Document:

Exhibit 4.7

 

Warrant Certificate No. PAW- __

 

 

NEITHER THE SECURITIES REPRESENTED BY THIS
CERTIFICATE NOR THE SECURITIES ISSUABLE UPON THE EXERCISE OF THIS WARRANT HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933,
AS AMENDED (THE “ACT”), OR ANY STATE SECURITIES LAWS, AND NEITHER SUCH SECURITIES NOR ANY INTEREST THEREIN MAY BE OFFERED,
SOLD, ASSIGNED OR OTHERWISE TRANSFERRED UNLESS (1) A REGISTRATION STATEMENT WITH RESPECT THERETO IS EFFECTIVE UNDER THE ACT AND
ANY APPLICABLE STATE SECURITIES LAWS, OR (2) AN EXEMPTION FROM SUCH REGISTRATION EXISTS AND THE COMPANY RECEIVES AN OPINION OF
COUNSEL TO THE HOLDER OF SUCH SECURITIES, WHICH COUNSEL AND OPINION ARE SATISFACTORY TO THE COMPANY, THAT SUCH SECURITIES MAY BE
OFFERED, SOLD, PLEDGED, ASSIGNED OR TRANSFERRED IN THE MANNER CONTEMPLATED WITHOUT AN EFFECTIVE REGISTRATION STATEMENT UNDER THE
ACT OR APPLICABLE STATE SECURITIES LAWS.

 

	Effective Date: [       ], 2019	Void After: [        ], 2024

 

DARIOHEALTH CORP.

 

WARRANT TO PURCHASE COMMON STOCK

 

DarioHealth Corp.,
a Delaware corporation (the “Company”), for value received on [ ], 2019 (the “Effective Date”),
hereby issues to [ ] (the “Holder” or “Warrant Holder”) this Warrant (the “Warrant”)
to purchase, [ ] shares (each such share as from time to time adjusted as hereinafter provided being a “Warrant
Share” and all such shares being the “Warrant Shares”) of the Company’s Common Stock (as defined
below), at the Exercise Price (as defined below), as adjusted from time to time as provided herein, on or before [ ], 2024
(the “Expiration Date”), all subject to the following terms and conditions. This Warrant is one of a series
of placement agent warrants of like tenor that have been issued in connection with the Company’s private offering of Series
[ ] Convertible Preferred Stock, pursuant to the terms of that certain Confidential Private Placement Memorandum of the Company
dated October 22, 2019, as the same may have been amended and supplemented from time to time and the Placement Agency Agreement
dated October 22, 2019, as the same may have been amended from time to time.

 

As used in this Warrant,
(i) “Business Day” means any day other than Saturday, Sunday or any other day on which commercial banks in the
City of New York, New York, are authorized or required by law or executive order to close; (ii) “Change of Control”
means (x) any transaction or series of related transactions (including any reorganization, merger or consolidation) that results
in the transfer of 51% or more of the voting securities of the Company (excluding, for these purposes, private placements of newly
issued shares), or (y) any transfer, disposition or sale of all or substantially all of the assets of the Company to another person;
(iii) “Common Stock” means the common stock of the Company, par value $0.0001 per share, including any securities
issued or issuable with respect thereto or into which or for which such shares may be exchanged for, or converted into, pursuant
to any stock dividend, stock split, stock combination, recapitalization, reclassification, reorganization or other similar event;
(iii) “Exercise Price” means $[ ] per share of Common Stock, subject to adjustment as provided herein; (iv)
 “Trading Day” means any day on which the Common Stock is traded (or available for trading) on its principal
trading market; and (v) “Affiliate” means any person that, directly or indirectly, through one or more intermediaries,
controls, is controlled by, or is under common control with, a person, as such terms are used and construed in Rule 144 promulgated
under the Securities Act of 1933, as amended (the “Securities Act”).

 

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		1.	DURATION AND EXERCISE OF WARRANTS

 

		(a)	Exercise Period. The Holder may exercise this
Warrant in whole or in part on any Business Day on or before 5:00 P.M., Eastern Time, on the Expiration Date, at which time this
Warrant shall become void and of no value.

 

		(b)	Exercise Procedures.

 

(i)           While
this Warrant remains outstanding and exercisable in accordance with Section 1(a), in addition to the manner set forth in Section
1(b)(ii) below, the Holder may exercise this Warrant in whole or in part at any time and from time to time by:

 

(A)       delivery
to the Company of a duly executed copy of the Notice of Exercise attached as Exhibit A;

 

(B)       surrender
of this Warrant to the Secretary of the Company at its principal offices or at such other office or agency as the Company may specify
in writing to the Holder; and

 

(C)       payment
of the then-applicable Exercise Price per share multiplied by the number of Warrant Shares being purchased upon exercise of the
Warrant (such amount, the “Aggregate Exercise Price”) made in the form of cash, or by certified check, bank
draft or money order payable in lawful money of the United States of America or in the form of a Cashless Exercise to the extent
permitted in Section 1(b)(ii) below.

 

(ii)           At
any time commencing six months after the Effective Date, the Holder may, in its sole discretion, exercise all or any part of the
Warrant in a “cashless” or “net-issue” exercise (a “Cashless Exercise”) by delivering
to the Company (1) the Notice of Exercise and (2) the original Warrant, pursuant to which the Holder shall surrender the right
to receive upon exercise of this Warrant, a number of Warrant Shares having a value (as determined below) equal to the Aggregate
Exercise Price, in which case, the number of Warrant Shares to be issued to the Holder upon such exercise shall be calculated using
the following formula:

 

X            =              Y
* (A - B)

  A

    2

     

    

 

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

 

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

 

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

 

		B	=	the then-current Exercise Price of the Warrant

 

Solely for the purposes
of this paragraph, “fair value” per share of Common Stock shall mean the Closing Price (as defined below) per
share of Common Stock on the date prior to the date on which the Notice of Exercise is deemed to have been given to the Company
pursuant to Section 11 hereto. “Closing Price” means, for any date, the price determined by the first of the
following clauses that applies:  (a) if the Common Stock is then listed or quoted on the New York Stock Exchange, the
NYSE MKT, the NASDAQ Global Select Market, the NASDAQ Global Market or the NASDAQ Capital Market or any other national securities
exchange, the closing price per share of the Common Stock for such date (or the nearest preceding date) on the primary eligible
market or exchange on which the Common Stock is then listed or quoted; (b) if prices for the Common Stock are then quoted on the
OTC Bulletin Board or any tier of the OTC Markets, the closing bid price per share of the Common Stock for such date (or the nearest
preceding date) so quoted; or (c) if prices for the Common Stock are then reported in the “Pink Sheets” published by
the National Quotation Bureau Incorporated (or a similar organization or agency succeeding to its functions of reporting prices),
the most recent closing bid price per share of the Common Stock so reported. If the Common Stock is not publicly traded as set
forth above, the “fair value” per share of Common Stock shall be reasonably and in good faith determined by the Board
of Directors of the Company as of the date which the Notice of Exercise is deemed to have been sent to the Company.

 

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

 

(iii)       Upon
the exercise of this Warrant in compliance with the provisions of this Section 1(b), and except as limited pursuant to the last
paragraph of Section 1(b)(ii), the Company shall promptly issue and cause to be delivered to the Holder a certificate for the Warrant
Shares purchased by the Holder. Each exercise of this Warrant shall be effective immediately prior to the close of business on
the date (the “Date of Exercise”) that the conditions set forth in Section 1(b) have been satisfied, as the
case may be. On the first Business Day following the date on which the Company has received each of the Notice of Exercise and
the Aggregate Exercise Price (or notice of a Cashless Exercise in accordance with Section 1(b)(ii)) (the “Exercise Delivery
Documents”), the Company shall transmit an acknowledgment of receipt of the Exercise Delivery Documents to the Company’s
transfer agent (the “Transfer Agent”). On or before the third Business Day following the date on which the Company
has received all of the Exercise Delivery Documents (the “Share Delivery Date”), the Company shall (X) provided
that the Transfer Agent is participating in The Depository Trust Company (“DTC”) Fast Automated Securities Transfer
Program, upon the request of the Holder, credit such aggregate number of shares of Common Stock to which the Holder is entitled
pursuant to such exercise to the Holder’s or its designee’s balance account with DTC through its Deposit Withdrawal
Agent Commission system, or (Y) if the Transfer Agent is not participating in the DTC Fast Automated Securities Transfer Program,
issue and dispatch by overnight courier to the address as specified in the Notice of Exercise, a certificate, registered in the
Company’s share register in the name of the Holder or its designee, for the number of shares of Common Stock to which the
Holder is entitled pursuant to such exercise. Upon delivery of the Exercise Delivery Documents, the Holder shall be deemed for
all corporate purposes to have become the holder of record of the Warrant Shares with respect to which this Warrant has been exercised,
irrespective of the date of delivery of the certificates evidencing such Warrant Shares.

 

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(iv)      [RESERVED]

 

(c)        Partial
Exercise. This Warrant shall be exercisable, either in its entirety or, from time to time, for part only of the number of Warrant
Shares referenced by this Warrant. If this Warrant is submitted in connection with any exercise pursuant to Section 1 and the number
of Warrant Shares represented by this Warrant submitted for exercise is greater than the actual number of Warrant Shares being
acquired upon such an exercise, then the Company shall as soon as practicable and in no event later than five (5) Business Days
after any exercise and at its own expense, issue a new Warrant of like tenor representing the right to purchase the number of Warrant
Shares purchasable immediately prior to such exercise under this Warrant, less the number of Warrant Shares with respect to which
this Warrant is exercised.

