser acknowledges that if he or she is a Registered Representative of a Financial Industry Regulatory Authority (“FINRA”)
member firm, he or she must give such firm the notice required by the FINRA’s Rules of Fair Practice, receipt of which must
be acknowledged by such firm prior to an investment in the Securities;


 


(ee) To
effectuate the terms and provisions hereof, the Purchaser hereby appoints the Placement Agent as its attorney-in-fact (and the
Placement Agent hereby accepts such appointment) for the purpose of carrying out the provisions of the Escrow Agreement by and
between the Company, the Placement Agent and the Escrow Agent (the “Escrow Agreement”) including, without
limitation, taking any action on behalf of, or at the instruction of, the Purchaser and executing any release notices required
under the Escrow Agreement and taking any action and executing any instrument that the Placement Agent may deem necessary or advisable
(and lawful) to accomplish the purposes hereof. All acts done under the foregoing authorization are hereby ratified and approved
and neither the Placement Agent nor any designee nor agent thereof shall be liable for any acts of commission or omission, for
any error of judgment, for any mistake of fact or law except for acts of gross negligence or willful misconduct. This power of
attorney, being coupled with an interest, is irrevocable while the Escrow Agreement remains in effect;


 


(ff) The
Purchaser understands, acknowledges and agrees with the Company that this subscription may be rejected, in whole or in part, by
the Company or the Placement Agent, in their sole and absolute discretion, at any time before any Closing notwithstanding prior
receipt by the Purchaser of notice of acceptance of the Purchaser’s subscription;


 


(gg) The
Purchaser agrees not to issue any public statement with respect to the Offering, Purchaser’s investment or proposed investment
in the Company or the terms of any agreement or covenant between them and the Company without the Company’s prior written
consent, except such disclosures as may be required under applicable law; and


 


(hh) The
Purchaser acknowledges that the information contained in the Transaction Documents or otherwise made available to the Purchaser
is confidential and non-public and agrees that all such information shall be kept in confidence by the Purchaser and neither used
by the Purchaser for the Purchaser’s personal benefit (other than in connection with this subscription) nor disclosed to
any third party for any reason, notwithstanding that a Purchaser’s subscription may not be accepted by the Company; provided,
however, that (a) the Purchaser may disclose such information to its affiliates and Advisors who may have a need for such information
in connection with providing advice to the Purchaser with respect to its investment in the Company so long as such affiliates
and Advisors have an obligation of confidentiality, and (b) this obligation shall not apply to any such information that (i) is
part of the public knowledge or literature and readily accessible at the date hereof, (ii) becomes part of the public knowledge
or literature and readily accessible by publication (except as a result of a breach of this provision) or (iii) is received from
third parties without an obligation of confidentiality (except third parties who disclose such information in violation of any
confidentiality agreements or obligations, including, without limitation, any subscription or other similar agreement entered
into with the Company).


 


6. Representations
and Warranties of the Company. The representations and warranties contained in Article III of the Unit Purchase Agreement
to be entered into by the Company and the Purchasers shall be incorporated herein by reference and shall be deemed to be made
under this Subscription Agreement.


 



    		9



     


    

 


7. Indemnification.
The Purchaser agrees to indemnify and hold harmless the Company, Laidlaw and each of their respective officers, directors, managers,
employees, agents, attorneys, control persons and affiliates from and against all losses, liabilities, claims, damages, costs,
fees and expenses whatsoever (including, but not limited to, any and all expenses incurred in investigating, preparing or defending
against any litigation commenced or threatened) based upon or arising out of any actual or alleged false acknowledgement, representation
or warranty, or misrepresentation or omission to state a material fact, or breach by the Purchaser of any covenant or agreement
made by the Purchaser herein or in any other document delivered in connection with this Subscription Agreement.


 


8. Binding
Effect. This Subscription Agreement will survive the death or disability of the Purchaser and will be binding upon and inure
to the benefit of the parties and their heirs, executors, administrators, successors, legal representatives, and permitted assigns.
If the Purchaser is more than one person, the obligations of the Purchaser hereunder will be joint and several and the agreements,
representations, warranties and acknowledgments herein will be deemed to be made by and be binding upon each such person and such
person’s heirs, executors, administrators, successors, legal representatives and permitted assigns.


