Document:

Separation Agreement

 Exhibit 10.1 
 SEPARATION AGREEMENT 
 This Separation Agreement (the “Separation Agreement”) is made and
entered into between Albert P. L. Stroucken (the “Executive”) and H.B. Fuller Company (the “Company”) this 20th day of November, 2006. 
 WHEREAS, Executive and the Company are parties to an Employment Agreement dated as of March 30, 2004 (the “Employment Agreement”); and 
 WHEREAS, the Employment Agreement was adopted for a term ending on March 31, 2007; and 
 WHEREAS, Executive advised the Company that he did not intend either to extend the term of the Employment Agreement following its scheduled expiration on
March 31, 2007 or to negotiate a new employment agreement; and 
 WHEREAS, in light of the foregoing, Executive and the Company have
engaged in comprehensive discussions concerning Executive’s separation from employment and the timing thereof, and have arrived at the following arrangement establishing their respective rights and obligations, including a reduction of Four
million dollars ($4,000,000.00) from payments and benefits Executive otherwise would have received in connection with Executive’s separation from the Company, intending to resolve all issues, differences and actual or potential claims between
them including, but not limited to, any claims that might arise out of the Employment Agreement; 
 NOW, THEREFORE, in consideration
of the mutual promises contained herein, Executive and the Company agree as follows: 
 1. Resignation. Executive’s resignation
from his positions of Chairman of the Board, President, Chief Executive Officer and director of the Company shall be effective as of 
  

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 the close of business on Friday, December 1, 2006 (the “Separation Date”). Executive shall continue to
receive his current Base Salary through the Separation Date, at which point his employment shall terminate. 
 2. Executive Plans.
Notwithstanding Executive’s resignation as of the Separation Date, the Company shall pay to Executive an amount equal to the value of such Performance Unit Awards (“PUP”) and Covered Employee Annual Incentive Awards (Short Term
Incentive Plan) as would otherwise have been payable to Executive under the terms of the Company’s Annual and Long-Term Incentive Plan for the Plan Year ending December 2, 2006 (the “Plan”) and Executive’s Award Agreement.
The payment(s) shall be made to Executive at the same time(s) as payments are made to other participants under the terms of the Plan, but in no event later than March 15, 2007. 
 3. Stock and Stock Options. All shares of restricted stock and stock options granted to Executive that by their terms remain unvested on the
Separation Date shall become fully vested as of the Separation Date. In addition, the expiration date of all stock options granted to Executive that by their terms remain unvested on the Separation Date shall be extended from the Separation Date
until the close of business on February 1, 2007. 
 4. Retirement Benefit Plans. Executive’s eligibility to participate in
the Company’s pension and 401(k) retirement savings plans shall cease as of the Separation Date, but Executive shall be entitled to receive the value of his vested accounts or benefits pursuant to the applicable terms of each such plan.

 5. SERP. Executive’s eligibility to participate in his Supplemental Executive Retirement Plan (“SERP”) shall cease
as of the Separation Date and the payment provided for under Section 9(c) of this Agreement is in lieu of any benefit Executive would otherwise be entitled to receive under the SERP. 
  

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 6. Welfare Benefit Plans. The Company shall cease to be obligated to provide life, personal
accident, medical, dental and disability benefits and insurance coverages for the Executive effective as of the Separation Date. 
 7.
Executive Perquisites. The Company shall cease to be obligated to pay Executive’s automobile, financial counseling, and executive physical examination allowances effective as of the Separation Date. 
 8. Relocation. Executive shall be eligible to receive relocation assistance and benefits for relocation to Pittsburgh or other U.S. city of his
choosing, in accordance with the Company’s relocation policy. 
 9. Company Payments. Notwithstanding any other provisions of the
Employment Agreement, and in consideration of the arrangements for Executive’s resignation mutually agreed to between the Company and Executive, the Company shall make the following payments to Executive: 
  

	 	a.	The gross sum of Eight hundred two thousand, four hundred thirty-one dollars ($802,431.00) to be paid to Executive as salary continuation in three equal installments, payable on
each of the first three anniversary dates of the Separation Date; 

  

	 	b.	The gross sum of One million, seven hundred sixty-eight thousand, eight hundred eighty-six dollars ($1,768,886.00) to be paid to Executive as incentive compensation continuation in
three equal installments, payable on each of the first three anniversary dates of the Separation Date; 

  

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	 	c.	The gross sum of Six million, one hundred eighteen thousand, six hundred sixty-seven dollars ($6,118,667.00) as a SERP benefit, payable to Executive on a date that is six months
after the Separation Date, plus accrued interest as provided under the terms of the SERP, with such amount to be adjusted as provided under the terms of the SERP for the use of specific offsets from prior employer benefits and actual Social Security
benefits payable at age 62, based upon no additional earnings after the Separation Date. 

