Exhibit 4.1


 


NEITHER THIS SECURITY NOR THE SECURITIES INTO WHICH THIS
SECURITY IS EXERCISABLE HAS BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE
IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”),
AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR
PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT
AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE COMPANY TO SUCH EFFECT.



 


 


	Warrant No. _______	May __, 2015


 


LABSTYLE INNOVATIONS CORP.


Common
Stock Purchase Warrant


 


THIS CERTIFIES THAT,
for value received, __________ (the “Holder”), is entitled to subscribe for and purchase, at the
Exercise Price (as defined below), from LabStyle Innovations Corp., a Delaware corporation (the “Company”),
shares of the Company’s common stock, par value $0.0001 (the “Common Stock”), at any time prior
to 5:00 p.m., New York time, on _________________ (the “Warrant Exercise Term”).


 


This Warrant is issued
in accordance with, and subject to, the terms and conditions described in the Warrant Exercise and Replacement Agreement, dated
May __ 2015, between the Holder and the Company (the “Warrant Exercise and Replacement Agreement”) entered
into in connection with the exercise of certain warrants issued to the Holder on ___________ pursuant to that certain Securities
Purchase Agreement dated __________.


 


All capitalized terms
used but not defined herein shall have the meanings ascribed to them in the Warrant Exercise and Replacement Agreement.


 


This Warrant is subject to the following
terms and conditions:


 


1.            Shares.
The Holder has, subject to the terms set forth herein, the right to purchase up to an aggregate of __________  shares of
Common Stock (the “Warrant Shares”) at a per share exercise price of $0.24, subject
to certain adjustments as provided for herein (the “Exercise Price”).


 


2.            Exercise of
Warrant.


 


(a)            Exercise.
This Warrant may be exercised by the Holder at any time prior to the Warrant Exercise Term, in whole or in part, by delivering
the notice of exercise attached as Exhibit A hereto (the “Notice of Exercise”), duly executed
by the Holder to the Company at its principal office, or at such other office as the Company may designate, accompanied by payment,
by wire transfer of immediately available funds to the order of the Company to an account designated by the Company, of the amount
obtained by multiplying the number of Warrant Shares designated in the Notice of Exercise by the Exercise Price (the “Purchase
Price”). For purposes hereof, “Exercise Date” shall mean the date on which all deliveries required
to be made to the Company upon exercise of this Warrant pursuant to this Section 2(a) shall have been made. The
Holder shall not be required to deliver the original Warrant in order to effect an exercise hereunder. No originals of the Notice
of Exercise shall be required to be delivered, nor shall any medallion guarantee (or any other type of guarantee or notarization)
of any Notice of Exercise shall be required.


 






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(b)            Cashless Exercise.
 


 


Notwithstanding anything
contained herein to the contrary, if and only if a registration statement covering the resale of all or any portion of the Warrant
Shares is not available for the resale of such Warrant Shares (such unregistered portion of the Warrant Shares, the “Unavailable
Warrant Shares”), the Holder may, in its sole discretion, exercise this Warrant solely with respect to the Unavailable
Warrant Shares (it being acknowledged, for the avoidance of doubt, that this Warrant may only be exercisable with respect to registered
Warrant Shares pursuant to Section 2(a) hereof) and, in lieu of making the cash payment otherwise contemplated to be made to the
Company upon such exercise in payment of the aggregate Exercise Price for such Unavailable Warrant Shares, elect instead to receive
upon such exercise the “Net Number” of shares of Common Stock determined according to the following formula (a “Cashless
Exercise”):


 





	X	=	Y  (A - B)
	 	 	A



 


		with:	X =          the
number of Warrant Shares to be issued to the Holder



 


		Y =	the
number of Unavailable Warrant Shares with respect to which the Warrant is being exercised



 


		A =	the
fair value per share of Common Stock on the date of exercise of this Warrant



 


		B =	the then-current Exercise Price of the Warrant



 


Solely for the purposes
of this paragraph, “fair value” per share of Common Stock shall mean (A) the average of the closing sales prices on
the Trading Market for the twenty (20) trading days immediately preceding the date on which the Notice of Exercise is deemed to
have been sent to the Company, or (B) if the Common Stock is not publicly traded as set forth above, as reasonably and in good
faith determined by the Board of Directors of the Company as of the date which the Notice of Exercise is deemed to have been sent
to the Company.