 


9. Modification.
This Subscription Agreement may not be modified or waived except by an instrument in writing signed by the party against whom
any such modification or waiver is sought.


 


10. Notices.
Any notice or other communication required or permitted to be given hereunder will be in writing and will be mailed by certified
mail, return receipt requested, or delivered against receipt to the party to whom it is to be given (a) if to the Company, at
the address set forth in the Unit Purchase Agreement or (b) if to the Purchaser, at the address set forth on the signature page
hereof (or, in either case, to such other address as the party will have furnished in writing in accordance with the provisions
of this Section 10). Any notice or other communication given by certified mail will be deemed given at the time of certification
thereof, except for a notice changing a party’s address which will be deemed given at the time of receipt thereof. Any notice
or other communication given by overnight courier will be deemed given at the time of delivery.


 


11. Assignability.
This Subscription Agreement and the rights, interests and obligations hereunder are not transferable or assignable by the
Purchaser and the transfer or assignment of any of the Securities will be made only in accordance with all applicable laws.


 


12. Applicable
Law. This Subscription Agreement will be governed by and construed under the laws of the State of New York as applied to agreements
among New York residents entered into and to be performed entirely within New York. The parties hereto (1) agree that any legal
suit, action or proceeding arising out of or relating to this Subscription Agreement will be instituted exclusively in New York
State Supreme Court, County of New York, or in the United States District Court for the Southern District of New York, (2) waive
any objection which the parties may have now or hereafter to the venue of any such suit, action or proceeding, and (3) irrevocably
consent to the jurisdiction of the New York State Supreme Court, County of New York, and the United States District Court for
the Southern District of New York in any such suit, action or proceeding. Each of the parties hereto further agrees to accept
and acknowledge service of any and all process which may be served in any such suit, action or proceeding in the New York State
Supreme Court, County of New York, or in the United States District Court for the Southern District of New York and agrees that
service of process upon it mailed by certified mail to its address will be deemed in every respect effective service of process
upon it, in any such suit, action or proceeding. THE PARTIES HERETO AGREE TO WAIVE THEIR RESPECTIVE RIGHTS TO A JURY TRIAL OF
ANY CLAIM OR CAUSE OF ACTION BASED UPON OR ARISING OUT OF THIS SUBSCRIPTION AGREEMENT OR ANY DOCUMENT OR AGREEMENT CONTEMPLATED
HEREBY.


 


13. Blue
Sky Qualification. The purchase of Securities pursuant to this Subscription Agreement is expressly conditioned upon the exemption
from qualification of the offer and sale of the Securities from applicable federal and state securities laws.


 



    		10



     


    

 


14. Use
of Pronouns. All pronouns and any variations thereof used herein will be deemed to refer to the masculine, feminine, neuter,
singular or plural as the identity of the person or persons referred to may require.


 


15. Confidentiality.
The Purchaser acknowledges and agrees that any information or data the Purchaser has acquired from or about the Company not
otherwise properly in the public domain, was received in confidence. The Purchaser agrees not to divulge, communicate or disclose,
except as may be required by law or for the performance of this Subscription Agreement, or use to the detriment of the Company
or for the benefit of any other person or persons, or misuse in any way, any confidential information of the Company, including
any trade or business secrets of the Company and any business materials that are treated by the Company as confidential or proprietary,
including, without limitation, confidential information obtained by or given to the Company about or belonging to third parties.


 


16.
Miscellaneous.


 


(a) This
Subscription Agreement, together with the Transaction Documents, constitute the entire agreement between the Purchaser and the
Company with respect to the subject matter hereof and supersede all prior oral or written agreements and understandings, if any,
relating to the subject matter hereof. The terms and provisions of this Subscription Agreement may be waived, or consent for the
departure therefrom granted, only by a written document executed by the party entitled to the benefits of such terms or provisions.


 


(b) Each
of the Purchaser’s and the Company’s representations and warranties made in this Subscription Agreement will survive
the execution and delivery hereof and delivery of the Securities.


 


(c) Each
of the parties hereto will pay its own fees and expenses (including the fees of any attorneys, accountants, appraisers or others
engaged by such party) in connection with this Subscription Agreement and the transactions contemplated hereby whether or not
the transactions contemplated hereby are consummated.