  

	 	d.	The gross sum payable to Executive as deferred compensation under the Company’s Key Employee Deferred Compensation Plan and as provided in the deferral schedule attached hereto
as Exhibit A, which schedule shall be subject to any adjustment which may be required to ensure compliance with Internal Revenue Code § 409A. As of November 7, 2006, such gross sum was four million, seven hundred ninety-one thousand, eight
hundred eighty-six dollars ($4,791,886.00). 

 10. Withholding. Unless expressly stated otherwise herein, all of the
payments to be made to Executive pursuant to this Separation Agreement shall be subject to all withholding and/or deductions required by applicable law. 
 11. Restrictive Covenant. Executive acknowledges and agrees that Executive’s covenants and agreements as set forth in Article 4 of the Employment Agreement shall remain fully binding and effective as
specified by their terms for a period ending on March 31, 2010. 
 12. Release of Claims. Executive and the Company intend to
settle any and all claims that Executive may have against the Company as a result of the Company’s hiring of Executive, 
  

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 Executive’s employment with the Company, Executive’s compensation while employed with the Company, and
Executive’s resignation from employment with the Company. Executive agrees that, in exchange for the Company’s promises in this Separation Agreement and in exchange for the consideration to be paid to Executive by the Company as described
above, Executive, on behalf of himself and his heirs, successors and assigns, hereby releases and forever discharges the Company, its subsidiaries and affiliates and all of their respective agents, officers, employees, directors, shareholders and
insurers (hereinafter, collectively “Fuller”) from any and all liability, claims, charges, demands or causes of action, which have or could be asserted against Fuller arising out of or in any way relating to Executive’s employment, or
the cessation of his employment, with Fuller or any other occurrence whatsoever arising on or before the date this Release is executed, including but not limited to: 
 A. Any claims, demands, or causes of action arising under, or any claim for relief on the basis of, an alleged violation of the Civil Rights Act of 1991, Title VII of the Civil Rights Act of 1964, the Age
Discrimination in Employment Act of 1967, as amended, the Employee Retirement Income Security Act, Title 42 U.S. Section 1985, the Americans with Disabilities Act, the Older Workers Benefits Protection Act, the Minnesota Human Rights Act,
and/or any other federal, state or local statute, ordinance, or regulation dealing in any way with employment or employment discrimination; 
 B. Any claims, demands, or causes of action on the basis of any breach of an expressed or implied employment contract under the common law of the State of Minnesota, or any other state, or on the basis of any claim of defamation, wrongful
discharge, and/or any other common law, statutory, or tort or any other claim whatsoever arising out of or in any way relating to Executive’s employment with and resignation from employment with Fuller and/or 
  

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 any other occurrence prior to the date of this release, but excluding: (i) any claims which Executive cannot waive
as a matter of law; and (ii) any claims for breach of the Company’s obligation with this Release; (iii) any claims arising from events occurring after the execution of this release; and (iv) Executive’s right to
indemnification under the Company’s articles of incorporation and its bylaws. 
 C. Executive warrants that he is legally competent to
execute this release and accept full responsibility therefore. Executive also agrees that he is signing this release voluntarily and with full knowledge of its significance and legal consequence. Executive acknowledges and agrees that he has been
advised to consult with an attorney before signing this release and that Fuller has given him a full twenty-one (21) days within which to consider this release, before signing, if he so desires.  
 D. Executive understands that he may rescind (that is, cancel) this release within seven (7) calendar days of signing it to reinstate claims under
the Age Discrimination in Employment Act of 1967 and within fifteen (15) calendar days to reinstate claims under the Minnesota Human Rights Act. To be effective, any such rescission must be in writing and delivered to Fuller in care of the
Vice-President, Human Resources, 1200 Willow Lake Boulevard, St. Paul, Minnesota. If delivered by mail, such rescission must be postmarked within the applicable rescission period and sent by certified mail, return receipt to H.B. Fuller Company at
P.O. Box 64683, St. Paul, Minnesota 55164-0683, attention Vice-President, Human Resources. Executive understands this release is effective upon signing, and that he has no right to rescind the release of for claims not specifically set forth in this
paragraph D. Executive understands that this release is a compromise and final settlement of all claims and fully discharges Fuller from any further obligations except those expressly specified in this Separation Agreement. 
  