 


For purposes of Rule
144 promulgated under the Securities Act, it is intended, understood and acknowledged that the Warrant Shares issued in a Cashless
Exercise transaction shall be deemed to have been acquired by the Holder, and the holding period for such shares shall be deemed
to have commenced, on the date this Warrant was originally issued.


 


(c)            Issuance of
Certificates. As soon as practicable after the exercise of this Warrant, in whole or in part, in accordance with Section 2(a)
or 2(b) hereof (and in no event later than two (2) Trading Days following the delivery of the Notice of Exercise), the Company,
at its expense, shall cause to be issued in the name of and delivered to the Holder: (i) a certificate or certificates for (or,
if applicable, by delivery through the facilities of the Depository Trust Company in electronic form of) the number of fully paid
and non-assessable Warrant Shares to which the Holder shall be entitled upon such exercise and, if applicable, (ii) a new warrant
of like tenor to purchase all of the Warrant Shares that may be purchased pursuant to the portion, if any, of this Warrant not
exercised by the Holder. The Holder shall for all purposes hereof be deemed to have become the Holder of record of such Warrant
Shares on the date on which the Notice of Exercise and payment of the Purchase Price in accordance with Section 2(a) hereof were
delivered and made, respectively, irrespective of the date of delivery of such certificate or certificates, except that if the
date of such delivery, notice and payment is a date when the stock transfer books of the Company are closed, such person shall
be deemed to have become the holder of record of such Warrant Shares at the close of business on the next succeeding date on which
the stock transfer books are open.


 






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


 


3.            Adjustment
of Exercise Price.


 


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


 


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


 






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(c)            Notice of Adjustments.
Upon any adjustment of the Exercise Price and any increase or decrease in the number of Warrant Shares purchasable upon the exercise
of this Warrant, then, and in each such case, the Company, within 15 days thereafter, shall give written notice thereof to the
Holder at the address of such Holder as shown on the books of the Company, which notice shall state the Exercise Price as adjusted
and, if applicable, the increased or decreased number of Warrant Shares purchasable upon the exercise of this Warrant, setting
forth in reasonable detail the method of calculation of each.


 


4.            Notices.
Any and all notices or other communications or deliveries required or permitted to be provided hereunder shall be in writing and
shall be deemed given and effective on the earliest of:

(a) the date of transmission, if such notice or communication is delivered via facsimile at the facsimile number or email attachment
as set forth on the signature pages attached hereto at or prior to 5:30 p.m. (New York City time) on a Trading Day, (b) the next
Trading Day after the date of transmission, if such notice or communication is delivered via facsimile at the facsimile number
or email attachment as set forth on the signature pages attached hereto on a day that is not a Trading Day or later than 5:30 p.m.
(New York City time) on any Trading Day, (c) the second (2nd) Trading Day following the date of mailing, if sent by
U.S. nationally recognized overnight courier service or (d) upon actual receipt by the party to whom such notice is required to
be given. The address for such notices and communications shall be as set forth in the Warrant Exercise and Replacement Agreement.


 


5.            Legends.
Unless the Warrant Shares are registered for resale with the Commission, each certificate evidencing the Warrant Shares issued
upon exercise of this Warrant shall be stamped or imprinted with a legend required pursuant to the Purchase Agreement.


 


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


 


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


 


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


 






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9.            No
Transfer. This Warrant and the Warrant Shares shall be assignable and transferable, provided that such assignment and transfer
shall be in compliance with all applicable laws, rules and regulations including, but not limited to, the Securities Act,
or any applicable state securities laws, and the terms and conditions hereof.


 


10.            Miscellaneous.


 


(a)            This Warrant
and disputes arising hereunder shall be governed by and construed and enforced in accordance with the laws of the State of New
York applicable to agreements made and to be performed wholly within such State, without regard to its conflict of law rules. Any
action brought by either party against the other concerning the transaction contemplated by this Warrant shall be brought only
in the state courts of New York or in the federal courts located in the state and county of New York. The parties to this Warrant
hereby irrevocably waive any objection to jurisdiction and venue of any action instituted hereunder and shall not assert any defense
based on lack of jurisdiction or venue or based upon forum non conveniens. The Company and Holder waive trial by jury.