 


(d) This
Subscription Agreement may be executed in two or more counterparts each of which will be deemed an original, but all of which
will together constitute one and the same instrument.


 


(e) Each
provision of this Subscription Agreement will be considered separable and, if for any reason any provision or provisions hereof
are determined to be invalid or contrary to applicable law, such invalidity or illegality will not impair the operation of or
affect the remaining portions of this Subscription Agreement.


 


(f) Paragraph
titles are for descriptive purposes only and will not control or alter the meaning of this Subscription Agreement as set forth
in the text.


 


17. Signature
Page. It is hereby agreed by the parties hereto that the execution by the Purchaser of this Subscription Agreement, in the place
set forth herein below, will be deemed and constitute the agreement by the Purchaser to be bound by all of the terms and conditions
hereof as well each of the other Transaction Documents, and will be deemed and constitute the execution by the Purchaser of all
such Transaction Documents without requiring the Purchaser’s separate signature on any of such Transaction Documents.


 




    		11



     


    

 


ANTI-MONEY
LAUNDERING REQUIREMENTS


 


	The
    USA PATRIOT Act	 	What
    is money laundering?	 	How
    big is the problem and why is it important?
	The
        USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new
        anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms
        have been required to have new, comprehensive anti-money laundering programs.

         

        To
        help you understand these efforts, we want to provide you with some information about money laundering and our steps to
        implement the USA PATRIOT Act.
	 	Money
    laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources
    or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking,
    robbery, fraud, racketeering, and terrorism	 	The
    use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets.
    According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion
    a year.


 


What
are we required to do to eliminate money laundering?


 


	Under
new rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set
up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction
and ensure compliance with the new laws.	 	As
part of our required program, we may ask you to provide various identification documents or other information. Until you provide
the information or documents we need, we may not be able to effect any transactions for you.



 


 


 



    		12



     


    

 


HOTH
THERAPEUTICS, INC.


SIGNATURE PAGE TO


SUBSCRIPTION AGREEMENT


 


Purchaser
hereby elects to purchase a total of  _________ units (the “Units”), each Unit consisting of (i)
one (1) share of common stock, par value $0.0001 per share (the “Common Stock”) and (ii) a warrant to purchase
one-half (0.5) share of Common Stock (“Warrant”), at a purchase price of $5.00 per Unit, for an aggregate Subscription
Amount of $____________. (NOTE: to be completed by the Purchaser).


 


	If
    the Purchaser is an INDIVIDUAL, and if purchased as JOINT TENANTS, as TENANTS IN COMMON, or as COMMUNITY PROPERTY:
	 
	Purchaser:	 	 	 	 	 
	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	Print Name	 	 	 	Social Security Number	 
	 	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	Signature	 	Date	 	Mailing Address	 
	 	 	 	 	 	 	 
	Co-Purchaser
    (if applicable):	 	 	 	 	 
	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	Print Name	 	 	 	Social Security Number	 
	 	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	Signature	 	Date	 	Address (if different from above)	 


 


	If the
    Purchaser is a PARTNERSHIP, CORPORATION, LIMITED LIABILITY COMPANY or TRUST:
	 	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	Name of Partnership, Corporation, Limited
    Liability Company or Trust	 	 	 	Federal Taxpayer Identification Number	 
	 	 	 	 	 	 	 
	 	By:	 	 	 	 	 	 
	 	 	Name:	 	 	 	 	Date	 
	 	 	Title:	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 	 	 	 	 	Business Address	 


 


AGREED
AND ACCEPTED:


 


HOTH
THERAPEUTICS, INC.


 


	By:	 	 	 	 
	 	Name:  	Robb Knie	 	Date	 
	 	Title: 	Chief Executive Officer	 	 


 




    		13



     


    

 


HOTH
THERAPEUTICS, INC.


ACCREDITED
INVESTOR CERTIFICATION


 


For
Individual Investors Only


(All
individual investors must INITIAL where appropriate. 


