Exhibit 10.27


 


Form of Lock-Up Agreement






[•], 2014


 


Aegis Capital Corp.


810 Seventh Avenue, 18th Floor


New York, New York 10019


 


Ladies and Gentlemen:


 


The undersigned understands
that Aegis Capital Corp. (the “Representative”) proposes to enter into an Underwriting Agreement (the “Underwriting
Agreement”) with Angion Biomedica Corp., a Delaware corporation (the “Company”), providing for the
initial public offering (the “Public Offering”) of shares of common stock, par value $0.01 per share, of the
Company (the “Shares”).


 


To induce the Representative
to continue its efforts in connection with the Public Offering, the undersigned hereby agrees that, without the prior written consent
of the Representative, the undersigned will not, during the period commencing on the date hereof and ending 180 days after the
date of the final prospectus (the “Prospectus”) relating to the Public Offering (the “Lock-Up Period”),
(1) offer, pledge, sell, contract to sell, grant, lend, or otherwise transfer or dispose of, directly or indirectly, any Shares
or any securities convertible into or exercisable or exchangeable for Shares, whether now owned or hereafter acquired by the undersigned
or with respect to which the undersigned has or hereafter acquires the power of disposition (collectively, the “Lock-Up
Securities”); (2) enter into any swap or other arrangement that transfers to another, in whole or in part, any of the
economic consequences of ownership of the Lock-Up Securities, whether any such transaction described in clause (1) or (2) above
is to be settled by delivery of Lock-Up Securities, in cash or otherwise; (3) make any demand for or exercise any right with respect
to the registration of any Lock-Up Securities; or (4) publicly disclose the intention to make any offer, sale, pledge or disposition,
or to enter into any transaction, swap, hedge or other arrangement relating to any Lock-Up Securities. Notwithstanding the foregoing,
and subject to the conditions below, the undersigned may transfer Lock-Up Securities without the prior written consent of the Representative
in connection with (a) transactions relating to Lock-Up Securities acquired in open market transactions after the completion of
the Public Offering; provided that no filing under Section 16(a) of the Securities Exchange Act of 1934, as
amended (the “Exchange Act”), shall be required or shall be voluntarily made in connection with subsequent sales
of Lock-Up Securities acquired in such open market transactions; (b) transfers of Lock-Up Securities as a bona fide gift,
by will or intestacy or to a family member or trust, partnership, limited liability company or other entity for the direct or indirect
benefit of the undersigned or a family member (for purposes of this lock-up agreement, “family member” means any relationship
by blood, marriage or adoption, not more remote than first cousin); (c) transfers of Lock-Up Securities to a charity or educational
institution; (d) if the undersigned, directly or indirectly, controls a corporation, partnership, limited liability company or
other business entity, any transfers of Lock-Up Securities to any shareholder, partner or member of, or owner of similar equity
interests in, the undersigned, as the case may be; (e) to the undersigned’s affiliates or to any investment fund or other
entity controlled or managed by the undersigned; (f) to a nominee or custodian of a person or entity to whom a disposition or transfer
would be permissible under clauses (a) through (e) above; or (g) pursuant to an order of a court or regulatory agency; provided
that in the case of any transfer pursuant to the foregoing clauses (b), (c), (d), (e) or (f), (i) any such transfer shall
not involve a disposition for value, (ii) each transferee shall sign and deliver to the Representative a lock-up agreement substantially
in the form of this lock-up agreement and (iii) no filing under Section 16(a) of the Exchange Act shall be required or shall
be voluntarily made. The undersigned also agrees and consents to the entry of stop transfer instructions with the Company’s
transfer agent and registrar against the transfer of the undersigned’s Lock-Up Securities except in compliance with this
lock-up agreement. Furthermore, the restrictions contained herein shall not apply to any transfers, sales, tenders or other


 




    	 



    	 



    

  


dispositions of any of the undersigned’s
Shares occurring after the consummation of the Public Offering, pursuant to a tender offer for securities of the Company that would,
if consummated, result in not less than a majority of the outstanding voting securities of the Company being disposed in such transaction
or pursuant to any other transaction, including, without limitation, a merger, consolidation or other business combination, resulting
in not less than a majority of the outstanding voting securities of the Company being disposed in such transaction (including,
without limitation, entering into any lock-up, voting or similar agreement pursuant to which the undersigned may agree to transfer,
sell, tender or otherwise dispose of any of the undersigned’s Shares in connection with any such transaction or to vote any
of the undersigned’s Shares in favor of any such transaction); provided that, if such tender offer or other transaction is
not completed, any of the undersigned’s Shares subject to this lock-up agreement shall remain subject to the restrictions
contained in this lock-up agreement.


