Document:

Employee Annual Incentive Plan

Plan Document

 

 

Plan Effective: January 1, 2004

 

Last PROPOSED Revision: June
11, 2012

 

 

 

 

 

 

 

 

 

 

n
Denotes that confidential information has been omitted pursuant to a request for confidential treatment and such confidential information
has been filed separately with the Securities Exchange Commission.

 

    	Last
amendment: June 11, 2012

    	 

    

 

 

 

Employee Annual Incentive Plan

 

 

I. Introduction/Purpose

 

This Employee Annual Incentive Plan has
been developed as a meaningful compensation tool for employees at all levels, who through high levels of performance, contribute
to the success and profitability of The Juniata Valley Bank. The Plan is designed to support organizational objectives, financial
goals, and the best interests of the shareholders as defined in the Bank’s Strategic Plan, by making available additional,
variable, and contingent at-risk compensation, in the form of cash awards.

 

The Employee Annual Incentive Plan is based
upon the achievement of required financial targets and other defined objectives consistent with those contained in the Strategic
Plan. The formulas and awards have been carefully constructed to integrate the interests of the shareholder as well as enable the
Bank to attract, retain, and motivate high quality personnel and support the continued growth and profitability of Juniata Valley
Financial Corp (Company).

 

The Plan is not meant to be a substitute
for salary increases, but supplemental to base salary and a reward for performance that contributes to outstanding levels of long-term
achievement.

   

II. Plan Year

 

The Plan year for this program will be
the calendar year. The effective date of the Plan is January 1, 2004. The performance measures
for this will be determined, calculated and approved annually.

   

III. Participation

 

In order to be eligible, an individual
must meet the following criteria:

 

		·	Must have been employed prior to July
1 of the Plan year; 

 

		·	Must be employed in a full-time or part-time
position; and

 

		·	Must receive an overall rating of “Good”
or better on his/her most recent individual performance evaluation prior to the Plan year award.

 

 

    	Last amendment:  June 11, 2012	Page 2 of 6

    	 

    

 

 

 

 

A participant's eligibility ceases at termination
of employment (other than retirement, death or disability), and the participant will not receive any awards under the Plan for
the year of termination. Termination as a result of retirement (as defined in the company’s retirement plans), death, or
disability will provide pro-rated awards in the Plan through the last working date for the year in which termination occurred.
If the participant dies during the Plan year, his/her designated beneficiary shall receive a pro-rated share of any award for which
he/she would have been eligible.

 

Due to the various levels of responsibility
of the positions within the Bank, the Board of Directors has selected the following Tiers of participation for the Employee Annual
Incentive Plan. These tiers will generally be based upon position responsibility and grade level.

 

Tier 1 – President and Chief
Executive Officer

 

Tier 2 – Executive Vice President/Chief
Financial Officer

 

Tier
3 –■ 

 

Tier
4 – ■)

 

Tier
5 –  ■

 

IV. Performance Factors

 

The annual portion of the Plan is based
upon company financial performance factors which may change from year to year. In general, these factors may be measures such as
return on assets, return on equity, net income, earnings per share or similar indicators. The factors and weighing of the factors
are determined at the beginning of each Plan year. Each factor has quantifiable objectives consisting of threshold, target and
optimum goals. The Company’s financial performance factors for the current year can be found in Exhibit
A.

 

V. Award Calculation and Distribution

 

Awards under the Plan are calculated according
to determination of the established performance factors at year end. Company performance between the threshold and target, and
target and optimum is interpolated. Awards are determined by taking the determined award percentage times eligible compensation.

 

With regard to discretionary changes to
award amounts relative to individual performance, please reference the following:

 

		·	Tier 4 ■

 

		·	Tier 3 ■.

 

 

    	Last amendment:  June 11, 2012	Page 3 of 6

    	 

    

 

 

 

 

		·	Tier 2 (Executive Vice President/Chief
Financial Officer) – After the award is calculated according to the financial performance factors, the President
and Chief Executive Officer may increase or decrease the award up to 5% (of the calculated award amount) based on the participant’s
individual performance for the year. 