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 13. Company Property. Executive agrees that, within seven business days following the Separation
Date, he shall return to the Company all Company books, records or other property in his possession under his control which, to date, has not already been returned. 
 14. Entire Agreement. This Separation Agreement contains the entire understanding between the parties with respect to Executive’s employment with the Company and his resignation from employment with the
Company. Executive hereby affirms that his rights to payments or benefits from the Employer by reason of such resignation are specified exclusively and completely by this Separation Agreement. Any modification of, or addition to, this Separation
Agreement must be in writing signed by Executive and by an authorized representative of the Company. 
 15. Non-Admission. This
Separation Agreement shall not in any way be construed as an admission by the Company or by Executive that either has acted wrongfully with respect to the other or any other person. 
 16. Non-assignability. This Separation Agreement is personal to Executive and may not be assigned by Executive without the written agreement of
the Company. This Agreement shall be binding on the Company, its successors and assigns. 
 17. Third Party Benefit. Nothing in this
Separation Agreement, express or implied, is intended to confer upon any person any rights, remedies or entitlements of any nature whatsoever. However, if Executive is deceased prior to the Company’s payment to him in full of the cash amounts
owed to him under this Separation Agreement, any such amounts remaining due shall be paid by the Company to the Executive’s estate. 
  

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 18. Choice of Law. This Separation Agreement shall be governed by, and interpreted in accordance
with, the laws of the State of Minnesota. 
 19. Executive’s Acknowledgment. Executive acknowledges and agrees that he has
received and read this Separation Agreement, that its provisions are understandable to him, and that he fully appreciates and understands the meaning of the terms of this Separation Agreement and their effect. Executive acknowledges and agrees that
he has been provided with a reasonable and sufficient period of twenty-one (21) days within which to consider whether or not to accept this Separation Agreement and that he has been advised to, and is fully aware of his right to, consult with
an attorney for advice in connection with this Separation Agreement prior to signing the it. Executive acknowledges that he has entered into this Separation Agreement freely and voluntarily. 
 IN WITNESS WHEREOF, the parties have executed this Agreement by their signatures below. 
  

			
		 	 /s/ Albert P. L. Stroucken

		 	Albert P. L. Stroucken
		
		 	H.B. Fuller Company
		
	By    	 	 /s/ Lee R. Mitau

		
	Its	 	 Chair of Corporate Governance and Nominating Committee

  

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	 Albert P. Stroucken
	  		  		  		  	Exhibit A	  	

 Key Employee Deferred Compensation Plan 
  

											
	 Deferral Year
	  	Payment
Election -
Installments	  	Frequency	  	 Payment Start
 Given A
 12-01-06
Termination
	  	 Account
 Balance As Of
 11-07-06
	 
	 2006
	  	1	  	Annual	  	Jun-07	  	$	108,240	 
	 2005
	  	1	  	Annual	  	Jun-07	  	$	1,076,766	*
	 2004
	  	11	  	Annual	  	Jan-07	  	$	311,836	 
	 2003
	  	11	  	Annual	  	Jan-07	  	$	403,969	 
	 2002
	  	132	  	Monthly	  	Jan-07	  	$	1,369,843	 
	 2001
	  	132	  	Monthly	  	Jan-07	  	$	723,108	 
	 2000
	  	132	  	Monthly	  	Jan-07	  	$	798,124	 
		  		  		  		  	$	4,791,886	 

	*	Includes FY 2004 PUP payments credited in 2005 

  