 

(d)          Disputes.
In the case of a dispute as to the determination of the Exercise Price or the arithmetic calculation of the Warrant Shares, the
Company shall promptly issue to the Holder the number of Warrant Shares that are not disputed and resolve such dispute in accordance
with Section 16.

 

		2.	ISSUANCE OF WARRANT SHARES

 

(a)          The
Company covenants that all Warrant Shares will, upon issuance in accordance with the terms of this Warrant, be (i) duly authorized,
fully paid and non-assessable, and (ii) free from all liens, charges and security interests, with the exception of claims arising
through the acts or omissions of any Holder and except as arising from applicable Federal and state securities laws.

 

(b)          The
Company shall register this Warrant upon records to be maintained by the Company for that purpose in the name of the record holder
of such Warrant from time to time. The Company may deem and treat the registered Holder of this Warrant as the absolute owner thereof
for the purpose of any exercise thereof, any distribution to the Holder thereof and for all other purposes.

 

(c)          The
Company will not, by amendment of its certificate of incorporation, by-laws or through any reorganization, transfer of assets,
consolidation, merger, dissolution, issue or sale of securities or any other voluntary action, avoid or seek to avoid the observance
or performance of any of the terms to be observed or performed hereunder by the Company, but will at all times in good faith assist
in the carrying out of all the provisions of this Warrant and in the taking of all action necessary or appropriate in order to
protect the rights of the Holder to exercise this Warrant, or against impairment of such rights.

 

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		3.	ADJUSTMENTS OF EXERCISE PRICE, NUMBER AND TYPE OF WARRANT
SHARES

 

(a)           The
Exercise Price and the number of shares purchasable upon the exercise of this Warrant shall be subject to adjustment from time
to time upon the occurrence of certain events described in this Section 3; provided, that notwithstanding the provisions
of this Section 3, the Company shall not be required to make any adjustment if and to the extent that such adjustment would require
the Company to issue a number of shares of Common Stock in excess of its authorized but unissued shares of Common Stock, less all
amounts of Common Stock that have been reserved for issue upon the conversion of all outstanding securities convertible into shares
of Common Stock and the exercise of all outstanding options, warrants and other rights exercisable for shares of Common Stock.
If the Company does not have the requisite number of authorized but unissued shares of Common Stock to make any adjustment, the
Company shall use its commercially best efforts to obtain the necessary stockholder consent to increase the authorized number of
shares of Common Stock to make such an adjustment pursuant to this Section 3.

 

(i)            Subdivision
or Combination of Stock. In case the Company shall at any time subdivide (whether by way of stock dividend, stock split or
otherwise) its outstanding shares of Common Stock into a greater number of shares, the Exercise Price in effect immediately prior
to such subdivision shall be proportionately reduced and the number of Warrant Shares shall be proportionately increased, and conversely,
in case the outstanding shares of Common Stock of the Company shall be combined (whether by way of stock combination, reverse stock
split or otherwise) into a smaller number of shares, the Exercise Price in effect immediately prior to such combination shall be
proportionately increased and the number of Warrant Shares shall be proportionately decreased. The Exercise Price and the Warrant
Shares, as so adjusted, shall be readjusted in the same manner upon the happening of any successive event or events described in
this Section 3(a)(i).

 

(ii)           Dividends
in Stock, Property, Reclassification. If at any time, or from time to time, all of the holders of Common Stock (or any shares
of stock or other securities at the time receivable upon the exercise of this Warrant) shall have received or become entitled to
receive, without payment therefore:

 

(A)       any
shares of stock or other securities that are at any time directly or indirectly convertible into or exchangeable for Common Stock,
or any rights or options to subscribe for, purchase or otherwise acquire any of the foregoing by way of dividend or other distribution,
or

 

(B)       additional
stock or other securities or property (including cash) by way of spin-off, split-up, reclassification, combination of shares or
similar corporate rearrangement (other than shares of Common Stock issued as a stock split or adjustments in respect of which shall
be covered by the terms of Section 3(a)(i) above),

 

then and in each such case, the Exercise
Price and the number of Warrant Shares to be obtained upon exercise of this Warrant shall be adjusted proportionately, and the
Holder hereof shall, upon the exercise of this Warrant, be entitled to receive, in addition to the number of shares of Common Stock
receivable thereupon, and without payment of any additional consideration therefor, the amount of stock and other securities and
property (including cash in the cases referred to above) that such Holder would hold on the date of such exercise had such Holder
been the holder of record of such Common Stock as of the date on which holders of Common Stock received or became entitled to receive
such shares or all other additional stock and other securities and property. The Exercise Price and the Warrant Shares, as so adjusted,
shall be readjusted in the same manner upon the happening of any successive event or events described in this Section 3(a)(ii).

 

(iii)          Reorganization,
Reclassification, Consolidation, Merger or Sale. If any recapitalization, reclassification or reorganization of the capital
stock of the Company, or any consolidation or merger of the Company with another corporation, or the sale of all or substantially
all of its assets or other transaction shall be effected in such a way that holders of Common Stock shall be entitled to receive
stock, securities, or other assets or property (an “Organic Change”), then, as a condition of such Organic
Change, lawful and adequate provisions shall be made by the Company whereby the Holder hereof shall thereafter have the right
to purchase and receive (in lieu of the shares of the Common Stock of the Company immediately theretofore purchasable and receivable
upon the exercise of the rights represented by this Warrant) such shares of stock, securities or other assets or property as may
be issued or payable with respect to or in exchange for a number of outstanding shares of such Common Stock equal to the number
of shares of such stock immediately theretofore purchasable and receivable assuming the full exercise of the rights represented
by this Warrant. In the event of any Organic Change, appropriate provision shall be made by the Company with respect to the rights
and interests of the Holder of this Warrant to the end that the provisions hereof (including, without limitation, provisions for
adjustments of the Exercise Price and of the number of shares purchasable and receivable upon the exercise of this Warrant) shall
thereafter be applicable, in relation to any shares of stock, securities or assets thereafter deliverable upon the exercise hereof.
The Company will not affect any such consolidation, merger or sale unless, prior to the consummation thereof, the successor corporation
(if other than the Company) resulting from such consolidation or merger or the corporation purchasing such assets shall assume
by written instrument reasonably satisfactory in form and substance to the Holder executed and mailed or delivered to the registered
Holder hereof at the last address of such Holder appearing on the books of the Company, the obligation to deliver to such Holder
such shares of stock, securities or assets as, in accordance with the foregoing provisions, such Holder may be entitled to purchase.
If there is an Organic Change, then the Company shall cause to be mailed
to the Holder at its last address as it shall appear on the books and records of the Company, at least 10 calendar days before
the effective date of the Organic Change, a notice stating the date on which such Organic Change is expected to become effective
or close, and the date as of which it is expected that holders of the Common Stock of record shall be entitled to exchange their
shares for securities, cash, or other property delivered upon such Organic Change; provided, that the failure to mail such notice
or any defect therein or in the mailing thereof shall not affect the validity of the corporate action required to be specified
in such notice. The Holder is entitled to exercise this Warrant during the 10-day period commencing on the date of such notice
to the effective date of the event triggering such notice. In
any event, the successor corporation (if other than the Company) resulting from such consolidation or merger or the corporation
purchasing such assets shall be deemed to assume such obligation to deliver to such Holder such shares of stock, securities or
assets even in the absence of a written instrument assuming such obligation to the extent such assumption occurs by operation
of law.

 

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(b)          Certificate
as to Adjustments. Upon the occurrence of each adjustment or readjustment pursuant to this Section 3, the Company at its expense
shall promptly compute such adjustment or readjustment in accordance with the terms hereof and furnish to each Holder of this Warrant
a certificate setting forth such adjustment or readjustment and showing in detail the facts upon which such adjustment or readjustment
is based. The Company shall promptly furnish or cause to be furnished to such Holder a like certificate setting forth: (i) such
adjustments and readjustments; and (ii) the number of shares and the amount, if any, of other property which at the time would
be received upon the exercise of the Warrant.

 

(c)          Certain
Events. If any event occurs as to which the other provisions of this Section 3 are not strictly applicable but the lack of
any adjustment would not fairly protect the purchase rights of the Holder under this Warrant in accordance with the basic intent
and principles of such provisions, or if strictly applicable would not fairly protect the purchase rights of the Holder under this
Warrant in accordance with the basic intent and principles of such provisions, then the Company's Board of Directors will, in good
faith, make an appropriate adjustment to protect the rights of the Holder; provided, that no such adjustment pursuant to
this Section 3(c) will increase the Exercise Price or decrease the number of Warrant Shares as otherwise determined pursuant to
this Section 3.

 

		4.	CHANGE OF CONTROL.

 

In case of any Change
of Control, then as a condition of such transaction, appropriate lawful provisions will be made whereby the Holder will have the
right to acquire and receive upon exercise of this Warrant in lieu of the Warrant Shares immediately theretofore subject to acquisition
upon the exercise of this Warrant, such shares of stock, securities or assets (including cash) that a holder of Warrant Shares
deliverable upon exercise of this Warrant would have been entitled to receive in such transaction as if this Warrant had been exercised
immediately prior to such transaction. In any such case, the Company will make appropriate provision to insure that the provisions
of this Section 4 hereof will thereafter be applicable as nearly as may be in relation to any shares of stock or securities thereafter
deliverable upon the exercise of this Warrant. In the event of a Change of Control in which all of the capital stock of the Company
is exchanged exclusively for cash, the Company may elect to cancel this Warrant upon payment to the Holder of a cash payment equal
to the excess, if any, between the cash price per share paid in the merger and the Exercise Price. If the cash price per share
paid in the transaction is less than the Exercise Price, the Warrant shall automatically be cancelled on the effective date of
the Change of Control, without the payment of any consideration to the Holder. In any event, the Company shall provide to the Holder
at least twenty (20) days advance written notice of any transaction involving a Change of Control.

