Document:

Unassociated Document

OxySure Systems, Inc.

 

 

 

 

 

 

 

 

 

 

	
OXYSURE SYSTEMS, INC.

 

SUBSCRIPTION BOOKLET

(COMMON STOCK) 

 

 

 

 

 

 

 

 

 

  

1

  

Subscription Booklet

 

 

	 
OxySure Systems, Inc., formerly Stationmate, Inc., a Wyoming Corporation

 

 

Attached are the following subscription documents to be completed and executed in order to subscribe for Shareholder Interests ("Interests") in OxySure Systems, Inc.:

 

PART I                      Offeree/Purchaser Questionnaire

 

PART II        Subscription Agreement

 

PART III       Shareholder Signature Page to the Bylaws of OxySure Systems, Inc.

 

 

2

 

 

INSTRUCTIONS

 

1       The applicable documents should be completed and executed in their entirety.

 

2.      Documents to be submitted by every prospective investor:

 

PART I.     One signed copy of the Investor Questionnaire, with all blanks filled in.

 

PART II.    One signed copy of the Subscription Agreement, with all blanks filled in.

 

PART III.  One signed copy of the Shareholder Signature Page to the Bylaws of Oxysure Systems, Inc.

3.    Every prospective investor whose subscription has been accepted must pay the purchase 

   price of the Interests promptly upon receipt of the Acceptance Notice (as defined in the
   Subscription Agreement) or by other arrangements with the Chairman of Oxysure
   Systems, Inc.. Payment shall be made by wire transfer of funds or by check in
  accordance with the following:

 

 

Payee:       OxySure Systems, Inc. 

 

Bank:        Silicon Valley Bank

Santa Clara, 

CA 95054-1191

   A/c#:         330-047-1107

 

 ABA#:        121-140-399

 

4.      Return this entire Booklet with the applicable documents signed to the following:

OxySure Systems, Inc. 

10880 John W. Elliott Drive 

Suite 600 

Frisco, Texas 75034 USA 

ATTN: Mr. Julian Ross

 

 

3

 

 

 

 

 

 

 

 

 

PART I. INVESTOR QUESTIONNAIRE

 

 

 

 

 

 

 

 

 

4

 

 

OXYSURE SYSTEMS, INC.

 

INVESTOR QUESTIONNAIRE 

(ALL INFORMATION WILL BE TREATED IN THE HIGHEST CONFIDENCE)

 

The information elicited by this Investor Questionnaire (the "Questionnaire") is to enable the Company to determine whether you or the prospective investor on whose behalf you are providing this information, as the case may be, meets the suitability requirements for purchasers under Regulation D promulgated under the Securities Act of
1933, as amended (the "Securities Act"), and similar requirements of other applicable securities laws. The Company will rely upon the information contained herein for the purpose of such determination and for the purpose of offering and selling shares ("Shares") in Oxysure Systems, Inc., a Delaware Corporation (the "Company"). The request to complete this Questionnaire does not constitute an offer of the Shares.

INSTRUCTIONS:

 

Answer all questions fully; if the answer to any question is "None" or "Not Applicable," please so state.

 

If you are furnishing this information on behalf of yourself or another person that is a natural person (i.e., an individual), please complete Sections 1 and 4 only. If you are furnishing this information on behalf of a prospective investor that is a corporation, partnership, or limited liability company, please complete Sections 2 and
4 only. If you are furnishing this information on behalf of a prospective investor that is a trust, please complete Sections 3 and 4 only. All questions should be answered with regard to the person investing in the Shares. For example, if a corporation is subscribing, all answers should relate to that corporation (and not the officer completing this Questionnaire).

 

If you are signing in a capacity other than your individual capacity, please attach evidence of your authority to sign in such capacity.

 

 

5

 

 

1.       NATURAL PERSON (INDIVIDUALS) N/A

 

 If the prospective investor is a natural person, please complete this Section 1.

 

A. Name:__________________________________________________________________ 

 

Date of birth:____________________Citizenship:__________________________________               

 

Social Security No.:__________________________________________________________   

 

Residence address:__________________________________________________________ 

 

Residence telephone number: __________________________________________________     

 

Business address:___________________________________________________________  

       ___________________________________________________________________________

 

        Business telephone number:_____________________________________________________ 

 

 

     Email Address:________________________________________________________________ 

 

     Marital status:________________________________________________________________ 

 

     Spouse's full name:_____________________________________________________________ 

 

      Spouse's employment:___________________________________________________________

 

      Spouse's business address:______________________________________________________

 

      Spouse's business telephone number:                                                                                                                     

 

      Communications should be sent to (check one): Business address: /___ / or Home address: /___ /

      Do you maintain a house or apartment, pay state income taxes, hold a driver's license or are you

      registered to vote, in any state other than the state listed as your residence above in this part A?

 

Yes _________           No______________              

 

          If "Yes," please state where and indicate whether such other state is the state of your principal

          residence. If it is not, please indicate why it is not.

 

 

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___________________________________________________________________________________________

 

 ___________________________________________________________________________________________

 

 ___________________________________________________________________________________________

 

B. Occupation:________________________________________________________________________________

 

Position and duties:____________________________________________________________________________

             ____________________________________________________________________________________________

 

             Any prior occupations or duties during the past five years (including name of employer, position held and length of service):

 

             C.    Do you have a net worth, or joint net worth with your spouse, in excess of $1,000,000?

 

Yes______              No __________             

 

              D.     Do you have an individual income in excess of $200,000 in each of the two most recent years,  or
joint income with your

              spouse in excess of $300,000 in each of those years, and have a reasonable expectation of exceeding such income level in the 

              current year?

Yes_________              No________              

 

 

7

 

 

 

2.      CORPORATIONS, PARTNERSHIPS, AND LIMITED LIABILITY COMPANIES

 

If the prospective investor is a corporation, partnership, or limited liability company, please complete this Section 2.

