Document:

bspe_ex1004.htm

EXHIBIT 10.04

 

THE SECURITIES REPRESENTED 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 MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER APPLICABLE FEDERAL AND STATE SECURITIES LAWS OR PURSUANT TO AN APPLICABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, WHICH OPINION SHALL BE REASONABLY ACCEPTABLE TO THE ISSUER.

PURSUANT TO THE TERMS OF SECTIONS 1 AND 2 OF THIS CONVERTIBLE DEBENTURE, ALL OR A PORTION OF THIS CONVERTIBLE DEBENTURE MAY HAVE BEEN REDEEMED OR CONVERTED, AND THEREFORE THE ACTUAL PRINCIPAL AMOUNT OUTSTANDING REPRESENTED BY THIS CONVERTIBLE DEBENTURE MAY BE LESS THAN THE AMOUNT SET FORTH ON THE FACE HEREOF.

BLACKSANDS PETROLEUM, INC.

5% Convertible Debenture

Original Issue Date: June 6, 2014

	
A-1

	
$1,500,000.00

 

In consideration of the receipt of $1,500,000, the undersigned, Blacksands Petroleum, Inc., a Nevada corporation (the “Issuer”), hereby promises to pay, in accordance with the Subscription Agreement (the “Subscription Agreement”), dated as of June 6, 2014, by and between Issuer and Pacific LNG Operations Ltd. (“Holder”), on June 6, 2017 (the “Maturity Date”), the principal amount of One Million Five Hundred Thousand Dollars ($1,500,000) (the “Principal Amount”), unless this debenture (“Debenture”) is earlier converted or repaid in accordance with Sections 1 or 2, and interest shall accrue hereon from the date hereof and be payable as provided herein, unless earlier converted or repaid in accordance with Sections 1 or 2 hereof.

 

This Debenture is the convertible debenture referred to in the Subscription Agreement and is entitled to the benefits thereof, and is subject to conversion as set forth in Sections 1.2 and Section 2 hereof. This Debenture, and all representations, warranties, covenants and agreements contained in the Subscription Agreement, shall be binding upon Issuer and its successors and assigns.

 

  

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1. Terms of the Debenture.

1.1 Interest; Interest Rate; Repayment.

 

(a) This Debenture shall bear interest at the rate of five percent (5%) (the “Interest Rate”) per annum based on a 360-day year. Interest shall be payable in arrears semi-annually on October 31 and April 30, commencing on October 31, 2014.

(b) All monetary payments to be made by Issuer hereunder shall be made in lawful money of the United States by wire transfer of immediately available funds by wire, in accordance with instructions to be provided by the Holder to the Issuer on or before October 15, 2014.

(c) If all or a portion of the principal amount of this Debenture or any interest payable thereon shall not be repaid when due, and the failure to make such payment continues for at least 10 days, then such overdue amounts shall bear interest at a rate of seven percent (7%) per annum from the date of such non-payment until such amount is paid in full.

(d) The Issuer shall have the right, at any time on or after October 31, 2014, to prepay some or all the outstanding principal amount, plus all accrued but unpaid interest on the principal amount being repaid, upon not less than 30 days prior written notice to the Holder (the “Prepayment Notice”). Such Prepayment Notice shall specify the date fixed for repayment and the principal and interest amount which is to be paid. The Holder shall not be required to surrender this Debenture in order for the Issuer to effect a prepayment hereunder; provided, however, that in the event that this Debenture is repaid in full, the Holder shall deliver this Debenture to the Issuer for cancellation within a reasonable time after such repayment. Notwithstanding anything to the foregoing, the Holder shall have the right to convert this Debenture pursuant to Section 2 after receipt of the Prepayment Notice and before the date of repayment.

1.2 Rights Upon Merger, Consolidation, Etc. If, at any time, Issuer proposes to consolidate with, or merge into, another corporation or entity, or to effect any sale or conveyance to another corporation or other entity of all or substantially all of the assets of Issuer, or effect any other corporate reorganization, in which the stockholders of Issuer immediately prior to such consolidation, merger, reorganization or sale would own capital stock of the entity surviving such merger, consolidation, reorganization or sale representing less than fifty (50%) percent of the combined voting power of the outstanding securities of such successor or combined entity immediately after such consolidation, merger, reorganization or sale (a “Liquidation Event”), then the holder of this Debenture shall have the right, upon the occurrence of the Liquidation Event, to convert this Debenture into the kind and amount of shares of stock and other securities and property receivable upon such Liquidation Event by a holder of the number of shares of common stock of the Company into which such shares of Series B Preferred Stock (as hereinafter defined) issuable upon conversion of this Debenture might have been converted immediately prior to such Liquidation Event.

