Document:

Exhibit 4.7

 

This form must be
delivered scanned and signed to hanpaka@orion-uw.com

Please call to confirm at Tel. 03-5760606

 

Exact and full name of the classified investor
____________________

 

Contact person __________________ mobile phone _______________
email address: __________________________

 

To

_____________________________

through

Orion Underwriting and Issuances Ltd. (hereinafter:
the “Funds Raising Manager”)

 

Re: Siyata Mobile Inc.

Private placement of shares together with
unlisted warrants (hereinafter: the “Allocated Securities”)

 

		1.	We hereby undertake towards Siyata Mobile Inc. (hereinafter:
the “Company”) to purchase shares and unlisted warrants at an amount as shall be allocated to us in the framework
of the private placement.

Issuance unit: 10 shares and warrants
to purchase 10 shares at a unit price of USD $100 according to a value of USD $10 per share.

 

		2.	Warrant terms:
	 	 	 

		a.	The warrants are unlisted and will be issued in the form annexed
hereto as Exhibit A.

 

		3.	We undertake to deliver to the Company, by the date to be
set forth in the Company’s acceptance notice, the full consideration for the securities to be allocated to us in the private placement.
	 	 	 

		4.	Should we not receive an acceptance notice detailing the
number of securities that were allocated to us in the framework of the private placement, within one business day from the date our offer
is sent, we shall contact you via telephone in order to confirm that you received our order.
	 	 	 

		5.	We irrevocably represent and undertake that (1) we are one
of the investors among those listed in Schedule One of the Securities Law, 5728-1968 (hereinafter: “Securities Law”) and
we fulfill the conditions set forth in such schedule, and we are aware of the significance of our being considered an investor that included
in such schedule and we agree to such, and we also undertake to deliver to the Company, if required, a confirmation of our being such
an investor and that we are a corporation incorporated in Israel; (2) we are not acting on behalf of or for any other person or entity;
(3) we are purchasing the securities for ourselves and not for purpose of distribution or sale to others, not on behalf of nor for others,
and not for our clients, but rather and only under conditions permitted in the Securities Law and in the regulations promogulated thereunder;
(4) we are residents of Israel, we are not a U.S. Person as defined in Regulation S that was enacted under the Securities Act of 1933,
and we are not purchasing the offered Securities for a U.S. Person and/or a person located in the US or with the intention to perform
“targeted marketing efforts” to U.S. Persons and/or with the intention to perform “Distribution” in the US (as
such term is defined in US securities law).
	 	 	 

		6.	We acknowledge that the securities to be allocated to us, if any, shall be allocated without any declaration
and/or representation and/or indemnification whatsoever (as-is), free of any debt, lien, charge or other third party right. We shall have
no demand and/or argument and/or claim against the Company and/or Funds Raising Manager and/or against any of their affiliated companies
and/or officers and/or managers and/or employees and/or consultants and/or anyone on their behalf, with respect to and/or in connection
with the Company and/or its condition, assets, and/or obligations, and/or its quarterly reports and cash flows, including those expected
to be published on a date shortly after the private placement, and the data included therein. The exercise shares shall have the same
rights as the current ordinary shares in the Company’s share capital, for all intents and purposes, starting from their issuance
date, and they shall be entitled to any dividends or other benefit with a record date later than the exercise date and allocation of the
exercise shares.

 

    

    

    

 

		7.	We have the financial, economic, and business ability, expertise,
and experience, in order to analyze the investment in the securities of the Company, and to assert the risks and chances of the transaction
and undertake its performance. Similarly, we have the ability to consider and understand the tax implications related to the securities
to be allocated to us. The purchase of the securities is made solely on the basis of our examinations and under our responsibility, we
did not receive any information, representations, or undertakings from the Company, the Funds Raising Manager, or anyone on their behalf,
including in connection with the Company’s condition, assets and obligations, and we did not receive, nor did we see or rely on
any prospectus and/or offering document, and we are aware that the representations and obligations that bind the Company are its representations,
declarations, and obligations that are included in its public reports.
	 	 	 

		8.	We acknowledge that issuing the securities to us is contingent,
inter alia, upon receiving approval of the Company’s board of directors, approval of NASDAQ in New York, USA (hereinafter:
the “Stock Exchange”) for listing such securities on the Stock Exchange, and any other approval necessary for the
private placement (all the above conditions together shall be hereinafter referred to as: the “Condition Precedent”).
We shall have no argument and/or claim against the Company and/or its officers and/or counsel and/or any other entity including the Funds
Raising Manager, if and insofar as the Condition Precedent shall ultimately not be fulfilled. Should the private placement not be performed
for any reasons whatsoever, including due to the fact that any of the Conditions Precedent were not fulfilled until January 16, 2021,
we shall have the option to terminate our participation in the private placement with a written notice.
	 	 	 

		9.	We confirm and agree that we are a corporation that is incorporated
in Israel, belonging to one of the investor types listed in Schedule One to the Securities Law, 5728-1968 (hereinafter: “Classified
Investor”), for purpose of Section 15A(b)(1) of such law, and we are aware of the fact that the Company is relying on such
confirmation and agreement of ours.
	 	 	 

		10.	We acknowledge that the securities to be allocated to us,
including the shares to be allocated to us upon exercising the warrants shall be subject to resale restrictions after allocation (lockup
provisions that shall be in effect for a period of six (6) months and one (1) day from the allocation day) in accordance with the relevant
rules and regulations in the United States. We undertake to fulfill such provisions as required under law at our own exclusive liability.
	 	 	 

		11.	We represent that we have no connection whatsoever with any of the Company’s interested parties
and/or officers.
	 	 	 

		12.	We undertake to execute all documents and disclosures customary in this type of transaction and/or that
shall be required under any securities laws.
	 	 	 

		13.	We consent that the Company report and/or publish reports required under the provisions of law in connection
with the foregoing share issuance.
	 	 	 

		14.	We confirm that we are aware of the fact that the share allocation shall be performed through book entry.
	 	 	 

		15.	We hereby grant permission to the below member of the Stock Exchange where the billing account is held
and instruct it to charge our account hereunder with the amount that the Funds Raising Manager shall stipulate as the amount the client
shall be charged.

 

We confirm that we are aware that the Company
may determine and change the scope of the private placement and postpone (subject to Section 8 above) or terminate the issuance of the
securities, all at its sole discretion. Similarly, we confirm that we are aware that the actual securities allocation may be lower than
the number of securities we asked for in the offer. Should the Company not accept our offer, or in the event of partial acceptance, we
shall have no argument and/or claim and/or demand against the Company and/or the Funds Raising Manager and/or any of their affiliated
companies and/or officers and/or employees and/or consultants and/or anyone on their behalf.

 

	Date	 	Name of Signatory	 	Signatory and Seal

 

Account to charge: Bank: ____________ Branch number:
_____________ Account no: ________________

 

Bank/Stock Exchange member for transferring the Securities:
Bank: ____________ Branch number: _____________ Account no: ________________

 

    2

    

    

 

Exhibit A

 

Form of Warrant

 

See attached.

 

 

3Exhibit 4.8

 

EXECUTION VERSION

 

THE SECURITIES TO WHICH THIS PRIVATE PLACEMENT
SUBSCRIPTION AGREEMENT RELATES HAVE NOT BEEN AND WILL NOT BE REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES
COMMISSION OF ANY STATE, AND WILL BE ISSUED IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE UNITED STATES SECURITIES ACT OF
1933, AS AMENDED (THE “1933 ACT”) AND APPLICABLE SECURITIES LAWS, AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT
TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE 1933 ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT
TO, THE REGISTRATION REQUIREMENTS OF THE 1933 ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS.

 

SIYATA MOBILE
INC.

(the “Issuer”)

SUBSCRIPTION AGREEMENT

-Units-

 

 

 

The units (the “Units”) will
be sold on a non-brokered private placement basis at a price of $0.10 per Unit. Each Unit will consist of one (1) common
share of the Issuer (each, a “Share”) and one-half of one common share purchase warrant (each whole common share purchase
warrant, a “Warrant”) with each whole Warrant entitling the holder thereof to purchase one additional common share
(each, a “Warrant Share”) of the Issuer at a price of $0.18 per Warrant Share for a period of 24 months from their
date of issue. The Units will be offered pursuant to exemptions from the registration and prospectus requirements of applicable securities
legislation. The Subscriber must be purchasing as principal or deemed under applicable securities laws to be purchasing as principal.

 

INSTRUCTIONS FOR COMPLETING THIS
SUBSCRIPTION PRIOR TO DELIVERY TO THE ISSUER

 

		1.	The subscriber (the “Subscriber”) must
complete the information required on page 2 with respect to subscription amounts, subscriber details, and alternate registration
and delivery particulars (if applicable), and must complete the personal information required on page 4. The Subscriber
acknowledges and agrees that this information will be provided to the TSX Venture Exchange (the “Exchange”).

  

		2.	The Subscriber must complete the applicable forms (the “Forms”)
at the end of Schedule B:

  

		(a)	All Subscribers who are Canadian residents must complete
Form 1 – “Certificate for Exemption”.

 

		(i)	All Subscribers who are individuals and subscribing pursuant
to section (j), (k) or (l) of the definition of “accredited investor” in National Instrument 45-106 Prospectus Exemptions
(“NI45-106”) must complete and execute Form 1, Schedule 1 – “Form 45-106F9: Form for Individual
Accredited Investors”.

 

		(ii)	All Subscribers who are resident in Ontario and subscribing
pursuant to the Friends, Family and Business Associates exemption in NI45-106 must complete and execute Form 1, Schedule 2 –
“Form 45-106F12: Risk Acknowledgment Form for Family, Friend and Business Associate Investors”.

 

		(iii)	All Subscribers who are resident in Saskatchewan and
subscribing pursuant to the Friends, Family and Business Associates exemption in NI45-106 must complete and execute Form 1, Schedule
3 – “Risk Acknowledgement – Saskatchewan Close Personal Friends and Business Associates”.

 

		(b)	All Subscribers who are U.S. Purchasers
(as defined in section 1.1 of Schedule “A” herein) must complete Form 2 – “Certificate of U.S.
Accredited Investor Status”.

 

		(c)	All Subscribers who are not individuals,
AND will hold more than 5% of the Issuer’s common shares on completion of the offering of Units must
complete Form 3 – “TSX Form 4C: Corporate Placee Registration Form” UNLESS the Subscriber has
a current Corporate Placee Registration Form on file with the Exchange and has checked the appropriate box on page 5 confirming same.

 

		3.	Return this subscription together with all applicable Forms
to Samantha Prest of Cassels Brock & Blackwell LLP, counsel to the Issuer, at sprest@cassels.com or Suite 2200, 885 West Georgia
Street, Vancouver British Columbia, V6C 3E8.

 

		4.	Complete payment for the total subscription price for the
subscribed for Units by wire to the Issuer per the following instructions:

 

     

     

    

 

For payment
in Canadian Dollars:

 

	BENEFICIARY BANK:	BANK OF MONTREAL 

    595 BURRARD STREET

    VANCOUVER, B.C., CANADA

    SWIFT CODE:  BOFMCAM2
	 	 
	CANADIAN BANK NUMBER:	001
	 	 
	TRANSIT NUMBER:	0004 (or use 00040, if a 5 digit # required)
	 	 
	ACCOUNT NUMBER:	CAD 1541-946
	 	 
	BENEFICIARY NAME & ADDRESS:	 
	 	 
	SIYATA MOBILE INC.	 
	 	 
	1001 Lenoir Street Suite A-414	 
	 	 
	Montreal, Quebec Canada H4C-2Z6	 

 

For payment
in US Dollars:

 

	BENEFICIARY BANK:	BANK OF MONTREAL 

    595 BURRARD STREET

    VANCOUVER, B.C., CANADA

    SWIFT CODE:  BOFMCAM2
	 	 
	CANADIAN BANK NUMBER:	001
	 	 
	TRANSIT NUMBER:	0004 (or use 00040, if a 5 digit # required)
	 	 
	ACCOUNT NUMBER:	
	 	 
	 	USD 4697-216
	 	 
	BENEFICIARY NAME & ADDRESS:	 
	 	 
	SIYATA MOBILE INC.	 
	 	 
	1001 Lenoir Street Suite A-414	 
	 	 
	Montreal, Quebec Canada H4C-2Z6	 
	 	 
	US CORRESPONDENT (for payments in USD only)	 
	 	 
	Wells Fargo PNBPUS3NNYC	 
	 	 
	ABA/Fedwire 026005092	 
	 	 
	NY, NY	 

 

    Subscription Agreement
- 2 -

     

    

 

TO:        SIYATA
MOBILE INC.

 

		1.	The Subscriber irrevocably subscribes for and agrees to purchase
from the Issuer the following securities:

 

	 	Number of Units at $0.10 each:	
	 	 	 
	 	Total subscription price for the subscribed
Units:	$

 

	2.	The Subscriber and the Issuer agree that the offering of
the Units shall be on the terms and conditions specified in Schedules “A” and “B” hereto. The Subscriber hereby
makes the representations, warranties, acknowledgments and agreements set out in Schedules “A” and “B” hereto
and in all applicable Forms, and acknowledges and agrees that the Issuer and its respective counsel will and can rely on such representations,
warranties, acknowledgments and agreements should this subscription be accepted.
	 	 