 

A. Name of entity:__________________________________________________________________________

 

Form of organization:________________________________________________________________________  

 

Date of formation:___________________________________________________________________________  

 

State or country in which organized:_____________________________________________________________

 

Address of entity (including street, city, state, country and zip code):____________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

       

Telephone number of organization: (______)_______________________________________________________  

 

 

Type of business:___________________________________________________________________________   

 

 

IRS Employer Identification Number:______________________________________________________________  

 

 

B. Number of shareholders, partners, or members:____________________________________________________  

                                  

 

Names of shareholders, partners, or members and percentage of beneficial ownership for each:

 

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

 

C.     Is the investor a corporation, a partnership, a limited liability company, a tax-exempt organization described in section

501 (c)(3) of the Internal Revenue Code, or a Massachusetts or similar business trust, not formed for the specific purpose

of acquiring the Interests, with total assets in excess of $5,000,000?

 

Yes_______          No______________              

 

D.     Is the investor a bank as defined in section 3(a)(2) of the Securities Act, a savings and loan association or other 

institution as defined in section 3(a)(5)(A) of the Securities Act; a broker or dealer registered pursuant to section 15 of the 

Securities Exchange Act of 1934,

 

 

 

8

 

 

 

as amended; an insurance company as defined in section 2(13) of the Securities Act; or an  investment company registered 

under the Investment Company Act of 1940, as amended?

 

Yes________           No_________              

 

E. Is the investor a business development company as defined in section 2(a)(48) of the Investment Company Act of 1940, 

as amended; a private business development company as  defined in section 202(a)(22) of the Investment Advisers Act of 

1940, as amended; or 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?

 

Yes_________         No___________              

 

F. ANSWER THIS QUESTION ONLY IF THE ANSWERS TO EACH OF QUESTIONS C, D AND E OF THIS SECTION 2 

ARE "NO." IF ANY OF SUCH QUESTIONS WERE  ANSWERED "YES," PLEASE SKIP THIS QUESTION AND PROCEED 

TO SECTION 4.

 

Is the investor an entity in which all of its equity owners are persons or entities that can answer "Yes" to at least one of the 

following questions: Section 1 -- Question C or Question D,  Section 2 -- Question C, Question D or Question E, Section 

3 -- Question C, Question D,  Question E or Question F?

 

Yes________           No________________              

 

If the answer to this question is "Yes" and if the answers to each of questions C, D and E of  this Section 2 are "No", then 

each beneficial owner of equity securities or equity  interests in the entity must complete a Questionnaire.

 

 

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3.       TRUSTS

 

If the investment will be in the name of a trust, please complete this Section 3.

 

A.     Name of trust:_______________________________________________________________________ 

 

Trustee of trust:__________________________________________________________________________  

 

B.     Address of trust (including street, city, state, country and zip code):

 

_______________________________________________________________________________________

 

_______________________________________________________________________________________

 

_______________________________________________________________________________________

 

 

 

Telephone number:(____)_____________________________________________________________________  

 

IRS Employer Identification Number:_____________________________________________________________ 

 

Number of beneficiaries: _______________________________________________________________________ 

 

 

Names of beneficiaries and percentage of beneficial interest (excluding contingency interests) for each:

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

 

C.    Is the trust a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the 

Interests, whose purchase is directed by a person who has such knowledge and experience in financial and business 

matters that he is capable of evaluating the merits and risks of an investment in the Interests?

 

Yes_______        No_____________              

 

D.   Is the trustee of the trust that is making the investment decision to purchase the Interests a bank as defined in 

section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in section 

3(a)(5)(A) of the Securities Act?

 

Yes_________        No__________              

 

 

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E.    Is the trust an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, 

as amended?

 

 

           Yes__________       No____________              

F.   Is the trust an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, 

as amended, (i) whose investment decision to purchase the Interests is made by a plan fiduciary, as defined in section 

3(21) of the Securities Act, which is either a bank, savings and loan association, insurance company or registered

investment adviser, (ii) which has total assets in excess of $5,000,000, or (iii) which is a self-directed plan whose investment 

decisions are made solely by persons that are accredited investors as defined in Rule 501 (a) promulgated under the 

Securities Act?

 

Yes________         No______________              

 

G.   Is the trust a plan established and maintained by a state, its political subdivisions, or any agency or instrumentality 

of a state or its political subdivisions, for the benefit of its employees, with total assets in excess of $5,000,000?

 

Yes__________         No______________              

 

H.  If the answers to questions C, D, E, F, and G of this Section 3 are "No", please answer the following questions (and if 

the answer to any of questions C, D, E, F, and G is "Yes", please skip this question and proceed to Section 4):

 

(i)     Is the trust a revocable grantor trust that may be amended or revoked at any time by the grantors?

 

Yes__________      No___________________              

 

(ii)    If the answer to subsection (i) is "yes", who are the grantors?

 

_______________________________________________________________________________

 

_______________________________________________________________________________

 

 

If the answer to subsection (i) is "Yes" (and if the answers to questions C, D, E, F, and G  are "No"), Section 1 of this 

Questionnaire should be completed by each grantor with  information about himself.

 

 

11

 

 

 

4.     INVESTMENT EXPERIENCE (TO BE COMPLETED BY ALL INVESTORS)

 

A. Does the investor have such knowledge of business, finance, securities and investments generally, and such experience 

(based on actual participation) in investments in particular, that he or it is capable of evaluating the risks and merits of 

the investment, and believes he or it can afford the complete loss of his or its investment in the Interests?

 

Yes___________           No______________              

 

B. Please indicate whether the investor has made the following types of investments in the past five years:

 

Stocks_____________________________________________________________________________

 

Limited partnerships__________________________________________________________________ 

 

Bonds_____________________________________________________________________________

 

Non-marketable securities______________________________________________________________

 

Other experience:_____________________________________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

                                                                                                                     

C. Does the amount of the investor's proposed investment in the interests exceed 10% of his or its net worth?

 

Yes________     No____________

 

 

 

12

 

 

 

THE UNDERSIGNED UNDERSTANDS THAT THE COMPANY AND ITS AFFILIATES AND ADVISORS WILL BE RELYING ON THE ACCURACY AND  COMPLETENESS OF THE RESPONSES TO THE FOREGOING QUESTIONS.
THE  COMPANY WILL KEEP SUCH RESPONSES IN CONFIDENCE, EXCEPT THAT THIS QUESTIONNAIRE MAY BE FURNISHED TO SUCH PARTIES AS THE COMPANY  DEEMS DESIRABLE TO ESTABLISH COMPLIANCE WITH FEDERAL AND STATE  SECURITIES
LAWS. THE ABOVE INFORMATION IS ACCURATE AND  COMPLETE IN ALL RESPECTS, AND THE UNDERSIGNED WILL NOTIFY THE  COMPANY PROMPTLY OF ANY CHANGES THAT OCCUR PRIOR TO THE PURCHASE OF THE INTERESTS.