 

		·	Tier 1 (President and Chief Executive
Officer) – After the award is calculated according to the financial performance factors, the Board may increase or decrease
the award up to 5% (of the calculated award amount) based on the participant’s individual performance for the year. 

 

Bank performance below threshold will result
in no awards being paid under the Plan. In the event this occurs, the President and Chief Executive Officer will have discretion
to grant individual awards, with approval by the Board of Directors, for performance bonuses to those individuals who have achieved
a high level of individual performance within their divisions.

 

Annual awards are paid in cash less normal
payroll tax withholding. Awards will normally be paid within 90 days following the end of the Plan year. Awards will be paid within
75 days following the end of the plan year. Any participant terminating employment (except retirement, death, or disability) prior
to the actual payment of the award will forfeit that award.

 

VI. Administration

 

Eligible Compensation for purpose of this
Plan is defined as a participant’s W-2 gross wages net of any option activity results, taxable retirement earnings, prior
year commissions and bonuses and any other imputed income resulting from employee benefits.

 

The Board of Directors of the Bank may
amend the Plan at any time.

 

Once established, performance factors will
remain in place for the year, unless the Board of Directors decides otherwise.

 

Participation, performance factors, thresholds,
targets and any other participation features are established each Plan year and may change from year to year according to the strategic
objectives of the bank.

 

The Plan does not constitute a contract
of employment, and participation in the Plan does not give any employee the right to be retained by the Bank or any right or claim
to an award under the Plan unless specifically accrued under the terms of this Plan.

 

Any right of a participant or his or her
beneficiary to the payment of an award under this Plan may not be assigned, transferred, pledged or encumbered.

 

Any adjustments to the financial performance
results utilized in this Plan because of extraordinary gains or losses or other items must be approved by the Board of Directors.

 

 

    	Last amendment:  June 11, 2012	Page 4 of 6

    	 

    

 

 

 

 

VII. Plan Approval

 

This Plan has been amended and approved
by the Board of Directors of Juniata Valley Financial Corp on

 

	 	 	 
	 	 	 
	By	 	 
	 	Board
of Directors 	 
	 	Juniata Valley Financial Corp	 

 

 

    	Last amendment:  June 11, 2012	Page 5 of 6

    	 

    

 

Exhibit A: Bank Performance Factors
and Award Schedule

 

Plan Year 2013

  

2013 Goals

 

	
        Performance Measures

        (Basic) Earnings Per Share (75%)

	Threshold	Target	Optimum
	$0.855	$.90	$.990
	Return on Average Equity (25%)
	Threshold	Target	Optimum
	7.097%	7.47%	8.217%

 

2013 Award Schedule

 

	 	President & CEO	EVP/CFO	 	 	 
	 	Tier 1*	Tier 2*	Tier 3*	Tier 4	Tier 5
	Min	12.00%	10.00%	■	■	■
	Target	20.00%	16.00%	■	■	■
	Max	30.00%	24.00%	■	■	■

  

NOTE: Awards will be interpolated
for performance levels between threshold and target and target and maximum.

 

*Please see additional notes for
these Tiers:

 

 

Tier
4 ■
. 

 

Tier
3  ■

 

Tier 2 (Executive Vice President/Chief
Financial Officer) – After the award is calculated according to the financial performance factors, the
President and Chief Executive Officer may increase or decrease the award up to 10%* (of the calculated award amount) based on the
participant’s individual performance for the year. 

 

Tier 1 (President and Chief Executive
Officer) – After the award is calculated according to the financial performance factors, the Board may increase
or decrease the award up to 10% (of the calculated award amount) based on the participant’s individual performance for the
year. 

 

*All discretionary adjustments within
the 10% (of the calculated award amount) being made by the President and Chief Executive Officer will be reviewed and approved
by the Board of Directors. 