		3.	Identity of and execution by Subscriber:

 

	BOX A: SUBSCRIBER INFORMATION AND EXECUTION
	 	 	 	 	 
	 
	(name of subscriber)
	 	 	 	 	 
	 
	(address – include city, province and postal code)
	 	 	 	 	
	 	 	 	 	X
	(telephone number)	 	(email address)	 	(signature of subscriber/authorized signatory)
	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	(if applicable, print name of signatory and office)

 

Execution hereof
by the Subscriber shall constitute an offer and agreement to subscribe for the Units set out in Item 1 above pursuant to the provisions
of Item 2 above, and acceptance by the Issuer shall effect a legal, valid and binding agreement between the Issuer and the Subscriber.
This subscription may be executed and delivered by facsimile, and shall be deemed to bear the date of acceptance below.

 

		4.	If the Units are to be registered other than as set out in
Box A, the Subscriber directs the Issuer to register and deliver the Units as follows:

 

	BOX B: ALTERNATE REGISTRATION INSTRUCTIONS
	 
	 
	(name of registered holder)
	 
	 
	(address of registered holder – include city, province and postal code)
	 
	 
	(registered holder: contact name, contact telephone number and contact email address)

 

		5.	If the Units are to be delivered other than as set out in Box A (or if completed, Box B):

 

	BOX C: ALTERNATE DELIVERY INSTRUCTIONS
	 
	 
	(name of recipient)
	 
	 
	(address of recipient – include city, province and postal code)
	 
	 
	(recipient: contact name, contact telephone number and contact email address)

 

[Signature page to follow]

 

    Subscription Agreement
- 3 -

     

    

 

ACCEPTANCE

 

	This subscription is accepted and agreed to by the Issuer	)	SIYATA MOBILE INC.
	 	)		 
	as of the ____ day of ______________________, 2020.	)	 	 
	 	)	Per:	 
	 	)	 	Authorized Signatory

 

    Subscription Agreement
- 4 -

     

    

 

PERSONAL INFORMATION

 

		1.	Present Ownership of Securities of the Issuer. The Subscriber either [check appropriate
box]:

 

		☐	owns, directly or indirectly, or exercises control or direction
over, no common shares of the Issuer or securities convertible into common shares of the Issuer; or

 

		☐	owns, directly or indirectly, or exercises control or direction
over, ______________ common shares of the Issuer and securities convertible or exercisable to acquire an additional ______________ common
shares of the Issuer.

 

		2.	Insider Status. The Subscriber either [check appropriate box]:

 

		☐	is an “Insider” of the Issuer as defined in the
British Columbia Securities Act, determined as follows:

 

		(a)	a director or officer of the Issuer;

 

		(b)	a director or officer of a person that is itself an insider
or subsidiary of the Issuer; or

 

		(c)	a person that has direct or indirect:

 

		(1)	beneficial ownership of or control or direction over; or

 

		(2)	a combination of beneficial ownership of and control or direction
over,

 

securities of the Issuer carrying more
than 10% of the voting rights attached to all the Issuer’s outstanding voting securities, excluding, for the purpose of the calculation
of the percentage held, any securities held by the person as underwriter in the course of a distribution.

 

		☐	is not an Insider of the Issuer.

 

		3.	“Pro Group” Status. The Subscriber either [check appropriate box]:

 

		☐	is a member of the “Pro Group” as defined in
the Rules of the Exchange, determined as follows:

 

		(a)	subject to subparagraphs (b) and (c), “Pro Group”
shall include, either individually or as a group:

 

		(1)	the member (i.e. a member of the Exchange under the Exchange
requirements);

 

		(2)	employees of the member;

 

		(3)	partners, officers and directors of the member;

 

		(4)	affiliates of the member; and

 

		(5)	associates of any parties referred to in subparagraphs (1)
through (4);

 

		(b)	the Exchange may, in its discretion, include a person or party
in or exclude a person from the Pro Group for the purposes of a particular calculation where the Exchange determines, respectively, that
the person is not acting at arm’s length or is acting at arm’s length of the member; and

 

    Subscription Agreement
- 5 -

     

    

 

		(c)	the member may deem a person who would otherwise be included
in the Pro Group pursuant to subparagraph (a) to be excluded from the Pro Group where the member determines that:

 

		(1)	the person is an affiliate or associate of the member acting
at arm’s length of the member;

 

		(2)	the associate or affiliate has a separate corporate and reporting
structure;

 

		(3)	there are sufficient controls on information flowing between
the member and the associate or affiliate; and

 

		(4)	the member maintains a list of such excluded persons; or

 

		☐	is not a member of the Pro Group.

 

		4.	Corporate Placees. If the Subscriber is not an individual and will hold more than 5% of
the Issuer’s common shares on completion of the offering of Units, the Subscriber either [check appropriate box]:

 

		☐	has a current Corporate Placee Registration Form on file
with the Exchange; or

 

		☐	has, with this subscription, duly completed, executed and
returned a Corporate Placee Registration Form for filing with the Exchange (Form 3 to this subscription).

 

		5.	Registrants. The Subscriber either [check appropriate box]:

 

		☐	is a dealer, adviser, investment fund manager, an ultimate
designated person or chief compliance officer as those terms are used pursuant to Applicable Securities Laws, or a person registered
or otherwise required to be registered under Applicable Securities Laws; or

 

		☐	is not a Registrant

 

    Subscription Agreement
- 6 -

     

    

 

SCHEDULE A

 

		1.	Interpretation

 

		1.1	Unless the context otherwise requires, reference in this
subscription to:

 

		(a)	“Applicable Securities Laws” means the
Securities Act or analogous legislation of the Reporting Jurisdictions and the Selling Jurisdictions and all rules, regulations, policies,
orders, notices and other instruments incidental thereto;

 

		(b)	“Closing” refers to the completion of
the purchase and sale of the Units, and if the purchase and sale occurs in two or more tranches, the “Closing” for
purposes of any particular Unit shall be the completion of the purchase and sale of that particular Unit;

 

		(c)	“Closing Date” means the date on which
the Closing shall occur;

 

		(d)	“Exchange” means the TSX Venture Exchange;

 

		(e)	“NI45-102” and “NI45-106”
refer to National Instrument 45-102 and National Instrument 45-106, respectively, of the Canadian Securities Administrators;

 

		(f)	“Public Record” refers to all public information
which has been filed by the Issuer pursuant to the Applicable Securities Laws of the Reporting Jurisdictions and otherwise pursuant to
the Applicable Securities Laws of any additional Selling Jurisdictions;

 

		(g)	“Reporting Jurisdictions” refers to the
provinces of British Columbia and Alberta;

 

		(h)	“Securities” means, collectively, the
Units, the Shares, the Warrants and the Warrant Shares;

 

		(i)	“Selling Jurisdictions” refers to all
jurisdictions where the Units are sold;

 

		(j)	“Shares” means the previously unissued
common shares of the Issuer comprising part of the Units;

 

		(k)	“subscription” or “subscription
agreement” means this subscription agreement and includes all schedules hereto and the Forms;

 

		(l)	“U.S. Person” means a (a) U.S. Person
as that term is defined in Rule 902(o) of Regulation S (“Regulation S”) promulgated under the U.S. Securities Act,
(b) any person purchasing securities on behalf or the account or benefit of any “U.S. Person” or any person in the United
States, (c) any person that receives or received an offer of the securities while in the United States, (d) any person that is in the
United States at the time the purchaser’s buy order was made or this subscription was executed or delivered. “U.S. person”
includes but is not limited to (i) any natural person resident in the United States; (ii) any partnership or corporation organized or
incorporated under the laws of the United States; (iii) any partnership or corporation organized outside the United States by a U.S.
person principally for the purpose of investing in securities not registered under the U.S. Securities Act, unless it is organized or
incorporated, and owned, by accredited investors who are not natural persons, estates or trusts; (iv) any estate or trust of which any
executor or administrator or trustee is a U.S. person;

 

		(m)	“U.S. Purchaser” means a (a) Subscriber
that is a U.S. Person, (b) any Subscriber purchasing Securities on behalf or the account or benefit of any U.S. Person or any person
in the United States, (c) any Subscriber that receives or received an offer of the Units while in the United States, (d) any Subscriber
that is in the United States at the time the Subscriber’s buy order was made or this subscription agreement was executed or delivered;

 

		(n)	“U.S. Securities Act” means the United
States Securities Act of 1933, as amended;

 

		(o)	“Warrants” has the meaning ascribed thereto
on the face page of this subscription agreement; and

 

		(p)	“Warrant Shares” has the meaning ascribed
thereto on the face page of this subscription agreement.

 

     

     

    

 

		1.2	In the subscription, the following terms have the meanings
defined in Regulation S: “designated offshore securities market”, “directed selling efforts”, “foreign
issuer” and “United States”.

     

		1.3	Unless otherwise stated, all dollar figures herein expressed
are in Canadian Dollars.

     

		1.4	References imputing the singular shall include the plural
and vice versa; references imputing individuals shall include corporations, partnerships, societies, associations, trusts and other artificial
constructs and vice versa; and references imputing gender shall include the opposite gender.

 

		2.	Description of Offering and Securities

 

		2.1	The Issuer is offering (the “Offering”)
up to 20,000,000 Units at a price of $0.10 per Unit for gross proceeds of up to $2,000,000. Each Unit will consist of one Share and one-half
of one Warrant. Each whole Warrant entitles the holder thereof to purchase one Warrant Share at a price of $0.18 per Warrant Share for
a period of 24 months from the date the Warrants are issued. Any unexercised Warrants shall automatically expire at the end of the period
of 24 months from the date the Warrants are issued.

 

		2.2	The Issuer may increase the size of the Offering at its sole
discretion, subject to the receipt of the necessary regulatory approvals. The Offering is not subject to any minimum aggregate offering
and there can be no guarantees that the Issuer will raise sufficient funds to meet its present or future objectives.

 

		2.3	The completion of transactions contemplated in this Subscription
is subject to the following conditions:

 

		(a)	the Exchange’s conditional acceptance of the Offering
on such conditions as may be acceptable to the Issuer, acting reasonably, and the Exchange’s acceptance of this Subscription;

 

		(b)	the receipt by the Issuer from the Subscriber, in form and
content satisfactory to the Issuer in its sole discretion, of any other documents required by the Exchange and Applicable Securities
Laws which the Issuer requests;

 

		(c)	the truth, at the time of acceptance and as at Closing, of
the Subscriber’s representations and warranties under this agreement; and

 

		(d)	the performance by the Subscriber of its covenants under
this agreement.

 

		3.	Eligibility and Subscription Procedure

 

		3.1	The Offering is being made pursuant to exemptions (the “Exemptions”)
from the registration and prospectus requirements of Applicable Securities Laws. The Subscriber acknowledges and agrees that the Issuer
and its respective counsel will and can rely on the representations, warranties, acknowledgments and agreements of the Subscriber contained
in this subscription and otherwise provided by the Subscriber to the Issuer to determine the availability of Exemptions should this subscription
be accepted.

 

		3.2	The Offering is not, and under no circumstances is to be
construed as, a public offering of the Securities. The Offering is not being made, and this subscription does not constitute, an offer
to sell or the solicitation of an offer to buy the Securities in any jurisdiction where, or to any person to whom, it is unlawful to
make such offer or solicitation.

 

		3.3	Subscribers must duly complete and execute this subscription
together with all applicable Forms hereto (please see the Instructions listed on the face page hereof) and return them to the
Issuer with payment for the total subscription price for the subscribed Units by way of a certified cheque, money order or bank draft
made payable to “Siyata Mobile Inc.”

 

		3.4	Subscriptions are irrevocable.

 

		3.5	A subscription will only be effective upon its acceptance
by the Issuer. Subscriptions will only be accepted if the Issuer is satisfied that, and will be subject to a condition for the benefit
of the Issuer that, the Offering can lawfully be made in the jurisdiction of residence of the Subscriber pursuant to an available Exemption
and that all other Applicable Securities Laws have been and will be complied with in connection with the proposed distribution. The Issuer
reserves the right to accept this subscription in whole or in part.

 

		3.6	No offering memorandum or other disclosure document has been
prepared or will be delivered to the Subscriber in connection with the Offering, and the Subscriber hereby expressly acknowledges and
confirms that it has not received, and has no need for, an offering memorandum or other disclosure document in connection with the Offering.

 

    Schedule A
- 2 -

     

    

 

		4.	Closing Procedure

 

		4.1	The Offering will be completed at one or more Closings at
such time or times, on such date or dates, and at such place or places, as the Issuer may determine. At each Closing, the Issuer will
deliver certificates representing the Shares and the Warrants to those Subscribers whose subscriptions have been accepted.

 

		4.2	In the event that the purchase and sale of the Units contemplated
by this subscription is not otherwise completed or only completed in part, the Issuer shall, as the case may be, immediately return this
subscription and the total subscription price for the subscribed Units or return the part of the part of the subscription price representing
the number of Units in respect of which this subscription was not completed, all without interest or deduction.