 

  

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2. Conversion.

 

2.1 Optional Conversion. Subject to the terms of this Section 2, the Holder shall have the right, but not the obligation, at any time prior to June 6, 2015, to convert all or any portion of the outstanding Principal Amount and/or accrued interest due and payable into fully paid and nonassessable shares of the Company’s Series B Convertible Preferred Stock (the “Series B Preferred Stock”) at the Conversion Price. The shares of Series B Preferred Stock to be issued upon such conversion are herein referred to as the “Conversion Shares.” The “Conversion Price” shall mean $1.00 per share of Series B Preferred Stock.

 

2.2 Mechanics of Holder’s Conversion. This Debenture will be converted by the Holder in part from time to time after the Issue Date, by submitting to the Issuer a Notice of Conversion (by facsimile or other reasonable means of communication dispatched on the Conversion Date (as hereinafter defined) prior to 6:00 p.m., New York, New York time). On each Conversion Date and in accordance with its Notice of Conversion, the Holder shall make the appropriate reduction to the Principal Amount and accrued interest as entered in its records and shall provide written notice thereof to the Issuer on the Conversion Date. Each date on which a Notice of Conversion is delivered or telecopied to Issuer in accordance with the provisions hereof shall be deemed a Conversion Date (the “Conversion Date”). A form of Notice of Conversion to be employed by the Holder is annexed hereto as Exhibit A. Pursuant to the terms of the Notice of Conversion, Issuer will issue a certificate representing the Conversion Shares to the Holder by physical delivery within five (5) business days after receipt by Issuer of the Notice of Conversion. In the case of the exercise of the conversion rights set forth herein the conversion privilege shall be deemed to have been exercised and the Conversion Shares issuable upon such conversion shall be deemed to have been issued upon the date of receipt by Issuer of the Notice of Conversion. The Holder shall be treated for all purposes as the record holder of such Series B Preferred Stock, unless the Holder provides Issuer written instructions to the contrary.

 

2.3 Conversion Mechanics.

 

(a) The number of shares of Series B Preferred Stock to be issued upon each conversion of this Debenture shall be determined by dividing that portion of the Principal Amount and interest to be converted, if any, by the then applicable Conversion Price.

 

(b) The Conversion Price and number and kind of shares or other securities to be issued upon conversion shall be subject to adjustment from time to time upon the happening of certain events while this conversion right remains outstanding, as follows:

 

(i) Reclassification, etc. If Issuer at any time shall, by reclassification or otherwise, change the Series B Preferred Stock into the same or a different number of securities of any class or classes, this Debenture, as to the unpaid Principal Amount and accrued interest thereon, shall thereafter be deemed to evidence the right to purchase an adjusted number of such securities and kind of securities as would have been issuable as the result of such change with respect to the Series B Preferred Stock (i) immediately prior to or (ii) immediately after such reclassification or other change at the sole election of the Holder.

 

  

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2.4 Issuance of New Debenture. Upon any partial conversion of this Debenture, a new Debenture containing the same date and provisions of this Debenture shall, at the request of the Holder, be issued by the Issuer to the Holder for the principal balance of this Debenture and interest which shall not have been converted or paid.

2.5 Concerning the Shares. The shares of Series B Preferred Stock issuable upon conversion of this Debenture may not be sold or transferred unless (i) such shares are sold pursuant to an effective registration statement under the Act or (ii) the Issuer’s transfer agent shall have been furnished with an opinion of counsel (which opinion shall be in form, substance and scope customary for opinions of counsel in comparable transactions) to the effect that the shares to be sold or transferred may be sold or transferred pursuant to an exemption from such registration or (iii) such shares are sold or transferred pursuant to Rule 144 under the Act (or a successor rule) (“Rule 144”). Until such time as the shares of Series B Preferred Stock issuable upon conversion of this Debenture have been registered under the Act or otherwise may be sold pursuant to Rule 144 without any restriction as to the number of securities as of a particular date that can then be immediately sold, each certificate for shares of Series B Preferred Stock issuable upon conversion of this Debenture that has not been so included in an effective registration statement or that has not been sold pursuant to an effective registration statement or an exemption that permits removal of the legend, shall bear a legend substantially in the following form, as appropriate:

“NEITHER THE ISSUANCE AND SALE OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE NOR THE SECURITIES INTO WHICH THESE SECURITIES ARE EXERCISABLE HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR APPLICABLE STATE SECURITIES LAWS. THE SECURITIES MAY NOT BE OFFERED FOR SALE, SOLD, TRANSFERRED OR ASSIGNED (I) IN THE ABSENCE OF (A) AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR (B) AN OPINION OF COUNSEL (WHICH COUNSEL SHALL BE SELECTED BY THE HOLDER), IN A GENERALLY ACCEPTABLE FORM, THAT REGISTRATION IS NOT REQUIRED UNDER SAID ACT OR (II) UNLESS SOLD PURSUANT TO RULE 144 OR RULE 144A UNDER SAID ACT.”

