Document:

Exhibit 10.3

 

Dave &
Buster’s Entertainment, Inc.

2014 Omnibus Incentive Plan

 

RESTRICTED STOCK UNIT AGREEMENT

(Time-Based)

 

THIS
RESTRICTED STOCK UNIT AGREEMENT (this “Award Agreement”) is made effective as of _____ __, 2021 (the “Date
of Grant”), between Dave & Buster’s Entertainment, Inc., a Delaware corporation (the “Company”)
and [●] (the “Participant”).

 

R
E C I T A L S:

 

WHEREAS,
the Company has adopted the Dave & Buster’s Entertainment, Inc. 2014 Omnibus Incentive Plan (as amended from time to time,
the “Plan”); and

 

WHEREAS,
the Compensation Committee of the Board of Directors of the Company (the “Committee”) has determined that it would be in
the best interests of the Company and its stockholders to grant the award (the “Award”) of restricted stock units
(each, an “RSU”) provided for herein to the Participant pursuant to the Plan and the terms set forth herein.

 

NOW
THEREFORE, in consideration of the mutual covenants hereinafter set forth, the parties agree as follows:

 

1.             Grant
of Award. The Company hereby grants to the Participant [●] RSUs. The RSU Award will vest in three (3) installments as follows:
[●] RSUs on the first anniversary of the Date of Grant, [●] RSUs on the second anniversary of the Date of Grant, and [●]
RSUs on third anniversary of the Date of Grant. Each RSU represents one notional share of common stock, par value $.01 per share, of
the Company (each, a “Share”), provided that the RSUs shall be settled in Shares in accordance with Section 2 below.

 

2.             Settlement;
Payment.

 

(a)             RSUs.
Subject to the terms of the Plan and this Award Agreement, including, without limitation, Section 4 hereof, and to the extent that it
would not cause a violation of Section 409A, each RSU shall be settled by the issuance of a Share as soon as practicable following the
applicable date of vesting, and in all events no later than sixty (60) days following the applicable date of vesting, as determined solely
by the Company (the date of settlement, the “Settlement Date”). RSUs settled via Share issuance shall be distributed
to the Participant or the Participant’s legal representative; provided, that the Company may, at its election, either (a) on or
after the Settlement Date, issue a certificate representing the Shares subject to this Award Agreement, or (b) not issue any certificate
representing Shares subject to this Award Agreement and instead document the Participant’s or the Participant’s legal representative’s
interest in the Shares by registering the Shares with the Company's transfer agent (or another custodian selected by the Company) in
book-entry form.

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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(b)             Award
Subject to Clawback Policy. The Participant agrees and acknowledges that the Participant is bound by, and the Award is subject to,
any clawback policy adopted by the Committee from time to time.

 

3.             Termination
of Service. Notwithstanding anything herein to the contrary:

 

(a)             Termination
of Service Due to Death or Disability. Upon a termination of the Participant’s Service by reason of death or Disability that
occurs at any time prior to the final Settlement Date, then the Award shall be settled in accordance with Section 2 above in respect
of the number of then-outstanding RSUs, except that notwithstanding Section 1, such RSUs shall be immediately fully vested and settled
within sixty (60) days following such termination of Service, subject to the applicable limitations set forth in Section 2 above.

 

For
purposes of this Award Agreement, “Disability” means (i) “Disability” as defined in any employment agreement
between the Participant and the Company or any of its Affiliates, or (ii) if there is no such employment agreement or if it does not
define Disability: the Participant is disabled to the extent that he or she is unable to engage in any substantial gainful activity by
reason of any medically determinable physical or mental impairment which can be expected to result in death or can be expected to last
for a continuous period of not less than twelve (12) months, or is receiving income replacement benefits for a period of not less than
three (3) months under an accident and health plan covering employees of Dave & Buster’s Management Corporation, Inc. The determination
of the Participant’s Disability shall be made in good faith by a physician reasonably acceptable to the Company.

 

(b)             Termination
of Service Due to Retirement. Upon a termination of the Participant’s Service by reason of Retirement that occurs at any time
prior to the final Settlement Date, then the Award shall continue to vest and be settled in accordance with Section 2 above, subject
to the applicable limitations set forth in Section 2 above.