 9Form of Warrant to Purchase Common Stock

 Exhibit 4.1 
 THIS WARRANT AND THE SECURITIES ISSUABLE UPON THE EXERCISE HEREOF HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. THEY MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED, HYPOTHECATED, OR OTHERWISE TRANSFERRED EXCEPT
PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AN EXEMPTION FROM SUCH REGISTRATION, OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT REGISTRATION IS NOT REQUIRED. 
 Issue Date: November 21, 2006 
 AKESIS
PHARMACEUTICALS, INC. 
 WARRANT TO PURCHASE COMMON STOCK 
 This Warrant to Purchase Common Stock (the “Warrant”) is issued to
[                            ] (the “Holder”) by Akesis Pharmaceuticals, Inc.,
a Nevada corporation (the “Company”), pursuant to the terms of that certain Securities Purchase Agreement (the “Purchase Agreement”) dated as of November 21, 2006 by and among the Company and
certain purchasers (the “Investors”), of the Company’s Common Stock and is one of a series of warrants (collectively, the “Warrants”) issued pursuant to the Purchase Agreement. Pursuant to
Section 1(b) of the Purchase Agreement, each Investor shall have the right to elect to either (a) receive a Warrant to purchase shares of the Company’s Common Stock, or (b) enter into a Registration Rights Agreement. The Holder
has elected to receive this Warrant. 
 1. Purchase of Shares. Subject to the terms and conditions hereinafter set forth and set forth
in the Purchase Agreement, the Holder of this Warrant is entitled during the Exercise Period, upon surrender of this Warrant at the principal office of the Company (or at such other place as the Company shall notify the Holder hereof in writing), to
purchase, in whole or in part, from the Company [                            ] fully paid and
nonassessable Shares, at an exercise price per share equal to the Exercise Price (as defined below). 
 2. Definitions.

 (a) “Act” shall mean the Securities Act of 1933, as amended. 
 (b) “Exercise Price” shall mean $0.60. 
 (c) “Exercise Period” shall mean the term commencing on the date of issuance of this Warrant and ending on the
expiration of this Warrant pursuant to Section 12 hereof. 
 (d) “Shares” shall mean shares of
the Company’s Common Stock. 

 (e) “Change of Control” shall mean (i) a sale, lease or
disposition of all or substantially all of the assets of the Company, or (ii) a merger or consolidation (in a single transaction or a series of related transactions) of the Company with or into any other corporation or corporations or other
entity, or any other corporate reorganization, where the stockholders of the Company immediately prior to such event do not retain more than fifty percent (50%) of the voting power of and interest in the successor entity (excluding any
transactions if the primary purpose of the transaction is to obtain financing from new or existing investors). 
 3. Method of
Exercise. While this Warrant remains outstanding and exercisable in accordance with Section 1 above, the Holder may exercise, in whole or in part, the purchase rights evidenced hereby. Such exercise shall be effected by: 
 (a) the surrender of the Warrant, together with a notice of exercise to the Secretary of the Company at its principal offices; and

 (b) the payment to the Company of an amount equal to the aggregate Exercise Price for the number of Shares being purchased.

 4. Net Exercise. In lieu of cash exercising this Warrant, the Holder of this Warrant may elect to receive shares equal to the value
of this Warrant (or the portion thereof being canceled) by surrender of this Warrant at the principal office of the Company together with notice of such election, in which event the Company shall issue to the Holder hereof a number of Shares
computed using the following formula: 
  

					
		  	Y (A - B)	  	
	X =  	  	A	  	

 Where 
 X —  The number of Shares to be issued to the Holder of this Warrant. 
 Y —  The number of Shares purchasable under this Warrant. 
 A —  The fair market value of
one Share. 
 B —  The Exercise Price (as adjusted to the date of such calculations). 
 For purposes of this Section 4, the fair market value of a Share shall mean the average of the closing bid and asked prices of Shares quoted in the
over-the-counter market in which the Shares are traded or the closing price quoted on any exchange on which the Shares are listed, whichever is applicable, as published in the Western Edition of The Wall Street Journal for the ten
(10) trading days prior to the date of determination of fair market value (or such shorter period of time during which such stock was traded over-the-counter or on such exchange). If the Shares are not traded on the over-the-counter market or
on an exchange, the fair market value shall be the price per Share that the Company could obtain from a willing buyer for Shares sold by the Company from authorized but unissued Shares, as such prices shall be determined in good faith by the
Company’s Board of Directors. 
  