Where
there are joint investors both parties must INITIAL):


 


	Initial(s) ______	 	I certify that I have a “net worth” of at least $1 million either individually or through aggregating my individual holdings and those in which I have a joint, community property or other similar shared ownership interest with my spouse. For purposes of calculating net worth under this paragraph, (i) the primary residence shall not be included as an asset, (ii) to the extent that the indebtedness that is secured by the primary residence is in excess of the fair market value of the primary residence, the excess amount shall be included as a liability, and (iii) if the amount of outstanding indebtedness that is secured by the primary residence exceeds the amount outstanding 60 days prior to the execution of this Subscription Agreement, other than as a result of the acquisition of the primary residence, the amount of such excess shall be included as a liability.
	 	 	 
	Initial(s) ______	 	I certify that I have had an annual gross income for the past two years of at least $200,000 (or $300,000 jointly with my spouse) and expect my income (or joint income, as appropriate) to reach the same level in the current year.
	 	 	 
	For Non-Individual Investors
 (all Non-Individual Investors must INITIAL where appropriate):
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a partnership, corporation, limited liability company or business trust that is 100% owned by persons who meet either of the criteria for individual investors, above.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a partnership, corporation, limited liability company or business trust that has total assets of at least $5 million and was not formed for the purpose of investing in the Company.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is an employee benefit plan whose investment decision is made by a plan fiduciary (as defined in ERISA §3(21)) that is a bank, savings and loan association, insurance company or registered investment adviser.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is an employee benefit plan whose total assets exceed $5,000,000 as of the date of the Subscription Agreement.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a self-directed employee benefit plan whose investment decisions are made solely by persons who meet either of the criteria for individual investors, above.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a U.S. bank, U.S. savings and loan association or other similar U.S. institution acting in its individual or fiduciary capacity.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a broker-dealer registered pursuant to §15 of the Securities Exchange Act of 1934.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is an organization described in §501(c)(3) of the Internal Revenue Code with total assets exceeding $5,000,000 and not formed for the specific purpose of investing in the Company.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a trust with total assets of at least $5,000,000, not formed for the specific purpose of investing in Company, and whose purchase is directed by a person with such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of the prospective investment.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is a plan established and maintained by a state or its political subdivisions, or any agency or instrumentality thereof, for the benefit of its employees, and which has total assets in excess of $5,000,000.
	 	 	 
	Initial(s) ______	 	The undersigned certifies that it is an insurance company as defined in §2(a)(13) of the Securities Act of 1933, as amended, or a registered investment company.




 



    		14



     


    

 


HOTH THERAPEUTICS, INC.


Investor Profile


(Must be completed
by Investor)




 


Section
A - Personal Investor Information


 


EXACT
Title in Which Securities Should be Held:


_______________________________________________________________________


 


Individual
Executing Profile:


_______________________________________________________________________


 


Social
Security Number(s) / Federal I.D. Number:


_______________________________________________________________________


 


Date
of Birth: _________________      Marital Status: ____________________


 


Joint
Party Date of Birth: __________________


 


Investment
Experience (Years): _____________


 


Annual
Income: _________


 


Net
Worth: _____________


 


Home
Street Address:


________________________________________________________________________


 


Home
City, State & Zip Code:


________________________________________________________________________


 


Home
Phone: ______________________    Home Fax: _______________________


 


Home
Email: _____________________________________________________________


 


Employer:


__________________________________________________________________


 


Employer
Street Address:


________________________________________________________________________


 


Employer
City, State & Zip Code:


________________________________________________________________________


 





Bus.
Phone: ______________________ Bus. Fax: _________________________


 


Bus.
Email: ________________________________


 


Type
of Business: __________________________________________


 


☐
Please check if you are a FINRA member or affiliate of a FINRA member firm


 


LAIDLAW
Account Executive / Outside Broker/Dealer:


__________________________________________



 




    		15



     


    

 


HOTH THERAPEUTICS, INC.


Investor Profile


(Must be completed
by Investor)




 


Section
B – Entity Investor Information


 


EXACT
Title in Which Securities Should be Held:


________________________________________________________________________


 


Authorized
Individual Executing Profile or Trustee:


________________________________________________________________________


 


Social
Security Numbers / Federal I.D. Number:


________________________________________________________________________


 


Investment
Experience (Years): _____________


 


Annual
Income: _______________


 


Net
Worth: _______________


 


Was
the Trust formed for the specific purpose of purchasing the Units?