 

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		5.	TRANSFERS AND EXCHANGES OF WARRANT AND WARRANT SHARES

 

(a)           Registration
of Transfers and Exchanges. Subject to Section 5(c), upon the Holder’s surrender of this Warrant, with a duly executed
copy of the Form of Assignment attached as Exhibit B, to the Secretary of the Company at its principal offices or at such
other office or agency as the Company may specify in writing to the Holder, the Company shall register the transfer of all or any
portion of this Warrant. Upon such registration of transfer, the Company shall issue a new Warrant, in substantially the form of
this Warrant, evidencing the acquisition rights transferred to the transferee and a new Warrant, in similar form, evidencing the
remaining acquisition rights not transferred, to the Holder requesting the transfer.

 

(b)          Warrant
Exchangeable for Different Denominations. The Holder may exchange this Warrant for a new Warrant or Warrants, in substantially
the form of this Warrant, evidencing in the aggregate the right to purchase the number of Warrant Shares which may then be purchased
hereunder, each of such new Warrants to be dated the date of such exchange and to represent the right to purchase such number of
Warrant Shares as shall be designated by the Holder. The Holder shall surrender this Warrant with duly executed instructions regarding
such re-certification of this Warrant to the Secretary of the Company at its principal offices or at such other office or agency
as the Company may specify in writing to the Holder.

 

(c)           Restrictions
on Transfers. This Warrant may not be transferred at any time without (i) registration under the Securities Act or (ii) an
exemption from such registration and a written opinion of legal counsel addressed to the Company that the proposed transfer of
the Warrant may be effected without registration under the Securities Act, which opinion will be in form and from counsel reasonably
satisfactory to the Company.

 

(d)          Permitted
Transfers and Assignments. Notwithstanding any provision to the contrary in this Section 5, the Holder may transfer, with or
without consideration, this Warrant or any of the Warrant Shares (or a portion thereof) to the Holder’s Affiliates (as such
term is defined under Rule 144 of the Securities Act) without obtaining the opinion from counsel that may be required by Section
5(c)(ii), provided, that the Holder delivers to the Company and its counsel certification, documentation, and other assurances
reasonably required by the Company’s counsel to enable the Company’s counsel to render an opinion to the Company’s
Transfer Agent that such transfer does not violate applicable securities laws.

 

		6.	MUTILATED OR MISSING WARRANT CERTIFICATE

 

If this Warrant is
mutilated, lost, stolen or destroyed, upon request by the Holder, the Company will, at its expense, issue, in exchange for and
upon cancellation of the mutilated Warrant, or in substitution for the lost, stolen or destroyed Warrant, a new Warrant, in substantially
the form of this Warrant, representing the right to acquire the equivalent number of Warrant Shares; provided, that, as
a prerequisite to the issuance of a substitute Warrant, the Company may require satisfactory evidence of loss, theft or destruction
as well as an indemnity from the Holder of a lost, stolen or destroyed Warrant.

 

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		7.	PAYMENT OF TAXES

 

The Company will pay
all transfer and stock issuance taxes attributable to the preparation, issuance and delivery of this Warrant and the Warrant Shares
(and replacement Warrants) including, without limitation, all documentary and stamp taxes; provided, however, that
the Company shall not be required to pay any tax in respect of the transfer of this Warrant, or the issuance or delivery of certificates
for Warrant Shares or other securities in respect of the Warrant Shares to any person or entity other than to the Holder.

 

		8.	FRACTIONAL WARRANT SHARES

 

No fractional Warrant
Shares shall be issued upon exercise of this Warrant. The Company, in lieu of issuing any fractional Warrant Share, shall round
up the number of Warrant Shares issuable to nearest whole share.

 

		9.	NO STOCK RIGHTS AND LEGEND

 

No holder of this Warrant,
as such, shall be entitled to vote or be deemed the holder of any other securities of the Company that may at any time be issuable
on the exercise hereof, nor shall anything contained herein be construed to confer upon the holder of this Warrant, as such, the
rights of a stockholder of the Company or the right to vote for the election of directors or upon any matter submitted to stockholders
at any meeting thereof, or give or withhold consent to any corporate action or to receive notice of meetings or other actions affecting
stockholders (except as provided herein), or to receive dividends or subscription rights or otherwise (except as provide herein).

 

Each certificate for
Warrant Shares initially issued upon the exercise of this Warrant, and each certificate for Warrant Shares issued to any subsequent
transferee of any such certificate, shall be stamped or otherwise imprinted with a legend in substantially the following form:

 

“THE SECURITIES
REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”),
OR ANY STATE SECURITIES LAWS, AND NEITHER SUCH SECURITIES NOR ANY INTEREST THEREIN MAY BE OFFERED, SOLD, PLEDGED, ASSIGNED OR OTHERWISE
TRANSFERRED UNLESS (1) A REGISTRATION STATEMENT WITH RESPECT THERETO IS EFFECTIVE UNDER THE ACT AND ANY APPLICABLE STATE SECURITIES
LAWS, OR (2) AN EXEMPTION FROM SUCH REGISTRATION EXISTS AND THE COMPANY RECEIVES AN OPINION OF COUNSEL TO THE HOLDER OF SUCH SECURITIES,
WHICH COUNSEL AND OPINION ARE REASONABLY SATISFACTORY TO THE COMPANY, THAT SUCH SECURITIES MAY BE OFFERED, SOLD, PLEDGED, ASSIGNED
OR TRANSFERRED IN THE MANNER CONTEMPLATED WITHOUT AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT OR APPLICABLE STATE SECURITIES
LAWS.”

 

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		10.	INTENTIONALLY OMITTED.

 

		11.	NOTICES

 

All notices, consents,
waivers, and other communications under this Warrant must be in writing and will be deemed given to a party when (a) delivered
to the appropriate address by hand or by nationally recognized overnight courier service (costs prepaid); (b) sent by facsimile
or e-mail with confirmation of transmission by the transmitting equipment; (c) received or rejected by the addressee, if sent by
certified mail, return receipt requested, if to the registered Holder hereof; or (d) seven days after the placement of the notice
into the mails (first class postage prepaid), to the Holder at the address, facsimile number, or e-mail address furnished by the
registered Holder to the Company, or if to the Company, to it at 8 HaTokhen Street, Caesarea Industrial Park, Israel 3088900, Attn:
CEO and CFO (or to such other address, facsimile number, or e-mail address as the Holder or the Company as a party may designate
by notice the other party).

 

		12.	SEVERABILITY

 

If a court of competent
jurisdiction holds any provision of this Warrant invalid or unenforceable, the other provisions of this Warrant will remain in
full force and effect. Any provision of this Warrant held invalid or unenforceable only in part or degree will remain in full force
and effect to the extent not held invalid or unenforceable.

 

		13.	BINDING EFFECT

 

This Warrant shall
be binding upon and inure to the sole and exclusive benefit of the Company, its successors and assigns, the registered Holder or
Holders from time to time of this Warrant and the Warrant Shares.

 

		14.	SURVIVAL OF RIGHTS AND DUTIES

 

This Warrant shall
terminate and be of no further force and effect on the earlier of 5:00 P.M., Eastern Time, on the Expiration Date or the date on
which this Warrant has been exercised in full.

 

		15.	GOVERNING LAW

 

This Warrant will be
governed by and construed under the laws of the State of New York without regard to conflicts of laws principles that would require
the application of any other law.

 

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		16.	DISPUTE RESOLUTION

 

In the case of a dispute
as to the determination of the Exercise Price or the arithmetic calculation of the Warrant Shares, the Company shall submit the
disputed determinations or arithmetic calculations via facsimile within two Business Days of receipt of the Notice of Exercise
giving rise to such dispute, as the case may be, to the Holder. If the Holder and the Company are unable to agree upon such determination
or calculation of the Exercise Price or the Warrant Shares within three Business Days of such disputed determination or arithmetic
calculation being submitted to the Holder, then the Company shall, within two Business Days, submit via facsimile (a) the disputed
determination of the Exercise Price to an independent, reputable investment bank selected by the Company and approved by the Holder
or (b) the disputed arithmetic calculation of the Warrant Shares to the Company’s independent, outside accountant. The Company
shall cause at its expense the investment bank or the accountant, as the case may be, to perform the determinations or calculations
and notify the Company and the Holder of the results no later than ten (10) Business Days from the time it receives the disputed
determinations or calculations. Such investment bank’s or accountant’s determination or calculation, as the case may
be, shall be binding upon all parties absent demonstrable error.

 

		17.	NOTICES OF RECORD DATE

 

Upon (a) any establishment
by the Company of a record date of the holders of any class of securities for the purpose of determining the holders thereof who
are entitled to receive any dividend or other distribution, or right or option to acquire securities of the Company, or any other
right, or (b) any capital reorganization, reclassification, recapitalization, merger or consolidation of the Company with or into
any other corporation, any transfer of all or substantially all the assets of the Company, or any voluntary or involuntary dissolution,
liquidation or winding up of the Company, or the sale, in a single transaction, of a majority of the Company’s voting stock
(whether newly issued, or from treasury, or previously issued and then outstanding, or any combination thereof), the Company shall
mail to the Holder at least ten (10) Business Days, or such longer period as may be required by law, prior to the record date specified
therein, a notice specifying (i) the date established as the record date for the purpose of such dividend, distribution, option
or right and a description of such dividend, option or right, (ii) the date on which any such reorganization, reclassification,
transfer, consolidation, merger, dissolution, liquidation or winding up, or sale is expected to become effective and (iii) the
date, if any, fixed as to when the holders of record of Common Stock shall be entitled to exchange their shares of Common Stock
for securities or other property deliverable upon such reorganization, reclassification, transfer, consolation, merger, dissolution,
liquidation or winding up.