 

		5.	Reporting and Consent

 

		5.1	The Subscriber, on its own behalf and on behalf of any other
person for whom it is contracting hereunder, expressly consents and agrees to:

 

		(a)	the Issuer collecting personal information regarding the
Subscriber for the purpose of completing the transactions contemplated by this subscription; and

 

		(b)	the Issuer releasing personal information regarding the Subscriber
and this Subscription, including the Subscriber’s name, residential address, telephone number, email address and registration and
delivery instructions, the number of Securities purchased, the number of securities of the Issuer held by the Subscriber, the status
of the Subscriber as an insider, as a Pro Group member or as otherwise represented herein, and, if applicable, information regarding
the beneficial ownership or the principals of the Subscriber, to securities regulatory authorities in compliance with Applicable Securities
Laws, to other authorities as required by law and to the registrar and transfer agent of the Issuer for the purpose of arranging for
the preparation of the certificates representing the Securities in connection with the Offering.

 

The purpose of the collection of the
information is to ensure the Issuer and its advisors will be able to issue Securities to the Subscriber in accordance with the instructions
of the Subscriber and in compliance with applicable corporate, securities and other laws, as well as Exchange requirements, and to obtain
the information required to be provided in documents required to be filed with securities regulatory authorities under Applicable Securities
Laws and with other authorities (including the Exchange) as required, which may include their public disclosure of such information. The
Subscriber, on its own behalf and on behalf of any other person for whom it is contracting hereunder, further expressly consents and agrees
to the collection, use and disclosure of all such personal information by securities regulatory authorities and other authorities in accordance
with their requirements (including for the purposes described in the Exchange’s Corporate Finance Manual Appendix 6A), including
but not limited to the publishing or making available to the public of such information and the provision of such information to third
party service providers for their collection, use and disclosure from time to time. The contact information for the officer of the Issuer
who can answer questions about the collection of information by the Issuer is as follows:

 

	Name & Title:	Gerald Bernstein, Chief Financial Officer
	Issuer Name:	Siyata Mobile Inc.
	Address:	1001 Lenoir St Suite A-414
	 	Montreal, QC H4C 2Z6
	Telephone No:	(514) 824-7357
	Email Address:	gerry@siyatamobile.com

 

		5.2	The Subscriber, on its own behalf and on behalf of any other
person for whom it is contracting hereunder, expressly acknowledges and agrees that:

 

		(a)	the Issuer may be required to provide applicable securities
regulators, or otherwise under the Proceeds of Crime (Money Laundering) and Terrorist Financing Act of Canada, a list setting
forth the identities of the purchasers of the Securities and any personal information provided by the Subscriber, and the Subscriber
hereby represents and warrants that to the best of the Subscriber’s knowledge, none of the funds representing the subscription
proceeds to be provided by the Subscriber (i) have been or will be derived from or related to any activity that is deemed criminal under
the law of Canada, the United States of America, or any other jurisdiction, or (ii) are being tendered on behalf of a person or entity
who has not been identified to the Subscriber; the Subscriber hereby further covenants that it shall promptly notify the Issuer if the
Subscriber discovers that any of such representations ceases to be true, and shall provide the Issuer with appropriate information in
connection herewith; and

 

    Schedule A
- 3 -

     

    

 

		(b)	it shall complete, sign and return such additional documentation
as may be required from time to time under Applicable Securities Laws or any other applicable laws in connection with the Offering and
this subscription.

 

		5.3	Furthermore, the Subscriber is hereby notified and acknowledges
that:

 

		(a)	the Issuer may deliver to the Ontario Securities Commission
certain personal information pertaining to the Subscriber, including such Subscriber’s full name, residential address, telephone
number and email address, the number of Securities purchased by the Subscriber and the total purchase price paid for such Securities,
the prospectus exemption relied on by the Issuer and the date of distribution of the Securities,

 

		(b)	such information is being collected indirectly by the Ontario
Securities Commission under the authority granted to it in securities legislation,

 

		(c)	such information is being collected for the purposes of the
administration and enforcement of the securities legislation of Ontario, and

 

		(d)	the Subscriber may contact the following public official
in Ontario with respect to questions about the Ontario Securities Commission’s indirect collection of such information at the following
address and telephone number:

 

Administrative Assistant to the Director
of Corporate Finance

Ontario Securities Commission

Suite 1903, Box 55, 20 Queen Street West

Toronto, Ontario, M5H 3S8

Telephone: (416) 593-8086

 

		6.	Resale Restrictions and Legending of Securities

 

		6.1	The Subscriber hereby acknowledges and agrees that the Offering
is being made pursuant to Exemptions and, as a result, the Securities will be subject to a number of statutory restrictions on resale
and trading. Until these restriction expire, the Subscriber will not be able to sell or trade the Securities unless the Subscriber complies
with an exemption from the prospectus and registration requirements under Applicable Securities Laws. In general, unless permitted under
Applicable Securities Laws, the Subscriber cannot trade the securities in Canada before the date that is four months and a day after
the date of the Closing. In addition to any statutory hold period imposed by Applicable Securities Laws, the Securities will be subject
to a hold period imposed by the Exchange of four months and a day after the date of the Closing. See also section 6.3 below.

 

		6.2	The Subscriber acknowledges and agrees that:

 

		(a)	the Securities have not been and will not be registered under
the U.S. Securities Act, or any State securities laws, and may not be offered and sold, directly or indirectly, in the United States
or by or to or for the account or benefit of a U.S. Person without registration under the U.S. Securities Act and any applicable State
securities laws, unless an exemption from registration is available;

 

		(b)	the Issuer has no present intention and is not obligated
under any circumstances to register the Securities, or to take any other actions to facilitate or permit any proposed resale or transfer
thereof in the United States or otherwise by or to or for the account or benefit of a U.S. Person, and in particular, the Subscriber
and the Issuer further acknowledge and agree that the Issuer is hereby required to refuse to register any transfer of the Securities
not made in accordance with the provisions of Regulation S, pursuant to registration under the U.S. Securities Act, or pursuant to an
available exemption from registration.

 

		6.3	The foregoing discussion on hold periods and resale restrictions
is a general summary only and is not intended to be comprehensive or exhaustive, or to apply in all circumstances. Subscribers are
advised to consult with their own advisors concerning their particular circumstances and the particular nature of the restrictions on
transfer, the extent of the applicable hold period and the possibilities of utilizing any further Exemptions or the obtaining of a discretionary
order to transfer any Securities. Subscribers are further advised against attempting to resell or transfer any Securities until they
have determined that any such resale or transfer is in compliance with the requirements of all Applicable Securities Laws, including
but not limited to compliance with restrictions on certain pre-trade activities and the filing with the appropriate regulatory authority
of reports required upon any resale of the Securities.

 

    Schedule A
- 4 -

     

    

 

		6.4	In the event that any of the Securities are subject to a
hold period or any other restrictions on resale and transferability, the Issuer will place a legend on the certificates representing
the Securities as are required under Applicable Securities Laws, by the Exchange or as it may otherwise deem necessary or advisable.

 

		7.	Finder’s Fees

 

		7.1	Subject to compliance with applicable laws and Exchange approval,
the Issuer may pay a finder’s fee or commission to persons who assist in the introduction of investors to the Issuer, which without
limiting the foregoing may include cash, common shares and/or convertible securities. No finder’s fee will be payable in respect
of Units offered or sold in the United States to a finder who is not registered as a broker-dealer under the United States Securities
Exchange Act of 1934, as amended, and applicable state securities laws, or unless such finder is exempt from such registration requirements.

 

		8.	Miscellaneous

 

		8.1	The Subscriber acknowledges and agrees that all costs and
expenses incurred by the Subscriber, including any fees and disbursements of any special counsel retained by the Subscriber, relating
to the purchase, resale or transfer of the Securities shall be borne by the Subscriber.

 

		8.2	Each party to this subscription covenants that it will, from
time to time both before and after the Closing, at the request and expense of the requesting party, promptly execute and deliver all
such other notices, certificates, undertakings, escrow agreements and other instruments and documents, and shall do all such other acts
and other things, as may be necessary or desirable for the purposes of carrying out the provisions of this subscription.

 

		8.3	Except as expressly provided for in this subscription and
in any agreements, instruments and other documents contemplated or provided for herein, this subscription contains the entire agreement
between the parties with respect to the sale of the Securities and there are no other terms, conditions, representations, warranties,
acknowledgments and agreements, whether expressed or implied, whether written or oral, and whether made by statute, common law, the parties
hereto or anyone else. This subscription may only be amended by instrument in writing signed by the parties hereto.

 

		8.4	The invalidity or unenforceability of any particular provision
of this subscription or any part thereof shall not affect or limit the validity or enforceability of the remaining provisions of this
subscription or part thereof.

 

		8.5	This subscription, including without limitation the terms,
conditions, representations, warranties, acknowledgments and agreements contained herein, shall survive and continue in full force and
effect and be binding upon the Subscriber and the Issuer notwithstanding the completion of the purchase and sale of the Securities, the
conversion or exercise thereof and any subsequent disposition thereof by the Subscriber.

 

		8.6	This subscription is not transferable or assignable. This
subscription shall enure to the benefit of and be binding upon the parties hereto and their respective successors and permitted assigns.

 

		8.7	This subscription is governed by the laws of the Province
of British Columbia and the federal laws of Canada applicable therein. The Subscriber, in his personal or corporate capacity, irrevocably
attorns to the jurisdiction of the courts of the Province of British Columbia.

 

		8.8	Time shall be of the essence hereof.

 

		8.9	This subscription may be executed in as many counterparts
as may be necessary and delivered by facsimile, and such counterparts and facsimiles shall be deemed to constitute one and the same original
instrument. Without limiting the foregoing, the Issuer may rely on facsimile delivery of this subscription, and acceptance of such facsimile
shall be effective to create a valid and binding agreement between the Subscriber and the Issuer.

 

    Schedule A
- 5 -

     

    

 

SCHEDULE B

 

	1.	Representations, Warranties, Acknowledgments and Agreements of the Subscriber

 

	1.1	The Subscriber hereby represents, warrants, certifies, acknowledges and agrees for the benefit of the
Issuer and its respective counsel that:

 

		(a)	the Subscriber is resident in the jurisdiction set out on page 3 above, and if such address is not located
in British Columbia, the Subscriber expressly certifies that it is not resident in British Columbia;

 

		(b)	no securities commission or similar regulatory authority has reviewed or passed on the merits of the Securities,
and in particular no governmental agency or authority, stock exchange or other regulatory body or any other entity has made any finding
or determination as to the merit for investment of, nor have any such agencies, authorities, exchanges, bodies or other entities made
any recommendation or endorsement with respect to, the Securities;

 

		(c)	there is no government or other insurance covering the Securities;

 

		(d)	there are risks associated with the purchase of the Securities, being speculative investments which involve
a substantial degree of risk;

 

		(e)	there are restrictions on the Subscriber’s ability to resell the Securities and it is the responsibility
of the Subscriber to find out what those restrictions are and to comply with them before selling the Securities;

 

		(f)	the Issuer has advised the Subscriber that it is relying on one or more exemptions from the requirements
to provide the Subscriber with a prospectus and to sell securities through a person registered to sell securities under the Applicable
Securities Laws, and as a consequence of acquiring the Securities pursuant to such exemption, certain protections, rights and remedies
provided in applicable securities legislation, including statutory rights of rescission or damages, may not be available to it;

 

		(g)	the Subscriber has been further advised that due to the fact that no prospectus has been or is required
to be filed with respect to any of the Securities under Applicable Securities Laws (i) the Subscriber may not receive information
that might otherwise be required to be provided to it under such legislation, (ii) the Issuer is relieved from certain obligations that
would otherwise apply under applicable legislation, and (iii) the Subscriber is restricted from using certain of the civil remedies available
under such legislation;

 

		(h)	the Subscriber has had access to all information regarding the Issuer and the Securities that the Subscriber
has considered necessary in connection with its investment decision, and, in particular, the Subscriber’s decision to execute this subscription
and purchase Units has been based entirely upon its review of the Public Record, including the Issuer’s financial statements, and has
not been based upon any written or oral representation or warranty as to fact or otherwise made by or on behalf of the Issuer;

 

		(i)	no person has made to the Subscriber any written or oral representations (i) that any person will resell
or repurchase the Securities, (ii) that any person will refund the purchase price for the Securities, (iii) as to the future price or
value of the Securities, or (iv) that the Securities will be listed and posted for trading or any stock exchange or that application has
been made to list the common shares of the Issuer on any stock exchange;

 

		(j)	the Subscriber is capable by reason of knowledge and experience in financial and business matters in general,
and investments in particular, of assessing and evaluating the merits and risks of an investment in the Securities, and is and will be
able to bear the economic loss of its entire investment in any of the Securities and can otherwise be reasonably assumed to have the capacity
to protect its own interest in connection with the investment;

 