 

For
purposes of this Award Agreement, “Retirement” means (i) “Retirement” as defined in any employment agreement
between the Participant and the Company or any of its Affiliates, or (ii) if there is no such employment agreement or if it does not
define Retirement: termination of the Participant’s Service, other than for Cause, after attaining (A) age sixty (60) and completing
ten (10) years of continued Service (i.e., without any termination of Service) with the Company or its Affiliates or (B) age sixty-five
(65).

 

(c)             Termination
without Cause or for Good Reason related to a Change of Control. Upon (i) a termination of the Participant’s Service by the
Company or one of its successors or Affiliates without Cause or due to the Participant’s resignation for Good Reason (excluding
termination by reason of death or Disability), in either case prior to the final Settlement Date (a “Specified Termination”)
and (ii) the Specified Termination occurs either within ninety (90) days before or within twelve (12) months following the occurrence
of a Change of Control of the Company (the “Protected Period”), that occurs at any time prior to the final Settlement
Date, then the Award shall be settled in accordance with Section 2 above in respect of the number of then-outstanding RSUs, except that
notwithstanding Section 1, such RSUs shall be immediately fully vested and thereafter settled on the Settlement Date next following such
termination of Service, subject to the applicable limitations set forth in Section 2 above; provided, that if a Specified Termination
should occur prior to a Change of Control of the Company, the Award shall remain outstanding for up to ninety (90) days following such
Specified Termination in order to determine whether such Specified Termination shall have occurred during a Protected Period such that
the Award shall be eligible for settlement pursuant to this Section 3(c).

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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(d)             Termination
without Cause. Upon a termination of the Participant’s Service by the Company or one of its successors or Affiliates without
Cause, that occurs at any time prior to the final Settlement Date, then the Award shall be settled in accordance with Section 2 above
in respect of the number of then-outstanding RSUs that would have vested on the applicable date of vesting coincident with or next following
such termination of Service, multiplied by a fraction, the numerator of which is the number of days elapsed after the immediately preceding
date of vesting through and including the date of termination of Service, and the denominator of which is [365], except that notwithstanding
Section 1, such RSUs shall be fully vested and settled on the Settlement Date next following such termination of Service, subject to
the applicable limitations set forth in Section 2 above.

 

(e)             For
purposes of this Award Agreement, “Cause” means (x) “Cause” as defined in any employment agreement between
the Participant and the Company or any of its Affiliates, or (y) if there is no such employment agreement or if it does not define Cause:
the willful and continued failure by the Participant to perform the duties assigned by the Company, failure to follow reasonable business-related
directions from the Company, gross insubordination, theft from the Company or its Affiliates, habitual absenteeism or tardiness, conviction
or plea of guilty or nolo contendere to a felony, misdemeanor involving fraud, theft or moral turpitude, or any other reckless
or willful misconduct that is contrary to the best interests of the Company or materially and adversely affects the reputation of the
Company.

 

(f)             For
purposes of this Award Agreement, “Good Reason” means (i) “Good Reason” as defined in any employment agreement
between the Participant and the Company or any of its Affiliates, or (ii) if there is no such employment agreement or if it does not
define Good Reason: Without the Participant’s consent, (A) a material reduction in the Participant’s annual base salary or
(B) a relocation of the Participant’s primary place of employment with the Company by more than fifty (50) miles from that in effect
as of the Date of Grant; provided, however, that neither item (A) nor item (B) shall constitute Good Reason unless the Participant has
provided written notice to the Company within thirty (30) days of the occurrence of such event and the Company shall have failed to cure
such event within thirty (30) days of receipt of such written notice.

 

(g)             Other
Terminations of Service. Upon a termination of the Participant’s Service prior to the final Settlement Date for any reason
other than pursuant to Sections 3(a), 3(b), 3(c) and 3(d) above, the Award, including any then-outstanding RSUs, shall immediately
terminate and be forfeited without consideration.

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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(h)             Release.
Upon a termination of the Participant’s Service prior to the final Settlement Date for termination without Cause pursuant to Section
3(d), settlement of any Award shall be conditioned first upon the Participant’s execution of a fully effective and non-revocable
general release (“Release”) in favor of the Company, its Board of Directors, Affiliates, and employees, in such form as reasonably
approved by the Company and the Participant within sixty (60) days of the Participant’s termination of Service, which Release shall
be provided to the Participant within five (5) days of the Participant’s termination of Service.