3. Miscellaneous.

3.1 Interest Rate. Any interest payable hereunder that is in excess of the maximum interest rate permitted under applicable law shall be reduced to the maximum interest rate permitted under such applicable law.

 

3.2 Notices. All notices and other communications required to be delivered hereunder shall be in accordance with the provisions in the Subscription Agreement.

 

3.3 Exercise of Rights. No failure on the part of a party to exercise, and no delay in exercising, any right under this Debenture, or any agreement contemplated hereby, shall operate as a waiver hereof by such party, nor shall any single or partial exercise of any right under this Debenture, or any agreement contemplated hereby, preclude any other or further exercise thereof or the exercise of any other right.

 

  

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3.4 Governing Law. This Debenture shall be governed by and construed in accordance with the provisions in the Subscription Agreement.

 

3.5 Transferability. This Debenture shall not be transferable in any manner without the express written consent of Issuer, which consent may not withheld in Issuer’s sole discretion.

 

3.6 Severability. If any provision of this Debenture is prohibited by law or otherwise determined to be invalid or unenforceable by a court of competent jurisdiction, the provision that would otherwise be prohibited, invalid or unenforceable shall be deemed amended to apply to the broadest extent that it would be valid and enforceable, and the invalidity or unenforceability of such provision shall not affect the validity of the remaining provisions of this Debenture so long as this Debenture as so modified continues to express, without material change, the original intentions of the parties as to the subject matter hereof and the prohibited nature, invalidity or unenforceability of the provision(s) in question does not substantially impair the respective expectations or reciprocal obligations of the parties or the practical realization of the benefits that would otherwise be conferred upon the parties. The parties will endeavor in good faith negotiations to replace the prohibited, invalid or unenforceable provision(s) with a valid provision(s), the effect of which comes as close as possible to that of the prohibited, invalid or unenforceable provision(s).

 

3.7 Amendments. No waiver shall be effective unless it is in writing and signed by an authorized representative of the waiving party. This Debenture can only be amended in a writing executed by the Issuer and the Holder.

*********************

 

  

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IN WITNESS WHEREOF, the Issuer has executed this Debenture on the date first above written.

 

	 	BLACKSANDS PETROLEUM, INC.	 
	 	 	 	 
	 	
By: 

	/s/ Rhonda Rosen	 
	 	Name:	Rhonda Rosen	 
	 	Title:	Interim President	 

 

  

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EXHIBIT “A”

NOTICE OF CONVERSION

(To be executed by the Holder in order to convert all or part of the Debenture)

 

The undersigned hereby converts $_________ of the principal due on June 6, 2017 under the Convertible Debenture issued by Blacksands Petroleum, Inc. (“Issuer”) dated as of June 6, 2014 into shares of Series B Preferred Stock of Issuer on and subject to the conditions set forth in Section 2 of such Debenture.

 

 

	Date of Conversion:	_____________________________________________________________
	 	 
	Conversion Price:	_____________________________________________________________
	 	 
	Number of Shares To Be Delivered:	_____________________________________________________________
	 	 
	Signature:	_____________________________________________________________
	 	 
	Print Name:	_____________________________________________________________
	 	 
	Address:	_____________________________________________________________
	 	 
	 	_____________________________________________________________

 

  

7EXHIBIT 10.1

 

EXHIBIT
10.1

 

SECURITIES
PURCHASE AGREEMENT

 

This
SECURITIES PURCHASE AGREEMENT (this “Agreement”), dated as of _____________, 2014, is between Cardiogenics
Holdings Inc., a Nevada corporation, (the “Company”), and the investor (the “Investor”),
as set forth in the signature page to this Agreement.

 

WHEREAS,
the Company is executing and delivering this Agreement in reliance upon the exemption from securities registration afforded
by Regulation S (“Regulation S”) as promulgated by the United States Securities and Exchange Commission (the
“SEC”) under the Securities Act of 1933, as amended (the “Securities Act”).