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 5. Certificates for Shares. Upon the exercise of the purchase rights evidenced by this Warrant,
one or more certificates for the number of Shares so purchased shall be issued as soon as practicable thereafter, and in any event within thirty (30) days of the delivery of the subscription notice. 
 6. Issuance of Shares. The Company covenants that the Shares, when issued pursuant to the exercise of this Warrant, will be duly and validly
issued, fully paid and nonassessable and free from all taxes, liens, and charges with respect to the issuance thereof. 
 7. Adjustment of
Exercise Price and Number of Shares. The number of and kind of securities purchasable upon exercise of this Warrant and the Exercise Price shall be subject to adjustment from time to time as follows: 
 (a) Subdivisions, Combinations and Other Issuances. If the Company shall at any time prior to the expiration of this Warrant
subdivide the Shares, by split-up or otherwise, or combine its Shares, or issue additional shares of its Shares as a dividend, the number of Shares issuable on the exercise of this Warrant shall forthwith be proportionately increased in the case of
a subdivision or stock dividend, or proportionately decreased in the case of a combination. Appropriate adjustments shall also be made to the purchase price payable per share, but the aggregate purchase price payable for the total number of Shares
purchasable under this Warrant (as adjusted) shall remain the same. Any adjustment under this Section 7(a) shall become effective at the close of business on the date the subdivision or combination becomes effective, or as of the record date of
such dividend, or in the event that no record date is fixed, upon the making of such dividend. 
 (b) Reclassification,
Reorganization and Consolidation. In case of any reclassification, capital reorganization, or change in the capital stock of the Company (other than as a result of a subdivision, combination, or stock dividend provided for in Section 7(a)
above), then the Company shall make appropriate provision so that the Holder of this Warrant shall have the right at any time prior to the expiration of this Warrant to purchase, at a total price equal to that payable upon the exercise of this
Warrant, the kind and amount of shares of stock and other securities and property receivable in connection with such reclassification, reorganization, or change by a Holder of the same number of Shares as were purchasable by the Holder of this
Warrant immediately prior to such reclassification, reorganization, or change. In any such case appropriate provisions shall be made with respect to the rights and interest of the Holder of this Warrant so that the provisions hereof shall thereafter
be applicable with respect to any shares of stock or other securities and property deliverable upon exercise hereof, and appropriate adjustments shall be made to the purchase price per share payable hereunder, provided the aggregate purchase price
shall remain the same. 
 (c) Notice of Adjustment. When any adjustment is required to be made in the number or kind of
shares purchasable upon exercise of the Warrant, or in the Exercise Price, the Company shall promptly notify the Holder of such event and of the number of Shares or other securities or property thereafter purchasable upon exercise of this Warrant.

 8. No Fractional Shares or Scrip. No fractional shares or scrip representing fractional shares shall be issued upon the exercise of
this Warrant, but in lieu of such fractional shares the Company shall make a cash payment therefor on the basis of the Exercise Price then in effect. 
  

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 9. Representations of the Company and the Holder. The Company represents that all corporate
actions on the part of the Company, its officers, directors and stockholders necessary for the sale and issuance of this Warrant have been taken. The Holder represents and acknowledges that the Warrant may be transferred in accordance with transfer
restrictions set forth in the Purchase Agreement. 
 10. Restrictive Legend. The Shares (unless registered under the Act) shall be
stamped or imprinted with a legend in substantially the following form (in addition to any other applicable legends as set forth in the Purchase Agreement): 
 THE SHARES REPRESENTED BY THIS CERTIFICATE HAVE BEEN ACQUIRED FOR INVESTMENT AND NOT WITH A VIEW TO, OR IN CONNECTION WITH, THE SALE OR DISTRIBUTION THEREOF, AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT
OF 1933, AS AMENDED. SUCH SHARES MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR AN EXEMPTION THEREFROM UNDER THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS. COPIES OF THE AGREEMENT COVERING THE PURCHASE OF THESE SHARES
AND RESTRICTING THEIR TRANSFER MAY BE OBTAINED AT NO COST BY WRITTEN REQUEST MADE BY THE HOLDER OF RECORD OF THIS CERTIFICATE TO THE SECRETARY OF THE COMPANY AT THE PRINCIPAL EXECUTIVE OFFICES OF THE COMPANY. 
 11. Rights of Stockholders. No holder of this Warrant shall be entitled, as a Warrant holder, to vote or receive dividends or be deemed the holder
of the Shares or any other securities of the Company which may at any time be issuable on the exercise hereof for any purpose, nor shall anything contained herein be construed to confer upon the Holder of this Warrant, as such, any of the rights of
a stockholder of the Company or any right to vote for the election of directors or upon any matter submitted to stockholders at any meeting thereof, or to give or withhold consent to any corporate action (whether upon any recapitalization, issuance
of stock, reclassification of stock, change of par value, consolidation, merger, conveyance, or otherwise) or to receive notice of meetings, or to receive dividends or subscription rights or otherwise until the Warrant shall have been exercised and
the Shares purchasable upon the exercise hereof shall have become deliverable, as provided herein. 
 12. Expiration of Warrant; Notice of
Certain Events Terminating This Warrant. 
 (a) This Warrant shall expire and shall no longer be exercisable upon the
earliest to occur of: 
 (i) 5:00 p.m., California local time, on the date of the third anniversary of the Closing (as
defined in the Purchase Agreement); or 
 (ii) Any Change of Control. 
  