 


☐ Yes ☐ No


 


Principal
Purpose (Trust):


_________________________________________________________


 


Type
of Business:


_______________________________________________________



 


Street
Address:


________________________________________________________________________


 


City,
State & Zip Code:


________________________________________________________________________


 


Phone:
______________________ Fax: ________________________


 


Email:
________________________________


 


☐
Please check if you are a FINRA member or affiliate of a FINRA member firm


 


LAIDLAW
Account Executive / Outside Broker/Dealer:


__________________________________________



 




    		16



     


    

 


Section
C – Securities Delivery Instructions (check one)


 


		☐	Please
deliver my securities to Laidlaw for deposit into my brokerage account.



 


		☐	Please
deliver my securities to the address listed in the above Investor Profile.



 


		☐	Please
deliver my securities to the below address:



 


________________________________________


________________________________________


________________________________________


________________________________________


 


Section
D – Investor Instructions for Payments (check one)


 


		☐	Please
make out my dividend and any other payment checks pursuant to the Units to “[INTL FC Stone Financial Inc. C/F] [Insert Client
Name]” and deliver such checks to Laidlaw so that they may deposit them into my Laidlaw brokerage account.



 


		☐	Please
make out my dividend and any other payment checks pursuant to the Units in the registered name set forth in the Investor Profile
and mail such checks to me at the address specified in the Investor Profile.



 


Investor
Signature: _____________________________________________________ Date:_______________


 


Joint
Signature (if applicable):______________________________________________Date:________________


 




    		17



     


    

 


Selling
Stockholder Notice and Questionnaire


Hoth
Therapeutics, Inc.


 


The
undersigned beneficial owners of shares of the Company’s common stock, par value $0.0001 per share (the “Common
Stock”) and warrants to purchase shares of Common Stock (each, a “Warrant”) of Hoth Therapeutics,
Inc. (the “Company”), understand that the Company has filed or intends to file with the Securities and Exchange
Commission (the “Commission”) a registration statement on Form S-1 (the “Registration Statement”)
under the Securities Act of 1933, as amended (the “Securities Act”) for the registration of the resale of the
shares of Common Stock and the shares of Common Stock issuable upon exercise of the Warrants (the “Warrant Shares”)
held by the undersigned (the “Registrable Securities”). This Questionnaire is being furnished to you and other
stockholders whose Registrable Securities will be included in the Registration Statement. This Questionnaire seeks information
necessary to complete the registration of these shares with the Commission.


 


To
sell or otherwise dispose of any Registrable Securities in the offering, a holder or beneficial owner of Registrable Securities
will be required to agree to be named as a selling stockholder in the related prospectus and execute and return this Selling Stockholder
Questionnaire.


 


Please
respond to every question unless otherwise directed. If the answer is “none” or “not applicable,”
please so state. Please include all information sought by the related question. Unless stated otherwise, answers should be given
as of the date you complete this Questionnaire. If there is any response or underlying factual matter about which you are uncertain,
please discuss the matter fully and include any additional explanation or information which you believe is helpful.


 


Certain
legal consequences arise from being named as a selling stockholder in the Registration Statement and the related prospectus. Accordingly,
holders and beneficial owners of Registrable Securities are advised to consult their own securities law counsel regarding the
consequences of being named or not being named as a selling stockholder in the Registration Statement and the related prospectus.


 


Please
complete, sign, date and email this Questionnaire as soon as possible to Nazia Khan Esq. at Sheppard, Mullin, Richter & Hampton
LLP, email: nkhan@sheppardmullin.com. Please call (212) 653-8179 with any questions regarding this Questionnaire.


 


NOTICE


 


The
undersigned beneficial owner (the “Selling Stockholder”) of Registrable Securities hereby elects to register
for resale the Registrable Securities owned by it and listed below in Question 5 (unless otherwise specified under such Question
5) in the Registration Statement.