 

WHEREAS,
in accordance with the Private Placement Memorandum of the Company (the “Private Placement Memorandum”),
the Company desires to offer and sell, upon the terms and conditions set forth in this Agreement in a Regulation S offering through
WDM Dom Maklerski S.A. (the “Offering Agent”) up to 15,000,000 shares (the “Offered Shares”)
of common stock, par value $0.00001 per share of Company (“Common Stock”) at an Offer Price per share of 0,33
PLN (approximately $ 0,11) (the “Private Placement”).

 

WHEREAS,
the Investor wishes to purchase, upon the terms and conditions stated in this Agreement, such number of Offered Shares as
is set forth immediately below Investor’s name on the signature page hereto.

 

NOW,
THEREFORE, in consideration of the foregoing, and for other good and valuable consideration, the receipt and sufficiency of
which are hereby acknowledged, the parties hereto agree as follows:

 

ARTICLE
1

SUBSCRIPTION

 

Section
1.1 Subscription. Subject to the terms and conditions set forth in this Agreement, at the Closing, the Company shall
issue and sell to the Investor and the Investor shall purchase from the Company the number of Offered Shares set forth on the
Investor’s signature page to this Agreement. To solicit Company’ acceptance of the Investor’s subscription
for Offered Shares, the Investor must provide an executed copy of this Agreement together with good funds for the purchase
price set forth on the signature page hereto (the “Purchase Price”) by a concurrent wire transfer of the
Purchase Price, as provided in the instructions attached to this Agreement as Schedule A.

 

Section
1.2 Rejection of Subscriptions. Company may reject any subscription for any reason or no reason in its sole
discretion.

 

Section
1.3
Compliance. In connection with the introduction of the Offered Shares for trading on New Connect, the alternative trading
system maintained by the Warsaw Stock Exchange in Poland (“New Connect”), the Private Placement shall be conducted
in compliance with applicable Polish securities law and regulations. 

 

    	 

    	 

    

 

ARTICLE
2

 

CLOSING
AND DELIVERY

 

Section
2.1 Closing.

 

(a)
Closing Date. The closing will take place on the third business day following acceptance by Company of the Investor’s
subscription in accordance with Section 1.1 and confirmation by the Company that the Offered Shares have been accepted for trading
on New Connect (the “Closing Date”), at the office of the Offering Agent, which is located at Plac Powstańców
Śląskich 1 lok. 201, 53-329 Wrocław, Poland on the Closing Date or at such other location or time as the parties
may agree (the “Closing”).

 

(b) Delivery
of Offered Shares in uncertificated form. On the Closing Date or any such later date that will result from
binding regulations of the National Depositary of Securities in Poland (the “NDS”), Company will deliver
to the Investor all Offered Shares purchased by the Investor pursuant to this Agreement and the regulations of the
NDS.

 

(c) Delivery
of Offered Shares in certificated form. The Investor acknowledges that any certificates or other evidence that may
be issued representing the Offered Shares shall bear any legend required by the securities laws of any state and be stamped
or otherwise imprinted with a legend substantially in the following form:

 

The
securities represented hereby have not been registered under the Securities Act of 1933, as amended, or any state securities laws
and neither the securities nor any interest therein may be offered, sold, transferred, pledged or otherwise disposed of except
pursuant to an effective registration under such act or an exemption from registration, which, in the opinion of counsel reasonably
satisfactory to this corporation, is available.

 

Section
2.2 Repayment of the Purchase Price.

 

In
the event when the Offered Shares are not admitted to trading on New Connect within 5 (five) months following the date of this
Agreement, unless the Purchase Price increased by 5% interest per annum has been repaid by the Offering Agent, Company shall repay
the Investor the Purchase Price increased by 5% interest per annum calculated for the period starting on the day payment of funds
to the account of the Offering Agent and ending on the day of repayment, and the Agreement shall terminate. Company undertakes
to perform the obligation within one month following the end of the period referred to in the preceding sentence. Should the Company
fail to perform this obligation, the Investor is authorized to calculate interest on the amount of Purchase Price increased by
interest due, at the rate of 2% for each month of delay.

 

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ARTICLE
3

 

REPRESENTATIONS
AND WARRANTIES

 

Section
3.1 Representations and Warranties of Company. The Company hereby represents and warrants to the Investor as follows:

 

(a)
Organization and Good Standing. The Company is an entity duly incorporated, validly existing and in good standing under
the laws of the State of Nevada and has full corporate power and authority to conduct its business as currently conducted.