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 (b) The Company shall provide at least ten (10) days prior written notice of any
event set forth in Section 12(a)(ii). 
 13. Notices. All notices and other communications required or permitted hereunder shall
be made pursuant to the notice provisions of the Purchase Agreement. 
 14. Governing Law. This Warrant and all actions arising out of
or in connection with this Agreement shall be governed by and construed in accordance with the laws of the State of California, without regard to the conflicts of law provisions of the State of California or of any other state. 
 15. Rights and Obligations Survive Exercise of Warrant. Unless otherwise provided herein, the rights and obligations of the Company, of the Holder
of this Warrant and of the holder of the Shares issued upon exercise of this Warrant, shall survive the exercise of this Warrant. 
 16.
Transfer of Warrant. Subject to applicable laws, this Warrant and all rights hereunder are transferable, by the Holder in person or by duly authorized attorney, upon delivery of this Warrant, to any transferee designated by Holder. The
transferee shall sign an investment letter in form and substance satisfactory to the Company. 
 17. Modifications and Waiver. This
Warrant and any provision hereof may be changed, waived, discharged or terminated only by an instrument in writing signed by the Company and (i) Investors holding Warrants representing at least 75% of the number of Shares then issuable upon
exercise of the Warrants, provided, however, that such modification, amendment or waiver is made with respect to all Warrants and does not adversely affect the Holder without adversely affecting all holders of Warrants in a similar manner; or
(ii) the Holder. 
 [Remainder of page intentionally left blank.] 
  

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 This Warrant to Purchase Common Stock is issued as of the date first set forth above. 
  

			
	AKESIS PHARMACEUTICALS, INC.
		
	By:	 	  
		 	Jay Lichter, President and Chief Executive Officer

 AKESIS PHARMACEUTICALS, INC. 
 SIGNATURE PAGE TO WARRANT TO PURCHASE COMMON
STOCK 

 EXHIBIT A 
 NOTICE OF EXERCISE 
  

	TO:	Akesis Pharmaceuticals, Inc. 

 Attention: President

 1. The undersigned hereby elects to purchase
                     Shares of Common Stock of Akesis Pharmaceuticals, Inc. pursuant to the terms of the attached Warrant. 
 2. Method of Exercise (Please initial the applicable blank): 
  

	 	 ̈	The undersigned elects to exercise the attached Warrant by means of a cash payment, and tenders herewith payment in full for the purchase price of the shares being purchased,
together with all applicable transfer taxes, if any. 

  

	 	 ̈	The undersigned elects to exercise the attached Warrant by means of the net exercise provisions of Section 4 of the Warrant. 

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

  

					
		  	  	  	
		  	(Name)	  	
			
		  	  	  	
			
		  	  	  	
		  	(Address)	  	

 4. The undersigned hereby represents and warrants that the aforesaid Shares are being acquired for
the account of the undersigned for investment and not with a view to, or for resale, in connection with the distribution thereof, and that the undersigned has no present intention of distributing or reselling such shares and all representations and
warranties of the undersigned set forth in Section 4 of the Purchase Agreement (as defined in the Warrant) are true and correct as of the date hereof. 
  

					
			
	 	 		 	   
		 		 	(Signature)
			
	 	 		 	   
		 		 	(Name)
			
	   	 		 	   
	(Date)	 		 	(Title)

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