 

Name of Investor:_______________________________________________________

 

Signature: __x___________________________________________________

 

Printed Name:___________________________________________________________

 

Title (if applicable):_______________________________________________________

 

Date:___________________________________________________________________

 

 

13

 

 

 

 

 

 

 

 

PART II. SUBSCRIPTION AGREEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

OXYSURE SYSTEMS, INC

OxySure Systems, Inc. 

10880 John W. Elliott Road, 

Suite 600

Frisco, Texas 75034 USA 

ATTN: Mr. Julian Ross

 

972-294-6555 FAX 972-294-6450 (fax)

 

SUBSCRIPTION AGREEMENT

 

This Subscription Agreement (this "Agreement"), dated as of__________________is entered into by and between Oxysure Systems, Inc., formerly Stationmate, Inc., a Wyoming corporation (the

"Company"), and,_____________the undersigned investor (the "Investor").

 

RECITALS

A.           Investor desires to purchase_______________shares (the "Shares") of the common stock, par value $0.001 per share (the "Common Stock"), of the Company for an aggregate purchase price

               of_____________________                      .

 

B.           The parties hereto desire to enter this Agreement to provide for the purchase by the Investor of the Shares on the terms set forth herein and to govern the parties' respective rights and obligations
with  

               respect thereto.

 

Accordingly, the parties agree as follows:

 

ARTICLE I

PURCHASE AND SALE OF COMMON STOCK

 

1.1     Purchase and Sale.

 

(a)           Subject to the terms and conditions set forth herein, the Company shall issue and sell and the Investor shall purchase the Shares. The purchase price (the "Purchase Price") for the Shares
shall 

  be___________per Share, for an aggregate Purchase Price of                                                                                  .

 

(b)          The Company shall deliver to the Investor one or more stock certificates representing the Shares registered in
the names and in the amounts as specified by the Investor, and the Investor shall 

 deliver an amount equal to the Purchase Price. Company
hereby acknowledges receipt of the Purchase Price on_________ 

 

(c)          The Investor agrees to deliver to the Company from time to time such documents and certificates as may be reasonably requested by the Company to comply with the applicable securities
laws 

 and all applicable rules and regulations.

ARTICLE II

 

INVESTOR REPRESENTATIONS AND WARRANTIES

 

 

 

15

 

 

2.1 Representations and Warranties. The Investor hereby represents and warrants to the Company as of the date hereof:

 

(a) Authority. The Investor has the requisite power and authority to enter into and to consummate the transactions contemplated hereby and otherwise
to carry out his obligations hereunder. This Agreement has been duly executed and delivered by the Investor and constitutes the valid and legally binding obligation of the Investor, enforceable against him in accordance with its terms, except as such enforceability may be limited by applicable bankruptcy, insolvency, reorganization, moratorium or similar laws relating to, or affecting generally the enforcement of, creditors rights and remedies or by other general principles of equity.

 

(b) No Solicitation. The offering of the Shares in the Company to the Investor was made only through direct, personal communication between the Investor
and a duly authorized representative of the Company and not through public solicitation or advertising.

 

(c) Investment Intent. The Investor is acquiring the Shares for his or its own account for investment purposes only and not with a view to or for distributing
or reselling such Shares or any part thereof or interest therein and the Investor does not presently have any reason to anticipate any change in circumstances or other particular occasion or event which would cause him or it to sell such Shares, without prejudice, however, to the Investor's right, subject to the provisions of this Agreement, at all times to sell or otherwise dispose of all or any part of such Shares pursuant to an effective registration statement under the Securities Act of 1933, as amended (the
"Securities Act"), or pursuant to an available exemption from the registration requirements thereunder and in compliance with applicable state securities laws; provided, however, that the Investor acknowledges that the Company has no obligation to register the Shares under the Securities Act or any other securities laws.

 

(d) Investor Status. The Investor hereby acknowledges that the acquisition of the Shares pursuant to this Agreement is suitable only for sophisticated
investors.

 

(e) Investment Company. The Investor is not, and following issuance of the Shares will not be, nor is the Investor an affiliate of an "Investment company'
within the meaning of the Investment Company Act of 1940, as amended, nor was Investor formed, reformed, or reorganized for the specific purpose of purchasing the Shares.

 

(f) Experience of Investor. The Investor, either alone or together with the Investor's representatives, has such knowledge, sophistication and experience
in business, investment and financial matters, and has such knowledge, sophistication and experience in evaluating and investing in common stocks and other securities based on actual participation in business, investment and financial matters, so as to be capable of evaluating the merits and risks of an investment in the Shares to be acquired by the Investor hereunder, and has so evaluated the merits and risks of such investment.

 

(g) Ability of Investor to Bear Risk of Investment. The Investor is able to bear the economic risk of an investment in the Shares to be acquired hereunder
and, at the present time, is able to afford a complete loss of such investment. The Investor is aware that the Company is a start up company and that no guarantees have been or can be made by the Company or any of its representatives respecting the future value, if any, of the Shares or the profitability or success of the business of the Company and no assurances are or have been made concerning the dividend or distribution by the Company of cash to its shareholders. 

 

 

16

 

 

(h) Access to Information. The Investor acknowledges that he has been afforded (i) the opportunity to ask such questions as the Investor has deemed necessary of, and to receive answers from, representatives of the Company concerning the terms and conditions of the Shares
offered hereunder and the merits and risks of investing in such Shares; (ii) access to relevant information about the Company and the Company's operations, management and business prospects sufficient to enable him to evaluate an investment in such Shares; and (iii) the opportunity to obtain such additional information which the Company possesses or can acquire without unreasonable effort or expense that is necessary to make an informed investment decision with respect to the investment.