 


The undersigned agrees
that, prior to engaging in any transaction or taking any other action that is subject to the terms of this lock-up agreement during
the period from the date hereof to and including the 34th day following the expiration of the Lock-Up Period, the undersigned
will give notice thereof to the Company and will not consummate any such transaction or take any such action unless it has received
written confirmation from the Company that the Lock-Up Period has expired.


 


If the undersigned is an
officer or director of the Company, (i) the undersigned agrees that the foregoing restrictions shall be equally applicable to any
issuer-directed or “friends and family” Shares that the undersigned may purchase in the Public Offering; (ii) the Representative
agrees that, at least three (3) business days before the effective date of any release or waiver of the foregoing restrictions
in connection with a transfer of Lock-Up Securities, the Representative will notify the Company of the impending release or waiver;
(iii) the Company has agreed in the Underwriting Agreement to announce the impending release or waiver by press release through
a major news service at least two (2) business days before the effective date of the release or waiver; and (iv) the Representative
agrees that the foregoing restrictions shall not be applicable to any transfer from an officer or director of the Company to the
Company or its parent entities upon death, disability or termination of employment, in each case, of such officer or director.
Any release or waiver granted by the Representative hereunder to any such officer or director shall only be effective two (2) business
days after the publication date of such press release. The provisions of this paragraph will not apply if (a) the release or waiver
is effected solely to permit a transfer of Lock-Up Securities not for consideration and (b) the transferee has agreed in writing
to be bound by the same terms described in this lock-up agreement to the extent and for the duration that such terms remain in
effect at the time of such transfer.


 


No provision in this agreement
shall be deemed to restrict or prohibit the exercise, exchange or conversion by the undersigned of any securities exercisable or
exchangeable for or convertible into Shares, as applicable; provided that the undersigned does not transfer the Shares acquired
on such exercise, exchange or conversion during the Lock-Up Period, unless otherwise permitted pursuant to the terms of this lock-up
agreement. In addition, no provision herein shall be deemed to restrict or prohibit the entry into or modification of a so-called
“10b5-1” plan at any time (other than the entry into or modification of such a plan in such a manner as to cause the
sale of any Lock-Up Securities within the Lock-Up Period).


 


The undersigned understands
that the Company and the Representative are relying upon this lock-up agreement in proceeding toward consummation of the Public
Offering. The undersigned further understands that this lock-up agreement is irrevocable and shall be binding upon the undersigned’s
heirs, legal representatives, successors and assigns.


 


The undersigned
understands that, (i) if the Underwriting Agreement is not executed by October 1, 2014, (ii) if the Underwriting Agreement
(other than the provisions thereof which survive termination) shall terminate or be terminated prior to the initial closing
date of the Shares to be sold thereunder, (iii) the


 




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registration statement relating to the Public
Offering is withdrawn by the Company, or (iv) the Company notifies the Representative that it does not intend to proceed with the
Offering, then the undersigned shall be released from all obligations under this lock-up agreement and this lock-up agreement shall
be void and of no further force or effect.


 


Whether or not the Public
Offering actually occurs depends on a number of factors, including market conditions. Any Public Offering will only be made pursuant
to an Underwriting Agreement, the terms of which are subject to negotiation between the Company and the Representative.


 


	 	Very truly yours,	 
	 	 	 
	 	 	 
	 	(Name - Please Print)	 
	 	 	 
	 	 	 
	 	(Signature)	 
	 	 	 
	 	 	 
	 	(Name of Signatory, in the case of entities - Please Print)
	 	 	 
	 	 	 
	 	(Title of Signatory, in the case of entities - Please Print)


 


	 	Address:	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 


 






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