 

(b) Authorization. Company’
execution and delivery of this Agreement, as well as its performance of its obligations under this Agreement, has been duly
and validly authorized by all required corporate action. This Agreement has been validly executed and is a legal, valid, and
binding obligation of Company, enforceable in accordance with its terms, except as such enforceability may be limited by
applicable bankruptcy, insolvency and similar laws relating to creditors’ rights generally and by general principles of
equity (regardless of whether such enforceability is considered in a proceeding in equity or at law).

 

(c) No
Filing or Registration. Except for (i) the filing of any required forms to comply with Regulation S or (ii) any state
filings that may be required in connection with the transactions contemplated by this Agreement, no filing or registration
with, or notice to or authorization, consent, finding by or approval of, any governmental authority is necessary for the
execution and delivery of this Agreement by the Company or the consummation by the Company of the transactions contemplated
hereby, the failure to obtain, make, or give which would be material to the Company’ business taken as a
whole.

 

(d) No
Conflict. The Company’s execution and delivery of this Agreement and the consummation of the transactions
contemplated hereby will not violate, conflict with, or result in a material breach of any provision of, or constitute a
material default under, or result in the termination of, or accelerate the performance required by, or result in a right of
payment, termination, or acceleration of any obligation under, or result in the creation of any lien upon any of its assets
(any such violation, conflict, breach, default, right of termination, or acceleration, loss or creation, an “Issuer
Violation”), under any provisions of (i) the articles of incorporation or bylaws of the Company, or (ii) subject to
obtaining any required third-party consents or other approvals, any note, bond, mortgage, indenture, deed of trust, license,
franchise, permit, concession, contract, lease, or other instrument or agreement of any kind to which the Company is now a
party or by which its assets may be bound or affected, unless such Issuer Violations as would not be material to the
Company’s business taken as a whole.

 

(e) Compliance
with Laws. Company is not in violation of, or under investigation with respect to any violation of, any material law
(whether common law or equity), statute, order, rule, regulation, ordinance, or judgment of any governmental authority
applicable to the Company. There is no litigation pending or, to the Company’s knowledge, threatened, against it or
involving its property or business, which would materially affect the Company’s business taken as a whole.

 

(f) No
Breach or Default. The Company is not in breach of or default under or with respect to any of its obligations under any
security issued by the Company or any material agreement, instrument, or other undertaking, to which it is a party or by
which it or any of its property is bound and which breach or default would materially affect the Company’s business
taken as a whole.

 

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(g) Transferability
of the Offered Shares. Beginning from the day of admission of the Offered Shares to trading on NewConnect, the
limitations of transferability of the Offered Shares referred to in sec. 3.2 (k)(d) shall not apply. In the event of breach
of this representation, the Company undertakes to pay contractual penalty in the amount agreed in sec. 2.2 above.

 

(h) Escrow. The
funds paid by the Investor upon subscription as Purchase Price for the Offered Shares shall be maintained in escrow
account opened by the Offering Agent and not transferred to the Company until the first day of listing of the Offered Shares
on New Connect.

 

Section
3.2 Representations and Warranties of the Investor. The undersigned Investor represents and warrants to the Company as
follows:

 

(a)
The Investor fully understands all of the risks related to the purchase of the Offered Shares. The Investor has carefully considered
and has discussed with the Investor’s professional legal, tax, accounting and financial advisors, to the extent the Investor
has deemed necessary, the suitability of an investment in the Offered Shares for the Investor’s particular tax and financial
situation and has determined that the Offered Shares being purchased by the Investor are a suitable investment for the Investor.
The Investor recognizes that an investment in the Offered Shares involves substantial risks, including the possible loss of the
entire amount of such investment.

 

(b)
The Investor acknowledges that (i) the Investor has had the opportunity to request copies of any documents, records and books
pertaining to this investment; (ii) any such documents, records and books that the Investor requested have been made
available for inspection by the Investor, the Investor’s attorney, accountant or other advisor(s); and (iii) the
Investor has read carefully the Private Placement Memorandum including, but not limited to, the list of Risk Factors in
Section 1 therein. The Investor has requested, received, reviewed and considered all information it deems relevant in making
an informed decision to purchase the Offered Shares.

 

(c)
The Investor and the Investor’s advisor(s) have had a reasonable opportunity to ask questions of and receive answers
from representatives of Company or Persons (as defined below) acting on behalf of Company concerning Company, the Private
Placement and the Offered Shares and all such questions have been answered to the full satisfaction of the Investor. For
purposes of this Agreement, “Person” means an individual, a limited liability company, a partnership, a
joint venture, a corporation, a trust, an unincorporated organization, any other entity and a government or any department or
agency thereof.