 

(i) Reliance. The Investor understands and acknowledges that (i) the Shares being offered and sold to Investor hereunder are being offered and sold without registration under the Securities Act in a private placement that is exempt from the registration provisions of
the Securities Act under Section 4(2) of the Securities Act and (ii) the availability of such exemption depends in part on, and that the Company will rely upon the accuracy and truthfulness of, the foregoing representations and the Investor hereby consents to such reliance.

 

(j) Certain Fees. Except as provided herein, no fees or commissions will be payable by the Investor to any broker, financial advisor, finder, investment banker, or bank with respect to the transactions contemplated by this Agreement. The Company acknowledges and agrees
that the Investor makes no representations or warranties with respect to the transactions contemplated hereby other than those specifically set forth in this Section 2.l.

 

2.2              Survival. All representations, warranties and covenants contained herein shall survive the execution
and delivery of this Agreement indefinitely.

 

2.3              Transfer Restrictions.

 

(a) If the Investor should decide to dispose of any Shares to be acquired hereunder, the Investor understands and agrees that he may do so only (i) pursuant to an effective registration
statement under the Securities Act, (ii) to the Company or (iii) pursuant to an available exemption or exclusion from the registration requirements of the Securities Act. In connection with any transfer of any Shares other than pursuant (i) to an effective registration statement, (ii) to the Company, (iii) to an affiliate of the Investor which is an "accredited investor" within the meaning of Rule 501(a) under the Securities Act, provided that any such transferee shall agree to be bound by the terms of this Agreement,
and (iv) in reliance on Rule 144 under the Securities Act, the Company may require that the transferor provide to the Company an opinion in form and substance reasonably satisfactory to the Company of counsel experienced in the area of United States securities laws selected by the transferor to the effect that such transfer does not require registration of such Shares under the Securities Act.

 

(b) The Investor agrees to the imprinting, so long as appropriate, of the following legend on certificates representing the Shares:

 

"THESE SHARES HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE

 

 

17

 

 

    IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER REGULATION D PROMULGATED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION OR EXCLUSION FROM THE REGISTRATION REQUIREMENTS THEREUNDER
AND IN COMPLIANCE WITH APPLICABLE STATE SECURITIES LAWS. THESE SHARES ARE SUBJECT TO CERTAIN RESTRICTIONS ON TRANSFER SET FORTH IN A SUBSCRIPTION AGREEMENT BETWEEN THE COMPANY AND THE ORIGINAL HOLDER HEREOF. A COPY OF SUCH AGREEMENT IS ON FILE AT THE PRINCIPAL OFFICE OF THE COMPANY."

 

The legend set forth above shall be removed in connection with any resale of Shares pursuant to an effective registration statement under the Securities Act or sooner if, in the opinion of counsel to the Company and the Investor experienced in the area of United States securities laws, such legend is no longer required under applicable
requirements of the Securities Act (including judicial interpretation and pronouncements issued by the staff of the Securities and Exchange Commission). The certificates representing the Shares shall also bear any other legends required by applicable federal or state securities laws, which legends shall be removed when, in the opinion of counsel to the Company, such legends are no longer required under the applicable requirements of such securities laws. In connection therewith, the Company may request, and the
Investor or other transferor shall provide, such information as the Company or its counsel may reasonably request to evaluate the propriety of removing any legends. The Company makes no representation, warranty or agreement as to the availability of any exemption from registration under the Securities Act with respect to any resale of Shares. The Investor agrees that the Company shall be entitled to make a notation on its records and give instructions to any transfer agent of the Company in order to implement
the restrictions on transfer set forth in this Section 2.3.

ARTICLE III MISCELLANEOUS

 

    3.1 Entire Agreement.     This Agreement embodies the entire  agreement
and understandingbetween the Investor and the Company and supersedes all prior agreements and understandings relating to the subject matter hereof.

 

    3.2 Waiver and Amendment. This Agreement may be amended, and the observance of any term hereof
may be waived (either retroactively or prospectively), with and only with the written consent of the Company and the Investor. No amendment or waiver consented to as provided herein will extend to or affect any obligation, covenant, or agreement not expressly amended or waived or impair any right, power or remedy consequent thereon.

    3.3 Notices, All notices and other communications provided for hereunder shall be in writing and delivered by teleoopier or (if expressly permitted under the applicable provisions hereof by telephone,
if the sender on the same day sends a confirming copy of such notice by a recognized overnight delivery service (charges prepaid), by registered or certified Mail with return receipt 

 

 

18

 

 

requested (postage prepaid) or by a recognized overnight delivery service (with charges prepaid). Any such notice must be sent:

 

(a)      If to Investor:

 

__________________________

 

__________________________

 

__________________________

 

 

(b)     If to the Company:

 

OxySure Systems, Inc. 

10880 John W. Elliott Road

Suite 600

Frisco, Texas 75034 USA

ATTN: Mr. Julian Ross

 

(c) If any notice required under this Agreement is permitted to be made, and is made, by telephone, actions taken or omitted to be taken in reliance thereon by the Investor shall be binding upon the Company notwithstanding any inconsistency between the notice provided by telephone and any subsequent writing in confirmation thereof provided
to the Investor; provided that any such action taken or omitted to be taken by the Investor shall have been in good faith and in accordance with the terms of this Agreement.

 

3.4 Successors and Assigns. All covenants and other agreements contained in this Agreement by or on behalf of any of the parties hereto bind and inure to the benefit of
its or his successors and assigns, whether or not so expressed.

 

3.5 Severability. Any provision of this Agreement that is prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of
such prohibition or unenforceability without invalidating the remaining provisions hereof, and any such prohibition or unenforceability in any jurisdiction shall (to the full extent permitted by applicable law) not invalidate or render unenforceable such provision in any other jurisdiction.

 

3.6 Construction. Each covenant contained herein shall be construed (absent express provision to the contrary) as being independent of each other covenant contained herein,
so that compliance with any one covenant shall not (absent such an express contrary provision) be deemed to excuse compliance with any other covenant. Where any provision herein refers to action to be taken by any person, or which such person is prohibited from taking, such provision shall be applicable whether such action is taken directly or indirectly by such person.