 


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


 


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


 


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


 


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


 


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


 


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


 


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


 


(i)            The remedies
provided in this Warrant shall be cumulative and in addition to all other remedies available under this Warrant and the Warrant
Exercise and Replacement Agreement, at law or in equity (including a decree of specific performance and/or other injunctive relief),
and nothing herein shall limit the right of the Holder to pursue actual damages for any failure by the Company to comply with the
terms of this Warrant. The Company acknowledges that a breach by it of its obligations hereunder will cause irreparable harm to
the Holder and that the remedy at law for any such breach may be inadequate. The Company therefore agrees that, in the event of
any such breach or threatened breach, the Holder of this Warrant shall be entitled, in addition to all other available remedies,
to an injunction restraining any breach, without the necessity of showing economic loss and without any bond or other security
being required.


 






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11.            Certain Defined Terms.


 


(a)            “Closing
Sale Price” means, for any security as of any date, the last closing trade price for such security on an Eligible Market
that is the principal market for such security, as reported by Bloomberg, or, if the Eligible Market that is the principal market
for such security begins to operate on an extended hours basis and does not designate the closing trade price, then the last trade
price of such security prior to 4:00:00 p.m., New York Time, as reported by Bloomberg, or, if the Eligible Market for such security
is not the principal securities exchange or trading market for such security, the last trade price, respectively, of such security
on the principal securities exchange or trading market where such security is listed or traded as reported by Bloomberg, or if
the foregoing do not apply, the last trade price of such security in the over-the-counter market on the electronic bulletin board
for such security as reported by Bloomberg, or, if no last trade price is reported for such security by Bloomberg, the average
of the ask prices of any market makers for such security as reported in the OTC Link or “pink sheets” by OTC Markets
Group Inc. (formerly Pink OTC Markets Inc.). If the Closing Sale Price cannot be calculated for a security on a particular date
on any of the foregoing bases, the Closing Sale Price of such security on such date shall be the fair market value as mutually
determined by the Company and the Required Holders (as hereinafter defined). If the Company and the Required Holders are unable
to agree upon the fair market value of such security, then the Board of Directors of the Company shall use its good faith judgment
to determine the fair market value. All such determinations to be appropriately adjusted for any stock dividend, stock split, stock
combination, reclassification or other similar transaction during the applicable calculation period.


 


(b)            “Eligible
Market” means the OTC Bulletin Board, OTCQX Market and/or OTCQB Market operated by OTC Markets Group, Inc., the NYSE MKT
LLC, The NASDAQ Global Market, The NASDAQ Global Select Market, The NASDAQ Capital Market or The New York Stock Exchange, Inc.


 


(c)            ”Required Holders”
means the holders of Warrants issued pursuant to the Warrant Exercise and Replacement Agreement representing at least a majority
of the shares of Common Stock underlying such Warrants then outstanding.


 


(d)            “Trading
Day” means any day on which the Common Stock is traded on an Eligible Market that is the principal market for such security;
provided that “Trading Day” shall not include any day on which the Common Stock is scheduled to trade on such
exchange or market for less than 4.5 hours or any day that the Common Stock is suspended from trading during the final hour of
trading on such exchange or market (or if such exchange or market does not designate in advance the closing time of trading on
such exchange or market, then during the hour ending at 4:00:00 p.m., New York time).


 


 


[Signature Page Follows]


 




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


 


	 	LABSTYLE INNOVATIONS CORP.
	 	 
	 	 
	 	By: 	         
	 	 	Name:
Title:



 



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Exhibit A


 


NOTICE OF EXERCISE


 


		TO:	LabStyle Innovations Corp., attention: President



 


The undersigned hereby
elects to purchase the below referenced shares (the “Warrant Shares”) of Common Stock of LabStyle Innovations
Corp. (the “Company”) pursuant to the terms of the attached Warrant, and tenders herewith payment of the purchase
price of such Warrant Shares in full. Payment of the purchase price is being made by (check one):


 


		____________	a cash exercise with respect to _________________ Warrant
Shares; or



		____________	a “cashless exercise” with respect to _______________
Warrant Shares (if permitted pursuant to Section 2(b) of the Warrant).



 


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


 


		1.	Name: __________________________________________________



		2.	Address: ________________________________________________



		3.	DWAC Instructions (if applicable): ___________________________________________



 


The undersigned
hereby represents and warrants the following:


 


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


 


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


 


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


 


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


 


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


 


 


	 
	(Signature and Date)




 



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