 

    	Last amendment: June 19, 2012
Last Schedule A revision and approval: February 8, 2013Exhibit 10.1

 

THE SHARES OF COMMON STOCK ISSUABLE
UPON EXERCISE OF THIS WARRANT (THE “WARRANT SHARES”) HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933 (THE
“SECURITIES ACT”) OR UNDER ANY STATE SECURITIES LAWS (“BLUE SKY LAWS”). NO TRANSFER, SALE, ASSIGNMENT,
PLEDGE, HYPOTHECATION OR OTHER DISPOSITION OF THE WARRANT SHARES OR ANY INTEREST THEREIN MAY BE MADE EXCEPT (A) PURSUANT TO
AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND ANY APPLICABLE BLUE SKY LAWS OR (B) IF THE COMPANY HAS BEEN FURNISHED
WITH AN OPINION OF COUNSEL FOR THE HOLDER, WHICH OPINION AND COUNSEL WILL BE REASONABLY SATISFACTORY TO THE COMPANY, TO THE EFFECT
THAT NO REGISTRATION IS REQUIRED BECAUSE OF THE AVAILABILITY OF AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT AND APPLICABLE
BLUE SKY LAWS.

 

No.: _________

 

WARRANT

 

To Purchase __________ Shares of Common
Stock of

 

FUSE SCIENCE, INC.

 

EXERCISABLE ON OR BEFORE, AND VOID AFTER

5:00 P.M. EASTERN TIME ON MARCH ___, 2018
(Five years from issuance)

 

THIS CERTIFIES THAT,
for good and valuable consideration, ______________________________ (“Holder”), or its registered assigns, is
entitled to subscribe for and purchase from FUSE SCIENCE, INC., a Nevada corporation (the “Company”),
at any time after March ___, 2013, to and including March ___, 2018, _______________________________________ (__________) fully
paid and non-assessable shares of the common stock of the Company (“Shares”) at the price of $0.30 per Share
(the “Warrant Exercise Price”), subject to the anti-dilution provisions of this Warrant.

 

The Shares that may
be acquired upon exercise of this Warrant are sometimes referred to herein as the “Warrant Shares.” As used
herein, the term “Holder” includes any party who acquires all or a part of this Warrant as a registered transferee
of Holder, or any record holder or holders of the Warrant Shares issued upon exercise, whether in whole or in part, of the Warrant.
The term “Shares” means the common stock, par value $0.001 per share, of the Company, and will also include
any capital stock of any class of the Company hereafter authorized which will not be limited to a fixed sum or percentage in respect
of the rights of the holders thereof to participate in dividends or in the distribution of assets upon the voluntary or involuntary
liquidation, dissolution, or winding up of the Company. The term “Convertible Securities” means any stock or
other securities convertible into, or exchangeable for, Shares.

    	 

    	 

    

 

This Warrant is subject
to the following provisions, terms and conditions:

 

1.Exercise;
Transferability. The rights represented by this Warrant may be exercised by the Holder hereof, in whole or in part (but
not as to a fractional Share), by written notice of exercise (in the form attached hereto) delivered to the Company at the principal
office of the Company prior to the expiration of this Warrant and accompanied or preceded by the surrender of this Warrant along
with payment of the Warrant Exercise Price for such Shares by cashier’s check or by wire transfer in immediately available
funds in accordance with instructions furnished by the Company.