		(k)	the Subscriber has been advised to consult its own investment, legal and tax advisors with respect to
the merits and risks of an investment in the Securities, Applicable Securities Laws and applicable resale restrictions, and in all cases
the Subscriber has not relied upon the Issuer or its respective counsel or advisors for investment, legal or tax advice, always having,
if desired, in all cases sought the advice of the Subscriber’s own personal investment advisor, legal counsel and tax advisors, and in
particular, the Subscriber has been advised and understands that it is solely responsible, and neither the Issuer nor its respective counsel
or advisors are in any way responsible, for the Subscriber’s compliance with Applicable Securities Laws and with applicable resale restrictions
regarding the holding and disposition of the Securities;

 

     

     

    

 

		(l)	to the knowledge of the Subscriber, the Offering was not advertised or solicited in any manner in contravention
of Applicable Securities Laws, and has not been made through or as a result of any general solicitation or general advertising or any
seminar or meeting whose attendees have been invited by general solicitation or general advertising;

 

		(m)	the Subscriber has no knowledge of a “material fact” or “material change”, as those
terms are defined in the Applicable Securities Laws applicable in its jurisdiction of residence, in respect of the affairs of the Issuer
that has not been generally disclosed to the public;

 

		(n)	the Subscriber is not a “control person” as defined in the policies of the Exchange, will not
become a “control person” by virtue of purchasing the Units as contemplated herein, and does not intend to act in concert with
any other person to form a control group of the Issuer;

 

		(o)	the Subscriber is not an investment club;

 

		(p)	the Subscriber has the legal capacity and competence to enter into and execute this subscription and to
take all actions required pursuant hereto, and if the Subscriber is not an individual, it is also duly formed and validly subsisting under
the laws of its jurisdiction of formation and all necessary approvals by its directors, shareholders, partners and others have been obtained
to authorize the entering into and execution of this subscription and the taking of all actions required hereto on behalf of the Subscriber;

 

		(q)	the Subscriber has duly and validly entered into, executed and delivered this subscription and it constitutes
a legal, valid and binding obligation of the Subscriber enforceable against it in accordance with its terms subject to applicable bankruptcy,
insolvency, reorganization, moratorium and other laws of general application affecting the enforcement of creditors’ rights generally
and as limited by laws relating to the availability of equitable remedies;

 

		(r)	the entering into of this subscription and the transactions contemplated hereby does not and will not,
conflict with, result in a violation or breach of, or constitute a default under, any of the terms and provisions of any law, regulation,
order or ruling applicable to the Subscriber, or of any agreement, contract or indenture, written or oral, to which it is or may be a
party or by which it is or may be bound, or, if the Subscriber is a corporation, its constating documents or any resolutions of its directors
or shareholders;

 

		(s)	with respect to compliance with the U.S. Securities Act:

 

		(i)	none of the Securities have been registered under the U.S. Securities Act, or under any state securities
or “blue sky” laws of any state of the United States, and, unless so registered, may not be offered or sold except pursuant
to an effective registration statement under the U.S. Securities Act or pursuant to an exemption from, or in a transaction not subject
to, the registration requirements of the U.S. Securities Act;

 

		(ii)	the Subscriber is neither an underwriter of, or dealer in, the common shares of the Issuer, nor participating,
pursuant to a contractual agreement or otherwise, in the distribution of the Securities;

 

		(iii)	the Subscriber is acquiring the Securities for investment only and not with a view to resale or distribution
and, in particular, has no intention to distribute, directly or indirectly, all or any of the Securities in the United States or to U.S.
Persons or to persons in the United States, and the Subscriber does not have any agreement or understanding (either written or oral) with
any U.S. Person or person in the United States respecting (A) the transfer or assignment of any rights or interests in any of the Securities;
(B) the division of profits, losses, fees, commissions, or any financial stake in connection with this subscription or the Securities;
or (C) the voting of any securities offered hereby or underlying any securities offered hereby;

 

		(iv)	the Subscriber does not intend to and will not engage in hedging transactions with regard to the Securities
unless in compliance with the U.S. Securities Act;

 

		(v)	any person who acquires Securities may at the Issuer’s discretion be required to provide the Issuer with
written certification that it is not a U.S. Person or person in the United States and that the Securities are not being acquired, directly
or indirectly, for the account or benefit of a U.S. Person or person in the United States; and

 

    Schedule B
- 2 -

     

    

 

		(vi)	the current structure of this transaction and all transactions and activities contemplated hereunder,
and the Subscriber’s participation therein, is not a scheme to avoid the registration requirements of the U.S. Securities Act;

 

		(t)	unless the Subscriber has completed Form 2 – Certificate of U.S. Accredited Investor Status, attached
hereto:

 

		(i)	the Subscriber is not a U.S. Person or person in the United States and is not acquiring the Securities,
directly or indirectly, for the account or the benefit of a U.S. Person or person in the United States;

 

		(ii)	the Securities have not been offered to the Subscriber while the Subscriber was in the United States,
and the individuals making the order to purchase the Securities and executing and delivering this subscription for the account or benefit
of the Subscriber were not in the United States when the order was placed or when this subscription was executed and delivered; and

 

		(iii)	the Subscriber is not purchasing the Units as the result of any “directed selling efforts”;
and

 

		(u)	if the Subscriber has completed Form 2 – Certificate of U.S. Accredited Investor Status, attached
hereto:

 

		(i)	the Subscriber, by completing Form 2 – Certificate of U.S. Accredited Investor Status, is representing
and warranting to the Issuer that the Subscriber is an “accredited investor” as the term is defined in Regulation D, and that
all information contained in the Subscriber’s completed Form 2 – Certificate of U.S. Accredited Investor Status is complete and
accurate in all respects and may be relied upon by the Issuer;

 

		(ii)	the Subscriber will not acquire the Securities as a result of, and will not itself engage in, any activities
undertaken for the purpose of, or that could reasonably be expected to have the effect of, conditioning the market in the United States
for the resale of any of the Securities; provided, however, that the Subscriber may sell or otherwise dispose of any of the Securities
pursuant to registration thereof under the U.S. Securities Act and any applicable state securities laws or under an exemption from such
registration requirements;

 

		(iii)	the Subscriber and its advisor(s) have had a reasonable opportunity to ask questions of and receive answers
from the Issuer in connection with the distribution of the Securities hereunder, and to obtain additional information, to the extent possessed
or obtainable without unreasonable effort or expense, necessary to verify the accuracy of the information about the Issuer;

 

		(iv)	the books and records of the Issuer were available upon reasonable notice for inspection, subject to certain
confidentiality restrictions, by the Subscriber during reasonable business hours at its principal place of business, and all documents,
records and books in connection with the distribution of the Securities hereunder have been made available for inspection by the Subscriber
and/or its advisor(s);

 

		(v)	the Subscriber hereby acknowledges that that upon the issuance thereof, and until such time as the same
is no longer required under the applicable securities laws and regulations, the certificates representing any of the Securities will bear
legends in substantially the form set forth on Form 2 hereto;

 

		(vi)	the Issuer will refuse to register any transfer of the Securities not made pursuant to an effective registration
statement under the U.S. Securities Act or pursuant to an available exemption from the registration requirements of the U.S. Securities
Act; and

 

		(vii)	the statutory and regulatory basis for the exemption claimed for the offer of the Securities would not
be available if the Offering is part of a plan or scheme to evade the registration provisions of the U.S. Securities Act.

 

    Schedule B
- 3 -

     

    

 

	1.2	The Subscriber hereby represents, warrants, acknowledges and agrees for the benefit of the Issuer and
its respective counsel that it is purchasing the Securities as principal (or is deemed under applicable securities laws to be doing so),
not for the benefit of any other person and not with a view to the resale or distribution of all or any of the Securities, and:

 

		(a)	in respect of all Subscribers resident in or otherwise subject to the securities laws of a Province
of Canada, it is:

 

		(i)	a person described in section 2.3 of NI45-106 by virtue of being an “accredited investor” as
defined in NI45-106, and provided that it is not a person that is or has been created or used solely to purchase or hold securities as
an “accredited investor” as described in paragraph (m) of the definition of “accredited investor” in NI45-106, and
the Subscriber has certified same by marking the applicable boxes and signing and returning Form 1 herein; or

 

		(ii)	a person described in section 2.5 of NI45-106 by virtue of being (A) a director, executive officer or
control person of the Issuer or of an affiliate of the Issuer; (B) a spouse, parent, grandparent, brother, sister, child or grandchild
of a director, executive officer or control person of the Issuer or an affiliate of the Issuer; (C) a parent, grandparent, brother, sister,
child or grandchild of the spouse of a director, executive officer or control person of the Issuer or of an affiliate of the Issuer; (D)
a close personal friend or close business associate of a director, executive officer or control person of the Issuer or of an affiliate
of the Issuer; (E) a founder of the Issuer or a spouse, parent, grandparent, brother, sister, child, close personal friend or close business
associate of a founder of the Issuer; (F) a parent, grandparent, brother, sister or child of a spouse of a founder of the Issuer; (G)
a person of which a majority of the voting securities are beneficially owned by, or a majority of the directors are, persons described
in paragraphs 1.2(a)(ii)(A) to 1.2(a)(ii)(F); or (H) a trust or estate of which all of the beneficiaries or a majority of the trustees
are persons described in paragraphs 1.2(a)(ii)(A) to 1.2(a)(ii)(F); and

 

		(b)	in respect of all U.S. Purchasers, it is an “accredited investor” as defined in Regulation
D and the Subscriber has certified same by marking the applicable boxes and signing and returning Form 2 herein; and

 

		(c)	in respect of all Subscribers resident outside of Canada or the United States:

 

		(i)	it is knowledgeable of, or has been independently advised as to, the applicable securities laws of the
securities regulatory authorities (the “International Authorities”) having application to the Offering and the Issuer
in the jurisdiction (the “International Jurisdiction”) in which the Subscriber is resident;

 

		(ii)	it is purchasing Securities pursuant to an applicable exemption from any prospectus, registration or similar
requirements under the applicable securities laws of the International Jurisdiction, or the Subscriber is permitted to purchase the Securities
under the applicable securities laws of the International Jurisdiction without the need to rely on such exemptions;

 

		(iii)	the applicable securities laws of the International Jurisdiction do not require the Issuer to make any
filings or seek any approvals of any nature whatsoever with or from any of the International Authorities in connection with the Offering
or the Securities, including any resale thereof;

 

		(iv)	the Offering and the completion of the offer and sale of the Securities to the Subscriber as contemplated
herein complies in all respects with the applicable securities laws of the International Jurisdiction, and does not trigger:

 

		(A)	any obligation to prepare and file a prospectus or similar or other offering document, or any other report
with respect to such purchase in the International Jurisdiction; or

 

		(B)	any continuous disclosure reporting obligation of the Issuer in the International Jurisdiction; and

 

		(v)	it will, if requested by the Issuer, deliver to the Issuer a certificate or opinion of local counsel from
the International Jurisdiction which will confirm the matters referred to in subparagraphs (ii), (iii) and (iv) above to the satisfaction
of the Issuer, acting reasonably.

 

    Schedule B
- 4 -

     

    

 

	2.	

Reliance, Notification, Indemnity and Survival

 

	2.1	The Subscriber acknowledges and agrees that the Issuer and its respective counsel will and can rely on
the representations, warranties, certifications, acknowledgments and agreements of the Subscriber contained in this subscription and otherwise
provided by the Subscriber to and with the Issuer to determine the availability of Exemptions should this subscription be accepted, and
otherwise in completing the offering, issue and sale of the Securities to the Subscriber in accordance with applicable laws.

 

	2.2	The Subscriber undertakes to notify the Issuer immediately of any change in any representation, warranty
or other information pertaining to the Subscriber herein or otherwise provided in connection with this subscription which takes place
prior to Closing.

 

	2.3	The Subscriber hereby agrees to indemnify and hold harmless the Issuer against all actions, claims, damages,
costs, expenses, losses and liabilities which it may suffer or incur as a result of this subscription.

 

	2.4	The representations, warranties, acknowledgements and agreements made by the Subscriber in this subscription
and otherwise provided by the Subscriber and the Issuer shall be true and correct as of the date of execution of this subscription and
as of Closing as if repeated thereat, and shall survive the Closing.