 




    		18



     


    

 


The
undersigned hereby provides the following information to the Company and represents and warrants that such information is accurate:


 


QUESTIONNAIRE


 


		1.	Name.
                                         Full Legal Name of Selling Stockholder:



 


	 	 
	 	 


 


		2.	Address
                                         for Notices to Selling Stockholder.



 


	 	 
	 	 
	 	 
	 	 
	 	 
	 	 
	 	Telephone:
	 	 
	 	 
	 	Fax:
	 	 
	 	 
	 	Email address:
	 	 
	 	 
	 	Contact Person:
	 	 


 


		3.	Relationship
                                         with the Company.



 


Describe
the nature of any position, office or other material relationship the Selling Stockholder or its affiliates, officers, directors
or principal equity holders (owners of 5% of more of the equity securities of the Seller Stockholder) has had with the Company
during the past three years:


 


	 	 
	 	 
	 	 


 



    		19



     


    

 


		4.	Organizational
                                         Structure. Please indicate or (if applicable) describe how the Selling Stockholder
                                         is organized.



 


		(a)	Is
                                         the Selling Stockholder a natural person? (If so, please mark the box and skip to
                                         Question 5.)



 


Yes
☐                                  No ☐


 


		(b)	Is
                                         the Selling Stockholder a reporting company under the Securities Exchange Act of 1934,
                                         as amended (the “Exchange Act”)? (If so, please mark the box and
                                         skip to Question 5.)



 


Yes
☐                                  No ☐

 


		(c)	Is
                                         the Selling Stockholder a majority-owned subsidiary of a reporting company under the
                                         Exchange Act? (If so, please mark the box and skip to Question 5.)



 


Yes
☐                                  No ☐

 


		(d)	Is
                                         the Selling Stockholder a registered investment company under the Investment Company
                                         Act of 1940? (If so, please mark the box and skip to Question 5.)



 


Yes
☐                                  No ☐

 


If
the answer to all of the foregoing questions is “no,” please complete the following:


 


		(e)	Legal
                                         Description of Selling Stockholder:



 


Please
describe the type of legal entity that the Selling Stockholder is (e.g., corporation, partnership, limited liability company,
etc.);


 


	 	 


 


		(f)	Please
                                         indicate whether the Selling Stockholder is controlled by another entity (such
                                         as a parent company, a corporate member, corporate shareholder, etc.) or is controlled
                                         by a natural person.



 


Controlled
by:                   Natural Person(s) ☐      Entity ☐  


 


If
you checked “Natural Person(s)”:


 


 Please
indicate the name of the natural person(s) who has voting or investment control over the shares held by the Selling Stockholder
and the position of control that person(s) holds in or over the Selling Stockholder, then move to Question 5. 


 


Name
of natural person(s):_____________________________________


 


Controlling
position in Selling Stockholder (e.g., sole member, controlling shareholder, sole stockholder, trustee, etc.):


_____________ __________________________________________________________


 



    		20



     


    

 


If
you checked “Entity”:


 


Please
indicate the name and type of entity that controls the Selling Stockholder.


 


Name
of controlling entity: ____________________________________


 


Type
of legal entity (e.g., corporation, partnership, limited liability company, etc.): ______________________________________________


 


Is
this entity controlled by another entity (such as a parent company, a corporate member, corporate shareholder, etc.)
or is it controlled by a natural person?


 


 Controlled
by:                   Natural Person(s) ☐       Entity* ☐


 


 If
you checked “Natural Person(s)”: 


 


Name
of natural person(s) who controls this entity and has voting or investment control over the shares held by the Selling Stockholder
the Selling Stockholder:


____________________________________________________


 


Natural
person’s position in this entity (e.g., sole member, controlling shareholder, sole stockholder, trustee, etc.):


____________________________________________________


 


*If
you answered “Entity” here, please repeat step (f) for each controlling entity moving up the corporate chain of control
until you reach the level at which there is only a natural person or persons in control (e.g., Acme LLC is controlled by ABC Corp.,
its member, which is controlled by X shareholder, its controlling shareholder). List the name of the entities along that chain
of control, the types of entity each is, the natural person(s) in control of the ultimately controlling entity, and his or her
control position over that entity in the lines below:


 


	 	 
	 	 
	 	 
	 	 
	 	 	 



 


(Continued
on next page...)


 




    		21



     


    

 


		5.	Beneficial
                                         Ownership of Registrable Securities:



 


This
question covers beneficial ownership of the Company’s securities.