 

2.Exchange
and Replacement. Subject to Sections 1 and 7 hereof, this Warrant is exchangeable upon the surrender
hereof by the Holder to the Company at its office for new Warrants of like tenor and date representing in the aggregate the right
to purchase the number of Warrant Shares purchasable hereunder, each of such new Warrants to represent the right to purchase such
number of Warrant Shares (not to exceed the aggregate total number purchasable hereunder) as will be designated by the Holder at
the time of such surrender. Upon receipt by the Company of evidence reasonably satisfactory to it of the loss, theft, destruction,
or mutilation of this Warrant, and, in case of loss, theft or destruction, of indemnity or security reasonably satisfactory to
it, and upon surrender and cancellation of this Warrant, if mutilated, the Company will make and deliver a new Warrant of like
tenor, in lieu of this Warrant. This Warrant will be promptly canceled by the Company upon the surrender hereof in connection with
any exchange or replacement. The Company will pay all expenses, taxes (other than stock transfer taxes), and other charges payable
in connection with the preparation, execution, and delivery of Warrants pursuant to this Section 2.

 

3.Issuance
of the Warrant Shares.

 

(a)The Company agrees
that the Warrant Shares purchased upon exercise of this Warrant will be and are deemed to be issued to the Holder as of the close
of business on the date on which this Warrant will have been surrendered and the payment made for such Warrant Shares as aforesaid.
Subject to the provisions of paragraph (b) of this Section 3, certificates for the Warrant Shares so purchased will
be delivered to the Holder within a reasonable time, not exceeding three (3) “Business Days” after the rights
represented by this Warrant will have been so exercised, and, unless this Warrant has expired, a new Warrant representing the right
to purchase the number of Warrant Shares, if any, with respect to which this Warrant will not then have been exercised will also
be delivered to the Holder within such time. As used herein “Business Day” shall mean, a day other than
Saturday, Sunday or any other day in which banks in New York, New York are authorized to be closed for business.

 

(b)Notwithstanding
the foregoing, however, the Company will not be required to deliver any certificate for Warrant Shares upon exercise of this Warrant
except in accordance with registration under or exemptions from the applicable securities registration requirements under the Securities
Act or applicable Blue Sky Laws. Nothing herein, however, will obligate the Company to effect registrations under the Securities
Act or applicable Blue Sky Laws. The Holder agrees to execute such documents and make such representations, warranties, and agreements
as may be required solely to comply with the exemptions relied upon by the Company for the issuance of the Warrant Shares.

    	2

    	 

    

 

4.Covenants
of the Company. The Company covenants and agrees that all Warrant Shares will, upon issuance, be duly authorized and issued,
fully paid, non-assessable and free from all taxes, liens and charges with respect to the issue thereof. The Company further covenants
and agrees that during the period within which the rights represented by this Warrant may be exercised, the Company will at all
times have authorized and reserved for the purpose of issue or transfer upon exercise of the subscription rights evidenced by this
Warrant a sufficient number of Shares to provide for the exercise of the rights represented by this Warrant.

 

5.Anti-Dilution
Adjustments. The provisions of this Warrant are subject to adjustment as provided in this Section 5.

 

(a)The Warrant Exercise
Price will be adjusted from time to time such that in case the Company will hereafter:

 

(i)pay
any dividends on any class of stock of the Company payable in Shares or Convertible Securities;

 

(ii)subdivide
its then outstanding Shares into a greater number of Shares; or

 

(iii)combine
outstanding Shares by reclassification or otherwise;

 

then, in any such event, the Warrant Exercise
Price in effect immediately prior to such event will (until adjusted again pursuant hereto) be adjusted immediately after such
event to a price (calculated to the nearest full cent) determined by dividing (A) the number of Shares outstanding immediately
prior to such event, multiplied by the then existing Warrant Exercise Price, by (B) the total number of Shares outstanding
immediately after such event (including in each case the maximum number of Shares issuable in respect of any Convertible Securities),
and the resulting quotient will be the adjusted Warrant Exercise Price per share. An adjustment made pursuant to this Section
5 will become effective immediately after the record date in the case of a dividend or distribution and will become effective
immediately after the effective date in the case of a subdivision, combination or reclassification. If, as a result of an adjustment
made pursuant to this Section 5, the Holder of any Warrant thereafter surrendered for exercise will become entitled to receive
shares of two or more classes of capital stock and other capital stock of the Company, the Board of Directors (whose determination
will be conclusive) will determine the allocation of the adjusted Warrant Exercise Price between or among shares of such classes
of capital stock. All calculations under this Section 5(a) will be made to the nearest cent or to the nearest 1/100 of a
share, as the case may be. In the event that at any time as a result of an adjustment made pursuant to this Section 5(a),
the holder of any Warrant thereafter surrendered for exercise will become entitled to receive any shares of capital stock of the
Company other than Shares, thereafter the Warrant Exercise Price of such other shares so receivable upon exercise of any Warrant
will be subject to adjustment from time to time in a manner and on terms as nearly equivalent as practicable to the provisions
with respect to Shares contained in this Section 5.