 

3.7 Execution in Counterparts. This Agreement may be executed in any number of counterparts and by different parties hereto in separate counterparts, each of which when
so executed shall be deemed to be an original and all of which taken together shall constitute one and the same agreement. Delivery of an executed counterpart of a signature page to this Agreement by telecopier shall be effective as delivery of a manually executed counterpart of this Agreement.

 

 

19

 

 

 

 

3.8 Governing Law. This Agreement shall be governed by and construed in accordance with the law of the State of Texas.

(THE NEXT PAGE IS THE SIGNATURE PAGE)

 

 

 

 

 

 

 

 

 

20

 

 

 

 

IN WITNESS WHEREOF, Subscriber has hereby executed this Subscription Agreement as of the date set forth below.

 

:

________________________________________                                                                
Subscriber's Address

Name of Subscriber

                                                                                                                                                             
______________________________________

                                             

                                                                                                                                                             
______________________________________

 

                                                                                                                                                             
______________________________________

_______________________________                                                                                     
 ___________________________________

Name and Title of Person who has                                                                                                  Signature
of Subscriber or Person who has filled

filled out this Subscription Agreement                                                                                          
out this Subscription Agreement on its behalf 

on behalf of Subscriber

__________________________________                                                                                
_________________________________________

Subscriber's Social Security                                                                                                              
 Date

or Tax ID No.

___________________________________

Aggregate Amount to be paid for Interests

 

The foregoing subscription is hereby accepted, subject to the terms and conditions hereof, as of

 

the_______________day of ____________________2009.

 

OXYSURE SYSTEMS, INC.

 

By:________________________________

     Julian Ross, Chairman & CEO

 

 

21

 

 

 

 

 

 

 

 

 

 

PART III.

SHAREHOLDER SIGNATURE PAGE TO THE BYLAWS OF OXYSURE SYSTEMS, INC.

 

 

 

 

 

 

 

 

 

 

 

22

 

 

SHAREHOLDER SIGNATURE PAGE

 

IN WITNESS WHEREOF, the undersigned Shareholder has approved and adopted, and is bound by, these Bylaws as of the date first set forth above.

 

Name of Shareholder:__________________________________________________________________________________________________

 

Signature for Shareholder:_______________________________________________________________________________________________

 

Title of  Signing Representative (if applicable):________________________________________________________________________________

 

Date of Signature:______________________________________________________________________________________________________

 

 

23Unassociated Document

OxySure Systems, Inc.

 

VOTING STOCK OPTION PLAN

VOTING STOCK OPTION AGREEMENT

THIS AGREEMENT (the “Agreement”) is made and entered into by and between OxySure Systems, Inc. (the “Company”) and_______(the “Optionee”) in connection with the grant of an Option under the OxySure Systems, Inc. Voting Stock Option Plan (the “Plan”).
The Agreement is made and entered into as of____________(the “Effective Date”).

W I T N E S S E T H:

WHEREAS, the Optionee is employed by the Company or one of its affiliates in a key position;

WHEREAS, the Company desires to encourage Optionee to own an equity interest in the Company and to give him added incentive to advance the interests of the Company through the Plan;

WHEREAS, the Company desires to grant the Optionee an Option to purchase voting shares of common stock in the Company, under terms and conditions established by the Administrator appointed by the Board of Directors; and

WHEREAS, notwithstanding any registration of the Company's stock or the availability of any exemption, all stock issued to Optionee shall not be resold until the expiration of twelve (12) months following the time at which the Company's stock becomes publicly traded in a recognized market.

NOW, THEREFORE, in consideration of these premises, the parties agree that the following shall constitute the Agreement between the Company and the Optionee:

 

 

 

	 1.  	 	
Definitions.  For purposes of this Agreement, defined terms shall have the meanings given to them by the Plan except as “Agreement”, which means this document as executed by the Company and the Optionee, and as it may be subsequently amended.

 

	 2.  	 	
Grant of Option.  Subject to the terms and conditions set forth in this Agreement, the Company grants to the Optionee an Option to purchase from the Company during the period ending five years from the Effective Date of this Agreement,_________Shares (“Shares”) at a price of $_____________per Share, subject to adjustment, if any, as provided in this Agreement and the Plan.  This Option is not an incentive stock option
within the meaning of Code section 422.

 

	 3.  	 	
The Option shall become vested and exercisable according to the following schedule:

 

	 	 (a)	
_____________of the Shares subject to the Option on or after the date which is one (1) year from the date the Option is granted, but only if Optionee is then an employee of the Company;

 

	 	 (b)	
_____________of the Shares subject to the Option on or after the date which is two (2) years from the date the Option is granted, but only if the Optionee is then an employee of the Company;

 

	 	 (c)	
 _____________of the Shares subject to the Option on or after the date which is three (3) years from the date the Option is granted, but only if the Optionee is then an employee of the Company;

 

	 	 (d)	_____________of the Shares subject to the Option on or after the date which is four (4) years from the date the Option is granted, but only if the Optionee is then an employee of the Company; and

 

 

 

1

 

 

 

 

	 	(e)	
_____________of the Shares subject to the Option on or after the date which is five (5) years from the date the Option is granted, but only if the Optionee is then an employee of the Company.

 

Notwithstanding the above, if the Optionee is an Eligible Individual on the date that a Change in Control occurs, all Options shall become fully vested and exercisable according to the schedule set forth above, and if the Optionee ceases to be an Eligible Individual by reason of death, any Options held by the Optionee shall become fully vested and immediately exercisable on the date such
Optionee ceases to be an Eligible Individual.

 

	 3. 	
Exercise Rights.  The Option granted pursuant to Paragraph 2 may be exercised during its term in full or in part, to the extent vested, as to any number of whole Shares (but no fractional shares), subject to the provisions of the Plan and of the following provisions.

 

Exercise of an Option shall not be effective until the Administrator has received written notice of exercise.  Such notice must specify the number of whole Shares to be purchased and be accompanied by payment in full of the aggregate exercise price of the number of Shares purchased. The Company shall not in any case be required
to sell, issue, or deliver a fractional share with respect to any Option.