 

		18.	RESERVATION OF SHARES

 

The Company shall reserve
and keep available out of its authorized but unissued shares of Common Stock for issuance upon the exercise of this Warrant, free
from pre-emptive rights, such number of shares of Common Stock for which this Warrant shall from time to time be exercisable. The
Company will take all such reasonable action as may be necessary to assure that such Warrant Shares may be issued as provided herein
without violation of any applicable law or regulation. Without limiting the generality of the foregoing, the Company covenants
that it will use commercially reasonable efforts to take all such action as may be necessary or appropriate in order that the Company
may validly and legally issue fully paid and nonassessable Warrant Shares upon the exercise of this Warrant and use commercially
reasonable efforts to obtain all such authorizations, exemptions or consents, including but not limited to consents from the Company’s
stockholders or Board of Directors or any public regulatory body, as may be necessary to enable the Company to perform its obligations
under this Warrant.

 

    10

     

    

 

		19.	NO THIRD PARTY RIGHTS

 

This Warrant is not
intended, and will not be construed, to create any rights in any parties other than the Company and the Holder, and no person or
entity may assert any rights as third-party beneficiary hereunder.

 

		20.	AMENDMENTS.

 

Any term of this Warrant
may be amended, supplemented or waived upon the written consent of the Company and the holders of a majority in interest of all
outstanding Placement Agent Warrants issued pursuant to the PAA, and such amendment, supplement or waiver shall be binding upon
the Company and all holders of such Placement Agent Warrants, including the Holder, whether or not the Holder has consented to
such amendment, supplement or waiver; provided, however, that any such amendment, supplement or waiver must apply to all
outstanding Placement Agent Warrants issued pursuant to the PAA.

 

[SIGNATURE PAGE FOLLOWS]

 

    11

     

    

 

IN WITNESS WHEREOF,
the Company has caused this Warrant to be duly executed as of the date first set forth above.

 

 

	DARIOHEALTH CORP.	 
	 	 
	 	 
	By:	 	 
	Name:	Zvi Ben-David	 
	Title:	Chief Financial Officer	 

 

    12

     

    

 

EXHIBIT A

 

NOTICE OF EXERCISE

 

(To be executed by the Holder of Warrant
if such Holder desires to exercise Warrant)

 

To DarioHealth Corp.:

 

The undersigned hereby
irrevocably elects to exercise this Warrant and to purchase thereunder, ___________________ full shares of DarioHealth Corp. common
stock issuable upon exercise of the Warrant and delivery of:

 

(1)       $_________
(in cash as provided for in the foregoing Warrant) and any applicable taxes payable by the undersigned pursuant to such Warrant;
and

 

(2)       __________
shares of Common Stock (pursuant to a Cashless Exercise in accordance with Section 1(b)(ii) of the Warrant) (check here if the
undersigned desires to deliver an unspecified number of shares equal the number sufficient to effect a Cashless Exercise [___]).

 

The undersigned
requests that certificates for such shares be issued in the name of:

 

_________________________________________

(Please print name, address and social security
or federal employer

identification number (if applicable))

 

_________________________________________

 

_________________________________________

 

The undersigned hereby
affirms that the undersigned is an accredited investor as defined under Rule 501 of Regulation D of the Securities Act of 1933.  
If the Holder cannot make the foregoing affirmation because it is factually incorrect, it shall be a condition to the exercise
of the Warrant that the Company receive such other representations as the Company considers necessary, acting reasonably, to assure
the Company that the issuance of securities upon exercise of this Warrant shall not violate any United States or other applicable
securities laws.

 

If the shares issuable
upon this exercise of the Warrant are not all of the Warrant Shares which the Holder is entitled to acquire upon the exercise of
the Warrant, the undersigned requests that a new Warrant evidencing the rights not so exercised be issued in the name of and delivered
to:

 

_________________________________________

(Please print name, address and social security
or federal employer

identification number (if applicable))

 

_________________________________________

 

_________________________________________

 

	 	Name of Holder (print):	 
	 	(Signature):	
	 	(By:)	
	 	(Title:)	 
	 	Dated:	 

 

    13

     

    

 

EXHIBIT B

 

FORM OF ASSIGNMENT

 

FOR VALUE RECEIVED,
___________________________________ hereby sells, assigns and transfers to each assignee set forth below all of the rights of the
undersigned under the Warrant (as defined in and evidenced by the attached Warrant) to acquire the number of Warrant Shares set
opposite the name of such assignee below and in and to the foregoing Warrant with respect to said acquisition rights and the shares
issuable upon exercise of the Warrant:

 

 

	Name of Assignee	Address	Number of Shares
		 	 
		 	 
		 	 
		 	 

 

 

If the total of the
Warrant Shares are not all of the Warrant Shares evidenced by the foregoing Warrant, the undersigned requests that a new Warrant
evidencing the right to acquire the Warrant Shares not so assigned be issued in the name of and delivered to the undersigned.

 

 

	 	Name of Holder (print):	 
	 	(Signature):	 
	 	(By:)	 
	 	(Title:)	 
	 	Dated:Exhibit 10.10

 

SUBSCRIPTION AGREEMENT

 

DarioHealth Corp.

8 HaTokhen Street

Caesarea Industrial Park

Israel 3088900

 

Ladies and Gentlemen:

 

1.             Subscription. The undersigned (the “Purchaser”), intending to be legally bound, hereby irrevocably agrees
to purchase from DarioHealth Corp., a Delaware corporation (the “Company”), the number of shares of Series A Preferred
Stock, par value $0.0001 (“Series A Preferred”), or such number of shares of Series A-1 Preferred Stock, par value
$0.0001 (the “Series A-1 Preferred” and collectively with the Series A Preferred, the “Shares”) set forth
on the signature page hereof at a purchase price of $1,000 per Share (“Share Price”), with a minimum investment amount
of $100,000 which minimum investment may be waived at the discretion of the Company and the Placement Agent which minimum investment
may be waived at the discretion of the Company and the Placement Agent. The Shares are being sold in the Offering (as defined below),
as more fully described in the Memorandum (as defined below). This Subscription Agreement (this “Subscription Agreement”)
is one in a series of similar subscription agreements (collectively, the “Subscription Agreements”) entered into pursuant
to the Offering.

 

2.             The Offering. This subscription is submitted to you in accordance with and subject to the terms and conditions described
in this Subscription Agreement and the Confidential Private Placement Memorandum of the Company dated October __, 2019, as amended
or supplemented from time to time, including all attachments, schedules and exhibits thereto (the “Memorandum”), relating
to the offering (the “Offering”) by the Company of a minimum of 8,000 Shares ($8,000,000) (the “Minimum Offering
Amount”), and up to a maximum of 15,000 Shares ($15,000,000) (the “Maximum Offering Amount”), with an over-allotment
amount of up to 5,000 Shares ($5,000,000) (the “Over-Allotment Amount”). SternAegis Ventures, through Aegis Capital
Corp., (“SternAegis”), has been engaged as exclusive placement agent in connection with the Offering (sometimes referred
to as the “Placement Agent”). The terms of the Offering are more completely described in the Memorandum and such terms
are incorporated herein in their entirety.

 

3.             Deliveries and Payment; Escrow of Funds. Simultaneously with the execution hereof, the Purchaser shall: (a) deliver
to SternAegis in accordance with the Subscription Instructions attached hereto, (i) one (1) completed and executed Omnibus Signature
Page to this Subscription Agreement and the Registration Rights Agreement (page 14), (ii) a completed Accredited Investor Certification
(pages 15-16), (iii) a completed Investor Profile (page 17) and (iv) one (1) completed and executed Tax Certification for U.S.
Persons or Non-U.S. Persons, as applicable (beginning on page 19); and (b) make a wire transfer payment to, “Signature Bank,
Escrow Agent for DarioHealth Corp.” in an amount equal to the product of (i) the number of Shares being subscribed for by
the Purchaser in the Offering as set forth on the signature page hereof, multiplied by (ii) the Share Price. Wire transfer instructions
are set forth on page 12 hereof under the heading “To subscribe for Shares in the private offering of DarioHealth Corp.”
Such funds will be held for the Purchaser's benefit in a non-interest-bearing escrow account (the “Escrow Account”)
until the earliest to occur of (a) a closing of the sale of the Minimum Offering Amount or more (the “First Closing”),
(b) the rejection of such subscription, or (c) the termination of the Offering by the Company or the Placement Agent. The Company
and the Placement Agent may continue to offer and sell the Shares and conduct additional closings for the sale of additional Shares
after the First Closing and until the termination of the Offering.

 

    1

     

    

 

4.             Acceptance of Subscription. The Purchaser understands and agrees that the Company, in its sole discretion, reserves
the right to accept or reject this or any other subscription for Shares, in whole or in part, notwithstanding prior receipt by
the Purchaser of notice of acceptance of this subscription. In furtherance of the foregoing, the Company shall have the right to
require potential subscribers to supply additional information and execute additional documents in a satisfactory manner, which
determination shall be at the sole discretion of the Company, prior to the acceptance of this Subscription Agreement. The Company
shall have no obligation hereunder until the Company shall execute and deliver to the Purchaser an executed copy of this Subscription
Agreement. If this subscription is rejected in whole, the Offering of Shares is terminated or the Minimum Offering Amount is not
raised, all funds received from the Purchaser will be returned without interest or offset, and this Subscription Agreement shall
thereafter be of no further force or effect. If this subscription is rejected in part, the funds for the rejected portion of this
subscription will be returned without interest or offset, and this Subscription Agreement will continue in full force and effect
to the extent this subscription was accepted.

