Document:

Exhibit 10.30

 

THIS WARRANT AND THE SHARES ISSUABLE HEREUNDER
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF
ANY STATE AND, EXCEPT AS SET FORTH IN SECTIONS 5.3 AND 5.4 BELOW, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS
AND UNTIL REGISTERED UNDER SAID ACT AND LAWS OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE COMPANY,
SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER IS EXEMPT FROM SUCH REGISTRATION.

 

WARRANT TO PURCHASE STOCK

 

	Company: 	PEREGRINE PHARMACEUTICALS, INC., a Delaware corporation
	Number of Shares: 	91,093
	Type/Series of Stock:	Common Stock
	Warrant Price: 	$2.47 per share
	Issue Date: 	August 30, 2012
	Expiration Date: 	August 30, 2018 See also Section 5.1(b).
	Credit Facility:	
        This Warrant to Purchase Stock (“Warrant”)
        is issued in connection with that certain Loan and Security Agreement of even date herewith among Oxford Finance LLC, as Lender
        and Collateral Agent, the Lenders from time to time party thereto, including MidCap Financial SBIC, LP and Silicon Valley Bank
        and the Company (as modified, amended and/or restated from time to time, the “Loan Agreement”).

         

 

THIS WARRANT CERTIFIES
THAT, for good and valuable consideration, MIDCAP FINANCIAL SBIC, LP (together with any successor or permitted assignee or transferee
of this Warrant or of any shares issued upon exercise hereof, “Holder”) is entitled to purchase the number of
fully paid and non-assessable shares (the “Shares”) of the above-stated Type/Series of Stock (the “Class”)
of the above-named company (the “Company”) at the above-stated Warrant Price, all as set forth above and as
adjusted pursuant to Section 2 of this Warrant, subject to the provisions and upon the terms and conditions set forth in this Warrant.

 

SECTION
1.            EXERCISE.

 

1.1            
Method of Exercise. Holder may at any time and from time to time exercise this Warrant, in whole or in part, by delivering
to the Company the original of this Warrant together with a duly executed Notice of Exercise in substantially the form attached
hereto as Appendix 1 and, unless Holder is exercising this Warrant pursuant to a cashless exercise set forth in Section 1.2, a
check, wire transfer of same-day funds (to an account designated by the Company), or other form of payment acceptable to the Company
for the aggregate Warrant Price for the Shares being purchased.

 

1.2            
Cashless Exercise. On any exercise of this Warrant, in lieu of payment of the aggregate Warrant Price in the manner as specified
in Section 1.1 above, but otherwise in accordance with the requirements of Section 1.1, Holder may elect to receive Shares equal
to the value of this Warrant, or portion hereof as to which this Warrant is being exercised. Thereupon, the Company shall issue
to the Holder such number of fully paid and non-assessable Shares as are computed using the following formula:

 

	X =     	Y(A-B)/A

 

where:

 

	X =     	the number of Shares to be issued to the Holder;

 

	Y =     	the number of Shares with respect to which this Warrant is being exercised (inclusive of the Shares surrendered to the Company
in payment of the aggregate Warrant Price);

 

    	1

    	 

    

 

	A =     	the Fair Market Value (as determined pursuant to Section 1.3 below) of one Share; and

 

	B =     	the Warrant Price.

 

1.3            
Fair Market Value. If the Company’s common stock is then traded or quoted on a nationally recognized securities exchange,
inter-dealer quotation system or over-the-counter market (a “Trading Market”), the fair market value of a Share
shall be the closing price or last sale price of a share of common stock reported for the Business Day immediately before the date
on which Holder delivers this Warrant together with its Notice of Exercise to the Company. If the Company’s common stock
is not traded in a Trading Market, the Board of Directors of the Company shall determine the fair market value of a Share in its
reasonable good faith judgment.

 

1.4            
Delivery of Certificate and New Warrant. Within a reasonable time after Holder exercises this Warrant in the manner set
forth in Section 1.1 or 1.2 above, the Company shall deliver to Holder a certificate representing the Shares issued to Holder upon
such exercise and, if this Warrant has not been fully exercised and has not expired, a new warrant of like tenor representing the
Shares not so acquired.

 

1.5            
Replacement of Warrant. On receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or
mutilation of this Warrant and, in the case of loss, theft or destruction, on delivery of an indemnity agreement reasonably satisfactory
in form, substance and amount to the Company or, in the case of mutilation, on surrender of this Warrant to the Company for cancellation,
the Company shall, within a reasonable time, execute and deliver to Holder, in lieu of this Warrant, a new warrant of like tenor
and amount.

 

1.6            
Treatment of Warrant Upon Acquisition of Company.

 

(a)             
Acquisition. For the purpose of this Warrant, “Acquisition” means any transaction or series of related
transactions involving: (i) the sale, lease, exclusive license, or other disposition of all or substantially all of the assets
of the Company (ii) any merger or consolidation of the Company into or with another person or entity (other than a merger or consolidation
effected exclusively to change the Company’s domicile), or any other corporate reorganization, in which the stockholders
of the Company in their capacity as such immediately prior to such merger, consolidation or reorganization, own less than a majority
of the Company’s (or the surviving or successor entity’s) outstanding voting power immediately after such merger, consolidation
or reorganization (or, if such Company stockholders beneficially own a majority of the outstanding voting power of the surviving
or successor entity as of immediately after such merger, consolidation or reorganization, such surviving or successor entity is
not the Company); or (iii) any sale or other transfer by the stockholders of the Company of shares representing at least a majority
of the Company’s then-total outstanding combined voting power.

 

(b)            
Treatment of Warrant at Acquisition. In the event of an Acquisition in which the consideration to be received by the Company’s
stockholders consists solely of cash, solely of Marketable Securities or a combination of cash and Marketable Securities (a “Cash/Public
Acquisition”), either (i) Holder shall exercise this Warrant pursuant to Section 1.1 and/or 1.2 and such exercise will
be deemed effective immediately prior to and contingent upon the consummation of such Acquisition or (ii) if Holder elects not
to exercise the Warrant, this Warrant will expire immediately prior to the consummation of such Acquisition.