 

Nothing in the Plan or in this Agreement shall be deemed to require the Company to issue any Shares upon exercise of any Option if such issuance would, in the opinion of counsel for the Company, constitute a violation of the Securities Act, as amended, or any other applicable statute or regulation, as then in effect.  At the time
of any exercise of an Option, the Company may, as a condition precedent to the exercise of such Option, require from the Optionee (or in the event of his death, his legal representatives, heirs, legatees, or distributees) such written representations, if any, concerning his intentions with regard to the retention or disposition of the shares being acquired by exercise of such Option and such written covenants and agreements, if any, as to the manner of disposal of such shares as, in the opinion of counsel to
the Company, may be necessary to ensure that any disposition by such Optionee (or in the event of his death, his legal representatives, heirs, legatees, or distributees), will not involve a violation of the Securities Act or any other applicable state or federal statute or regulation, as then in effect.

 

	 4. 	
Notice of Exercise.  This Option may be exercised in accordance with Paragraphs 2 and 3, by written notice to the Administrator at the address provided in this Agreement, which notice shall:

 

	 	a) 	
specify the number of Shares to be purchased and the exercise price to be paid for such Shares;

 

	 	b)	
if the person exercising this Option is not the Optionee himself, contain or be accompanied by evidence satisfactory to the Administrator of such person’s right to exercise this Option;

 

	 	c)  	
be accompanied by payment in full of the purchase price in the form of cash, a certified or cashier’s check to the order of the Company, or a wire transfer of immediately available funds;

 

	 	d)	
be accompanied by the amount that the Company deems necessary to satisfy the Company’s obligation to withhold federal, state, or local income or other taxes incurred by reason of the exercise.  Such amount shall be paid in cash; and

 

	 	e)  	
Include the Exercise of Stock Option Agreement.

 

	 5. 	Investment Restriction.  The Optionee agrees that the Shares acquired on exercise of this Option shall be acquired for his own account for investment only and not with a view to, or for resale in connection with, any distribution or public offering thereof within the meaning of the Securities Act or other applicable securities laws.  If the Administrator so determines, any certificate of Common Stockholders
issued upon exercise of this Option shall bear a legend (set forth in the Plan) to the effect that the Shares have been so acquired.  The Company may, but in no event shall be required to, bear any expenses of complying with the Securities Act, other applicable securities laws, or the rules and regulations of any national securities exchange or other regulatory authority in connection with the registration, 

 

             

 

2

 

 

 

	 	 	qualification, or transfer, as the case may be, of this Option or any Shares acquired upon the exercise thereof.  The foregoing restrictions on the transfer of the Shares shall be inoperative if:  (a) the Company previously shall have been furnished with an opinion of counsel, satisfactory to the Company, to the effect that such transfer will not require registration under the Securities Act or other applicable securities
laws; or (b) the Shares shall have been duly registered in compliance with the Securities Act and other applicable securities laws.

	6.  	
Right of First Refusal - Subsequent Transfer.  The Optionee agrees that the Shares acquired on exercise of this Option will be subject to the right of first refusal described in this Paragraph for the period beginning on the date that the Option is exercised and ending on the date which is twelve (12) months after the date the Optionee ceases to be an Eligible Individual.  Prior to any subsequent transfer, the Shares must first
be offered by written notice to the Company.  This notice of proposed transfer shall state the number of Shares to be transferred, the name of the proposed transferee, the consideration for the proposed transfer, and the terms and conditions of the proposed transfer.  The Optionee shall also submit with the notice copies of all papers and other documents to be used in connection with the proposed transfer.  Any deviation from the terms outlined in the notice, however slight, shall
require a new notice thereby effecting a new option for the Company under this Paragraph.  The Company must exercise its option to purchase, as to all or a portion of the Shares offered, within fourteen (14) days of receipt of the notice of proposed transfer.  The Company’s option shall be exercised by means of written notice of exercise to the Optionee within the period designated below.

 

If the option is not exercised in full by the Company within fourteen (14) days after the notice of proposed transfer, the unexercised part of the option shall lapse, and then the proposed transfer must be completed within ninety (90) days following the end of the period for exercise, but only upon the same terms and at a price which is no less than that set forth in the
notice of proposed transfer.  Any such permitted transfer, however, shall be conditioned upon the proposed transferee executing such documents as the Administrator may reasonably request which evidences the transferee’s agreement to abide by the terms and provisions of both Paragraph 5 and this Paragraph concerning the Shares, or any interest therein proposed to be acquired, and to agree to any legends and to any restrictions on transferability as the Administrator may reasonably require to ensure
compliance with federal and state securities laws and other applicable laws and regulations.

 

In accepting an offer to purchase, the Company agrees to complete the purchase pursuant to the terms of the notice of proposed transfer and at the greater of the Fair Market Value of the Shares on the date the Company provides notice of exercise to the Optionee or the price specified in the notice of proposed transfer.  The terms of the payment of the purchase price shall in no
event be less favorable than the terms of an independent third party offer.

 

	7. 	
 Sale after IPO.  Notwithstanding any other provision of this Agreement, in the event that the Company completes an initial public offering of its shares resulting in the trading of its shares in a recognized market, the shares shall not be sold for a period of 12 months thereafter.

 

	8. 	
Transferability and Exercise Restrictions.  This Option shall not be transferable except by will or by the laws of descent and distribution.  During the Optionee’s lifetime this Option may be exercised only by him.  No assignment or transfer of this Option, whether voluntary or involuntary, by operation of law or otherwise, except a transfer by will or by the laws of descent or distribution, shall vest in the
assignee or transferee any interest or right whatsoever in this Option.

 

	9.  	Status of Optionee.  The Optionee shall have no right as a Shareholder with respect to any Shares covered by this Option until a certificate representing such shares is issued to him. No adjustment shall be made for dividends (ordinary or extraordinary, whether in cash or other property), distributions, or other rights for which the record date is prior to the date such certificate is issued, except as provided in
Paragraph 6.5 of the Plan
	 	 	 

 

 

3

 

 

 

	10.	
No Effect on Capital Structure.  This Option shall not affect the right of the Company or any Affiliate to reclassify, recapitalize, or otherwise change its capital or debt structure or to merge, consolidate, convey any or all of its assets, dissolve, liquidate, wind up, or otherwise reorganize.