 

(d)
The Investor is not subscribing for the Offered Shares as a result of or subsequent to any advertisement, article, notice or
other communication published in any newspaper, magazine or similar media or broadcast over television, radio or the Internet
(including without limitation, internet “blogs,” bulletin boards, discussion groups and social networking sites)
or presented at any seminar, meeting or conference whose attendees have been invited by any general solicitation or general
advertising.

 

(e)
The Investor has sufficient knowledge and experience in financial, tax and business matters to enable the Investor to utilize
the information made available to the Investor in connection with the Private Placement, to evaluate the merits and risks of
an investment in the Offered Shares and to make an informed investment decision with respect to an investment in the Offered
Shares.

 

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(f)
The Investor acknowledges that the Offered Shares prior to their admission to trading on New Connect, may not be sold or
otherwise transferred without registration under the Securities Act and applicable state securities laws or an applicable
exemption therefrom. The Investor acknowledges that neither the offer nor sale of the Offered Shares have been registered
under the Securities Act or under the securities laws of any state. The Investor represents and warrants that the Investor is
acquiring the Offered Shares for the Investor’s own account, for investment purposes and not with a view toward resale
or distribution within the meaning of the Securities Act, except pursuant to sales registered or exempted under the
Securities Act, i.e. trading of the Offered Shares on New Connect. The Investor is aware that the Company intends to apply
for admission of the Offered Shares to trading on New Connect, therefore (i) the Offered Shares are not currently eligible
for resale in reliance upon Rule 144 (as defined below) and (ii) the Company has no obligation to register the Offered Shares
purchased hereunder.

 

(g)
If this Agreement is executed and delivered on behalf of a partnership, corporation, trust, estate or other entity: (i) such
partnership, corporation, trust, estate or other entity is duly organized and validly existing and has the full legal right
and power and all authority and approval required (a) to execute and deliver this Agreement and all other instruments
executed and delivered by or on behalf of such partnership, corporation, trust, estate or other entity in connection with the
purchase of the Offered Shares, and (b) to purchase and hold the Offered Shares; and (ii) the signature of the party signing
on behalf of such partnership, corporation, trust, estate or other entity is binding upon such partnership, corporation,
trust, estate or other entity.

 

(h)
The Investor understands that the Offered Shares are being offered and sold to it in reliance on specific exemptions from the
registration requirements of United States federal and state securities laws and that the Company is relying in part upon the
truth and accuracy of, and the Investor’s compliance with, the representations, warranties, agreements, acknowledgments
and understandings of the Investor set forth herein in order to determine the availability of such exemptions and the
eligibility of the Investor to acquire the Offered Shares.

 

(i)
The Investor understands that no United States federal or state agency or any other government or governmental agency has
passed on or made any recommendation or endorsement of the Offered Shares or the fairness or suitability of the investment in
the Offered Shares nor have such authorities passed upon or endorsed the merits of the offering of the Offered
Shares.

 

(j)
This Agreement has been duly and validly authorized, executed and delivered on behalf of the Investor and shall constitute
the legal, valid and binding obligations of such Investor enforceable against the Investor in accordance its
terms.

 

(k)
The Investor is not a “U.S. Person” as defined in Rule 902(k) of Regulation S and:

 

(a) 
not acting for the account or benefit of a U.S. Person and is purchasing the Offered Shares in an offshore transaction pursuant
to Regulation S;

 

(b) 
the Investor understands that neither the Offered Shares nor the underlying securities have not been and will not be registered
under the Securities Act and may not be offered, resold, pledged or otherwise transferred by such Investor except: (a) (i) in
the United States to a person whom the seller reasonably believes is a qualified institutional buyer in a transaction meeting
the requirements of Rule 144, (ii) outside the United States in a transaction complying with the provisions of Rule 903 or Rule
904 of Regulation S, (iii) pursuant to an exemption from registration under the Securities Act provided by Rule 144 (if available),
or (iv) pursuant to an effective registration statement under the Securities Act; and (b) in accordance with any applicable securities
laws of any state of the United States and other jurisdictions;

 

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(c) 
the Investor acknowledges that, if in the future it decides to resell, pledge or otherwise transfer the Offered Shares or any
beneficial interests in any of the Offered Shares prior to the date which is twelve (12) months after the later of (a) the date
when the Offered Shares are first offered to persons (other than distributors) pursuant to Regulation S and (b) the date of closing
of the Private Placement and admission of the Offered Shares to trading on New Connect, it will do so only (i) in compliance with
the restrictions set forth herein, (ii) pursuant to an effective registration statement under the Securities Act, or (iii) in
accordance with the provisions of Rule 144 (if available) or Regulation S, and in each of such cases in accordance with any applicable
securities laws of any state of the United States;

 

(d) 
the Investor agrees to, and each subsequent holder is required to, notify any purchaser of the Offered Shares from it of the resale
restrictions referred to in paragraphs (k)(c)(ii) and (k)(c)(iii) above, if then applicable; The foregoing notice and resale restrictions
do not apply to transactions on New Connect; and

 

(e) 
the Investor acknowledges that, prior to any proposed transfer of any of the Offered Shares other than pursuant to an effective
registration statement, the transferee of any of the Offered Shares may be required to provide certifications and other documentation
relating to the non-US Person status of such transferee.