 

4.             No
Right to Continued Service. The granting of the Award evidenced hereby and this Award Agreement shall impose no obligation on the
Company or any Affiliate to continue the Service of the Participant and shall not lessen or affect any right that the Company or any
Affiliate may have to terminate the Service of such Participant.

 

5.             Shareholder
Rights. Neither the Participant nor the Participant’s representative shall have any rights as a shareholder of the Company
with respect to the RSUs until such Person receives the Shares, if any, issued upon settlement.

 

6.             Non-Solicitation
and Non-Hire. If the Participant has an employment agreement with the Company or any of its Subsidiaries that contains non-solicitation
and/or non-hire covenants, the covenants are incorporated into this Award Agreement by reference. To the extent the Participant does
not have an employment agreement containing such covenants, the following restrictive covenants shall apply:

 

As
a material incentive for the Company to enter into this Award Agreement, during the term of the Participant’s employment with the
Company or any of its Subsidiaries and for a period of twelve (12) months from the termination of the Participant’s employment
for any reason (including, without limitation, resignation by the Participant) (the "Non-Solicitation and Non-Hire Period")
the Participant shall not, directly or indirectly, on the Participant’s own behalf or on behalf of any other person, partnership,
entity, association, or corporation, induce or attempt to influence, induce, or encourage anyone who is or, within the six (6) months
prior to the date of termination was, an employee of the Company or any of its Subsidiaries at or above the managerial level (including,
without limitation, General Managers, Assistant General Managers, store departmental managers, and all higher-ranking managers) (for
purposes of this Section 6, an “Employee”), client, supplier, vendor, licensee, distributor, contractor or other business
relation of the Company or any of its Subsidiaries to cease doing business with, adversely alter or interfere with its business relationship
with, the Company or any of its Subsidiaries. Further, during the Non-Solicitation and Non-Hire Period, the Participant shall not, on
the Participant’s own behalf or on behalf of any other person, partnership, entity, association, or corporation, (i) solicit or
seek to hire any Employee, or in any other manner attempt directly or indirectly to influence, induce, or encourage any Employee to leave
their employ (provided, however, that nothing herein shall restrict the Participant from engaging in any general solicitation that is
not specifically targeted at such persons), nor shall the Participant use or disclose to any person, partnership, entity, association,
or corporation any information concerning the names, addresses or personal telephone numbers of any Employee, (ii) without the Company's
prior written consent, hire, employ or engage as a consultant any Employee, or (iii) directly or indirectly solicit, induce, or attempt
to influence, induce, or encourage any person, partnership, entity, association, or corporation that is a client or customer of the Company
or its Subsidiaries and who or which the Participant helped to schedule or conduct a special event or corporate teambuilding while employed
by the Company or its Subsidiaries to schedule or conduct a special event or corporate teambuilding through another person, partnership,
entity, association, or corporation.

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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This
Section 6 shall survive termination or settlement of the Award and termination or satisfaction of the Award Agreement.

 

7.             Securities
Laws/Legend on Certificates. The issuance and delivery of Shares shall comply with all applicable requirements of law, including
(without limitation) the Securities Act of 1933, as amended, the rules and regulations promulgated thereunder, state securities laws
and regulations, and the regulations of any stock exchange or other securities market on which the Company’s securities may then
be traded. If the Company deems it necessary to ensure that the issuance of securities under the Plan is not required to be registered
under any applicable securities laws, the Participant shall deliver to the Company an agreement or certificate containing such representations,
warranties and covenants as the Company which satisfies such requirements. The certificates representing the Shares shall be subject
to such stop transfer orders and other restrictions as the Committee may deem reasonably advisable, and the Committee may cause a legend
or legends to be put on any such certificates to make appropriate reference to such restrictions.

 

8.             Transferability.
Unless otherwise provided by the Committee, the Award may not be assigned, alienated, pledged, attached, sold or otherwise transferred
or encumbered by the Participant other than by will or by the laws of descent and distribution, and any such purported assignment, alienation,
pledge, attachment, sale, transfer or encumbrance shall be void and unenforceable against the Company or any Affiliate; provided
that, the designation of a beneficiary shall not constitute an assignment, alienation, pledge, attachment, sale, transfer or encumbrance.
No such permitted transfer of the Award to heirs or legatees of the Participant shall be effective to bind the Company unless the Committee
shall have been furnished with written notice thereof and a copy of such evidence as the Committee may deem necessary to establish the
validity of the transfer and the acceptance by the transferee or transferees of the terms and conditions hereof.