 

	11.  	
Termination of Option.  If an Optionee ceases to be an Eligible Individual, the Option shall terminate ninety (90) days after such Optionee ceases to be an Eligible Individual. Notwithstanding the foregoing, if an Optionee ceases to be an Eligible Individual by reason of Disability, the Optionee shall have the right for six (6) months after the date of Disability to exercise an Option to the extent such Option is exercisable on the date
of his Disability, and if an Optionee ceases to be an Eligible Individual by reason of death, Optionee’s designated beneficiary shall have the right for six (6) months after the date of death to exercise the Option, to the extent such Option is exercisable on the date of death.  At the end of such ninety (90) day or six (6) month period, as applicable, the Option shall terminate and cease to be exercisable.  Each Optionee shall have the right to designate a beneficiary on the form provided
by the Administrator.  If no beneficiary is designated, the Optionee’s estate shall have the rights of a beneficiary. This Option is not exercisable after the expiration of five (5) years from the date it is granted.

 

	12. 	
Adjustments Upon Changes in Capitalization, Merger, Etc.  Notwithstanding any other provision of this Agreement, in the event of any change in the number of outstanding Shares that is (a) effected without receipt of consideration by the Company, by reason of a common stockholders dividend, split, combination, exchange of shares or other ownership interests, merger, or other recapitalization, in which the Company is the surviving entity,
or (b) by reason of a spin-off of a part of the Company into a separate entity, or assumptions and conversions of outstanding grants due to an acquisition by the Company of a separate entity, the aggregate number and class of the reserved Shares, the number and class of Shares subject to each outstanding Option, and the exercise price of each outstanding Option shall be automatically adjusted to accurately and equitably reflect the effect of such change. In the event of a dispute concerning such adjustment, the
Administrator has full discretion to determine the resolution of the dispute.  Such determination shall be final, binding, and conclusive.  The number of reserved Shares or the number of Shares subject to any outstanding Option shall be automatically reduced to the extent necessary to eliminate any fractional Shares

 

	13.  	
Administrator Authority.  Any question concerning the interpretation of this Agreement, any adjustments required to be made under this Agreement, and any controversy which may arise under this Agreement shall be determined by the Administrator in its sole discretion.

 

	14. 	
Plan Controls.  The terms of this Agreement are governed by the terms of the Plan, a copy of which has been provided to Optionee and is made a part of this Agreement as if fully set forth in this Agreement, and in the case of any inconsistency between the terms of this Agreement and the terms of the Plan, the terms of the Plan shall control.

 

	15. 	Notice.  Whenever any notice is required or permitted under this Agreement, such notice must be in writing and delivered (personally or by courier), telecopied (if confirmed) or sent by mail.  Any notice required or permitted to be delivered under this Agreement shall be deemed to be delivered on the date which it is personally delivered, or, whether actually received or not, on the third business day after it is deposited
in the United States mail, certified or registered, postage prepaid, addressed to the person who is to receive it at the address which such person has previously specified by written notice delivered in accordance with this Agreement. The Company or Optionee may change, at any time and from time to time, by written notice to the other, the address previously specified for receiving notices.  It is the Optionee’s responsibility to provide a current address to the Administrator.  Failure
to do so will forfeit Optionee’s right to any notices otherwise required.  Until changed in accordance with this Agreement, the Company and the Optionee specify their respective addresses as set forth below:
	 	 

 

 

Administrator:        Common Stockholders Option Administrator

 

c/o OxySure Systems, Inc.

Attention:  Julian Ross

10880 John W. Elliott Road

Suite 600

Frisco, Texas  75034

 

4

 

 

 

	Company: 	OxySure Systems, Inc

Attention:  Julian Ross

10880 John W. Elliott Road

Suite 600

Frisco, Texas  75034

 

                                                                                                         
Optionee:                           __________________

 

  __________________

 

  __________________ 

 

 

	16.	
Information Confidential.  AS PARTIAL CONSIDERATION FOR THE GRANTING OF THIS OPTION, THE OPTIONEE AGREES THAT HE WILL KEEP CONFIDENTIAL ALL INFORMATION AND KNOWLEDGE THAT HE HAS RELATING TO THE MANNER AND AMOUNT OF HIS OR ANY OTHER PERSON’S PARTICIPATION IN THE PLAN OR CAPITAL STRUCTURE OF THE COMPANY; PROVIDED, THAT SUCH INFORMATION MAY BE DISCLOSED AS REQUIRED BY LAW AND MAY BE GIVEN IN CONFIDENCE TO THE OPTIONEE’S SPOUSE,
TAX AND FINANCIAL ADVISORS, OR TO A FINANCIAL INSTITUTION TO THE EXTENT THAT SUCH INFORMATION IS NECESSARY TO SECURE A LOAN. THE COMPANY MAY SEEK DAMAGES, INCLUDING FORFEITURE OF THIS OPTION, FOR ANY BREACH OF THE FOREGOING CONFIDENTIALITY REQUIREMENT.

 

	17.  	
Governing Law.  Except as is otherwise provided in Paragraph 10.17 of the Plan, the provisions of this Agreement shall be governed by the contract law of the State of Texas.

 

	18.  	
Acknowledgments.  In connection with this Agreement and issuance of any Shares, and a certificate therefore, pursuant to the Option,  Optionee acknowledges as follows:

 

	 	A. 	
THE OPTIONS AND THE SHARES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), OR THE SECURITIES LAWS OF ANY STATE AND ARE BEING OFFERED AND SOLD IN RELIANCE ON EXEMPTIONS FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND SUCH LAWS.  THE OPTIONS AND THE SHARES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE COMMISSION OR ANY STATE SECURITIES OR OTHER REGULATORY AUTHORITY,
NOR HAVE ANY OF THE FOREGOING AUTHORITIES PASSED UPON OR ENDORSED THE MERITS OF THE OPTIONS OR THE ACCURACY OR ADEQUACY OF ANY INFORMATION ABOUT THE COMPANY, THE OPTIONS, THE SHARES OR THE PLAN, WHICH THE COMPANY IS MAKING AVAILABLE TO THE OPTIONEE.