 

    Schedule B
- 5 -

     

    

 

FORM 1

 

CERTIFICATE FOR EXEMPTION

 

In addition to the representations, warranties
acknowledgments and agreements contained in the subscription to which this Form 1 – Certificate for Exemption is attached, the Subscriber
hereby represents, warrants and certifies to the Issuer that the Subscriber is purchasing the securities set out in the subscription as
principal, it is resident in the jurisdiction set out on the Acceptance Page of the subscription and: [check all appropriate boxes]

 

Category 1: Accredited Investor

 

The Subscriber is [check appropriate box and
complete related blanks]:

 

	 ☐	(a)	except in Ontario, a Canadian financial institution, or a Schedule III bank;
	 	 	 
	☐	(b)	except in Ontario, the Business Development Bank of Canada incorporated under the Business Development Bank of Canada Act
(Canada);
	 	 	 
	☐	(c)	except in Ontario, a subsidiary of any person referred to in paragraphs (a) or (b), if the person owns all of the voting securities
of the subsidiary, except the voting securities required by law to be owned by directors of that subsidiary;
	 	 	 
	☐	(d)	except in Ontario, a person registered under the securities legislation of a jurisdiction of Canada, as an adviser or dealer;
	 	 	 
	☐	(e)	an individual registered under the securities legislation of a jurisdiction of Canada as a representative of a person referred to
in paragraph (d);
	 	 	 
	☐	(e.1)	an individual formerly registered under the securities legislation of a jurisdiction of Canada, other
than an individual formerly registered solely as a representative of a limited market dealer under one or both of the Securities Act
(Ontario) or the Securities Act (Newfoundland and Labrador);
	 	 	 
	☐	(f)	except in Ontario, the Government of Canada or a jurisdiction of Canada, or any crown corporation, agency or wholly owned entity
of the Government of Canada or a jurisdiction of Canada;
	 	 	 
	☐	(g)	except in Ontario, a municipality, public board or commission in Canada and a metropolitan community, school board, the Comité
de gestion de la taxe scolaire de l’île de Montréal or an intermunicipal management board in Québec;
	 	 	 
	☐	(h)	except in Ontario, any national, federal, state, provincial, territorial or municipal government of or in any foreign jurisdiction, or
any agency of that government;
	 	 	 
	☐	(i)	except in Ontario, a pension fund that is regulated by either the Office of the Superintendent of Financial Institutions (Canada),
a pension commission or similar regulatory authority of a jurisdiction of Canada;
	 	 	 
	☐	(j)	an individual who, either alone or with a spouse, beneficially owns financial assets having an aggregate realizable value that before taxes, but net of any related liabilities, exceeds Cdn$1,000,000;

                                                                 

                                                                If qualifying under this paragraph, the Subscriber must also complete and sign Schedule 1 attached hereto entitled “Form 45-106F9: Form for Individual Accredited Investors”.

	 	 	 
	☐	(j.1)	an individual who beneficially owns financial assets having an aggregate realizable value that, before taxes, but net of any related
liabilities exceeds $5,000,000;
	 	 	 
	☐	(k)	an individual whose net income before taxes exceeded Cdn$200,000 in each of the two most recent calendar years or whose net income before taxes combined with that of a spouse exceeded Cdn$300,000 in each of the two most recent calendar years and who, in either case, reasonably expects to exceed that net income level in the current calendar year;

                                                                 

                                                                If qualifying under this paragraph, the Subscriber must also complete and sign Schedule 1 attached hereto entitled “Form 45-106F9: Form for Individual Accredited Investors”.

	 	 	 
	☐	
    (l)
	an individual who, either alone or with a spouse, has net assets of at least Cdn$5,000,000;

                                                                 

                                                                If qualifying under this
                                            paragraph, the Subscriber must also complete and sign Schedule 1 attached hereto entitled
                                            “Form 45-106F9: Form for Individual Accredited Investors”.

 

    

     

    

 

	☐	(m)	a person, other than an individual or investment fund, that has net assets of at least Cdn$5,000,000 as shown on its most recently
prepared financial statements;
	 	 	 
	☐	
    (n)
	an investment fund that distributes or has distributed its securities only to:

                                                                 

                                                                (i)a person that is or was an accredited investor at the time of the distribution;

                                                                 

                                                                (ii)a person that acquires or acquired securities in the circumstances referred to in sections 2.10 and 2.19 of NI45-106, or

                                                                 

                                                                (iii)a person described in paragraph (i) or (ii) that acquires or acquired securities under section 2.18 of NI45-106;

	 	 	 
	☐	(o)	an investment fund that distributes or has distributed securities under a prospectus in a jurisdiction of Canada for which the regulator
or, in Quebec, the securities regulatory authority, has issued a receipt;
	 	 	 
	☐	(p)	a trust company or trust corporation registered or authorized to carry on business under the Trust and Loan Companies Act (Canada)
or under comparable legislation in a jurisdiction of Canada or a foreign jurisdiction, acting on behalf of a fully managed account managed
by the trust company or trust corporation, as the case may be;
	 	 	 
	☐	(q)	a person acting on behalf of a fully managed account managed by that person, if that person is registered or authorized to carry
on business as an adviser or the equivalent under the securities legislation of a jurisdiction of Canada or a foreign jurisdiction;
	 	 	 
	☐	(r)	a registered charity under the Income Tax Act (Canada) that, in regard to the trade, has obtained advice from an eligibility
adviser or an adviser registered under the securities legislation of the jurisdiction of the registered charity to give advice on the
securities being traded;
	 	 	 
	☐	(s)	an entity organized in a foreign jurisdiction that is analogous to any of the entities referred to in paragraphs (a) to (d) or paragraph
(i) in form and function;
	 	 	 
	☐	(t)	a person in respect of which all of the owner of interests, direct, indirect or beneficial, except the voting securities required
by law to be owned by directors, are persons that are accredited investors;
	 	 	 
	☐	(u)	an investment fund that is advised by a person registered as an adviser or a person that is exempt from registration as an adviser;
	 	 	 
	☐	(v)	a person that is recognized or designated by the securities regulatory authority or, except in Ontario and Quebec, the regulator
as an accredited investor; or
	 	 	 
	☐	(w)	a trust established by an accredited investor for the benefit of the accredited investor’s family members of which a majority of
the trustees are accredited investors and all of the beneficiaries are the accredited investor’s spouse, a former spouse of the accredited
investor or a parent, grandparent, brother, sister, child or grandchild of that accredited investor, of that accredited investor’s spouse
or of that accredited investor’s former spouse.

 

AND

 

If the Subscriber is a resident of, or otherwise
subject to the securities laws of, Ontario, the Subscriber is [check appropriate box]:

 

	☐	(aa)	 a bank listed in Schedule I, II or III to the Bank Act (Canada);
	 	 	 
	☐	(bb)	an association to which the Cooperative Credit Associations Act (Canada) applies or a central cooperative credit society for
which an order has been made under subsection 473(1) of that Act;
	 	 	 
	☐	(cc)	a loan corporation, trust company, trust corporation, insurance company, treasury branch, credit union, caisse populaire, financial
services cooperative or credit union league or federation that is authorized by a statute of Canada or Ontario to carry on business in
Canada or Ontario, as the case may be;
	 	 	 
	☐	(dd)	the Business Development Bank of Canada;

 

    

     

    

 

	☐	(ee)	a subsidiary of any person or company referred to in clause (aa), (bb), (cc) or (dd), if the person or company owns all of the voting
securities of the subsidiary, except the voting securities required by law to be owned by directors of that subsidiary;
	 	 	 
	☐	(ff)	a person or company registered under the securities legislation of a province or territory of Canada as an adviser or dealer, except
as otherwise prescribed by the regulations;
	 	 	 
	☐	(gg)	the Government of Canada, the government of a province or territory of Canada, or any Crown corporation, agency or wholly owned entity
of the Government of Canada or of the government of a province or territory of Canada;
	 	 	 
	☐	(hh)	a municipality, public board or commission in Canada and a metropolitan community, school board, the Comité de gestion de
la taxe scolaire de l’Île de Montréal or an intermunicipal management board in Quebec;
	 	 	 
	☐	(ii)	any national, federal, state, provincial, territorial or municipal government of or in any foreign jurisdiction, or any agency of
that government;
	 	 	 
	☐	(jj)	a pension fund that is regulated by either the Office of the Superintendent of Financial Institutions (Canada) or a pension commission
or similar regulatory authority of a province or territory of Canada;
	 	 	 
	☐	(kk)	a person or company that is recognized or designated by the Ontario Securities Commission as an accredited investor; or
	 	 	 
	☐	(ll)	such other persons or companies as may be prescribed by the regulations under the Securities Act (Ontario).

 

Additional Instruction: If the Subscriber
is an individual and qualifies under Category 1 as an “Accredited Investor” pursuant to paragraphs (j), (k) or
(l) above, it must also complete and sign Schedule 1 attached hereto entitled
“Form 45-106F9: Form for Individual Accredited Investors”.

 

Definitions:

 

“Canadian financial institution”
means

 

		(a)	an association governed by the Cooperative Credit Associations Act (Canada) or a central cooperative
credit society for which an order has been made under section 473(1) of that Act, or

 

		(b)	a bank, loan corporation, trust company, trust corporation, insurance company, treasury branch, credit
union, caisse populaire, financial services cooperative, or league that, in each case, is authorized by an enactment of Canada or a jurisdiction
of Canada to carry on business in Canada or a jurisdiction of Canada;

 

“EVCC” means an employee venture
capital corporation that does not have a restricted constitution, and is registered under Part 2 of the Employee Investment Act
(British Columbia), R.S.B.C. 1996 c. 112, and whose business objective is making multiple investments;

 

“financial assets” means

 

		(a)	cash,

 

		(b)	securities, or

 

		(c)	a contract of insurance, a deposit or an evidence of a deposit that is not a security for the purposes
of securities legislation;

 

“fully managed account” means
an account of a client for which a person makes the investment decisions if that person has full discretion to trade in securities for
the account without requiring the client’s express consent to a transaction;

 

“investment fund” means a mutual
fund or a non-redeemable investment fund, and, for greater certainty in British Columbia, includes an EVCC and a VCC;

 

“person” includes

 

		(a)	an individual,

 

    

     

    

 

		(b)	a corporation,

 

		(c)	a partnership, trust, fund and an association, syndicate, organization or other organized group of persons,
whether incorporated or not, and

 

		(d)	an individual or other person in that person’s capacity as a trustee, executor, administrator or personal
or other legal representative;

 

“related liabilities” means

 

		(a)	liabilities incurred or assumed for the purpose of financing the acquisition or ownership of financial
assets, or

 

		(b)	liabilities that are secured by financial assets;

 

“Schedule III bank” means an
authorized foreign bank named in Schedule III of the Bank Act (Canada);

 

“spouse” means, an individual
who,

 

		(a)	is married to another individual and is not living separate and apart within the meaning of the Divorce
Act (Canada), from the other individual; or

 

		(b)	is living with another individual in a marriage-like relationship, including a marriage-like relationship
between individuals of the same gender; or

 

		(c)	in Alberta, is an individual referred to in paragraph (a) or (b), or is an adult interdependent partner
within the meaning of the Adult Interdependent Relationships Act (Alberta);

 

“subsidiary” means in issuer
that is controlled directly or indirectly by another issuer and includes a subsidiary of that subsidiary;

 

“VCC” means a venture capital
corporation registered under Part 1 of the Small Business Venture Capital Act (British Columbia), R.S.B.C. 1996 c. 429, whose business
objective is making multiple investments.

 

Category 2: Family, Friends and Business
Associates

 

The Subscriber is [check appropriate box and
complete related blanks]:

 

	☐	(a)	a director, executive officer or control person of the Issuer or of an affiliate of the Issuer;

 

	☐	(b)	a spouse, parent, grandparent, brother, sister, grandchild or child of a director, executive officer or
control person of the Issuer or of an affiliate of the Issuer;

 

	☐	(c)	a parent, grandparent, brother, sister, grandchild or child of the spouse of a director, executive officer
or control person of the Issuer or of an affiliate of the Issuer;

 

	☐	(d)	a close personal friend* of a director, executive officer or control person of the Issuer or of an affiliate
of the Issuer;

 

	☐	(e)	a close business associate** of a director, executive officer or control person of the Issuer or of an
affiliate of the Issuer;

 

	☐	(f)	a founder of the Issuer or a spouse, parent, grandparent, brother, sister, grandchild, child, close personal
friend or close business associate of a founder of the Issuer;

 

	☐	(g)	a parent, grandparent, brother, sister, grandchild or child of a spouse of a founder of the Issuer,

 

	☐	(h)	a person of which a majority of the voting securities are beneficially owned by persons described
in paragraphs (a) to (g);

 

	☐	(i)	a person of which a majority of the directors are persons described in paragraphs (a) to (g);

 

	☐	(j)	a trust or estate of which all of the beneficiaries are persons described in paragraphs (a) to
(g); or

 

	☐	(k)	a trust or estate of which a majority of the trustees or executors are persons described in paragraphs
(a) to (g),

 

    

     

    

 

of which the relevant
director, executive officer, control person or founder of the Issuer or affiliate thereof referred to in paragraphs (b) to (k) above is:

 

	 	State name:	                          

 

	 	State the length of your relationship
    with this person:	                     

 

Additional Instruction: If the Subscriber
qualifies under Category 2 and is a resident of Ontario, it must also complete
and sign Schedule 2 attached hereto entitled “Form 45-106F12: Risk Acknowledgment Form for Family, Friend and Business
Associate Investors”. If the Subscriber qualifies under Category 2 and
is a resident of Saskatchewan, it must also complete and sign Schedule 3 attached hereto entitled “Risk Acknowledgement –
Saskatchewan Close Personal Friends and Business Associates”.

 

		Notes:	

 

		*	“close personal friend” means an individual who has known the named director, executive
officer, control person or founder well enough and for a sufficient period of time to be in a position to assess the capabilities and
trustworthiness of that person. The term “close personal friend” can include a family member who is not already specifically
identified in paragraphs (b), (c), (f) or (g) if the family member otherwise meets the criteria described above. An individual’s
relationship with the named director, executive officer, control person or founder must be direct. An individual is not a “close
personal friend” solely because that individual is a relative, a member of the same club, organization, association or religious
group, a co-worker, colleague or associate at the same workplace, a client, customer, former client or former customer, a mere acquaintance,
or connected through some form of social media, such as Facebook, Twitter or LinkedIn.