 

(c)             
The Company shall provide Holder with written notice of its request relating to the Cash/Public Acquisition (together with such
reasonable information as Holder may reasonably require regarding the treatment of this Warrant in connection with such contemplated
Cash/Public Acquisition giving rise to such notice), which is to be delivered to Holder not less than seven (7) Business Days prior
to the closing of the proposed Cash/Public Acquisition. In the event the Company does not provide such notice, then if, immediately
prior to the Cash/Public Acquisition, the fair market value of one Share (or other security issuable upon the exercise hereof)
as determined in accordance with Section 1.3 above would be greater than the Warrant Price in effect on such date, then this Warrant
shall automatically be deemed on and as of such date to be exercised pursuant to Section 1.2 above as to all Shares (or such other
securities) for which it shall not previously have been exercised, and the Company shall promptly notify the Holder of the number
of Shares (or such other securities) issued upon such exercise to the Holder and Holder shall be deemed to have restated each of
the representations and warranties in Section 4 of the Warrant as the date thereof.

 

    	2

    	 

    

 

(d)            
Upon the closing of any Acquisition other than a Cash/Public Acquisition defined above, the acquiring, surviving or successor entity
shall assume the obligations of this Warrant, and this Warrant shall thereafter be exercisable for the same securities and/or other
property as would have been paid for the Shares issuable upon exercise of the unexercised portion of this Warrant as if such Shares
were outstanding on and as of the closing of such Acquisition, subject to further adjustment from time to time in accordance with
the provisions of this Warrant.

 

(e)             
As used in this Warrant, “Marketable Securities” means securities meeting all of the following requirements:
(i) the issuer thereof is then subject to the reporting requirements of Section 13 or Section 15(d) of the Securities Exchange
Act of 1934, as amended (the “Exchange Act”), and is then current in its filing of all required reports and
other information under the Act and the Exchange Act; (ii) the class and series of shares or other security of the issuer that
would be received by Holder in connection with the Acquisition were Holder to exercise this Warrant on or prior to the closing
thereof is then traded in Trading Market, and (iii) Holder would be able to publicly re-sell, within six (6) months following the
closing of such Acquisition, all of the issuer’s shares and/or other securities that would be received by Holder in such
Acquisition were Holder to exercise this Warrant in full on or prior to the closing of such Acquisition.

 

SECTION
2.            ADJUSTMENTS TO THE SHARES AND WARRANT PRICE.

 

2.1            
Stock Dividends, Splits, Etc. If the Company declares or pays a dividend or distribution on the outstanding shares of the
Class payable in common stock or other securities or property (other than cash), then upon exercise of this Warrant, for each Share
acquired, Holder shall receive, without additional cost to Holder, the total number and kind of securities and property which Holder
would have received had Holder owned the Shares of record as of the date the dividend or distribution occurred. If the Company
subdivides the outstanding shares of the Class by reclassification or otherwise into a greater number of shares, the number of
Shares purchasable hereunder shall be proportionately increased and the Warrant Price shall be proportionately decreased. If the
outstanding shares of the Class are combined or consolidated, by reclassification or otherwise, into a lesser number of shares,
the Warrant Price shall be proportionately increased and the number of Shares shall be proportionately decreased.

 

2.2            
Reclassification, Exchange, Combinations or Substitution. Upon any event whereby all of the outstanding shares of the Class
are reclassified, exchanged, combined, substituted, or replaced for, into, with or by Company securities of a different class and/or
series, then from and after the consummation of such event, this Warrant will be exercisable for the number, class and series of
Company securities that Holder would have received had the Shares been outstanding on and as of the consummation of such event,
and subject to further adjustment thereafter from time to time in accordance with the provisions of this Warrant. The provisions
of this Section 2.2 shall similarly apply to successive reclassifications, exchanges, combinations substitutions, replacements
or other similar events.

 

2.3            
No Fractional Share. No fractional Share shall be issuable upon exercise of this Warrant and the number of Shares to be
issued shall be rounded down to the nearest whole Share. If a fractional Share interest arises upon any exercise of the Warrant,
the Company shall eliminate such fractional Share interest by paying Holder in cash the amount computed by multiplying the fractional
interest by (i) the fair market value (as determined in accordance with Section 1.3 above) of a full Share, less (ii) the then-effective
Warrant Price.

 

2.4            
Notice/Certificate as to Adjustments. Upon each adjustment of the Warrant Price, Class and/or number of Shares, the Company,
at the Company’s expense, shall notify Holder in writing within a reasonable time setting forth the adjustments to the Warrant
Price, Class and/or number of Shares and facts upon which such adjustment is based. The Company shall, upon written request from
Holder, furnish Holder with a certificate of its Chief Financial Officer, including computations of such adjustment and the Warrant
Price, Class and number of Shares in effect upon the date of such adjustment.

 

SECTION
3.            REPRESENTATIONS AND COVENANTS OF THE COMPANY.

 

3.1            
Representations and Warranties. The Company represents and warrants to, and agrees with, the Holder as follows: All Shares
which may be issued upon the exercise of this Warrant, shall, upon issuance, be duly authorized, validly issued, fully paid and
non-assessable, and free of any liens and encumbrances except for restrictions on transfer provided for herein or under applicable
federal and state securities laws. The Company covenants that it shall at all times cause to be reserved and kept available out
of its authorized and unissued capital stock such number of shares of the Class, common stock and other securities as will be sufficient
to permit the exercise in full of this Warrant.

 

    	3

    	 

    

 

3.2            
Notice of Certain Events. If the Company proposes at any time to:

 

(a)             
declare any dividend or distribution upon the outstanding shares of the Class or common stock, whether in cash, property, stock,
or other securities and whether or not a regular cash dividend;

 

(b)            
offer for subscription or sale pro rata to the holders of the outstanding shares of the Class any additional shares of any class
or series of the Company’s stock (other than pursuant to contractual pre-emptive rights);

 

(c)             
effect any reclassification, exchange, combination, substitution, reorganization or recapitalization of the outstanding shares
of the Class; or

 

(d)            
effect an Acquisition or to liquidate, dissolve or wind up.