 

5.             Representations and Warranties.

 

The Purchaser hereby
acknowledges, represents, warrants, and agrees as follows:

 

(a)            None
of the Shares or the shares of common stock of the Company issuable upon conversion of the Shares (the “Conversion Securities”)
offered pursuant to the Memorandum are registered under the Securities Act of 1933, as amended (the “Securities Act”),
or any state securities laws. The Purchaser understands that the offering and sale of the Shares is intended to be exempt from
registration under the Securities Act, by virtue of Section 4(a)(2) thereof and the provisions of Regulation D (“Regulation
D”) as promulgated by the United States Securities and Exchange Commission (the “SEC”) thereunder, based, in
part, upon the representations, warranties and agreements of the Purchaser contained in this Subscription Agreement.

 

(b)           Prior to the execution of this Subscription Agreement, the Purchaser and the Purchaser’s attorney, accountant, purchaser
representative and/or tax adviser, if any (collectively, the “Advisers”), have received the Memorandum and all other
documents requested by the Purchaser, have carefully reviewed them and understand the information contained therein.

 

(c)           Neither the SEC nor any state securities commission or other regulatory authority has approved the Shares or the Conversion
Securities or passed upon or endorsed the merits of the Offering or confirmed the accuracy or determined the adequacy of the Memorandum.
The Memorandum has not been reviewed by any federal, state or other regulatory authority.

 

    2

     

    

 

(d)           All documents, records, and books pertaining to the investment in the Shares (including, without limitation, the Memorandum)
have been made available for inspection by such Purchaser and its Advisers, if any.

 

(e)           The Purchaser and its Advisers, if any, have had a reasonable opportunity to ask questions of and receive answers from a
person or persons acting on behalf of the Company concerning the offering of the Shares and the business, financial condition and
results of operations of the Company and LabStyle Innovation Ltd. (the “Subsidiary”) and all such questions have
been answered to the full satisfaction of the Purchaser and its Advisers, if any.

 

(f)            In evaluating the suitability of an investment in the Company and the Shares, the Purchaser has not relied upon any representation
or information (oral or written) other than as stated in the Memorandum and the Purchaser and its Advisors have had access, through
the Memorandum and/or the EDGAR system, to true and complete copies of the Company’s most recent Annual Report on Form 10-K
for the fiscal year ended December 31, 2018 (the “10-K”) and all other reports filed by the Company pursuant to the
Securities Exchange Act of 1934, as amended, since the filing of the 10-K and prior to the date hereof and have reviewed such filings
(the “SEC Reports”).

 

(g)           The Purchaser is unaware of, is in no way relying on, and did not become aware of the Offering through or as a result of,
any form of general solicitation or general advertising including, without limitation, any article, notice, advertisement or other
communication published in any newspaper, magazine or similar media or broadcast over television, radio or the Internet (including,
without limitation, internet “blogs,” bulletin boards, discussion groups and social networking sites) in connection
with the Offering and is not subscribing for the Shares and did not become aware of the Offering through or as a result of any
seminar or meeting to which the Purchaser was invited by, or any solicitation of a subscription by, a person not previously known
to the Purchaser in connection with investments in securities generally.

 

(h)           The Purchaser has taken no action that would give rise to any claim by any person for brokerage commissions, finders’
fees or the like relating to this Subscription Agreement or the transactions contemplated hereby (other than commissions to be
paid by the Company to the Placement Agent or as otherwise described in the Memorandum).

 

(i)            The Purchaser, together with its Advisers, if any, has such knowledge and experience in financial, tax, and business matters,
and, in particular, investments in securities, so as to enable it to utilize the information made available to it in connection
with the Offering to evaluate the merits and risks of an investment in the Shares and the Company and to make an informed investment
decision with respect thereto.

 

(j)            The Purchaser is not relying on the Company, the Placement Agent or any of their respective employees or agents with respect
to the legal, tax, economic and related considerations of an investment in the Company and the Shares, and the Purchaser has relied
on the advice of, or has consulted with, only its own Advisers.

 

(k)           The Purchaser is acquiring the Shares solely for such Purchaser’s own account for investment purposes only and not
with a view to or intent of resale or distribution thereof, in whole or in part. The Purchaser has no agreement or arrangement,
formal or informal, with any person to sell or transfer all or any part of the Shares constituting the Shares or the Conversion
Securities, and the Purchaser has no plans to enter into any such agreement or arrangement.

 

    3

     

    

 

(l)            The Purchaser must bear the substantial economic risks of the investment in the Shares indefinitely because
none of the Shares or Conversion Securities may be sold, hypothecated or otherwise disposed of unless subsequently registered
under the Securities Act and applicable state securities laws or an exemption from such registration is available. Legends shall
be placed on the securities included in the Shares to the effect that they have not been registered under the Securities Act or
applicable state securities laws and appropriate notations thereof will be made in the Company’s stock books. Stop transfer
instructions will be placed with the transfer agent of the Shares, if any. The Company has agreed that purchasers of the Shares
will have, with respect to the Conversion Securities, the registration rights described in the Memorandum. Notwithstanding such
registration rights, there can be no assurance that there will be any market for resale of the Shares or the Conversion Securities,
nor can there be any assurance that such securities will be freely transferable at any time in the foreseeable future.

 

(m)          The Purchaser has adequate means of providing for such Purchaser’s current financial needs and foreseeable contingencies
and has no need for liquidity from its investment in the Shares for an indefinite period of time.

 

(n)           The Purchaser is aware that an investment in the Shares is high risk, involving a number of very significant risks and has
carefully read and considered the matters set forth under the caption “Risk Factors” in the Memorandum and in the SEC
Reports, and, in particular, acknowledges that the Company with its Subsidiary is a development stage company which has only recently
entered the commercialization stage of its technology, has had significant operating losses since inception, limited revenues from
operations to date, and are engaged in highly competitive businesses.

 

(o)           The Purchaser meets the requirements of at least one of the suitability standards for an “accredited investor”
as that term is defined in Regulation D and as set forth on the Accredited Investor Certification contained herein.

 

(p)           The Purchaser (i) if a natural person, represents that the Purchaser has reached the age of 21 and has full power and authority
to execute and deliver this Subscription Agreement and all other related agreements or certificates and to carry out the provisions
hereof and thereof; (ii) if a corporation, partnership, or limited liability company or partnership, or association, joint stock
company, trust, unincorporated organization or other entity, represents that such entity was not formed for the specific purpose
of acquiring the Shares, such entity is duly organized, validly existing and in good standing under the laws of the state of its
organization, the consummation of the transactions contemplated hereby is authorized by, and will not result in a violation of
state law or its charter or other organizational documents, such entity has full power and authority to execute and deliver this
Subscription Agreement and all other related agreements or certificates and to carry out the provisions hereof and thereof and
to purchase and hold the securities constituting the Shares, the execution and delivery of this Subscription Agreement has been
duly authorized by all necessary action, this Subscription Agreement has been duly executed and delivered on behalf of such entity
and is a legal, valid and binding obligation of such entity; or (iii) if executing this Subscription Agreement in a representative
or fiduciary capacity, represents that it has full power and authority to execute and deliver this Subscription Agreement in such
capacity and on behalf of the subscribing individual, ward, partnership, trust, estate, corporation, or limited liability company
or partnership, or other entity for whom the Purchaser is executing this Subscription Agreement, and such individual, partnership,
ward, trust, estate, corporation, or limited liability company or partnership, or other entity has full right and power to perform
pursuant to this Subscription Agreement and make an investment in the Company, and represents that this Subscription Agreement
constitutes a legal, valid and binding obligation of such entity. The execution and delivery of this Subscription Agreement will
not violate or be in conflict with any order, judgment, injunction, agreement or controlling document to which the Purchaser is
a party or by which it is bound.

 

    4

     

    

 

(q)           The Purchaser and the Advisers, if any, have had the opportunity to obtain any additional information, to the extent the
Company has such information in their possession or could acquire it without unreasonable effort or expense, necessary to verify
the accuracy of the information contained in the Memorandum and all documents received or reviewed in connection with the purchase
of the Shares and have had the opportunity to have representatives of the Company provide them with such additional information
regarding the terms and conditions of this particular investment and the financial condition, results of operations, and business
of the Company and the Subsidiary deemed relevant by the Purchaser or the Advisers, if any, and all such requested information,
to the extent the Company has such information in their possession or could acquire it without unreasonable effort or expense,
has been provided to the full satisfaction of the Purchaser and the Advisers, if any.

 

(r)            Any information which the Purchaser has heretofore furnished or is furnishing herewith to the Company or the Placement Agent
is complete and accurate and may be relied upon by the Company and the Placement Agent in determining the availability of an exemption
from registration under federal and state securities laws in connection with the offering of securities as described in the Memorandum.
The Purchaser further represents and warrants that it will notify and supply corrective information to the Company and the Placement
Agent immediately upon the occurrence of any change therein occurring prior to the Company's issuance of the securities contained
in the Shares.

 

(s)           The Purchaser has significant prior investment experience, including investment in non-listed and non-registered securities.
The Purchaser is knowledgeable about investment considerations in development-stage companies with limited operating histories.
The Purchaser has a sufficient net worth to sustain a loss of its entire investment in the Company and the Shares in the event
such a loss should occur. The Purchaser's overall commitment to investments which are not readily marketable is not excessive in
view of the Purchaser’s net worth and financial circumstances and the purchase of the Shares will not cause such commitment
to become excessive. Investment in the Company and the Shares as contemplated by this Subscription Agreement is suitable for the
Purchaser.