 

		**	“close business associate” means an individual who has had sufficient prior business
dealings with the named director, executive officer, control person or founder to be in a position to assess the capabilities and trustworthiness
of that person. An individual’s relationship with the named director, executive officer, control person or founder must be direct. An
individual is not a “close business associate” solely because that individual is a member of the same club, organization, association
or religious group, a co-worker, colleague or associate at the same workplace, a client, customer, former client or former customer, a
mere acquaintance, or connected through some form of social media, such as Facebook, Twitter or LinkedIn.

 

Category 3: $150,000 Purchaser

 

		☐	The Subscriber is:

 

		(a)	not an individual and has an acquisition cost for the Units of not less than $150,000 paid in cash
at the time of the distribution;

 

		(b)	purchasing the Units as principal; and

 

		(c)	not a person that is or has been created or used solely to purchase or hold securities in reliance
on the exemption provided by section 2.10 of NI 45-106.

 

Category 4: Employees, Officers, Directors
and Consultants

 

The Subscriber is [check appropriate box]:

 

	☐	(a)	a current or former employee of the Issuer or of a “related entity” of the Issuer;
	 	 	 
	☐	(b)	an executive officer of the Issuer or of a “related entity” of the Issuer;
	 	 	 
	☐	(c)	a director of the Issuer or of a “related entity” of the Issuer;
	 	 	 
	☐	(d)	a consultant of the Issuer or of a “related entity” of the Issuer; or
	 	 	 
	☐	(e)	a “permitted assign” of a person described in paragraphs (a) to (d),

 

and its participation in the Offering is voluntary.

 

* * * * * * *

 

    

     

    

 

The representations, warranties, statements and
certification made in this Certificate are true and accurate as of the date of this Certificate and will be true and accurate as of the
Closing. If any such representation, warranty, statement or certification becomes untrue or inaccurate prior to the Closing, the Subscriber
shall give the Issuer immediate written notice thereof.

 

The Subscriber acknowledges and agrees that the
Issuer will and can rely on this Certificate in connection with the Subscriber’s subscription.

 

IN WITNESS, the undersigned has executed this Certificate
as of the                            day of                                , 2020.

 

	If a corporation, partnership or other entity:	 	If an individual:
	 	 	 
	                              	 	                                     
	Print Name of Subscriber	 	Print Name of Subscriber
	 	 	 
	                  	 	                                 
	Signature of Authorized Signatory	 	Signature
	 	 	 
	                	 	                          
	Name and Position of Authorized Signatory	 	Jurisdiction of Residence of Subscriber
	 	 	 
	                  	 	 
	Jurisdiction of Residence of Subscriber	 	 

 

 

    

     

    

 

Form
1

 

SCHEDULE
1

 

Form
45-106F9

Form
for Individual Accredited Investors

 

	WARNING!

    This investment
    is risky. Don’t invest unless you can afford to lose all the money you pay for this investment.

 

	SECTION
    1 TO BE COMPLETED BY THE ISSUER OR SELLING SECURITY HOLDER
	1.
    About your investment
	Type of securities:  Units

                                                                                 
	Issuer:  Siyata
    Mobile Inc. (the “Issuer”)
	Purchased from:  the Issuer

                                                                                 

	SECTIONS
    2 TO 4 TO BE COMPLETED BY THE PURCHASER
	2.
    Risk acknowledgement
	This
    investment is risky. Initial that you understand that:	Your
    

    initials
	Risk
    of loss – You could lose your entire investment of $ ________. [Instruction: Insert the total dollar amount of the investment.]	 
	Liquidity
    risk – You may not be able to sell your investment quickly – or at all.	 
	Lack
    of information – You may receive little or no information about your investment.	 
	Lack
    of advice – You will not receive advice from the salesperson about whether this investment is suitable for you unless the
    salesperson is registered. The salesperson is the person who meets with, or provides information to, you about making this investment.
    To check whether the salesperson is registered, go to  www.aretheyregistered.ca.	 
	3.
    Accredited investor status
	If
    you are relying on a prospectus exemption contained in any of sections (j), (k), or (l) of Category 1 “Accredited Investor”
    in Form 1, you must meet at least one of the following criteria to be able to make this investment. Initial the statement
    that applies to you. (You may initial more than one statement.) The person identified in section 6 is responsible for ensuring that
    you meet the definition of accredited investor. That person, or the salesperson identified in section 5, can help you if you have
    questions about whether you meet these criteria.	Your
    

    initials
	●   Your
    net income before taxes was more than $200,000 in each of the 2 most recent calendar years, and you expect it to be more than $200,000
    in the current calendar year. (You can find your net income before taxes on your personal income tax return.)	 
	●   Your
    net income before taxes combined with your spouse’s was more than $300,000 in each of the 2 most recent calendar years, and
    you expect your combined net income before taxes to be more than $300,000 in the current calendar year.	 
	●   Either
    alone or with your spouse, you own more than $1 million in cash and securities, after subtracting any debt related to the cash and
    securities.	 
	●   Either
    alone or with your spouse, you have net assets worth more than $5 million. (Your net assets are your total assets (including real
    estate) minus your total debt.)	 
	 	 	 

     

     

    

 

	4.
    Your name and signature
	By
    signing this form, you confirm that you have read this form and you understand the risks of making this investment as identified
    in this form.
	First
    and last name (please print):
	Signature:

                                                                                 
	Date:
	SECTION
    5 TO BE COMPLETED BY THE SALESPERSON
	5.
    Salesperson information
	[Instruction:
    The salesperson is the person who meets with, or provides information to, the purchaser with respect to making this investment. That
    could include a representative of the issuer or selling security holder, a registrant or a person who is exempt from the registration
    requirement.]
	First
    and last name of salesperson (please print):
	Telephone:	Email:
	Name
    of firm (if registered):
	SECTION
    6 TO BE COMPLETED BY THE ISSUER OR SELLING SECURITY HOLDER
	6.
    For more information about this investment
	Siyata
                                            Mobile Inc.

                                            1001 Lenoir St., Suite A-414

                                            Montreal, Quebec, H4C 2Z6

    Attention:
    Gerald Bernstein, Chief Financial Officer

    Telephone:
    (514) 824-7357

    Email:
    gerry@siyatamobile.com

    For
    more information about prospectus exemptions, contact your local securities regulator. You can find contact information at www.securities-administrators.ca.

     

	 	 	 

Form instructions:

 

		1.	This
                                            form does not mandate the use of a specific font size or style but the font must be legible.

 

		2.	The
                                            information in sections 1, 5 and 6 must be completed before the purchaser completes and signs
                                            the form.

 

		3.	The
                                            purchaser must sign this form. Each of the purchaser and the issuer or selling security holder
                                            must receive a copy of this form signed by the purchaser. The issuer or selling security
                                            holder is required to keep a copy of this form for 8 years after the distribution.

 

     

     

    

 

Form
1

 

SCHEDULE
2

 

ONTARIO
RESIDENTS ONLY

 

Form
45-106F12

Risk
Acknowledgement Form for Family, Friend and Business Associate Investors

 

	WARNING!

    This investment
    is risky. Don’t invest unless you can afford to lose all the money you pay for this investment.

 

	SECTION
    1 TO BE COMPLETED BY THE ISSUER
	1.
    About your investment
	Type
                                            of securities:  Units

                                                                                 
	Issuer:
     Siyata Mobile Inc. (the “issuer”)
	SECTIONS
    2 TO 4 TO BE COMPLETED BY THE PURCHASER
	2.
    Risk acknowledgement
	This
    investment is risky. Initial that you understand that:	Your
    initials
	Risk
    of loss – You could lose your entire investment of $ ________.  [Instruction: Insert the total dollar
    amount of the investment.] investment.]	 
	Liquidity
    risk – You may not be able to sell your investment quickly – or at all.	 
	Lack
    of information – You may receive little or no information about your investment. The information you receive may be limited
    to the information provided to you by the family member, friend or close business associate specified in section 3 of this form.	 
	3.
    Family, friend or business associate status
	You
    must meet one of the following criteria to be able to make this investment. Initial the statement that applies to you:	Your initials
	A)
                                            You are:

     

    1)
    [check all applicable boxes]

     

    ☐
    a director of the issuer or an affiliate of the issuer

     

    ☐
    an executive officer of the issuer or an affiliate of the issuer

     

    ☐
    a control person of the issuer or an affiliate of the issuer

     

    ☐
    a founder of the issuer

     

    OR

     

    2)
    [check all applicable boxes]

     

    ☐   a
    person of which a majority of the voting securities are beneficially owned by, or a majority of the directors are, (i) individuals
    listed in (1) above and/or (ii) family members, close personal friends or close business associates of individuals listed in (1)
    above

     

    ☐   a
    trust or estate of which all of the beneficiaries or a majority of the trustees or executors are (i) individuals listed in (1) above
    and/or (ii) family members, close personal friends or close business associates of individuals listed in (1) above
	 
	 	 
	 	 	 	 	 	 

     

     

    

 

	B)
                                            You are a family member of ____________________________________ [Instruction: Insert the
                                            name of the person who is

                                            your relative either directly or through his or her spouse], who holds the following
                                            position at the issuer or an affiliate of the issuer: _______________________________.

    You
    are the ____________________________ of that person or that person’s spouse. [Instruction: To qualify for this investment,
    you must be (a) the spouse of the person listed above or (b) the parent, grandparent, brother, sister, child or grandchild of that
    person or that person’s spouse.]
	 
	C)
                                            You are a close personal friend of _______________________________ [Instruction: Insert
                                            the name of your close personal friend], who holds the following position at the issuer
                                            or an affiliate of the issuer: _______________________________.

    You
    have known that person for _____ years.
	 
	D)
                                            You are a close business associate of ______________________________ [Instruction: Insert
                                            the name of your close business associate], who holds the following position at the issuer
                                            or an affiliate of the issuer: ____________________________.

    You
    have known that person for _____ years.
	 
	4.
    Your name and signature
	By
    signing this form, you confirm that you have read this form and you understand the risks of making this investment as identified
    in this form. You also confirm that you are eligible to make this investment because you are a family member, close personal friend
    or close business associate of the person identified in section 5 of this form.
	First
    and last name (please print):
	Signature:	Date:
	SECTION
    5 TO BE COMPLETED BY PERSON WHO CLAIMS THE CLOSE PERSONAL RELATIONSHIP, IF APPLICABLE
	5.
    Contact person of the issuer or an affiliate of the issuer
	[Instruction:
                                            To be completed by the director, executive officer, control person or founder with whom the
                                            purchaser has a close personal relationship indicated under sections 3B, C or D of this form.]

     

    By
    signing this form, you confirm that you have, or your spouse has, the following relationship with the purchaser: [check the box
    that applies]

    ☐
    family relationship as set out in section 3B of this form

    ☐
    close personal friendship as set out in section 3C of this form

    ☐
    close business associate relationship as set out in section 3D of this form

	First
    and last name of contact person (please print):
	Position
    with the issuer or affiliate of the issuer (director, executive officer, control person or founder):
	Telephone:	Email:
	Signature:

                                                                                 
	Date:
	 	 	 	 	 	 

    - 2 -

     

    

  

	SECTION
6 TO BE COMPLETED BY THE ISSUER
	6.
    For more information about this investment
	Siyata
                                            Mobile Inc.

                                            1001 Lenoir St., Suite A-414

                                            Montreal, Quebec, H4C 2Z6

     

    Attention:
    Gerald Bernstein, Chief Financial Officer

     

    Telephone:
    (514) 824-7357

     

    Email:
    gerry@siyatamobile.com

     

    For
    more information about prospectus exemptions, contact your local securities regulator. You can find contact information at www.securities-administrators.ca.

     

	Signature
                                            of executive officer of the issuer (other than the purchaser):

                                                                                 
	Date:

 

Form
instructions:

 

		1	This
                                            form does not mandate the use of a specific font size or style but the font must be legible.

 

		2.	The
                                            information in sections 1, 5 and 6 must be completed before the purchaser completes and signs
                                            the form.

 

		3.	The
                                            purchaser, an executive officer who is not the purchaser and, if applicable, the person who
                                            claims the close personal relationship to the purchaser must sign this form. Each of the
                                            purchaser, contact person at the issuer and the issuer must receive a copy of this form signed
                                            by the purchaser. The issuer is required to keep a copy of this form for 8 years after the
                                            distribution.

 

		4.	The
                                            detailed relationships required to purchase securities under this exemption are set out in
                                            section 2.5 of National Instrument 45-106 Prospectus and Registration Exemptions. For guidance on the meaning of “close
                                            personal friend” and “close business associate”, please refer to sections
                                            2.7 and 2.8, respectively, of Companion Policy 45-106CP Prospectus and Registration Exemptions.