 

(b)Upon each adjustment
of the Warrant Exercise Price pursuant to Section 5(a), the Holder of each Warrant will thereafter (until another such
adjustment) be entitled to purchase at the adjusted Warrant Exercise Price the number of shares, calculated to the nearest full
share, obtained by multiplying the number of shares specified in such Warrant (as adjusted as a result of all adjustments in the
Warrant Exercise Price in effect prior to such adjustment) by the Warrant Exercise Price in effect prior to such adjustment and
dividing the product so obtained by the adjusted Warrant Exercise Price.

    	3

    	 

    

 

(c)In case of any
consolidation or merger to which the Company is a party other than a merger or consolidation in which the Company is the continuing
corporation, or in case of any sale or conveyance to another corporation of the property of the Company as an entirety or substantially
as an entirety, or in the case of any statutory exchange of securities with another corporation (including any exchange effected
in connection with a merger of a third corporation into the Company), there will be no adjustment under Section 5(a)
above but the Holder of each Warrant then outstanding will have the right thereafter to convert such Warrant into the kind and
amount of shares of capital stock and other securities and property which he would have owned or have been entitled to receive
immediately after such consolidation, merger, statutory exchange, sale, or conveyance had such Warrant been converted immediately
prior to the effective date of such consolidation, merger, statutory exchange, sale, or conveyance and in any such case, if necessary,
appropriate adjustment will be made in the application of the provisions set forth in this Section 5 with respect to the
rights and interests thereafter of any Holders of the Warrant, to the end that the provisions set forth in this Section 5
will thereafter correspondingly be made applicable, as nearly as may reasonably be, in relation to any shares of stock and other
securities and property thereafter deliverable on the exercise of the Warrant. The provisions of this Section 5(c) will
similarly apply to successive consolidations, mergers, statutory exchanges, sales or conveyances.

 

(d)Upon any adjustment
of the Warrant Exercise Price pursuant to this Section 5, then and in each such case, the Company will give written notice
thereof, by First-class mail, postage prepaid, addressed to the Holder as shown on the books of the Company, which notice will
state the Warrant Exercise Price resulting from such adjustment and the increase or decrease, if any, in the number of Shares purchasable
at such price upon the exercise of this Warrant, setting forth in reasonable detail the method of calculation and the facts upon
which such calculation is based.

 

6.Registration
Rights. 

 

(a)On or before the
date which is not later than thirty (30) days after the earlier of (i) expiration of the Series B Warrants (the “Series
B Warrants”) issued pursuant to that certain Securities Purchase Agreement dated March 4, 2013, by and among the Company
and the buyers named therein or (ii) the exercise of all the Series B Warrants, the Company shall use commercially reasonable efforts
to prepare and file with the Securities and Exchange Commission (the “Commission”), a Registration Statement
and/or such other documents, including a prospectus, and/or any other appropriate disclosure document as may be reasonably necessary
in the opinion of counsel for the Company in order to comply with the provisions of the Securities Act, so as to permit a public
offering and sale of the Warrant Shares and/or other securities then issuable upon exercise of the Warrant (the “Registrable
Shares”) of Holders for a period of not less than twelve (12) consecutive months (the “Registration Statement”).
The Company shall pay all costs (excluding transfer taxes, if any, and Holders’ pro rata portions of the selling discount
or commissions), fees and expenses in connection with the Registration Statement filed pursuant to this Section 6(a), without
limitation, the Company’s legal and accounting fees, printing expenses and blue sky fees and expenses.