 

then, in connection with each such event,
the Company shall give Holder:

 

(1)            
at least seven (7) Business Days prior written notice of the date on which a record will be taken for such dividend, distribution,
or subscription rights (and specifying the date on which the holders of outstanding shares of the Class will be entitled thereto)
or for determining rights to vote, if any, in respect of the matters referred to in (a) and (b) above; and

 

(2)            
in the case of the matters referred to in (c) and (d) above at least seven (7) Business Days prior written notice of the date when
the same will take place (and specifying the date on which the holders of outstanding shares of the Class will be entitled to exchange
their shares for the securities or other property deliverable upon the occurrence of such event).

 

Reference is made to Section 1.6(c) whereby
this Warrant will be deemed to be exercised pursuant to Section 1.2 hereof if the Company does not give written notice to Holder
of a Cash/Public Acquisition as required by the terms hereof. Company will also provide information requested by Holder that is
reasonably necessary to enable Holder to comply with Holder’s accounting or reporting requirements.

 

SECTION
4.            REPRESENTATIONS, WARRANTIES OF THE HOLDER.

 

The Holder represents
and warrants to the Company as follows:

 

4.1            
Purchase for Own Account. This Warrant and the securities to be acquired upon exercise of this Warrant by Holder are being
acquired for investment for Holder’s account, not as a nominee or agent, and not with a view to the public resale or distribution
within the meaning of the Act. Holder also represents that it has not been formed for the specific purpose of acquiring this Warrant
or the Shares.

 

4.2            
Disclosure of Information. Holder is aware of the Company’s business affairs and financial condition and has received
or has had full access to all the information it considers necessary or appropriate to make an informed investment decision with
respect to the acquisition of this Warrant and its underlying securities. Holder further has had an opportunity to ask questions
and receive answers from the Company regarding the terms and conditions of the offering of this Warrant and its underlying securities
and to obtain additional information (to the extent the Company possessed such information or could acquire it without unreasonable
effort or expense) necessary to verify any information furnished to Holder or to which Holder has access.

 

    	4

    	 

    

 

4.3            
Investment Experience. Holder understands that the purchase of this Warrant and its underlying securities involves substantial
risk. Holder has experience as an investor in securities of companies in the development stage and acknowledges that Holder can
bear the economic risk of such Holder’s investment in this Warrant and its underlying securities and has such knowledge and
experience in financial or business matters that Holder is capable of evaluating the merits and risks of its investment in this
Warrant and its underlying securities and/or has a preexisting personal or business relationship with the Company and certain of
its officers, directors or controlling persons of a nature and duration that enables Holder to be aware of the character, business
acumen and financial circumstances of such persons.

 

4.4            
Accredited Investor Status. Holder is an “accredited investor” within the meaning of Regulation D promulgated
under the Act.

 

4.5            
The Act. Holder understands that this Warrant and the Shares issuable upon exercise hereof have not been registered under
the Act in reliance upon a specific exemption therefrom, which exemption depends upon, among other things, the bona fide nature
of the Holder’s investment intent as expressed herein. Holder understands that this Warrant and the Shares issued upon any
exercise hereof must be held indefinitely unless subsequently registered under the Act and qualified under applicable state securities
laws, or unless exemption from such registration and qualification are otherwise available. Holder is aware of the provisions of
Rule 144 promulgated under the Act.

 

4.6            
No Voting Rights. Holder, as a Holder of this Warrant, will not have any voting rights until the exercise of this Warrant.

 

SECTION
5.            MISCELLANEOUS.

 

5.1            
Term; Automatic Cashless Exercise Upon Expiration.

 

(a)             
Term. Subject to the provisions of Section 1.6 above, this Warrant is exercisable in whole or in part at any time and from
time to time on or before 6:00 PM, Eastern time, on the Expiration Date and shall be void thereafter.

 

(b)            
Automatic Cashless Exercise upon Expiration. In the event that, upon the Expiration Date, the fair market value of one Share
(or other security issuable upon the exercise hereof) as determined in accordance with Section 1.3 above is greater than the Warrant
Price in effect on such date, then this Warrant shall automatically be deemed on and as of such date to be exercised pursuant to
Section 1.2 above as to all Shares (or such other securities) for which it shall not previously have been exercised, and the Company
shall, within a reasonable time, deliver a certificate representing the Shares (or such other securities) issued upon such exercise
to Holder.

 

5.2            
Legends. Each certificate evidencing Shares shall be imprinted with a legend in substantially the following form:

 

THE SHARES EVIDENCED BY THIS CERTIFICATE
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF
ANY STATE AND, EXCEPT AS SET FORTH IN THAT CERTAIN WARRANT TO PURCHASE STOCK ISSUED BY THE ISSUER TO MIDCAP FINANCIAL SBIC, LP
DATED AUGUST 30, 2012, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS AND UNTIL REGISTERED UNDER SAID ACT AND
LAWS OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE ISSUER, SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER
IS EXEMPT FROM SUCH REGISTRATION.

 

    	5

    	 

    

 

5.3            
Compliance with Securities Laws on Transfer. This Warrant and the Shares issued upon exercise of this Warrant may not be
transferred or assigned in whole or in part except in compliance with applicable federal and state securities laws by the transferor
and the transferee (including, without limitation, the delivery of investment representation letters and legal opinions reasonably
satisfactory to the Company, as reasonably requested by the Company). The Company shall not require Holder to provide an opinion
of counsel if the transfer is to an affiliate of Holder, provided that any such transferee is an “accredited investor”
as defined in Regulation D promulgated under the Act. Additionally, the Company shall also not require an opinion of counsel if
there is no material question as to the availability of Rule 144 promulgated under the Act.

 

5.4           
Transfer
Procedure. After receipt by Holder of the executed Warrant, MidCap may transfer all or part of this Warrant to one or more
of MidCap’s affiliates (each, an “MidCap Affiliate”), by execution of an Assignment substantially in the
form of Appendix 2. Subject to the provisions of Article 5.3 and upon providing the Company with written notice, MidCap, any such
MidCap Affiliate and any subsequent Holder, may transfer all or part of this Warrant or the Shares issuable upon exercise of this
Warrant to any transferee, provided, however, in connection with any such transfer, the MidCap Affiliate(s) or any subsequent Holder
will give the Company notice of the portion of the Warrant being transferred with the name, address and taxpayer identification
number of the transferee and Holder will surrender this Warrant to the Company for reissuance to the transferee(s) (and Holder
if applicable).