 

(t)            The Purchaser is satisfied that the Purchaser has received adequate information with respect to all matters which it or
the Advisers, if any, consider material to its decision to make an investment in the Company and the Shares as contemplated by
this Subscription Agreement.

 

(u)           The Purchaser acknowledges that any estimates or forward-looking statements or projections included in the Memorandum were
prepared by the Company in good faith but that the attainment of any such projections, estimates or forward-looking statements
cannot be guaranteed by the Company or the Subsidiary and should not be relied upon.

 

    5

     

    

 

(v)           No oral or written representations have been made, or oral or written information furnished, to the Purchaser or the Advisers,
if any, in connection with the Offering which are in any way inconsistent with the information contained in the Memorandum.

 

(w)          Within five (5) days after receipt of a request from the Company or the Placement Agent, the Purchaser will provide such
information and deliver such documents as may reasonably be necessary to comply with any and all laws and ordinances to which the
Company or the Placement Agent is subject.

 

(x)           The Purchaser's substantive relationship with either the Company, the Placement Agent or subagent through which the Purchaser
is subscribing for Shares predates such Placement Agent's or such subagent's contact with the Purchaser regarding an investment
in the Shares.

 

(y)           THE SHARES OFFERED HEREBY (INCLUDING THE SHARES COMPRISING THE CONVERSION SECURITIES UNDERLYING SUCH SHARES) HAVE NOT BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR ANY STATE SECURITIES LAWS AND ARE BEING OFFERED AND SOLD IN RELIANCE
ON EXEMPTIONS FROM THE REGISTRATION REQUIREMENTS OF SAID ACT AND SUCH LAWS. SUCH SECURITIES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY
AND RESALE AND MAY NOT BE TRANSFERRED OR RESOLD EXCEPT AS PERMITTED UNDER SAID ACT AND SUCH LAWS PURSUANT TO REGISTRATION OR EXEMPTION
THEREFROM. SUCH SECURITIES HAVE NOT BEEN RECOMMENDED, APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE COMMISSION, ANY STATE
SECURITIES COMMISSION OR ANY OTHER REGULATORY AUTHORITY, NOR HAVE ANY OF THE FOREGOING AUTHORITIES PASSED UPON OR ENDORSED THE
MERITS OF THIS OFFERING OR THE ACCURACY OR ADEQUACY OF THE MEMORANDUM OR THIS SUBSCRIPTION AGREEMENT. ANY REPRESENTATION TO THE
CONTRARY IS UNLAWFUL.

 

(z)            In making an investment decision, investors must rely on their own examination of the Company, the Subsidiary and the terms
of the Offering, including the merits and risks involved. The Purchaser should be aware that it will be required to bear the financial
risks of investment in the Company and the Shares for an indefinite period of time.

 

(aa)          (For
ERISA plans only) The fiduciary of the ERISA plan (the “Plan”) represents that such fiduciary has been informed
of and understands the Company’s investment objectives, policies and strategies, and that the decision to invest “plan
assets” (as such term is defined in ERISA) in the Company is consistent with the provisions of ERISA that require diversification
of plan assets and impose other fiduciary responsibilities. The Purchaser fiduciary or Plan (a) is responsible for the decision
to invest in the Company; (b) is independent of the Company or any of its affiliates; (c) is qualified to make such investment
decision; and (d) in making such decision, the Purchaser fiduciary or Plan has not relied primarily on any advice or recommendation
of the Company or any of its affiliates.

 

    6

     

    

 

(bb)         The Purchaser should check the Office of Foreign Assets Control (“OFAC”) website at <http://www.treas.gov/ofac>
before making the following representations. The Purchaser represents that the amounts invested by it in the Company in the
Offering were not and are not directly or indirectly derived from activities that contravene federal, state or international laws
and regulations, including anti-money laundering laws and regulations. Federal regulations and Executive Orders administered by
OFAC prohibit, among other things, the engagement in transactions with, and the provision of services to, certain foreign countries,
territories, entities and individuals. The lists of OFAC prohibited countries, territories, persons and entities can be found on
the OFAC website at <http://www.treas.gov/ofac>. In addition, the programs administered by OFAC (the “OFAC Programs”)
prohibit dealing with individuals1
or entities in certain countries regardless of whether such individuals or entities appear on the OFAC lists.

 

(cc)         To the best of the Purchaser’s knowledge, none of: (1) the Purchaser; (2) any person controlling or controlled by
the Purchaser; (3) if the Purchaser is a privately-held entity, any person having a beneficial interest in the Purchaser; or (4)
any person for whom the Purchaser is acting as agent or nominee in connection with this investment is a country, territory, individual
or entity named on an OFAC list, or a person or entity prohibited under the OFAC Programs. Please be advised that the Company may
not accept any amounts from a prospective investor if such prospective investor cannot make the representation set forth in the
preceding paragraph. The Purchaser agrees to promptly notify the Company and the Placement Agent should the Purchaser become aware
of any change in the information set forth in these representations. The Purchaser understands and acknowledges that, by law, the
Company may be obligated to “freeze the account” of the Purchaser, either by prohibiting additional subscriptions from
the Purchaser, declining any redemption requests and/or segregating the assets in the account in compliance with governmental regulations,
and the Placement Agent may also be required to report such action and to disclose the Purchaser’s identity to OFAC. The
Purchaser further acknowledges that the Company may, by written notice to the Purchaser, suspend the redemption rights, if any,
of the Purchaser if the Company reasonably deems it necessary to do so to comply with anti-money laundering regulations applicable
to the Company and the Placement Agent or any of the Company’s other service providers. These individuals include specially
designated nationals, specially designated narcotics traffickers and other parties subject to OFAC sanctions and embargo programs.

 

(dd)         To the best of the Purchaser’s knowledge, none of: (1) the Purchaser; (2) any person controlling or controlled by
the Purchaser; (3) if the Purchaser is a privately-held entity, any person having a beneficial interest in the Purchaser; or (4)
any person for whom the Purchaser is acting as agent or nominee in connection with this investment is a senior foreign political
figure,2 or any immediate family3
member or close associate4 of a senior
foreign political figure, as such terms are defined in the footnotes below.

 

 

1
These individuals include specially designated nationals, specially designated narcotics traffickers and other parties
subject to OFAC sanctions and embargo programs.

 

2
A “senior foreign political figure” is defined as a senior official in the executive, legislative, administrative,
military or judicial branches of a foreign government (whether elected or not), a senior official of a major foreign political
party, or a senior executive of a foreign government-owned corporation. In addition, a “senior foreign political figure”
includes any corporation, business or other entity that has been formed by, or for the benefit of, a senior foreign political
figure.

 

3
“Immediate family” of a senior foreign political figure typically includes the figure’s parents,
siblings, spouse, children and in-laws.

 

4
A “close associate” of a senior foreign political figure is a person who is widely and publicly known
to maintain an unusually close relationship with the senior foreign political figure, and includes a person who is in a position
to conduct substantial domestic and international financial transactions on behalf of the senior foreign political figure.

 

    7

     

    

 

(ee)         If the Purchaser is affiliated with a non-U.S. banking institution (a “Foreign Bank”), or if the Purchaser receives
deposits from, makes payments on behalf of, or handles other financial transactions related to a Foreign Bank, the Purchaser represents
and warrants to the Company that: (1) the Foreign Bank has a fixed address, other than solely an electronic address, in a country
in which the Foreign Bank is authorized to conduct banking activities; (2) the Foreign Bank maintains operating records related
to its banking activities; (3) the Foreign Bank is subject to inspection by the banking authority that licensed the Foreign Bank
to conduct banking activities; and (4) the Foreign Bank does not provide banking services to any other Foreign Bank that does not
have a physical presence in any country and that is not a regulated affiliate.

 

6.             Indemnification. The Purchaser agrees to indemnify and hold harmless the Company the Subsidiary, the Placement Agent
(including its selected dealers, if any), and their respective officers, directors, employees, agents, control persons and affiliates
from and against all losses, liabilities, claims, damages, costs, fees and expenses whatsoever (including, but not limited to,
any and all expenses incurred in investigating, preparing or defending against any litigation commenced or threatened) based upon
or arising out of any actual or alleged false acknowledgment, representation or warranty, or misrepresentation or omission to state
a material fact, or breach by the Purchaser of any covenant or agreement made by the Purchaser herein or in any other document
delivered in connection with this Subscription Agreement.

 

7.             Irrevocability; Binding Effect. The Purchaser hereby acknowledges and agrees that the subscription hereunder is irrevocable
by the Purchaser, except as required by applicable law, and that this Subscription Agreement shall survive the death or disability
of the Purchaser and shall be binding upon and inure to the benefit of the parties and their heirs, executors, administrators,
successors, legal representatives, and permitted assigns. If the Purchaser is more than one person, the obligations of the Purchaser
hereunder shall be joint and several and the agreements, representations, warranties, and acknowledgments herein shall be deemed
to be made by and be binding upon each such person and such person's heirs, executors, administrators, successors, legal representatives,
and permitted assigns.

 

8.             Modification. This Subscription Agreement shall not be modified or waived except by an instrument in writing signed
by the party against whom any such modification or waiver is sought.

 

9.             Immaterial Modifications to the Registration Rights Agreement. The Company may, at any time prior to the First Closing,
modify the Registration Rights Agreement if necessary to clarify any provision therein, without first providing notice or
obtaining prior consent of the Purchaser, if, and only if, such modification is not material in any respect.