 

(l) Issuer
Reliance. The Investor understands that Company has entered or will enter into this Agreement with the Investor in
reliance upon the Investor’s representations to Company, as set forth above.

 

ARTICLE
4

CONDITIONS TO CLOSING

 

Section
4.1 Conditions to Company’ Obligations. Except for as may be waived in writing by Company and as provided in
Section 4.1(a) below, all of the obligations of Company under this Agreement are subject to the fulfillment, prior to or at
the Closing of each of the following conditions:

 

(a) Representations
and Warranties True. The representations and warranties of the Investor contained in this Agreement shall be true and
correct in all material respects as of the Closing.

 

(b)
The Investor shall have delivered an executed copy of this Agreement and the Purchase Price in accordance with Section
1.1.

 

(c)
The Common Stock shall have been approved and accepted for trading on the Alternative Trading System on the NewConnect
market.

 

(d)
Subscriptions for a minimum of 100,000 PLN of the Offered Shares in the Private Placement shall have been received and
accepted by the Company, nevertheless there might be some exceptions allowed in individual cases.

 

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Section
4.2
Conditions to the Investor’s Obligations. Except as may be waived in writing by the Investor and as provided in Section
4.2(a) below, all of the obligations of the Investor under this Agreement are subject to the fulfillment, prior to or at the Closing,
of each of the following conditions:

 

(a)Representations
and Warranties True. The representations and warranties of Company contained in this Agreement shall be true and correct in
all material respects as of the Closing.

 

ARTICLE
5

 

SURVIVAL
OF REPRESENTATIONS AND WARRANTIES

 

Section
5.1 The representations and warranties of Company, and the Investor herein shall survive the Closing until the expiration
of all applicable statutes of limitation.

 

ARTICLE
6

MISCELLANEOUS

 

Section
6.1
Amendments. This Agreement may be amended only by a written document signed by Company and agreed to in writing by the Investor.

 

Section
6.2
Counterparts and Facsimile Signatures. This Agreement has been signed in Polish and English language versions and may be executed
in any number of counterparts of each language versions and signature pages may be delivered by electronic transmission; each
such counterpart or signature page shall be deemed to be an original. In case of discrepancies between Polish and English language
version, the Polish version shall prevail.

 

Section
6.3
Assignment. Neither this Agreement nor any right created hereby shall be assignable by Company or the Investor (or any permitted
assignee of Company or the Investor) without the prior written consent of the other party, except that this Agreement may be assigned
(i) by the Investor to (a) an entity that wholly owns, is wholly owned by or is wholly under common ownership with the Investor
or any permitted assignee of the Investor; (b) a trust for the benefit of the Investor or his or her immediate family members;
or (c) by will or the laws of descent and distribution; or (ii) by Company to the successor in interest to all or substantially
all of its business. Any attempt to assign any right under this Agreement in violation of this Section 6.3 shall be void. Nothing
in this Agreement, express or implied, is intended to confer upon any person, other than the parties hereto and their respective
permitted successors, permitted assigns, heirs, executors, administrators, or personal representatives, any rights or remedies
under or by reason of this Agreement.

 

Section
6.4
Entire Agreement. Except as provided to the contrary herein, this Agreement, and the Disclosure Documents contain the full
and entire understanding and agreement between the parties with regard to the subject hereof and supersede all prior agreements
and understandings of the parties with regard to such matters. Neither party shall be liable or bound to the other in any manner
by any representations, warranties, covenants or agreements except as specifically set forth herein or therein.

 

    	7

    	 

    

 

Section
6.5 Governing Law; Submission to Jurisdiction. This Agreement shall be governed by and enforced pursuant to the laws of
Poland. The parties to this Agreement hereby irrevocably submit to the exclusive jurisdiction of the proper court for the
Investor’s seat.

 

Section
6.6 Severability. In case any provision of this Agreement shall be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby unless, as a
result of the selective enforcement of such remaining provisions a party hereto would fail to realize a benefit that was a
fundamental part of the reason for such party to have entered into this Agreement.