 

5.5            
Notices. All notices and other communications hereunder from the Company to the Holder, or vice versa, shall be deemed delivered
and effective (i) when given personally, (ii) on the third (3rd) Business Day after being mailed by first-class registered or certified
mail, postage prepaid, (iii) upon actual receipt if given by facsimile or electronic mail and such receipt is confirmed in writing
by the recipient, or (iv) on the first Business Day following delivery to a reliable overnight courier service, courier fee prepaid,
in any case at such address as may have been furnished to the Company or Holder, as the case may be, in writing by the Company
or such Holder from time to time in accordance with the provisions of this Section 5.5. All notices to Holder shall be addressed
as follows until the Company receives notice of a change of address in connection with a transfer or otherwise:

 

MIDCAP FINANCIAL SBIC, LP

7255 Woodmont Avenue, Suite 200

Bethesda, Maryland 20814

Attn: Portfolio Management- Life Sciences

Fax: (301) 941-1450

Email: lviera@midcapfinancial.com

 

Notice to the Company
shall be addressed as follows until Holder receives notice of a change in address:

 

PEREGRINE PHARMACEUTICALS, INC.

14282 Franklin Avenue

Tustin, California 92780

Attn: Mark R. Ziebell, Vice President, General Counsel

Telephone: (714) 508-6080

Facsimile: (714) 838-9433

Email: mziebell@peregrineinc.com

 

5.6            
Waiver. This Warrant and any term hereof may be changed, waived, discharged or terminated (either generally or in a particular
instance and either retroactively or prospectively) only by an instrument in writing signed by the party against which enforcement
of such change, waiver, discharge or termination is sought.

 

5.7            
Attorneys’ Fees. In the event of any dispute between the parties concerning the terms and provisions of this Warrant,
the party prevailing in such dispute shall be entitled to collect from the other party all costs incurred in such dispute, including
reasonable attorneys’ fees.

 

    	6

    	 

    

 

5.8            
Counterparts; Facsimile/Electronic Signatures. This Warrant may be executed in counterparts, all of which together shall
constitute one and the same agreement. Any signature page delivered electronically or by facsimile shall be binding to the same
extent as an original signature page with regards to any agreement subject to the terms hereof or any amendment thereto.

 

5.9            
Governing Law. This Warrant shall be governed by and construed in accordance with the laws of the State of California, without
giving effect to its principles regarding conflicts of law.

 

5.10         
Headings. The headings in this Warrant are for purposes of reference only and shall not limit or otherwise affect the meaning
of any provision of this Warrant.

 

5.11         
Business Days. “Business Day” is any day that is not a Saturday, Sunday or a day on which Silicon Valley
Bank is closed.

 

 

 

 

[Remainder of page left blank intentionally]

 

[Signature page follows]

 

 

 

 

 

 

 

 

 

 

    	7

    	 

    

 

IN WITNESS WHEREOF,
the parties have caused this Warrant to Purchase Stock to be executed by their duly authorized representatives effective as of
the Issue Date written above.

 

	“COMPANY”	 
	 	 	 
	PEREGRINE PHARMACEUTICALS, INC.	 
	 	 	 
	 	 	 
	By:	/s/ Paul Lytle	 
	 	 	 
	Name:	 Paul Lytle	 
	
        

         
	(Print)	 
	 	 	 
	Title: 	Chief Financial Officer	 
	 	 	 
	 	 	 
	“HOLDER”	 
	 	 	 
	MIDCAP FINANCIAL SBIC, LP	 
	 	 	 
	By:	Midcap
        Financial SBIC GP, LLC	 
	 	 	 
	By:	/s/ Josh Groman	 
	 		 
	Name:	Josh Groman	 
	
        

         
	(Print)	 
	 	 	 
	Title:	Authorized Signatory	 

    	[Signature
                                                                                                                                                                                               Page
                                                                                                                                                                                               to
                                                                                                                                                                                               Warrant
                                                                                                                                                                                               to
                                                                                                                                                                                               Purchase
                                                                                                                                                                                               Stock]

    	 

    

 

APPENDIX 1

 

NOTICE OF EXERCISE

 

1.               
The undersigned Holder hereby exercises its right purchase ___________ shares of the Common Stock of PEREGRINE PHARMACEUTICALS,
INC. (the “Company”) in accordance with the attached Warrant To Purchase Stock, and tenders payment of the aggregate
Warrant Price for such shares as follows:

 

[ ]check in the
amount of $________ payable to order of the Company enclosed herewith

 

[ ]Wire transfer
of immediately available funds to the Company’s account

 

[ ]Cashless Exercise
pursuant to Section 1.2 of the Warrant

 

[ ]Other [Describe]
__________________________________________

 

2.               
Please issue a certificate or certificates representing the Shares in the name specified below:

 

                                                         

Holder’s
Name

 

_______________________

_______________________

(Address)

 

3.               
By its execution below and for the benefit of the Company, Holder hereby restates each of the representations and warranties in
Section 4 of the Warrant to Purchase Stock as of the date hereof.

 

	 	 	HOLDER:
	 	 	 
	 	 	____________________
	 	 	 
	 	 	By:____________________
	 	 	 
	 	 	Name:__________________
	 	 	 
	 	 	Title:___________________
	 	 	 
	 	 	Date:___________________

 

 

    	Appendix 1

    	 

    

 

 

APPENDIX 2

 

ASSIGNMENT

 

For value received,
MIDCAP FINANCIAL SBIC, LP hereby sells, assigns and transfers unto

 

	Name:     	 	 
	 	 	 
	Address:     	 	 
	 	 	 
	Tax ID:     	 	 

 

that certain Warrant to Purchase
Stock issued by PEREGRINE PHARMACEUTICALS, INC. (the “Company”), on August 30, 2012 (the “Warrant”)
together with all rights, title and interest therein.

 

	 	MIDCAP FINANCIAL SBIC, LP	 
	 	 	 	 
	 	By: Midcap Financial SBIC GP, LLC	 
	 	 	 
	 	By:	 	 
	 	 	 	 
	 	Name:	 	 
	 	 	 	 
	 	Title:	 	 
	 	 	 	 
	Date:                                   	 	 	 

 

 

By its execution below, and for the benefit
of the Company, _____________________________ (“MidCap Transferee”) makes each of the representations and warranties
set forth in Article 4 of the Warrant and agrees to all other provisions of the Warrant as of the date hereof.