 

	 	B. 	THE OPTIONS AND SHARES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY AND RESALE AND MAY NOT BE TRANSFERRED OR RESOLD EXCEPT AS PERMITTED UNDER THE PLAN, THE SECURITIES ACT OF 1933, AS AMENDED, AND THE APPLICABLE STATE SECURITIES LAWS, PURSUANT TO REGISTRATION OR EXEMPTION THEREFROM.  THE SHARES REPRESENTED BY THIS CERTIFICATE ARE SUBJECT TO RESTRICTIONS ON TRANSFER CONTAINED IN A VOTING STOCK OPTION AGREEMENT BETWEEN THE COMPANY
AND CERTAIN SHAREHOLDERS OF THE COMPANY.  A COPY OF THE VOTING STOCK OPTION AGREEMENT AND VOTING STOCK OPTION PLAN IS ON FILE WITH THE COMPANY AND WILL BE FURNISHED WITHOUT COST TO THE HOLDER HEREOF UPON WRITTEN REQUEST TO THE SECRETARY OF THE COMPANY.
	 	 	 

 

    

 

5

 

 

 

 

	 	C. 	
 THE EFFECTIVENESS OF ANY SALE OR OTHER TRANSFER OF THE SHARES WILL BE CONDITIONED UPON RECEIPT BY THE COMPANY OF AN OPINION OF COUNSEL, SATISFACTORY TO THE COMPANY AND ITS COUNSEL, THAT THE SALE OR TRANSFER MAY BE MADE WITHOUT REGISTRATION UNDER THE SECURITIES ACT AND ANY OTHER APPLICABLE STATE SECURITIES LAWS.  ANY PARTICIPANT WHO ACQUIRES SHARES WILL BE REQUIRED TO REPRESENT THAT HE OR SHE WILL NOT SELL OR OTHERWISE DISPOSE OF
THAT COMMON STOCK WITHOUT REGISTRATION OR OTHER COMPLIANCE WITH THE AFORESAID STATUTES AND THE RULES AND REGULATIONS PROMULGATED UNDER THOSE STATES, INVESTORS SHOULD BE AWARE THAT THEY MAY BE REQUIRED TO BEAR THE FINANCIAL RISKS OF THIS INVESTMENT FOR AN INDEFINITE PERIOD OF TIME.

 

	 	D.	
At the request of an Optionee, the Company's most recent audited annual financial statement and other information regarding the Company will be provided to each Optionee for review, and, upon request of the Optionee, the Company's current Business Plan, if any, will be provided to each Optionee for review by the Optionee or the investment advisor(s) of the Optionee.  The Company encourages the Optionee to review these materials as often
as Optionee desires and to ask the executive officer of the Company in charge of monitoring the Plan any questions concerning the Company, the Plan, this Option or the Shares which Optionee may have.  In addition, upon the request of the Optionee, each Optionee shall be given access to information concerning the Company equivalent to that information generally made available to the Company's common shareholders.

 

	 	E.	
Optionee shall not have registration rights for the Shares purchased by Optionee pursuant to this Option.

 

	 	F.  	
The Optionee represents that the Optionee is familiar with the terms and provisions of this Voting Stock Option Agreement, including all restrictions on alienation and hereby accepts the Option subject to all of the terms and provisions thereof.  The Optionee hereby agrees to accept as binding, conclusive and final all decisions or interpretations of the Board or the Administrator, as the case may be, upon any questions arising under this
Agreement.

 

	 	G. 	
The undersigned, being the spouse of the above-named Optionee, does hereby acknowledge that the undersigned has read and is familiar with the provisions of the above Voting Stock Option Agreement, and the undersigned hereby agrees thereto and joins therein to the extent, if any, that the agreement and joinder of the undersigned may be necessary.

 

	 	H.  	
I have, either alone or together with my advisors, such knowledge and experience in financial and business and financial matters and in investments of this nature that I am capable of bearing the economic risks and evaluating the merits and risks of an investment in the Company and thereby making an informed investment decision and protecting my own interest therein.  I am not relying upon any other person in connection with evaluating
such merits and risks.

 

	 	I.  	
I have received or had access to all information and documents that I consider necessary or advisable to enable me to make an informed decision concerning the Shares and I have had an opportunity to ask questions of and receive answers from the Company or its designated representative concerning the terms and conditions of this investment; and all such questions, if any, have been answered to my full satisfaction.

 

	 	J. 	
I am familiar with the Company's business and I believe that the Shares are the type of investment that I wish to hold for investment and that the nature and amount of the investment is consistent with my investment program.  I am aware that the purchase of the Shares and operation of the Company involves a high degree of risk, and that there is, and will be, no public market for the Shares.

 

	 	K.  	I have relied on my own tax, investment, and legal advisors with respect to the considerations of purchasing the Shares.

 

 

6

 

 

 

 

 

 

	 	L. 	
It is my present sole intention to purchase, receive and hold the Shares as my private investment for my own account only and I am unaware of any occurrence, event or circumstance upon the happening of which I intend to transfer, divide, sell or otherwise distribute the Shares.

 

	 	M. 	
I agree that a restrictive legend may be placed on the certificate representing the Shares, and that transfer of the Shares may be refused by the Company, or its transfer agent if in the opinion of the Company's counsel any proposed sale or transfer of the Shares by me would not be in compliance with the applicable federal, state or other securities laws.

 

	 	N.  	I agree not to take any action that would bring this sale within the registration requirements of federal, state or other securities laws, and I agree to indemnify and hold the Company and its officers and directors harmless against all loss, costs, liabilities and expenses arising out of or related to the resale or distribution of the Shares to me in violation of applicable federal, state or other securities laws.

 

 

 

 

 

7

 

SIGNATURES OF OPTIONEE(S)/PURCHASER(S)

Date:_________________________                                                                           __________________________________________

                                                __________________________________________

 

Date:_________________________                                                                          ___________________________________________

                                             Name: ______________________________________

 

                                             Address: ____________________________________

 

IN WITNESS WHEREOF, the Company and the Optionee have executed this Agreement this day of__________, 20_________

OxySure Systems, Inc.

 

By: ________________________________________          

Title: ________________________________________          

 

 

8

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