 

9.             Withholding.
The Participant may be required to pay to the Company or any Affiliate and the Company shall have the right and is hereby authorized
to withhold any applicable withholding taxes in respect of the Award, its exercise or transfer and to take such other action as may be
necessary in the opinion of the Committee to satisfy all obligations for the payment of such withholding taxes.

 

10.           Notices.
Any notification required by the terms of this Award Agreement shall be given in writing and shall be deemed effective upon personal
delivery or within three (3) days of deposit with the United States Postal Service, by registered or certified mail, with postage and
fees prepaid. A notice shall be addressed to the Company, Attention: General Counsel, at its principal executive office and to the Participant
at the address that he or she most recently provided to the Company.

 

11.           Entire
Agreement. This Award Agreement and the Plan constitute the entire contract between the parties hereto with regard to the subject
matter hereof and supersede any other agreements, representations or understandings (whether oral or written and whether express or implied)
which relate to the subject matter hereof.

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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12.           Waiver.
No waiver of any breach or condition of this Award Agreement shall be deemed to be a waiver of any other or subsequent breach or condition
whether of like or different nature.

 

13.           Successors
and Assigns. The provisions of this Award Agreement shall inure to the benefit of, and be binding upon, the Company and its successors
and assigns and upon the Participant, the Participant’s assigns and the legal representatives, heirs and legatees of the Participant’s
estate, whether or not any such person shall have become a party to this Award Agreement and have agreed in writing to be joined herein
and be bound by the terms hereof.

 

14.           Governing
Law; Jurisdiction; Waiver of Jury Trial.

 

(a)             This
Award Agreement and all claims, causes of action or proceedings (whether in contract, in tort, at law or otherwise) that may be based
upon, arise out of or relate to this Award Agreement shall be governed by the internal laws of the State of Delaware, excluding any conflicts
or choice-of-law rule or principle that might otherwise refer construction or interpretation of the Award Agreement to the substantive
law of another jurisdiction. Each party to this Award Agreement agrees that it shall bring all claims, causes of action and proceedings
(whether in contract, in tort, at law or otherwise) that may be based upon, arise out of or be related to the Award Agreement exclusively
in the Delaware Court of Chancery or, in the event (but only in the event) that such court does not have subject-matter jurisdiction
over such claim, cause of action or proceeding, exclusively in the United States District Court for the District of Delaware (the “Chosen
Court”) and hereby (i) irrevocably submits to the exclusive jurisdiction of the Chosen Court, (ii) waives any objection
to laying venue in any such proceeding in the Chosen Court, (iii) waives any objection that the Chosen Court is an inconvenient
forum or does not have jurisdiction over any party and (iv) agrees that service of process upon such party in any such claim or
cause of action shall be effective if notice is given in accordance with this Award Agreement. 

 

(b)             EACH
OF THE PARTIES HERETO IRREVOCABLY WAIVES ALL RIGHT TO A TRIAL BY JURY IN ANY CLAIM OR CAUSE OF ACTION (WHETHER IN CONTRACT, IN TORT,
AT LAW OR OTHERWISE) INSTITUTED BY OR AGAINST SUCH PARTY IN RESPECT OF ITS, HIS OR HER OBLIGATIONS HEREUNDER.

 

15.           Award
Subject to Plan. By entering into this Award Agreement the Participant agrees and acknowledges that the Participant has received
and read a copy of the Plan. The Award is subject to the Plan. The terms and provisions of the Plan as it may be amended from time to
time are hereby incorporated herein by reference. In the event of a conflict between any term or provision contained herein and a term
or provision of the Plan, the applicable terms and provisions of the Plan will govern and prevail. Capitalized terms not otherwise defined
herein shall have the same meanings as in the Plan.

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

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16.           No
Guarantees Regarding Tax Treatment. The Participant shall be responsible for all taxes with respect to the Award. The Committee and
the Company make no guarantees regarding the tax treatment of the Award.

 

17.           Amendment.
The Committee may amend or alter this Award Agreement and the Award granted hereunder at any time, subject to the terms of the Plan.

 

18.           Signature
in Counterparts. This Award Agreement may be signed in counterparts, manually or electronically, and each of which will be an original,
with the same effect as if the signatures to each were upon the same instrument.