 

 

	 	MIDCAP TRANSFEREE	 
	 	 	 	 
	 	By:	 	 
	 	 	 	 
	 	Name:	 	 
	 	 	 	 
	 	Title:	 	 

 

 

 

 

 

 

 

    	Appendix 2Exhibit 10.31

 

THIS WARRANT AND THE SHARES ISSUABLE HEREUNDER
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF
ANY STATE AND, EXCEPT AS SET FORTH IN SECTIONS 5.3 AND 5.4 BELOW, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS
AND UNTIL REGISTERED UNDER SAID ACT AND LAWS OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE COMPANY,
SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER IS EXEMPT FROM SUCH REGISTRATION.

 

WARRANT TO PURCHASE STOCK

 

	Company: 	PEREGRINE PHARMACEUTICALS, INC., a Delaware corporation
	Number of Shares: 	45,547
	Type/Series of Stock:	Common Stock
	Warrant Price: 	$2.47 per share
	Issue Date: 	August 30, 2012
	Expiration Date: 	August 30, 2018 See also Section 5.1(b).
	Credit Facility:	
        This Warrant to Purchase Stock (“Warrant”)
        is issued in connection with that certain Loan and Security Agreement of even date herewith among Oxford Finance LLC, as Lender
        and Collateral Agent, the Lenders from time to time party thereto, including MidCap Financial SBIC, LP and Silicon Valley Bank
        and the Company (as modified, amended and/or restated from time to time, the “Loan Agreement”).

         

 

THIS WARRANT CERTIFIES
THAT, for good and valuable consideration, SILICON VALLEY BANK (together with any successor or permitted assignee or transferee
of this Warrant or of any shares issued upon exercise hereof, “Holder”) is entitled to purchase the number of
fully paid and non-assessable shares (the “Shares”) of the above-stated Type/Series of Stock (the “Class”)
of the above-named company (the “Company”) at the above-stated Warrant Price, all as set forth above and as
adjusted pursuant to Section 2 of this Warrant, subject to the provisions and upon the terms and conditions set forth in this Warrant.
Reference is made to Section 5.4 of this Warrant whereby Silicon Valley Bank shall transfer this Warrant to its parent company,
SVB Financial Group.

 

SECTION
1.            EXERCISE.

 

1.1            
Method of Exercise. Holder may at any time and from time to time exercise this Warrant, in whole or in part, by delivering
to the Company the original of this Warrant together with a duly executed Notice of Exercise in substantially the form attached
hereto as Appendix 1 and, unless Holder is exercising this Warrant pursuant to a cashless exercise set forth in Section 1.2, a
check, wire transfer of same-day funds (to an account designated by the Company), or other form of payment acceptable to the Company
for the aggregate Warrant Price for the Shares being purchased.

 

1.2            
Cashless Exercise. On any exercise of this Warrant, in lieu of payment of the aggregate Warrant Price in the manner as specified
in Section 1.1 above, but otherwise in accordance with the requirements of Section 1.1, Holder may elect to receive Shares equal
to the value of this Warrant, or portion hereof as to which this Warrant is being exercised. Thereupon, the Company shall issue
to the Holder such number of fully paid and non-assessable Shares as are computed using the following formula:

 

	X =     	Y(A-B)/A

 

where:

 

	X =     	the number of Shares to be issued to the Holder;

 

	Y  =     	the number of Shares with respect to which this Warrant is being exercised (inclusive of the Shares surrendered to the Company
in payment of the aggregate Warrant Price);

 

    	1

    	 

    

 

	A =     	the Fair Market Value (as determined pursuant to Section 1.3 below) of one Share; and

 

	B =     	the Warrant Price.

 

1.3            
Fair Market Value. If the Company’s common stock is then traded or quoted on a nationally recognized securities exchange,
inter-dealer quotation system or over-the-counter market (a “Trading Market”), the fair market value of a Share
shall be the closing price or last sale price of a share of common stock reported for the Business Day immediately before the date
on which Holder delivers this Warrant together with its Notice of Exercise to the Company. If the Company’s common stock
is not traded in a Trading Market, the Board of Directors of the Company shall determine the fair market value of a Share in its
reasonable good faith judgment.

 

1.4            
Delivery of Certificate and New Warrant. Within a reasonable time after Holder exercises this Warrant in the manner set
forth in Section 1.1 or 1.2 above, the Company shall deliver to Holder a certificate representing the Shares issued to Holder upon
such exercise and, if this Warrant has not been fully exercised and has not expired, a new warrant of like tenor representing the
Shares not so acquired.

 

1.5            
Replacement of Warrant. On receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or
mutilation of this Warrant and, in the case of loss, theft or destruction, on delivery of an indemnity agreement reasonably satisfactory
in form, substance and amount to the Company or, in the case of mutilation, on surrender of this Warrant to the Company for cancellation,
the Company shall, within a reasonable time, execute and deliver to Holder, in lieu of this Warrant, a new warrant of like tenor
and amount.

 

1.6            
Treatment of Warrant Upon Acquisition of Company.

 

(a)             
Acquisition. For the purpose of this Warrant, “Acquisition” means any transaction or series of related
transactions involving: (i) the sale, lease, exclusive license, or other disposition of all or substantially all of the assets
of the Company (ii) any merger or consolidation of the Company into or with another person or entity (other than a merger or consolidation
effected exclusively to change the Company’s domicile), or any other corporate reorganization, in which the stockholders
of the Company in their capacity as such immediately prior to such merger, consolidation or reorganization, own less than a majority
of the Company’s (or the surviving or successor entity’s) outstanding voting power immediately after such merger, consolidation
or reorganization (or, if such Company stockholders beneficially own a majority of the outstanding voting power of the surviving
or successor entity as of immediately after such merger, consolidation or reorganization, such surviving or successor entity is
not the Company); or (iii) any sale or other transfer by the stockholders of the Company of shares representing at least a majority
of the Company’s then-total outstanding combined voting power.