 

10.           Notices. Any notice or other communication required or permitted to be given hereunder shall be in writing and shall
be deemed effectively given: (a) upon personal delivery to the party notified, (b) when sent by confirmed email or facsimile if
sent during normal business hours of the recipient, if not confirmed, then on the next business day, (c) five days after having
been sent by registered or certified mail, return receipt requested, postage prepaid, or (d) one day after deposit with a nationally
recognized overnight courier, specifying next day delivery, with written verification of receipt. The Company and the Purchaser
hereby consent to the delivery of communications and notices to such parties at their respective address, email or facsimile number
set forth on the signature page hereto, or to such other address as such party shall have furnished in writing in accordance with
the provisions of this Section 10.

 

    8

     

    

 

11.           Assignability. This Subscription Agreement and the rights, interests and obligations hereunder are not transferable
or assignable by the Purchaser and the transfer or assignment of the Shares or the Conversion Securities shall be made only in
accordance with all applicable laws.

 

12.           Applicable Law. This Subscription Agreement shall be governed by and construed in accordance with the laws of the
State of New York applicable to contracts to be wholly-performed within said State.

 

13.           Arbitration. The parties agree to submit all controversies to arbitration in accordance with the provisions set forth
below and understand that:

 

(a)           Arbitration is final and binding on the parties.

 

(b)           The parties are waiving their right to seek remedies in court, including the right to a jury trial.

 

(c)           Pre-arbitration discovery is generally more limited and different from court proceedings.

 

(d)           The arbitrator’s award is not required to include factual findings or legal reasoning and any party’s right
to appeal or to seek modification of rulings by arbitrators is strictly limited.

 

(e)           The panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securities
industry.

 

(f)            All controversies which may arise between the parties concerning this Subscription Agreement shall be determined by arbitration
pursuant to the rules then pertaining to the Financial Industry Regulatory Authority, Inc. (“FINRA”) in New York City,
New York. Judgment on any award of any such arbitration may be entered in the Supreme Court of the State of New York or in any
other court having jurisdiction of the person or persons against whom such award is rendered. Any notice of such arbitration or
for the confirmation of any award in any arbitration shall be sufficient if given in accordance with the provisions of this Agreement.
The parties agree that the determination of the arbitrators shall be binding and conclusive upon them.

 

14.           Blue Sky Qualification. The purchase of Shares under this Subscription Agreement is expressly conditioned upon the
exemption from qualification of the offer and sale of the Shares from applicable federal and state securities laws. The Company
shall not be required to qualify this transaction under the securities laws of any jurisdiction and, should qualification be necessary,
the Company shall be released from any and all obligations to maintain its offer, and may rescind any sale contracted, in the jurisdiction.

 

    9

     

    

 

15.           Use of Pronouns. All pronouns and any variations thereof used herein shall be deemed to refer to the masculine, feminine,
neuter, singular or plural as the identity of the person or persons referred to may require.

 

16.           Confidentiality. The Purchaser acknowledges and agrees that any information or data the Purchaser has acquired from
or about the Company or the Subsidiary, not otherwise properly in the public domain, was received in confidence. The Purchaser
agrees not to divulge, communicate or disclose, except as may be required by law or for the performance of this Agreement, or use
to the detriment of the Company or the Subsidiary or for the benefit of any other person or persons, or misuse in any way, any
confidential information of the Company or the Subsidiary, including any scientific, technical, trade or business secrets of the
Company or the Subsidiary and any scientific, technical, trade or business materials that are treated by the Company or the Subsidiary
as confidential or proprietary, including, but not limited to, ideas, discoveries, inventions, developments and improvements belonging
to the Company or the Subsidiary and confidential information obtained by or given to the Company or the Subsidiary about or belonging
to third parties.

 

17.           Miscellaneous.

 

(a)           This Subscription Agreement, together with the Registration Rights Agreement, constitute the entire agreement between the
Purchaser and the Company with respect to the subject matter hereof and supersede all prior oral or written agreements and understandings,
if any, relating to the subject matter hereof. The terms and provisions of this Subscription Agreement may be waived, or consent
for the departure therefrom granted, only by a written document executed by the party entitled to the benefits of such terms or
provisions.

 

(b)           The representations and warranties of the Purchaser made in this Subscription Agreement shall survive the execution and
delivery hereof and delivery of the Shares constituting the Shares.

 

(c)           Each of the parties hereto shall pay its own fees and expenses (including the fees of any attorneys, accountants, appraisers
or others engaged by such party) in connection with this Subscription Agreement and the transactions contemplated hereby whether
or not the transactions contemplated hereby are consummated.

 

(d)           This Subscription Agreement may be executed in one or more counterparts each of which shall be deemed an original, but all
of which shall together constitute one and the same instrument.

 

(e)           Each provision of this Subscription Agreement shall be considered separable and, if for any reason any provision or provisions
hereof are determined to be invalid or contrary to applicable law, such invalidity or illegality shall not impair the operation
of or affect the remaining portions of this Subscription Agreement.

 

    10

     

    

 

(f)            Paragraph titles are for descriptive purposes only and shall not control or alter the meaning of this Subscription Agreement
as set forth in the text.

 

(g)           The Purchaser understands and acknowledges that there may be multiple closings for this Offering.

 

18.           Omnibus Signature Page. This Subscription Agreement is intended to be read and construed in conjunction with the
Registration Rights Agreement pertaining to the issuance by the Company of the Shares to subscribers pursuant to the Memorandum.
Accordingly, pursuant to the terms and conditions of this Subscription Agreement and such related agreements it is hereby agreed
that the execution by the Purchaser of this Subscription Agreement, in the place set forth herein, shall constitute agreement to
be bound by the terms and conditions hereof and the terms and conditions of the Registration Rights Agreement, with the same effect
as if each of such separate but related agreement were separately signed.

 

19.           Book Entry Registration of the Shares. The Company will issue the Shares and the shares of Common Stock underlying
the Series A Preferred and/or the Series A-1 Preferred by registering them in book entry form with the Company's transfer agent
in Investor’s name and the applicable restrictions will be noted in the records of the Company's transfer agent and in the
book entry system, except for investments made via custodian accounts such as Pensions and IRA's in which case physical certificates
evidencing the shares and warrants will be issued if so requested.

 

[REMAINDER OF PAGE INTENTIONALLY LEFT
BLANK]

 

    11

     

    

 

PRIVATE PLACEMENT OFFERING OF 

DarioHealth
Corp. 

 

SUBSCRIPTION INSTRUCTIONS

 

To subscribe for Shares in the private
offering of DarioHealth Corp.:

 

		1.	Date and Fill in the number of Shares being purchased and Complete and Sign the Omnibus
Signature Page to the Subscription Agreement (page 14).

 

		2.	Initial the Accredited Investor Certification page attached to the Subscription Agreement
(pages 15-16).

 

		3.	Complete and return the Investor Profile (page 17).

 

		4.	Complete and Sign the Tax Certification for U.S. Persons or Non-U.S. Persons, as applicable
(beginning on page 19).

 

		5.	Fax or e-mail all forms to Tierney S. Picardal at 347-772-3121/ inbox@sternaegis.com.

 

		6.	Please wire funds directly to the escrow account pursuant to the following instructions (unless
other arrangements have been made); checks cannot be accepted:

 

	Bank Name: Signature Bank
	 
	Bank Address: 950 Third Avenue, NY, NY 10022 (IF wiring banker requests this info)
	 
	ABA Number: 026013576
	 
	SWIFT CODE: SIGNUS33
	 
	A/C Name: Signature Bank, as Agent for DarioHealth Corp.
	 
	DarioHealth Corp. Address (if requested): 8 HaTokhen Street, Caesarea Industrial Park
	 
	Israel 3088900
	 
	A/C Number: 1503781596
	 
	REF. outgoing wire with the following information
	 
	FBO:	 Investor Name	 
	 	 	 
	SSN/TIN	 
	 	 
	Address	 

 

    12

     

    

 

ANTI MONEY LAUNDERING REQUIREMENTS

 

 

	
        The USA PATRIOT Act

         
	What is money laundering?	How big is the problem and why is it important?
	
         

        The USA PATRIOT Act is designed to detect, deter, and punish
        terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial
        institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs.

         

        To help you understand these efforts, we want to provide you
        with some information about money laundering and the Placement Agent’s efforts to implement the USA PATRIOT Act.
	
         

        Money laundering is the process of disguising illegally obtained
        money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide
        variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism.
	
         

        The use of the U.S. financial system by criminals to facilitate
        terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts
        the amount of worldwide money laundering activity at $1 trillion a year.

 

	What the Placement Agent is required to do to help eliminate money laundering?
	
         

        Under new rules required by the USA PATRIOT Act, the Placement
        Agent’s anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent
        audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with the new laws.
	
         

        As part of the Placement Agent’s required program, it
        may ask you to provide various identification documents or other information. Until you provide the information or documents that
        the Placement Agent needs, it may not be able to effect any transactions for you.

 

    13

     

    

 

DarioHealth
Corp.

OMNIBUS SIGNATURE PAGE TO THE

SUBSCRIPTION
AGREEMENT AND Registration Rights AGREEMENT

 

Subscriber hereby elects to subscribe
under the Subscription Agreement for a total of $__________ of Series A Preferred / Series A-1 Preferred (circle one) Shares at
a price of $1,000.00 per Share (NOTE: to be completed by subscriber) and, by execution and delivery hereof, Subscriber hereby
executes the Subscription Agreement and agrees to be bound by the terms and conditions of the Subscription Agreement and the Registration
Rights Agreement.