 

19.           Electronic
Signature and Delivery. This Award Agreement may be accepted by return signature or by electronic confirmation. Each party agrees
that the electronic signatures, whether digital or encrypted, of the parties included in this Award Agreement are intended to authenticate
this writing and to have the same force and effect as manual signatures.  Delivery of a copy of this Agreement or any other document
contemplated hereby bearing an original or electronic signature by facsimile transmission (whether directly from one facsimile device
to another by means of a dial-up connection or whether mediated by the worldwide web), by electronic mail in “portable document
format” (“.pdf”) form, or by any other electronic means intended to preserve the original graphic and pictorial appearance
of a document, will have the same effect as physical delivery of the paper document bearing an original or electronic signature.

 

20.           Severability.
The provisions of this Award Agreement are severable and if any one or more provisions are determined to be illegal or otherwise unenforceable,
in whole or in part, the remaining provisions shall nevertheless be binding and enforceable.

 

IN
WITNESS WHEREOF, the Company and the Participant have executed this Restricted Stock Unit Agreement as of the date first set forth above.

 

 

PARTICIPANT

 

 

 

	By:	 	 	 
	 	[●]	 	 

 

 

 

	 	DAVE & BUSTER’S ENTERTAINMENT,
    INC.
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	By:	 	 
	 	 	 	Name:
	 	 	 	Title:

 

    	 	D&B Team Member - [●]
Restricted Stock Unit Award Agreement – Performance Based

Page 7 of 7Exhibit 10.1

 

PROMISSORY
NOTE

 

		$[________]	As of April 20, 2021

 

Capitol Investment
Corp. V (“Maker”) promises to pay to the order of [] or his successors or assigns (“Payee”) the principal
sum of [     ] ($[      ]) in lawful money of the United States of America, on the terms and conditions described below.

 

1. Principal. The
principal balance of this Note shall be repayable on the consummation of the Maker’s initial merger, share exchange, asset
acquisition or other similar business combination with one or more businesses or entities (a “Business Combination”).
Holder understands that if a Business Combination is not consummated, this Note will not be repaid and all amounts owed hereunder
will be forgiven except to the extent that the Maker has funds available to it outside of its trust account established in
connection with its initial public offering.

 

2.
Interest. No interest shall accrue on the unpaid principal balance of this Note.

 

3.
Application of Payments. All payments shall be applied first to payment in full of any costs incurred in the collection
of any sum due under this Note, including (without limitation) reasonable attorneys’ fees, then to the payment in full of
any late charges and finally to the reduction of the unpaid principal balance of this Note.

 

4.
Events of Default. The following shall constitute Events of Default:

 

(a)
Failure to Make Required Payments. Failure by Maker to pay the principal of this Note within five (5) business days
following the date when due.

 

(b)
Voluntary Bankruptcy, Etc. The commencement by Maker of a voluntary case under the Federal Bankruptcy Code, as now
constituted or hereafter amended, or any other applicable federal or state bankruptcy, insolvency, reorganization, rehabilitation
or other similar law, or the consent by it to the appointment of or taking possession by a receiver, liquidator, assignee, trustee,
custodian, sequestrator (or other similar official) of Maker or for any substantial part of its property, or the making by it of
any assignment for the benefit of creditors, or the failure of Maker generally to pay its debts as such debts become due, or the
taking of corporate action by Maker in furtherance of any of the foregoing.

 

(c)
Involuntary Bankruptcy, Etc. The entry of a decree or order for relief by a court having jurisdiction in the premises
in respect of maker in an involuntary case under the Federal Bankruptcy Code, as now or hereafter constituted, or any other applicable
federal or state bankruptcy, insolvency or other similar law, or appointing a receiver, liquidator, assignee, custodian, trustee,
sequestrator (or similar official) of Maker or for any substantial part of its property, or ordering the winding-up or liquidation
of its affairs, and the continuance of any such decree or order unstayed and in effect for a period of 60 consecutive days.

 

    1

     

    

 

5.
Remedies.

 

(a)
Upon the occurrence of an Event of Default specified in Section 4(a), Payee may, by written notice to Maker, declare this
Note to be due and payable, whereupon the principal amount of this Note, and all other amounts payable thereunder, shall become
immediately due and payable without presentment, demand, protest or other notice of any kind, all of which are hereby expressly
waived, anything contained herein or in the documents evidencing the same to the contrary notwithstanding.