 

(b)            
Treatment of Warrant at Acquisition. In the event of an Acquisition in which the consideration to be received by the Company’s
stockholders consists solely of cash, solely of Marketable Securities or a combination of cash and Marketable Securities (a “Cash/Public
Acquisition”), either (i) Holder shall exercise this Warrant pursuant to Section 1.1 and/or 1.2 and such exercise will
be deemed effective immediately prior to and contingent upon the consummation of such Acquisition or (ii) if Holder elects not
to exercise the Warrant, this Warrant will expire immediately prior to the consummation of such Acquisition.

 

(c)             
The Company shall provide Holder with written notice of its request relating to the Cash/Public Acquisition (together with such
reasonable information as Holder may reasonably require regarding the treatment of this Warrant in connection with such contemplated
Cash/Public Acquisition giving rise to such notice), which is to be delivered to Holder not less than seven (7) Business Days prior
to the closing of the proposed Cash/Public Acquisition. In the event the Company does not provide such notice, then if, immediately
prior to the Cash/Public Acquisition, the fair market value of one Share (or other security issuable upon the exercise hereof)
as determined in accordance with Section 1.3 above would be greater than the Warrant Price in effect on such date, then this Warrant
shall automatically be deemed on and as of such date to be exercised pursuant to Section 1.2 above as to all Shares (or such other
securities) for which it shall not previously have been exercised, and the Company shall promptly notify the Holder of the number
of Shares (or such other securities) issued upon such exercise to the Holder and Holder shall be deemed to have restated each of
the representations and warranties in Section 4 of the Warrant as the date thereof.

 

    	2

    	 

    

 

(d)            
Upon the closing of any Acquisition other than a Cash/Public Acquisition defined above, the acquiring, surviving or successor entity
shall assume the obligations of this Warrant, and this Warrant shall thereafter be exercisable for the same securities and/or other
property as would have been paid for the Shares issuable upon exercise of the unexercised portion of this Warrant as if such Shares
were outstanding on and as of the closing of such Acquisition, subject to further adjustment from time to time in accordance with
the provisions of this Warrant.

 

(e)             
As used in this Warrant, “Marketable Securities” means securities meeting all of the following requirements:
(i) the issuer thereof is then subject to the reporting requirements of Section 13 or Section 15(d) of the Securities Exchange
Act of 1934, as amended (the “Exchange Act”), and is then current in its filing of all required reports and
other information under the Act and the Exchange Act; (ii) the class and series of shares or other security of the issuer that
would be received by Holder in connection with the Acquisition were Holder to exercise this Warrant on or prior to the closing
thereof is then traded in Trading Market, and (iii) Holder would be able to publicly re-sell, within six (6) months following the
closing of such Acquisition, all of the issuer’s shares and/or other securities that would be received by Holder in such
Acquisition were Holder to exercise this Warrant in full on or prior to the closing of such Acquisition.

 

SECTION
2.            ADJUSTMENTS TO THE SHARES AND WARRANT PRICE.

 

2.1            
Stock Dividends, Splits, Etc. If the Company declares or pays a dividend or distribution on the outstanding shares of the
Class payable in common stock or other securities or property (other than cash), then upon exercise of this Warrant, for each Share
acquired, Holder shall receive, without additional cost to Holder, the total number and kind of securities and property which Holder
would have received had Holder owned the Shares of record as of the date the dividend or distribution occurred. If the Company
subdivides the outstanding shares of the Class by reclassification or otherwise into a greater number of shares, the number of
Shares purchasable hereunder shall be proportionately increased and the Warrant Price shall be proportionately decreased. If the
outstanding shares of the Class are combined or consolidated, by reclassification or otherwise, into a lesser number of shares,
the Warrant Price shall be proportionately increased and the number of Shares shall be proportionately decreased.

 

2.2            
Reclassification, Exchange, Combinations or Substitution. Upon any event whereby all of the outstanding shares of the Class
are reclassified, exchanged, combined, substituted, or replaced for, into, with or by Company securities of a different class and/or
series, then from and after the consummation of such event, this Warrant will be exercisable for the number, class and series of
Company securities that Holder would have received had the Shares been outstanding on and as of the consummation of such event,
and subject to further adjustment thereafter from time to time in accordance with the provisions of this Warrant. The provisions
of this Section 2.2 shall similarly apply to successive reclassifications, exchanges, combinations substitutions, replacements
or other similar events.

 

2.3            
No Fractional Share. No fractional Share shall be issuable upon exercise of this Warrant and the number of Shares to be
issued shall be rounded down to the nearest whole Share. If a fractional Share interest arises upon any exercise of the Warrant,
the Company shall eliminate such fractional Share interest by paying Holder in cash the amount computed by multiplying the fractional
interest by (i) the fair market value (as determined in accordance with Section 1.3 above) of a full Share, less (ii) the then-effective
Warrant Price.

 

2.4            
Notice/Certificate as to Adjustments. Upon each adjustment of the Warrant Price, Class and/or number of Shares, the Company,
at the Company’s expense, shall notify Holder in writing within a reasonable time setting forth the adjustments to the Warrant
Price, Class and/or number of Shares and facts upon which such adjustment is based. The Company shall, upon written request from
Holder, furnish Holder with a certificate of its Chief Financial Officer, including computations of such adjustment and the Warrant
Price, Class and number of Shares in effect upon the date of such adjustment.

 

SECTION
3.            REPRESENTATIONS AND COVENANTS OF THE COMPANY.

 

3.1            
Representations and Warranties. The Company represents and warrants to, and agrees with, the Holder as follows: All Shares
which may be issued upon the exercise of this Warrant, shall, upon issuance, be duly authorized, validly issued, fully paid and
non-assessable, and free of any liens and encumbrances except for restrictions on transfer provided for herein or under applicable
federal and state securities laws. The Company covenants that it shall at all times cause to be reserved and kept available out
of its authorized and unissued capital stock such number of shares of the Class, common stock and other securities as will be sufficient
to permit the exercise in full of this Warrant.