 


		(a)	Please
                                         state the number of shares of the Company’s Common Stock (excluding the Registrable
                                         Securities but including any shares issuable upon exercise of warrants or other convertible
                                         securities) including any vesting schedules, as applicable that the Selling Stockholder
                                         beneficially owns as of the date of this Questionnaire:



 


	 	 
	 	 
	 	 


 


		(b)	Please
                                         state the number of shares of the Registrable Securities that the Selling Stockholder
                                         wishes to have registered for resale in the Registration Statement.



 


Common
Stock: ______________________


 


Warrants:
______________________ (exercisable for _________________ shares of Common Stock).


 


		6.	Broker-Dealer
                                         Status:



 


		(a)	Is
                                         the Selling Stockholder a broker-dealer?



 


Yes
☐                                  No ☐

 


		(b)	If
                                         “yes” to Question 6(a), did the Selling Stockholder receive the Registrable
                                         Securities as compensation for investment banking services to the Company?



 


Yes
☐                                  No ☐

 


		Note:	If
                                         the answer to Question 6(b) is no, Commission’s staff has indicated that you should
                                         be identified as an underwriter in the Registration Statement.



 


		(c)	Is
                                         the Selling Stockholder an affiliate of a broker-dealer?



 


Yes
☐                                  No ☐

 


		(d)	If
                                         the Selling Stockholder is an affiliate of a broker-dealer, does the Selling Stockholder
                                         certify that it purchased the Registrable Securities in the ordinary course of business,
                                         and at the time of the purchase of the Registrable Securities to be resold, the Selling
                                         Stockholder had no agreements or understandings, directly or indirectly, with any person
                                         to distribute the Registrable Securities?



 


Yes
☐                                  No ☐

 


		Note:	If
                                         the answer to Question 6(d) is no, the Commission’s staff has indicated that you
                                         should be identified as an underwriter in the Registration Statement.



 



    		22



     


    

 


		7.	Legal
                                         Proceedings with the Company. Is the Company a party to any pending legal proceeding
                                         in which the Selling Stockholder is named as an adverse party?



 


Yes
☐                                  No ☐

 


State
any exceptions here:


 


	 	 


 


		8.	Arrangements
                                         with respect to Registrable Securities. Except as set forth below in this Item 8,
                                         the undersigned has not entered into any written or oral agreements, understandings or
                                         arrangements with any underwriter or broker-dealer regarding the sale of the Registrable
                                         Securities.



 


State
any exceptions here:


 


	 	 


 


		9.	Reliance
                                         on Responses. The undersigned acknowledges and agrees that the Company and its legal
                                         counsel shall be entitled to rely on its responses in this Questionnaire in all matters
                                         pertaining to the Registration Statement and the sale of any Registrable Securities pursuant
                                         to the Registration Statement.



 


[SIGNATURE
PAGE FOLLOWS]


 




    		23



     


    

 


The
undersigned agrees to promptly notify the Company of any inaccuracies or changes in the information provided herein that may occur
subsequent to the date hereof at any time while the Registration Statement remains effective.


 


By
signing below, the undersigned consents to the disclosure of the information contained herein in its answers to Questions 1 through
9 and the inclusion of such information in the Registration Statement and the related prospectus and any amendments or supplements
thereto.


 


IN
WITNESS WHEREOF the undersigned, by authority duly given, has caused this Notice and Questionnaire to be executed and delivered
either in person or by its duly authorized agent.


 


	BENEFICIAL OWNER (individual)	 	BENEFICIAL OWNER (entity)
	 	 	 
	 	 	 
	Print Name(s)	 	Name of Entity
	 	 	 
	 	 	 
	Signature	 	Signature
	 	 	 
	 	 	Print Name:  	                            
	Signature (if Joint Tenants or Tenants in Common)	 	 
	 	 	Title: 	             
	 	 	 	 	 


 


PLEASE
PDF A COPY OF THE COMPLETED AND EXECUTED NOTICE AND QUESTIONNAIRE, AND RETURN THE ORIGINAL TO:


 


Nazia
Khan, Esq.


Sheppard,
Mullin, Richter & Hampton LLP


Email:
nkhan@sheppardmullin.com


Ph:
212-653-8179


 




 


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