 

(b)
Upon the occurrence of an Event of Default specified in Sections 4(b) and 4(c), the unpaid principal balance of, and all
other sums payable with regard to, this Note shall automatically and immediately become due and payable, in all cases without any
action on the part of Payee.

 

6.
Conversion. Upon consummation of a Business Combination, the Holder shall have the option, but not the obligation,
to convert the principal balance of this Note, in whole or in part at the option of the Holder, into warrants (“Warrants”)
of the Maker at a price of $1.50 per Warrant; provided, however, that the Holder shall be permitted to convert this Note only if
the shareholders of the Maker or the target business in any such Business Combination, whichever may be required in connection
with such Business Combination, have approved the issuance of the Warrants to the Holder if such approval is necessary under applicable
rules. The Warrants will be identical to the “private placement warrants” (as such term is defined in the Maker’s
final prospectus for its initial public offering, dated December 1, 2020). As promptly after notice by Holder to Maker to convert
the principal balance of this Note, which must be made at least 24 hours prior to the consummation of the Business Combination,
as reasonably practicable and after Holder’s surrender of this Note, Maker shall have issued and delivered to Holder, without
any charge to Holder, a certificate or certificates (issued in the name(s) requested by Holder) for the number of Warrants of Maker
issuable upon the conversion of this Note.

 

7.
Waivers. Maker and all endorsers and guarantors of, and sureties for, this Note waive presentment for payment, demand,
notice of dishonor, protest, and notice of protest with regard to the Note, all errors, defects and imperfections in any proceedings
instituted by Payee under the terms of this Note, and all benefits that might accrue to Maker by virtue of any present or future
laws exempting any property, real or personal, or any part of the proceeds arising from any sale of any such property, from attachment,
levy or sale under execution, or providing for any stay of execution, exemption from civil process, or extension of time for payment;
and Maker agrees that any real estate that may be levied upon pursuant to a judgment obtained by virtue hereof, on any writ of
execution issued hereon, may be sold upon any such writ in whole or in part in any order desired by Payee.

 

8.
Unconditional Liability. Maker hereby waives all notices in connection with the delivery, acceptance, performance,
default, or enforcement of the payment of this Note, and agrees that its liability shall be unconditional, without regard to the
liability of any other party, and shall not be affected in any manner by any indulgence, extension of time, renewal, waiver or
modification granted or consented to by Payee, and consents to any and all extensions of time, renewals, waivers, or modifications
that may be granted by Payee with respect to the payment or other provisions of this Note, and agree that additional makers, endorsers,
guarantors, or sureties may become parties hereto without notice to them or affecting their liability hereunder.

 

9.
Notices. Any notice called for hereunder shall be deemed properly given if (i) sent by certified mail, return receipt
requested, (ii) personally delivered, (iii) dispatched by any form of private or governmental express mail or delivery service
providing receipted delivery, (iv) sent by telefacsimile or (v) sent by e-mail, to the following addresses or to such other address
as either party may designate by notice in accordance with this Section:

 

    2

     

    

 

If to Maker:

 

Capitol Investment Corp.
V

1300 17th Street, Suite 820

Arlington, VA 22209

 

If to Payee:

 

[      ]

 

Notice shall be deemed
given on the earlier of (i) actual receipt by the receiving party, (ii) the date shown on a telefacsimile transmission confirmation,
(iii) the date on which an e-mail transmission was received by the receiving party’s on-line access provider (iv) the date
reflected on a signed delivery receipt, or (vi) two (2) Business Days following tender of delivery or dispatch by express mail
or delivery service.

 

10.
Construction. This Note shall be construed and enforced in accordance with the domestic, internal law, but not the
law of conflict of laws, of the State of New York.

 

11.
Severability. Any provision contained in this Note which is prohibited or unenforceable in any jurisdiction shall,
as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining
provisions hereof, and any such prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable
such provision in any other jurisdiction.

 

IN WITNESS WHEREOF,
Maker, intending to be legally bound hereby, has caused this Note to be duly executed the day and year first above written.

 

	 	CAPITOL INVESTMENT CORP. V
	 	 
	 	By: 	                  
	 	Name:
	 	Title:

 

    3

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