 

    	3

    	 

    

 

3.2            
Notice of Certain Events. If the Company proposes at any time to:

 

(a)             
declare any dividend or distribution upon the outstanding shares of the Class or common stock, whether in cash, property, stock,
or other securities and whether or not a regular cash dividend;

 

(b)            
offer for subscription or sale pro rata to the holders of the outstanding shares of the Class any additional shares of any class
or series of the Company’s stock (other than pursuant to contractual pre-emptive rights);

 

(c)             
effect any reclassification, exchange, combination, substitution, reorganization or recapitalization of the outstanding shares
of the Class; or

 

(d)            
effect an Acquisition or to liquidate, dissolve or wind up.

 

then, in connection with each such event,
the Company shall give Holder:

 

(1)            
at least seven (7) Business Days prior written notice of the date on which a record will be taken for such dividend, distribution,
or subscription rights (and specifying the date on which the holders of outstanding shares of the Class will be entitled thereto)
or for determining rights to vote, if any, in respect of the matters referred to in (a) and (b) above; and

 

(2)            
in the case of the matters referred to in (c) and (d) above at least seven (7) Business Days prior written notice of the date when
the same will take place (and specifying the date on which the holders of outstanding shares of the Class will be entitled to exchange
their shares for the securities or other property deliverable upon the occurrence of such event).

 

Reference is made to Section 1.6(c) whereby
this Warrant will be deemed to be exercised pursuant to Section 1.2 hereof if the Company does not give written notice to Holder
of a Cash/Public Acquisition as required by the terms hereof. Company will also provide information requested by Holder that is
reasonably necessary to enable Holder to comply with Holder’s accounting or reporting requirements.

 

SECTION
4.            REPRESENTATIONS, WARRANTIES OF THE HOLDER.

 

The Holder represents
and warrants to the Company as follows:

 

4.1            
Purchase for Own Account. This Warrant and the securities to be acquired upon exercise of this Warrant by Holder are being
acquired for investment for Holder’s account, not as a nominee or agent, and not with a view to the public resale or distribution
within the meaning of the Act. Holder also represents that it has not been formed for the specific purpose of acquiring this Warrant
or the Shares.

 

4.2            
Disclosure of Information. Holder is aware of the Company’s business affairs and financial condition and has received
or has had full access to all the information it considers necessary or appropriate to make an informed investment decision with
respect to the acquisition of this Warrant and its underlying securities. Holder further has had an opportunity to ask questions
and receive answers from the Company regarding the terms and conditions of the offering of this Warrant and its underlying securities
and to obtain additional information (to the extent the Company possessed such information or could acquire it without unreasonable
effort or expense) necessary to verify any information furnished to Holder or to which Holder has access.

 

    	4

    	 

    

 

4.3            
Investment Experience. Holder understands that the purchase of this Warrant and its underlying securities involves substantial
risk. Holder has experience as an investor in securities of companies in the development stage and acknowledges that Holder can
bear the economic risk of such Holder’s investment in this Warrant and its underlying securities and has such knowledge and
experience in financial or business matters that Holder is capable of evaluating the merits and risks of its investment in this
Warrant and its underlying securities and/or has a preexisting personal or business relationship with the Company and certain of
its officers, directors or controlling persons of a nature and duration that enables Holder to be aware of the character, business
acumen and financial circumstances of such persons.

 

4.4            
Accredited Investor Status. Holder is an “accredited investor” within the meaning of Regulation D promulgated
under the Act.

 

4.5            
The Act. Holder understands that this Warrant and the Shares issuable upon exercise hereof have not been registered under
the Act in reliance upon a specific exemption therefrom, which exemption depends upon, among other things, the bona fide nature
of the Holder’s investment intent as expressed herein. Holder understands that this Warrant and the Shares issued upon any
exercise hereof must be held indefinitely unless subsequently registered under the Act and qualified under applicable state securities
laws, or unless exemption from such registration and qualification are otherwise available. Holder is aware of the provisions of
Rule 144 promulgated under the Act.

 

4.6            
No Voting Rights. Holder, as a Holder of this Warrant, will not have any voting rights until the exercise of this Warrant.

 

SECTION
5.            MISCELLANEOUS.

 

5.1            
Term; Automatic Cashless Exercise Upon Expiration.

 

(a)             
Term. Subject to the provisions of Section 1.6 above, this Warrant is exercisable in whole or in part at any time and from
time to time on or before 6:00 PM, Pacific time, on the Expiration Date and shall be void thereafter.

 

(b)            
Automatic Cashless Exercise upon Expiration. In the event that, upon the Expiration Date, the fair market value of one Share
(or other security issuable upon the exercise hereof) as determined in accordance with Section 1.3 above is greater than the Warrant
Price in effect on such date, then this Warrant shall automatically be deemed on and as of such date to be exercised pursuant to
Section 1.2 above as to all Shares (or such other securities) for which it shall not previously have been exercised, and the Company
shall, within a reasonable time, deliver a certificate representing the Shares (or such other securities) issued upon such exercise
to Holder.

 

5.2            
Legends. Each certificate evidencing Shares shall be imprinted with a legend in substantially the following form:

 

THE SHARES EVIDENCED BY THIS CERTIFICATE
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE SECURITIES LAWS OF
ANY STATE AND, EXCEPT AS SET FORTH IN THAT CERTAIN WARRANT TO PURCHASE STOCK ISSUED BY THE ISSUER TO SILICON VALLEY BANK DATED
August 30, 2012, MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED UNLESS AND UNTIL REGISTERED UNDER SAID ACT AND LAWS
OR, IN THE OPINION OF LEGAL COUNSEL IN FORM AND SUBSTANCE SATISFACTORY TO THE ISSUER, SUCH OFFER, SALE, PLEDGE OR OTHER TRANSFER
IS EXEMPT FROM SUCH REGISTRATION.

 

    	5

    	 

    

 

5.3            
Compliance with Securities Laws on Transfer. This Warrant and the Shares issued upon exercise of this Warrant may not be
transferred or assigned in whole or in part except in compliance with applicable federal and state securities laws by the transferor
and the transferee (including, without limitation, the delivery of investment representation letters and legal opinions reasonably
satisfactory to the Company, as reasonably requested by the Company). The Company shall not require Holder to provide an opinion
of counsel if the transfer is to SVB Financial Group (Silicon Valley Bank’s parent company) or any other affiliate of Holder,
provided that any such transferee is an “accredited investor” as defined in Regulation D promulgated under the Act.
Additionally, the Company shall also not require an opinion of counsel if there is no material question as to the availability
of Rule 144 promulgated under the Act.