    	4

    	 

    

 

(b)Holders covenant
and agree to provide the Company with all such information and materials concerning Holders and their intended method of distribution
of their respective Registrable Shares and take all such action as may be reasonably required to permit the company to comply with
all applicable requirements of the Commission and to obtain acceleration of the effective date of the Registration Statement.

 

(c)In connection
with the Registration Statement, the Company covenants and agrees that the Company shall use commercially reasonable efforts to
have the Registration Statement it files pursuant to Section 6(a) declared effective at the earliest practicable time.

 

(d)The Company shall
furnish to each Holder such number of copies of the Registration Statement and of each such amendment and supplement thereto (in
each case including each preliminary prospectus and summary prospectus) in conformity with the requirements of the Securities Act,
and such other documents as each Holder may reasonably request in order to facilitate the disposition of the Registrable Shares
by each Holder.

 

(e)If the Company
shall fail to comply with the provisions of this Section 6, the Company shall, in addition to any other equitable or
other relief available to Holders, be liable for any or all special and consequential damages sustained by Holders.

 

(f)The Company shall
prepare and file with the Commission such amendments and supplements to the Registration Statement and the prospectus used in connection
therewith as may be reasonably necessary to keep the Registration Statement effective for at least twelve (12) months, and to comply
with the provisions of the Securities Act with respect to the disposition of all Registrable Shares covered by the Registration
Statement during such period in accordance with the intended methods of disposition by Holders set forth in the Registration Statement.
If at any time the Commission should institute or threaten to institute any proceedings for the purpose of issuing a stop order
suspending the effectiveness of the Registration Statement, the Company will promptly notify each Holder and will use all reasonable
efforts to prevent the issuance of any such stop order or to obtain the withdrawal thereof as soon as possible. The Company will
use commercially reasonable efforts and take all reasonably necessary action which may be required in qualifying or registering
the Registrable Shares included in a Registration Statement for offering and sale under the securities or blue sky laws of such
states as reasonably are required by Holders, provided that the Company shall not be obligated to execute or file any general consent
to service of process or to qualify as a foreign corporation to do business under the laws of any such jurisdiction. The Company
shall use commercially reasonable efforts to cause the Registrable Shares covered by the Registration Statement to be registered
with or approved by such other governmental agencies or authorities of the United States or any state thereof as may be reasonably
necessary to enable Holders to consummate the disposition of the Registrable Shares.

 

(g)The Company shall
indemnify Holders and each person, if any, who controls each Holder within the meaning of Section 15 of the Securities Act or Section
20(a) of the Exchange Act, against all loss, claim, damage, expense or liability (including all expenses reasonably incurred in
investigating, preparing or defending against any claim whatsoever) to which any of them may become subject under the Securities
Act, the Exchange Act or otherwise, arising from the Registration Statement.

    	5

    	 

    

 

(h)Each Holder and
its successors and assigns, shall severally, and not jointly, indemnify the Company, its officers and directors and each person,
if any, who controls the Company within the meaning of Section 15 of the Securities Act or Section 20(a) of the Exchange Act, against
all loss, claim, damage or expense or liability (including all expenses reasonably incurred in investigating, preparing or defending
against any claim whatsoever) to which they may become subject under the Securities Act, the Exchange Act or otherwise, arising
from written information furnished by such Holder or such Holder’s successors or assigns, for specific inclusion in the Registration
Statement to the same extent and with the same effect as the provisions contained on any underwriting agreement pursuant to which
the underwriters have agreed to indemnify the Company, except that the maximum amount which may be recovered from each Holder pursuant
to this paragraph or otherwise shall be limited to the amount of net proceeds received by such Holder from the sale of the Registrable
Shares.