 

If the Purchaser is an INDIVIDUAL, and
if purchased as JOINT TENANTS, as TENANTS IN COMMON, or as COMMUNITY PROPERTY:

 

	 	 	 
	Print Name(s)	 	Social Security Number(s)
	 	 	 
	 	 	 
	Signature(s) of Subscriber(s)	 	Signature
	 	 	 
	 	 	 
	Date	 	Address

 

If the Purchaser is a PARTNERSHIP, CORPORATION,
LIMITED LIABILITY COMPANY or TRUST:

 

	 	 	 
	Name of Entity	 	Federal Taxpayer
	 	 	Identification Number
	 	 	 
	By:	 	 	 
	 	Name:	 	State of Organization
	 	Title:	 	 
	 	 	 
	 	 	 
	Date	 	Address
	 	 	 
	 	 	 
	Fax Number	 	Email Address
	 	 	 
	DarioHealth Corp.	 	AEGIS CAPTIAL CORP.
	 	 	 
	 	 	 
	By:	 	By:
	 	Authorized Officer	 	 	Authorized Officer

 

    14

     

    

 

DarioHealth
Corp.

ACCREDITED INVESTOR CERTIFICATION

 

For Individual Investors Only

(all Individual Investors must INITIAL
where appropriate):

 

Initial
_______          I have an individual net worth, or joint net worth with my spouse, as of the date hereof in excess of $1 million.
For purposes of calculating net worth under this category, (i) the undersigned’s primary residence shall not be included
as an asset, (ii) indebtedness that is secured by the undersigned’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,
(iii) to the extent that the indebtedness that is secured by the primary residence is in excess of the fair market value
of the primary residence, the excess amount shall be included as a liability, and (iv) if the amount of outstanding indebtedness
that is secured by the primary residence exceeds the amount outstanding 60 days prior to the execution of this Subscription Agreement,
other than as a result of the acquisition of the primary residence, the amount of such excess shall be included as a liability.

 

Initial
_______          I have had an annual gross income for the past two years of at least $200,000 (or $300,000 jointly with my spouse)
and expect my income (or joint income, as appropriate) to reach the same level in the current year.

 

Initial
_______          I am a director or executive officer of DarioHealth Corp.

 

For Non-Individual
Investors

(all Non-Individual
Investors must INITIAL where appropriate):

 

Initial
_______          The investor certifies that it is a partnership, corporation, limited liability company or business trust that is 100%
owned by persons who meet at least one of the criteria for Individual Investors set forth above.

 

Initial
_______          The investor certifies that it is a partnership, corporation, limited liability company or any organization described
in Section 501(c)(3) of the Internal Revenue Code, Massachusetts or similar business trust that has total assets of at least
$5,000,000f and was not formed for the purpose of investing the Company.

 

Initial
_______          The investor certifies that it is an employee benefit plan within the meaning of the Employee Retirement Income
Security Act of 1974, whose investment decision is made by a plan fiduciary (as defined in ERISA §3(21)) that is a bank, savings
and loan association, insurance company or registered investment adviser.

 

Initial
_______           The investor certifies that it is an employee benefit plan whose total assets exceed $5,000,000 as of the date of
this Agreement.

 

    15

     

    

 

Initial
_______          The undersigned certifies that it is a self-directed employee benefit plan whose investment decisions are made solely
by persons who meet either of the criteria for Individual Investors.

 

Initial
_______          The investor certifies that it is a U.S. bank, U.S. savings and loan association or other similar U.S. institution
acting in its individual or fiduciary capacity.

 

Initial
_______          The undersigned certifies that it is a broker-dealer registered pursuant to §15 of the Securities Exchange
Act of 1934.

 

Initial
_______          The investor certifies that it is an organization described in §501(c)(3) of the Internal Revenue Code with
total assets exceeding $5,000,000 and not formed for the specific purpose of investing in the Company.

 

Initial
_______          The investor certifies that it is a trust with total assets of at least $5,000,000, not formed for the specific
purpose of investing in the Company, and whose purchase is directed by a person with such knowledge and experience in financial
and business matters that he is capable of evaluating the merits and risks of the prospective investment.

 

Initial
_______         The investor certifies that it is a plan established and maintained by a state or its political subdivisions, or
any agency or instrumentality thereof, for the benefit of its employees, and which has total assets in excess of $5,000,000.

 

Initial
_______          The investor certifies that it is an insurance company as defined in §2(13) of the Securities Act, or a registered
investment company.

 

Initial
_______          An investment company registered under the Investment Company Act of 1940 or a business development company as defined
in Section 2(a)(48) of that Act.

 

Initial
_______          A Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c)
or (d) of the Small Business Investment Act of 1958.

 

Initial
_______           A private business development company as defined in Section 202(a)(22) of the Investment Advisers Act of 1940.

 

    16

     

    

 

DarioHealth
Corp.

Investor Profile (Must
be completed by Investor)

 

Section A - Personal Investor Information

For All Purchasers

Certificate Title: ______________________________________________________________________________

Individual(s) executing this subscription: __________________________________________________________

Social Security Number(s) for all signatories:
________________________________

Entity Federal I.D. Number: _____________________________________________

Date(s) of Birth: ______________ 

Marital Status: _______________

Years Investment Experience: ______________ 

Aegis Capital Acct Executive or Outside Broker/Dealer: ______
/Aegis Rep 3-Digit I.D._____/Aegis Acct #_______

Check if you are a FINRA member or affiliate of a FINRA member
firm: ____

Check Investment Objective(s)
(See definitions on following page): ____Preservation of Capital ____Income

____Capital Appreciation ____Trading
Profits ____Speculation

____Other (please specify)

The source of funds for this investment is my personal or my
entity's assets  _____Yes   _____No

 

For Purchasers as Individual or as Joint Tenants, Tenants
in Common, and Community Property 

Annual Income(s): ___________________ 

Liquid Net Worth(s):__________________

Net Worth(s) (excluding value of primary residence): ________________

Select Tax Bracket(s): ____ 15% or below ____ 25% - 27.5% ____
Over 27.5%

 

For All Purchasers, by the Primary Contact

Home Street Address: ______________________________________________________________________

Home City, State & Zip Code: _______________________________________________________________

Home Phone: ___________________ Home Fax: _________________Home
Email: ____________________

Employer: ___________________________________

Type of Business: _____________________________

Employer Street Address: ___________________________________________________________________

Employer City, State & Zip Code: ____________________________________________________________

Bus. Phone: _____________________Bus. Fax: ___________________Bus.
Email: ____________________

 

For All Purchasers

If you are a United States
citizen, please list the number and jurisdiction of issuance of any other government-issued document evidencing residence
and bearing a photograph or similar safeguard (such as a driver’s license or passport), and provide a photocopy of each of
the documents you have listed.

If you are NOT
a United States citizen, for each jurisdiction of which you are a citizen or in which you work or reside, please
list (i) your passport number and country of issuance or (ii) alien identification card number AND (iii) number and country
of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard,
and provide a photocopy of each of these documents you have listed. These photocopies must be certified by a lawyer as to authenticity.

Government-Issued Identification Document Number(s)
and Jurisdiction(s):_______________________

In addition, please provide a legible photocopy
of your Identification Document(s) with your subscription

 

Section B – Securities Delivery
Instructions

____ Please deliver securities to the Employer Address listed
in Section A.

____ Please deliver securities to the Home Address listed in
Section A.

____ Please deliver securities to the following address: _____________________________________________

 

Section C –Wire Transfer Instructions

____ I will wire funds from my outside
account according to the “Subscription Instructions” Page.

____ I will wire funds from my Aegis Capital
Account.

____The funds for this investment are rolled
over, tax deferred from __________ within the allowed 60 day window.

 

	 	 	 	 
	Investor Signature	 	Date	 
	 	 	 	 
	 	 	 	 
	Investor Signature	 	Date	 

 

    17

     

    

 

Investment Objectives: The typical
investment listed with each objective are only some examples of the kinds of investments that have historically been consistent
with the listed objectives. However, neither the Company nor the Placement Agent can assure that any investment will achieve your
intended objective. You must make your own investment decisions and determine for yourself if the investments you select are appropriate
and consistent with your investment objectives.

 

Neither the Company nor the Placement Agent
assumes responsibility to you for determining if the investments you selected are suitable for you.

 

Preservation of Capital: An investment
objective of Preservation of Capital indicates you seek to maintain the principal value of your investments and are interested
in investments that have historically demonstrated a very low degree of risk of loss of principal value. Some examples of typical
investments might include money market funds and high quality, short-term fixed income products.

 

Income: An investment objective
of Income indicates you seek to generate income from investments and are interested in investments that have historically
demonstrated a low degree of risk of loss of principal value. Some examples of typical investments might include high quality,
short and medium-term fixed income products, short-term bond funds and covered call options.

 

Capital Appreciation: An investment
objective of Capital Appreciation indicates you seek to grow the principal value of your investments over time and are willing
to invest in securities that have historically demonstrated a moderate to above average degree of risk of loss of principal value
to pursue this objective. Some examples of typical investments might include common stocks, lower quality, medium-term fixed income
products, equity mutual funds and index funds.

 

Trading Profits: An investment objective
of Trading Profits indicates you seek to take advantage of short-term trading opportunities, which may involve establishing
and liquidating positions quickly. Some examples of typical investments might include short-term purchases and sales of volatile
or low priced common stocks, put or call options, spreads, straddles and/or combinations on equities or indexes. This is a high-risk
strategy.

 

Speculation: An investment objective
of Speculation indicates you seek a significant increase in the principal value of your investments and are willing to accept
a corresponding greater degree of risk by investing in securities that have historically demonstrated a high degree of risk of
loss of principal value to pursue this objective. Some examples of typical investments might include lower quality, long-term fixed
income products, initial public offerings, volatile or low priced common stocks, the purchase or sale of put or call options, spreads,
straddles and/or combinations on equities or indexes, and the use of short-term or day trading strategies.

 

Other: Please specify.

 

    18

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