 

    - 3 -

     

    

 

Form
1

 

SCHEDULE
3

 

SASKATCHEWAN
RESIDENTS ONLY

 

FORM
45-106F5

Risk
Acknowledgement - Saskatchewan Close Personal Friends and Close Business Associates

 

I
acknowledge that this is a risky investment:

 

	●	I
                                            am investing entirely at my own risk.
	●	No
                                            securities regulatory authority has evaluated or endorsed the merits of these securities.
	●	The
                                            person selling me these securities is not registered with a securities regulatory authority
                                            and has no duty to tell me whether this investment is suitable for me.
	●	I
                                            will not be able to sell these securities for 4 months.
	●	I
                                            could lose all the money I invest.
	●	I
                                            do not have a 2-day right to cancel my purchase of these securities or the statutory rights
                                            of action for misrepresentation I would have if I were purchasing the securities under a
                                            prospectus.

 

I
am investing $                                        [total consideration] in total; this includes any amount I am obliged to pay in future.

 

I
am a close personal friend or close business associate of                                                                                         [state
name], who is a                                                                                 [state
title - founder, director, executive officer or control person] of                                                                            [state
name of issuer or its affiliate – if an affiliate state “an affiliate of the issuer” and give the issuer’s
name].

 

I
acknowledge that I am purchasing based on my close relationship with                                                 [state name of founder, director, executive
officer or control person] whom I know well enough and for a sufficient period of time to be able to assess her/his capabilities
and trustworthiness.

 

I
acknowledge that this is a risky investment and that I could lose all the money I invest.

 

	 	 	 
	Date	 	Signature
    of Purchaser
	 	 	 
	 	 	 
	 	 	Print
    name of Purchaser

 

Sign
2 copies of this document. Keep one copy for your records.

     

     

    

 

You
are buying Exempt Market Securities

 

They
are called exempt market securities because two parts of securities law do not apply to them. If an issuer wants to sell exempt
market securities to you:

 

	●	the
                                            issuer does not have to give you a prospectus (a document that describes the investment in
                                            detail and gives you some legal protections), and
	●	the
                                            securities do not have to be sold by an investment dealer registered with a securities regulatory
                                            authority.

 

There
are restrictions on your ability to resell exempt market securities. Exempt market securities are more risky than other securities.

 

You
may not receive any written information about the issuer or its business

 

If
you have any questions about the issuer or its business, ask for written clarification before you purchase the securities. You should
consult your own professional advisers before investing in the securities.

 

You
will not receive advice.

 

Unless
you consult your own professional advisors, you will not get professional advice about whether the investment is suitable for you.

 

For
more information on the exempt market, refer to the Saskatchewan Financial Services Commission’s website at http://www.sfsc.gov.sk.ca.

 

INSTRUCTION:
THE PURCHASER MUST SIGN 2 COPIES OF THIS FORM. THE PURCHASER AND THE ISSUER MUST EACH RECEIVE A SIGNED COPY.

 

     

     

    

 

FORM
2

 

CERTIFICATE
OF U.S. ACCREDITED INVESTOR STATUS

 

In
addition to the representations, warranties, acknowledgments and agreements contained in the subscription agreement (the “subscription”)
to which this Form 2 – Certificate of U.S. Accredited Investor Status is attached, the Subscriber hereby represents, warrants and
certifies to the Issuer that the Subscriber is purchasing the securities set out in the subscription as principal, that the Subscriber
is a resident of the jurisdiction of its disclosed address set out in the Subscriber’s information on page 3 of the subscription,
and:

 

		1.	The
                                            Subscriber hereby represents, warrants, acknowledges and agrees to and with the Issuer that
                                            the Subscriber:

 

		(d)	is
                                            a U.S. Person;

 

		(e)	has
                                            such knowledge and experience in financial and business matters as to be capable of evaluating
                                            the merits and risks of the transactions detailed in the subscription and it is able to bear
                                            the economic risk of loss arising from such transactions;

 

		(f)	is
                                            acquiring the Securities for its own account, for investment purposes only and not with a
                                            view to any resale, distribution or other disposition of the Securities in violation of the
                                            United States securities laws and, in particular, it has no intention to distribute either
                                            directly or indirectly any of the Securities in the United States or to U.S. Persons; provided,
                                            however, that the Subscriber may sell or otherwise dispose of any of the Securities pursuant
                                            to registration thereof pursuant to the United States Securities Act of 1933, as amended
                                            (the “U.S. Securities Act”), and any applicable State securities laws
                                            or if an exemption from such registration requirements is available or registration is otherwise
                                            not required under this U.S. Securities Act;

 

		(g)	is
                                            not acquiring the Securities as a result of any form of general solicitation or general advertising,
                                            as such terms are defined for purposes of Regulation D under the U.S. Securities Act, including
                                            without limitation any advertisement, article, notice or other communication published in
                                            any newspaper, magazine or similar media or broadcast over radio or television or other form
                                            of telecommunications, or published or broadcast by means of the Internet or any other form
                                            of electronic display, or any seminar or meeting whose attendees have been invited by general
                                            solicitation or general advertising;

 

		(h)	understands
                                            the Securities have not been and will not be registered under the U.S. Securities Act or
                                            the securities laws of any state of the United States and that the sale contemplated hereby
                                            is being made in reliance on an exemption from such registration requirements;

 

		(i)	satisfies
                                            one or more of the categories indicated below (check appropriate box):

 

		☐	Category 1:	An
organization described in Section 501(c)(3) of the United States Internal Revenue Code, a corporation, a Massachusetts or similar business
trust or a partnership, not formed for the specific purpose of acquiring the Securities offered, with total assets in excess of US $5,000,000;

 

		☐	Category 2:	A
natural person whose individual net worth, or joint net worth with that person’s spouse, on the date of purchase exceeds US $1,000,000
excluding the value of the primary residence of that person;

 

		Note:	For
                                            purposes of calculating “net worth” under this paragraph:

 

		(i)	The
                                            person’s primary residence shall not be included as an asset;

 

		(ii)	Indebtedness
                                            that is secured by the person’s primary residence, up to the estimated fair market
                                            value of the primary residence at the time of the sale of securities, shall not be included
                                            as a liability (except that if the amount of such indebtedness outstanding at the time of
                                            the sale of securities exceeds the amount outstanding 60 days before such time, other than
                                            as a result of the acquisition of the primary residence, the amount of such excess shall
                                            be included as a liability); and

 

		(iii)	Indebtedness
                                            that is secured by the person’s primary residence in excess of the estimated fair market
                                            value of the primary residence at the time of the sale of securities shall be included as
                                            a liability.

 

		☐	Category 3:	A
natural person who had an individual income in excess of US $200,000 in each of the two most recent years or joint income with that
person’s spouse in excess of US $300,000 in each of those years and has a reasonable expectation of reaching the same income
level in the current year;

 

     

     

    

 

		☐	Category 4:	A
bank as defined under Section (3)(a)(2) of the U.S. Securities Act or savings and loan association or other institution as defined
in Section 3(a)(5)(A) of the U.S. Securities Act, whether acting in its individual or fiduciary capacity; a broker or dealer registered
pursuant to Section 15 of the Securities Exchange Act of 1934 (United States); an insurance company as defined in Section 2(13)
of the U.S. Securities Act; an investment company registered under the United States Investment Company Act of 1940 or a business
development company as defined in Section 2(a)(48) of such Act; a Small Business Investment Company licensed by the U.S. Small Business
Administration under Section 301(c) or (d) of the United States Small Business Investment Act of 1958; a plan established
and maintained by a state, its political subdivisions, or an agency or instrumentality of a state or its political subdivisions, for
the benefit of its employees if the plan has total assets in excess of US$5,000,000; an employee benefit plan within the meaning of the
Employee Retirement Income Security Act of 1974 (United States) if investment decision is made by a plan fiduciary, as defined
in Section 3(21) of such act, which is either a bank, savings and loan association, insurance company or registered investment adviser,
or if the employee benefit plan has total assets in excess of US$5,000,000, or, if a self-directed plan, with investment decisions made
solely by persons that are accredited investors;

 

		☐	Category 5:	A
private business development company as defined in Section 202(a)(22) of the United States Investment Advisers Act of 1940;

 

		☐	Category 6:	A
director or executive officer of the Issuer;

 

		☐	Category 7	A
trust that (a) has total assets in excess of US$5,000,000, (b) was not formed for the specific purpose of acquiring the Securities and
(c) is directed in its purchases of securities by a person who has such knowledge and experience in financial and business matters that
he or she is capable of evaluating the merits and risks of an investment in the Securities as described in Rule 506(b)(2)(ii) under
the U.S. Securities Act; or

 

		☐	Category 8	An
entity in which all of the equity owners are accredited investors; and

 

		(j)	if
                                            an individual, is a resident of the state or other jurisdiction of its disclosed address
                                            set out in the Subscriber’s information on page 3 of its subscription; or if not an
                                            individual, has received and accepted the offer to acquire the Securities at the office of
                                            the Subscriber at the disclosed address set out in the Subscriber’s information on
                                            page 3, of its subscription.

 

		2.	The
                                            Subscriber acknowledges and agrees that:

 

		(a)	the
                                            Subscriber has not acquired the Securities as a result of, and will not itself engage in
                                            any activities undertaken for the purpose of, or that could reasonably be expected to have
                                            the effect of, conditioning the market in the United States for the resale of any of the
                                            Securities; provided, however, that the Subscriber may sell or otherwise dispose of any of
                                            the Securities pursuant to registration of any of the Securities pursuant to the U.S. Securities
                                            Act and any applicable state securities laws or under an exemption from such registration
                                            requirements and as otherwise provided herein;

 

		(b)	if
                                            the Subscriber decides to offer, sell or otherwise transfer any of the Securities, it will
                                            not offer, sell or otherwise transfer any of such securities, directly or indirectly, unless:

 

		(i)	the
                                            sale is to the Issuer;

 

		(ii)	the
                                            sale is made pursuant to the requirements of Rule 904 promulgated under the U.S. Securities
                                            Act;

 

		(iii)	the
                                            sale is made pursuant to the exemption from the registration requirements under the U.S.
                                            Securities Act provided by Rule 144 thereunder if available and in accordance with any
                                            applicable state securities or “Blue Sky” laws; or

 

		(iv)	the
                                            Securities are sold in a transaction that does not require registration under the U.S. Securities
                                            Act or any applicable U.S. state laws and regulations governing the offer and sale of securities,
                                            and it has prior to such sale furnished to the Issuer an opinion of counsel reasonably satisfactory
                                            to the Issuer;

 

    	 	Form 2	Certificate for
	 	- 2 -	U.S. Status

     

    

 

		(c)	upon
                                            the issuance thereof, and until such time as the same is no longer required under the applicable
                                            requirements of the U.S. Securities Act or applicable U.S. State laws and regulations, the
                                            certificates representing any of the Securities will bear a legend in substantially the following
                                            form:

 

“THE
SECURITIES REPRESENTED HEREBY HAVE NOT BEEN REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE “U.S. SECURITIES
ACT”) OR UNDER THE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES. THE HOLDER HEREOF, BY PURCHASING SUCH SECURITIES, AGREES
FOR THE BENEFIT OF THE ISSUER OF SUCH SECURITIES AND ITS SUCCESSORS (THE “CORPORATION”) THAT SUCH SECURITIES MAY BE OFFERED,
SOLD, PLEDGED OR OTHERWISE TRANSFERRED ONLY (A) TO THE CORPORATION; (B) OUTSIDE THE UNITED STATES IN ACCORDANCE WITH RULE 904 OF REGULATION
S UNDER THE U.S. SECURITIES ACT AND IN COMPLIANCE WITH LOCAL LAWS AND REGULATIONS; (C) IN ACCORDANCE WITH THE EXEMPTION FROM REGISTRATION
UNDER THE U.S. SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER, IF AVAILABLE, AND IN COMPLIANCE WITH APPLICABLE STATE SECURITIES LAWS;
OR (D) IN A TRANSACTION THAT DOES NOT REQUIRE REGISTRATION UNDER THE U.S. SECURITIES ACT OR ANY APPLICABLE STATE SECURITIES LAWS, AND,
IN THE CASE OF PARAGRAPH (C) OR (D), THE SELLER HAS PRIOR TO SUCH TRANSFER FURNISHED TO THE CORPORATION AN OPINION OF COUNSEL OF RECOGNIZED
STANDING IN FORM AND SUBSTANCE SATISFACTORY TO THE CORPORATION TO SUCH EFFECT. DELIVERY OF THIS CERTIFICATE MAY NOT CONSTITUTE GOOD DELIVERY
IN SETTLEMENT OF TRANSACTIONS ON STOCK EXCHANGES IN CANADA.”