 

Section
6.7
Notices. Except as otherwise specifically provided herein, all notices and other communications required or permitted under
this Agreement must be in writing and may be given by personal or customary form of electronic delivery or U.S. mail, or confirmed
facsimile. If given by mail, such notice must be sent by registered or certified mail, postage prepaid, mailed to the party at
the respective address set forth below, and shall be effective only if and when received by the party to be notified. For purposes
of notice, the addresses of the parties shall, until changed as hereinafter provided, be as follows:

 

	 	If
    to Company:	Cardiogenics
    Holdings Inc.
	 	 	625
    Northam Drive, Unit 8
	 	 	Mississauga,
    Ontario L4V 1WB, Canada
	 	 	Attention:
    Yahia A. Gawad, CEO
	 	 	Fax:
    +1 (905) 673-9865
	 	 	Email:
    ygawad@cardiogenics.com 

 

	 	With
    a copy to:	______________________
	 	 	______________________
	 	 	______________________

 

If
to the Investor, to the address set forth on the signature page of this Agreement, or at such other address or facsimile number
as any party may have advised the other by notice.

 

[SIGNATURE
PAGE FOLLOWS]

 

    	8

    	 

    

 

IN
WITNESS WHEREOF, this Agreement is hereby duly executed by each party hereto as of the date first written above.

 

INVESTOR:

 

PLN
amount of investment: PLN _____________ (say:

 

_____________________________________
zloty) (the “Purchase Price”)

 

Number
of Offered Shares Subscribed for: _____________ (say:

 

_______________________________________)

 

Exact
name in which the Offered Shares are to be issued:

_________________________________________________

 

__________________________________________

Signature

 

Date:
_____________, 2014

 

__________________________

(Print
Name of Investor)

 

Address:

 

________________________________

 

Fax
Number: _________________________

 

Email
Address: ___________________________

 

Acceptance
Dated: ___________________________

 

	Cardiogenics
    Holdings Inc.	 
	 	 
	By:		 
	Name:	Yahia A. Gawad	 
	Title:	Chief Executive
    Officer	 

 

    	9

    	 

    

 

SCHEDULE
A

 

	1.		EXECUTED DOCUMENTS SHOULD
BE MAILED TO:

 

DOM
MAKLERSKI WDM S.A.

Plac
Powstańców Śląskich 1 lok. 201, 53-329 Wrocław, Poland

Attention:
Wojciech Grzegorczyk

Fax:
(71) 79 11 556

Email:
wojciech.grzegorczyk@wdmsa.pl

 

	2.		IF
                                         YOU ARE WIRING FUNDS, THE FUNDS SHOULD BE WIRED AS FOLLOWS:

 

The
amount of the payment for Offered Shares shall be transferred to the bank account of the Offering Agent number 98 1060 0076
0000 3300 0051 1731, accepting subscription order. Payment from particular Investor (both Retail and Institutional, jointly
named as “Investors”) should be made from appropriate bank account. This Investor should be the owner or co-owner
of above bank account.

 

In
the event of the Offering cancelation or any other situation, which will cause the necessity to return payments to the Investors,
the Offering Agent will return whole amount of payments to all Investors. The return will be done on appropriate Investor’s
bank account indicated by particular Investor within 7 business days from informing by the Offering Agent of the Offering cancelation
or other situation, which will cause the necessity to return payments to the Investors. The payments shall be returned without
any reimbursement for costs incurred by the Investors in the course of subscribing for Offered Shares, and be net of all transfer
expenses and without interest.

 

All
payments for Offered Shares by the Investors may be made only in PLN.

 

Any
overpayments (either as a result of lack of Allotment of Offered Shares or as a result of any proportional reduction) will start
to be returned not later than seven business days after the Allotment Date without any interest or any other compensation.

 

A
subscription placed without any payment will be invalid. A subscription placed with partial payment will be valid with respect
to such number of Offered Shares for which payment has been made.

 

Investors
who were initially allocated Offered Shares are obliged to pay the Offer Price with respect of such Offered Shares not later than
on the last day of subscription period for Institutional Investors. The amount of the payment should be equal to the multiple
of the number of Offered Shares for which the Investor is placing the subscription order at the Offer Price. The Offering Agent
accepting subscription orders may charge the brokerage commission, if any, for execution of this action.

 

Investors
will be required to pay an amount in PLN corresponding to the number of Offered Shares initially allocated to such Investor multiplied
by the Offer Price. Payment for the Offered Shares has to be made from the banking account owned or co-owned by particular Investor.

 

    	10

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