 

5.4            
Transfer Procedure. After receipt by Silicon Valley Bank of the executed Warrant, Silicon Valley Bank will transfer all
of this Warrant to its parent company, SVB Financial Group. By its acceptance of this Warrant, SVB Financial Group hereby makes
to the Company each of the representations and warranties set forth in Section 4 hereof and agrees to be bound by all of the terms
and conditions of this Warrant as if the original Holder hereof. Subject to the provisions of Section 5.3 and upon providing the
Company with written notice, SVB Financial Group and any subsequent Holder may transfer all or part of this Warrant or the Shares
issuable upon exercise of this Warrant to any transferee, provided, however, in connection with any such transfer, SVB Financial
Group or any subsequent Holder will give the Company notice of the portion of the Warrant being transferred with the name, address
and taxpayer identification number of the transferee and Holder will surrender this Warrant to the Company for reissuance to the
transferee(s) (and Holder if applicable); and provided further, that any subsequent transferee other than SVB Financial Group
shall agree in writing with the Company to be bound by all of the terms and conditions of this Warrant.

 

5.5            
Notices. All notices and other communications hereunder from the Company to the Holder, or vice versa, shall be deemed delivered
and effective (i) when given personally, (ii) on the third (3rd) Business Day after being mailed by first-class registered or certified
mail, postage prepaid, (iii) upon actual receipt if given by facsimile or electronic mail and such receipt is confirmed in writing
by the recipient, or (iv) on the first Business Day following delivery to a reliable overnight courier service, courier fee prepaid,
in any case at such address as may have been furnished to the Company or Holder, as the case may be, in writing by the Company
or such Holder from time to time in accordance with the provisions of this Section 5.5. All notices to Holder shall be addressed
as follows until the Company receives notice of a change of address in connection with a transfer or otherwise:

 

SVB Financial Group

Attn: Treasury Department

3003 Tasman Drive, HA 200

Santa Clara, CA 95054

Telephone: 408-654-7400

Facsimile: 408-496-2405

Email: warradmi@svb.com

 

Notice to the Company
shall be addressed as follows until Holder receives notice of a change in address:

 

PEREGRINE PHARMACEUTICALS, INC.

14282 Franklin Avenue

Tustin, California 92780

Attn: Mark R. Ziebell, Vice President, General Counsel

Telephone: (714) 508-6080

Facsimile: (714) 838-9433

Email: mziebell@peregrineinc.com

 

5.6            
Waiver. This Warrant and any term hereof may be changed, waived, discharged or terminated (either generally or in a particular
instance and either retroactively or prospectively) only by an instrument in writing signed by the party against which enforcement
of such change, waiver, discharge or termination is sought.

 

    	6

    	 

    

 

5.7            
Attorneys’ Fees. In the event of any dispute between the parties concerning the terms and provisions of this Warrant,
the party prevailing in such dispute shall be entitled to collect from the other party all costs incurred in such dispute, including
reasonable attorneys’ fees.

 

5.8            
Counterparts; Facsimile/Electronic Signatures. This Warrant may be executed in counterparts, all of which together shall
constitute one and the same agreement. Any signature page delivered electronically or by facsimile shall be binding to the same
extent as an original signature page with regards to any agreement subject to the terms hereof or any amendment thereto.

 

5.9            
Governing Law. This Warrant shall be governed by and construed in accordance with the laws of the State of California, without
giving effect to its principles regarding conflicts of law.

 

5.10         
Headings. The headings in this Warrant are for purposes of reference only and shall not limit or otherwise affect the meaning
of any provision of this Warrant.

 

5.11         
Business Days. “Business Day” is any day that is not a Saturday, Sunday or a day on which Silicon Valley
Bank is closed.

 

 

 

[Remainder of page left blank intentionally]

 

[Signature page follows]

 

 

 

 

 

    	7

    	 

    

 

IN WITNESS WHEREOF,
the parties have caused this Warrant to Purchase Stock to be executed by their duly authorized representatives effective as of
the Issue Date written above.

 

	“COMPANY”	 	 
	 	 	 
	PEREGRINE PHARMACEUTICALS, INC.	 	 
	 	 	 
	 	 	 
	By:/s/ Paul Lytle          	 	 
	 	 	 
	Name:Paul Lytle          	 	 
	
                    (Print)

         
	 	 
	Title:Chief Financial Officer	 	 
	 	 	 
	 	 	 
	“HOLDER”	 	 
	 	 	 
	SILICON VALLEY BANK	 	 
	 	 	 
	 	 	 
	By:/s/ Brett Maver          	 	 
	 	 	 
	Name:Brett Maver          	 	 
	
                   (Print)

         
	 	 
	Title:Relationship Manager	 	 

 

 

    	[Signature
                                                                                                                                                                                               Page
Warrant to Purchase Stock]

    	 

    

 

APPENDIX 1

 

NOTICE OF EXERCISE

 

1.               
The undersigned Holder hereby exercises its right purchase ___________ shares of the Common Stock of PEREGRINE PHARMACEUTICALS,
INC. (the “Company”) in accordance with the attached Warrant To Purchase Stock, and tenders payment of the aggregate
Warrant Price for such shares as follows:

 

[ ]check in the
amount of $________ payable to order of the Company enclosed herewith

 

[ ]Wire transfer
of immediately available funds to the Company’s account

 

[ ]Cashless Exercise
pursuant to Section 1.2 of the Warrant

 

[ ]Other [Describe]
__________________________________________

 

2.               
Please issue a certificate or certificates representing the Shares in the name specified below:

 

_________________________________________

Holder’s Name

 

_________________________________________

 

_________________________________________

(Address)

 

3.               
By its execution below and for the benefit of the Company, Holder hereby restates each of the representations and warranties in
Section 4 of the Warrant to Purchase Stock as of the date hereof.

 

	 	 	HOLDER:
	 	 	 
	 	 	____________________
	 	 	 
	 	 	By:____________________
	 	 	 
	 	 	Name:___________________
	 	 	 
	 	 	Title:____________________
	 	 	 
	 	 	Date:____________________

 

 

 

 

Appendix 1

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