 

and
provided that if any of the Securities are being sold by the Subscriber in an off-shore transaction and in compliance with the requirements
of Rule 904 of Regulation S, at a time when the Issuer is a “foreign issuer” as defined in Rule 902 of Regulation S, the
legend set forth above may be removed by providing a declaration to the Issuer and its transfer agent in the form attached as Schedule
1 to Form 2 hereof or such other evidence as the Issuer or its transfer agent may from time to time prescribe (which may include an opinion
of counsel satisfactory to the Issuer and its transfer agent), to the effect that the sale of the securities is being made in compliance
with Rule 904 of Regulation S;

 

and
provided further, that if any of the Securities are being sold pursuant to Rule 144 of the U.S. Securities Act and in compliance with
any applicable state securities laws, the legend may be removed by delivery to the Issuer’s transfer agent of an opinion satisfactory
to the Issuer and its transfer agent to the effect that the legend is no longer required under applicable requirements of the U.S. Securities
Act and state securities laws;

 

		(d)	the
                                            Issuer may make a notation on its records or instruct the registrar and transfer agent of
                                            the Issuer in order to implement the restrictions on transfer set forth and described herein
                                            and the subscription;

 

		(e)	the
                                            Subscriber understands and acknowledges that the Issuer (i) is not obligated to remain a
                                            “foreign issuer” within the meaning of Rule 902 of Regulation S, (ii) may not,
                                            at the time the Securities are resold by it or at any other time, be a foreign issuer, and
                                            (iii) may engage in one or more transactions which could cause the Issuer not to be a foreign
                                            issuer;

 

		(f)	the
                                            Subscriber understands and agrees that the financial statements of the Issuer have been prepared
                                            in accordance with Canadian generally accepted accounting principles or International Financial
                                            Reporting Standards, which differ in some respects from United States generally accepted
                                            accounting principles, and thus may not be comparable to financial statements of United States
                                            companies;

 

		(g)	the
                                            Subscriber understands that the Securities are “restricted securities” under
                                            applicable federal securities laws and that the U.S. Securities Act and the rules of the
                                            Securities Exchange Commission (the “SEC”) provide in substance that the
                                            Subscriber may dispose of the Securities only pursuant to an effective registration statement
                                            under the U.S. Securities Act or an exemption therefrom, and, other than as set out herein,
                                            the Subscriber understands that the Issuer has no obligation to register any of the Securities
                                            or to take action so as to permit sales pursuant to the U.S. Securities Act (including Rule
                                            144 thereunder). Accordingly, the Subscriber understands that absent registration, under
                                            the rules of the SEC, the Subscriber may be required to hold the Securities indefinitely
                                            or to transfer the Securities in the United States or to U.S. Persons in “private placements”
                                            which are exempt from registration under the U.S. Securities Act, in which event the transferee
                                            will acquire “restricted securities” subject to the same limitations as in the
                                            hands of the Subscriber. As a consequence, the Subscriber understands that it must bear the
                                            economic risks of the investment in the Securities for an indefinite period of time.

 

    	 	Form 2	Certificate for
	 	- 3 -	U.S. Status

     

    

 

		(h)	the
                                            Subscriber understands and agrees that there may be material tax consequences to the Subscriber
                                            of an acquisition, disposition or exercise of any of the Securities, and the Issuer gives
                                            no opinion and makes no representation with respect to the tax consequences to the Subscriber
                                            under United States, state, local or foreign tax law of the Subscriber’s acquisition
                                            or disposition of such Securities, and in particular, no determination has been made whether
                                            the Issuer will be a “passive foreign investment company” (“PFIC”)
                                            within the meaning of Section 1291 of the United States Internal Revenue Code (the “Code”),
                                            provided, however, the Issuer agrees that it shall provide to the Subscriber, upon written
                                            request, all of the information that would be required for United States income tax reporting
                                            purposes by a United States security holder making an election to treat the Issuer as a “qualified
                                            electing fund” for the purposes of the Code, should the Issuer or the Subscriber determine
                                            that the Issuer is a PFIC in any calendar year following the Subscriber’s purchase
                                            of the Securities; and

 

		(i)	the
                                            funds representing the subscription price which will be advanced by the Subscriber to the
                                            Issuer hereunder will not represent proceeds of crime for the purposes of the Uniting
                                            and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct
                                            Terrorism Act (the “PATRIOT Act”) and the Subscriber acknowledges
                                            that the Issuer may in the future be required by law to disclose the Subscriber’s name
                                            and other information relating to the subscription and the Subscriber’s subscription
                                            hereunder, on a confidential basis, pursuant to the PATRIOT Act, and that no portion of the
                                            subscription price to be provided by the Subscriber (i) has been or will be derived from
                                            or related to any activity that is deemed criminal under the laws of the United States of
                                            America, or any other jurisdiction, or (ii) is being tendered on behalf of a person or entity
                                            who has not been identified to or by the Subscriber, and it shall promptly notify the Issuer
                                            if the Subscriber discovers that any of such representations ceases to be true and provide
                                            the Issuer with appropriate information in connection therewith.

 

*
* * * * * *

 

The
representations, warranties, statements and certification made in this Certificate are true and accurate as of the date of this Certificate
and will be true and accurate as of the Closing. If any such representation, warranty, statement or certification becomes untrue or inaccurate
prior to the Closing, the Subscriber shall give the Issuer immediate written notice thereof.

 

Capitalized
terms not specifically defined in this Certificate have the meaning ascribed to them in the subscription to which this Certificate is
attached.

 

The
Subscriber acknowledges and agrees that the Issuer will and can rely on this Certificate in connection with the Subscriber’s subscription.

 

IN
WITNESS, the undersigned has executed this Certificate as of the                   day of                                        , 2020.

 

	If
    a corporation, partnership or other entity:	 	If
    an individual:
	 	 	 
	 	 	 
	Print
    Name of Subscriber	 	Print
    Name of Subscriber
	 	 	 
	 	 	 
	Signature
    of Authorized Signatory	 	Signature
	 	 	 
	 	 	 
	Name
    and Position of Authorized Signatory	 	Jurisdiction
    of Residence of Subscriber
	 	 	 
	 	 	 
	Jurisdiction
    of Residence of Subscriber	 	 

 

    	 	Form 2	Certificate for
	 	- 4 -	U.S. Status

     

    

 

Form
2

 

SCHEDULE
2

 

DECLARATION
FOR REMOVAL OF LEGEND

 

		To:	Computershare
                                            Investor Services Inc. (the “Transfer Agent”), as registrar and transfer
                                            agent for the Common Shares of Siyata Mobile Inc. (the “Issuer”).

 

The
undersigned:

 

		(A)	acknowledges
                                                                                                                                                                                                                               that the sale of                          common
                                                                                                                                                                                                                               shares of the Issuer, represented by its Certificate No.                  
                                                                                                                                                                                                                               and to which this declaration relates, has been made in reliance on Rule 904 of Regulation S under the United States Securities
                                                                                                                                                                                                                               Act of 1933, as amended (the “U.S. Securities Act”); and

 

		(B)	certifies
                                            that:

 

		(1)	the
                                            undersigned is not an “affiliate” (as defined in Rule 405 under the U.S. Securities
                                            Act) of the Issuer or a “distributor” or an affiliate of a “distributor”;

 

		(2)	the
                                            offer of such securities was not made to a “U.S. Person” or to a person in the
                                            United States and either (a) at the time the buy order was originated, the buyer was outside
                                            the United States, or the seller and any person acting on its behalf reasonably believe that
                                            the buyer was outside the United States, or (b) the transaction was executed on or through
                                            the facilities of a “designated offshore securities market”, and neither the
                                            seller nor any person acting on its behalf knows that the transaction was prearranged with
                                            a buyer in the United States;

 

		(3)	neither
                                            the seller nor any affiliate of the seller nor any person acting on any of their behalf engaged
                                            or will engage in any “directed selling efforts” in connection with the offer
                                            and sale of such securities;

 

		(4)	the
                                            sale is bona fide and not for the purpose of “washing off” the resale restrictions
                                            imposed because the securities are “restricted securities” (as that term is defined
                                            in Rule 144(a)(3) under the U.S. Securities Act);

 

		(5)	the
                                            seller does not have a short position in the securities sold in reliance on Rule 904 of Regulation
                                            S under the U.S. Securities Act and does not intend to replace such securities with fungible
                                            unrestricted securities; and

 

		(6)	the
                                            contemplated sale is not a transaction, or part of a series of transactions, which, although
                                            in technical compliance with Regulation S, is part of a plan or scheme to evade the registration
                                            provisions of the U.S. Securities Act.

 

Unless
otherwise specified, terms used herein have the meanings given to them by Regulation S.

 

	By:	X	 
	 	Signature	 
	 	 	 
	 	 	 
	 	Name
    (please print)	 
	 	 	 
	 	 	 
	 	Date	 

 

     

     

    

 

Affirmation
By Seller’s Broker-Dealer

 

We
have read the foregoing representations of our customer,                                                                       (the “Seller”) dated                                     , with
regard to our sale, for such Seller’s account, of the                                      common shares, represented by certificate number                                      
(the “Shares”), of the Issuer described therein, and on behalf of ourselves we certify and affirm that (A) we
have no knowledge that the transaction has or had been prearranged with a buyer in the United States, (B) the transaction was
executed on or through the facilities of a “designated offshore securities market” and (C) neither we, nor any person
acting on our behalf, engaged in any “directed selling efforts” in connection with the offer and sale of such
securities. Unless otherwise specified, terms used herein have the meanings given to them by Regulation S.

 

	 	 	 
	 	Name
    of Firm	 
	 	 	 
	By:	X	 
	 	Authorized
    Officer	 
	 	 	 
	 	 	 
	 	Name
    and Position (please print)	 
	 	 	 
	 	 	 
	 	Date	 

 

     

     

    

 

FORM
3

 

 

 

FORM
4C

CORPORATE
PLACEE REGISTRATION FORM

 

This
Form will remain on file with the Exchange and must be completed if required under section 4(b) of Part II of Form 4B. The corporation,
trust, portfolio manager or other entity (the “Placee”) need only file it on one time basis, and it will be referenced for
all subsequent Private Placements in which it participates. If any of the information provided in this Form changes, the Placee must
notify the Exchange prior to participating in further placements with Exchange listed issuers. If as a result of the Private Placement,
the Placee becomes an Insider of the Issuer, Insiders of the Placee are reminded that they must file a Personal Information Form (2A)
or, if applicable, Declarations, with the Exchange.

 

		1.	Placee
                                            Information:

 

		(a)	Name:
                                                                                                                                                                                                                                         

 

		(b)	Complete
                                            Address:                                                                                                                                                                       
	 	 	 
	 	 	                                                                                                                                                                                                         

 

		(c)	Jurisdiction
                                            of Incorporation or Creation:                                                                                                                                 

 

		2.	(a)	Is
the Placee purchasing securities as a portfolio manager (Yes/No)?                                                                                      

 

		(b)	Is
                                            the Placee carrying on business as a portfolio manager outside of Canada (Yes/No)?                                                

 

		3.	If
                                            the answer to 2(b) above was “Yes”, the undersigned certifies that:

 

		(a)	It
                                            is purchasing securities of an Issuer on behalf of managed accounts for which it is making
                                            the investment decision to purchase the securities and has full discretion to purchase or
                                            sell securities for such accounts without requiring the client’s express consent to
                                            a transaction;

 

		(b)	it
                                            carries on the business of managing the investment portfolios of clients through discretionary
                                            authority granted by those clients (a “portfolio manager” business) in                                                          
                                            [jurisdiction], and
it is permitted by law to carry on a portfolio manager business in that jurisdiction;

 

		(c)	it
                                            was not created solely or primarily for the purpose of purchasing securities of the Issuer;

 

		(d)	the
                                            total asset value of the investment portfolios it manages on behalf of clients is not less
                                            than $20,000,000; and

 

		(e)	it
                                            has no reasonable grounds to believe, that any of the directors, senior officers and other
                                            insiders of the Issuer, and the persons that carry on investor relations activities for the
                                            Issuer has a beneficial interest in any of the managed accounts for which it is purchasing.

 

		4.	If
                                            the answer to 2(a). above was “No”, please provide the names and addresses of
                                            Control Persons of the Placee:

 

	Name*	City	Province
    or State	Country
	 	 	 	 
	 	 	 	 
	 	 	 	 

 

	*	If
                                            the Control Person is not an individual, provide the name of the individual that makes the
                                            investment decisions on behalf of the Control Person

 

     

     

    

 

		5.	Acknowledgement
                                            – Personal Information and Securities Laws

 

		(a)	“Personal
                                            Information” means any information about an identifiable individual, and includes information
                                            contained in sections 1, 2 and 4, as applicable, of this Form.

 

		(b)	The
                                            undersigned hereby acknowledges and agrees that it has obtained the express written consent
                                            of each individual to:

 

		(i)	the
                                            disclosure of Personal Information by the undersigned to the Exchange (as defined in Appendix
                                            6B) pursuant to this Form; and

 

		(ii)	the
                                            collection, use and disclosure of Personal Information by the Exchange for the purposes described
                                            in Appendix 6B or as otherwise identified by the Exchange, from time to time.

 

		(c)	The
                                            undersigned acknowledges that it is bound by the provisions of applicable Securities Law,
                                            including provisions concerning the filing of insider reports and reports of acquisitions.

 

Dated
and certified (if applicable), acknowledged and agreed, at                                                                                                       

 

on
                                                                               .

 

	 	 
	 	(Name
    of Purchaser - please print)
	 	 
	 	 
	 	(Authorized
    Signature)
	 	 
	 	 
	 	(Official
    Capacity - please print)
	 	 
	 	 
	 	(please
    print name of individual whose signature appears above)

 

THIS
IS NOT A PUBLIC DOCUMENT

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