 

(i)The Company shall
not permit the inclusion of any securities other than the Registrable Shares to be included in any Registration Statement filed
pursuant to this Section 6 hereof without the prior written consent of the Holders of a majority of the Registrable
Shares, which consent will not be unreasonably withheld or delayed.

 

(j)Notwithstanding
the provisions of this Section 6, the Company shall not be required to maintain the Registration Statement effective if
the Company delivers an opinion to Holders and to the Company’s transfer agent, in form and substance satisfactory to counsel
to the transfer agent, to the effect that the entire number of Registrable Shares proposed to be sold by Holders may otherwise
be sold, in the manner proposed by Holders may otherwise be sold, without registration under the Securities Act.

 

7.No Voting
Rights. This Warrant will not entitle the Holder to any voting rights or other rights as a shareholder of the Company.

 

8.Notice
of Transfer of Warrant or Resale of the Warrant Shares. The Holder, by acceptance hereof, agrees to give written notice
to the Company before transferring this Warrant or transferring any Warrant Shares of such Holder’s intention to do so, describing
briefly the manner of any proposed transfer. Holder shall also furnish the Company with an opinion of counsel reasonably acceptable
to it to the effect that promptly upon receiving such written notice, the Company will present copies thereof to counsel to the
original purchaser of this Warrant. The proposed transfer may be effected without registration under the Securities Act or applicable
Blue Sky Laws. The prospective transferee or purchaser will also execute such documents and make such representations, warranties,
and agreements as may be required solely to comply with the exemptions relied upon by the Company for the transfer or disposition
of the Warrant or Warrant Shares.

 

9.Fractional
Shares. Fractional shares will not be issued upon the exercise of this Warrant, but in any case where the holder would,
except for the provisions of this Section, be entitled under the terms hereof to receive a fractional share, the number of Shares
will be rounded up to the nearest whole Share.

    	6

    	 

    

 

10.Governing
Law. This Warrant shall be governed by the laws of the State of Nevada.

 

IN WITNESS WHEREOF,
the Company has caused this Warrant to be signed by its duly authorized officer and this Warrant to be dated March ___, 2013.

 

	 	FUSE SCIENCE, INC.
	 	 
	 	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 

 

 

    	7

    	 

    

 

SUBSCRIPTION FORM

(To be signed upon exercise of Warrant)

 

The undersigned, the
holder of the within Warrant, hereby irrevocably elects to exercise the purchase right represented by such Warrant for, and to
purchase thereunder, ____________ _________________ of the shares of Common Stock of Fuse Science, Inc.. to which such Warrant
relates and herewith makes payment of $__________________ therefore in cash or by certified check and requests that the certificate
for such shares be issued in the name of, and be delivered to, ______________________, the address for which is set forth below
the signature of the undersigned.

 

	Dated:	 	 	 
	 	 	 	
	 	 	 	(Signature)
	 	 	 	 
	 	 	 	
	 	 	 	(Name)
	 	 	 	 
	 	 	 	
	 	 	 	(Address)
	 	 	 	 
	 	 	 	
	 	 	 	Social Security or Tax Ident. No.

 

 

 

    	 

    	 

    

 

ASSIGNMENT FORM

(To be signed upon authorized transfer
of Warrant)

 

FOR VALUE RECEIVED,
the undersigned hereby sells, assigns, and transfers unto ______________________________ the right to purchase ____________ shares
of Common Stock of Fuse Science, Inc. to which the within Warrant relates and appoints ___________________ attorney, to transfer
said right on the books of ________________ with full power of substitution in the premises.

 

	Dated:	 	 	 
	 	 	 	
	 	 	 	(Signature)
	 	 	 	 
	 	 	 	
	 	 	 	(Name)
	 	 	 	 
	 	 	 	
	 	 	 	(Address)
	 	 	 	 
	 	 	 	
	 	 	 	Social Security or Tax Ident. No.

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