Document:

Exhibit
4.12

 

FORM
OF

ADIAL
PHARMACEUTICALS, INC.

STOCK
OPTION GRANT NOTICE

 

Adial
Pharmaceuticals, Inc. (the “Company”), pursuant to its 2017 Equity Incentive Plan (the “Plan”),
hereby grants to Optionholder an option to purchase the number of shares of the Company’s Common Stock set forth below.
This option is subject to all terms and conditions as set forth herein and in the related Option Agreement, the Plan and the Notice
of Exercise, each of which are attached hereto and incorporated herein in their entirety.

 

	 	Optionholder:	 	 
	 	Date of Grant:	 	 
	 	Vesting Commencement
    Date:	 	 
	 	Number of Shares Subject
    to Option:	 	 
	 	Exercise Price (Per
    Share):	 	 
	 	Total Exercise Price:	 	 
	 	Expiration Date:	 	 

 

	Type
    of Grant:	☐	  Incentive
    Stock Option1	☐	Nonstatutory Stock
    Option

 

	Vesting
    Schedule:	 
	 	 
	Payment:	By one or a combination
    of the following items (described in the Option Agreement):
	 	 
	 	☐    By
    cash or check
	 	☐    By
delivery of already owned shares 

 

Additional
Terms/Acknowledgements: Optionholder acknowledges receipt of, and understands and agrees to, this Stock Option Grant Notice,
the Option Agreement and the Plan. Optionholder acknowledges and agrees that this Stock Option Grant Notice and the Option Agreement
may not be modified, amended or revised except as provided in the Plan. Optionholder further acknowledges that as of the Date
of Grant, this Stock Option Grant Notice, the Option Agreement, and the Plan set forth the entire understanding between Optionholder
and the Company regarding this option award and supersede all prior oral and written agreements, promises and/or representations
on that subject with the exception of (i) options previously granted and delivered to Optionholder, (ii) any compensation
recovery policy that is adopted by the Company or is otherwise required by applicable law, and (iii) any written employment
or severance arrangement that would provide for vesting acceleration of this option upon the terms and conditions set forth therein.
By accepting this option, Optionholder consents to receive such documents by electronic delivery and to participate in the Plan
through an on-line or electronic system established and maintained by the Company or another third party designated by the Company.

  

1
If this is an Incentive Stock Option, it (plus other outstanding Incentive Stock Options) cannot be first exercisable
for more than $100,000 in value (measured by exercise price) in any calendar year. Any excess over $100,000 is a Nonstatutory
Stock Option.

  

     

     

    

  

	Adial
    Pharmaceuticals, Inc.	 	 	Optionholder
	 	 	 	 	 
	By:	 	 	 	 
	 	Signature	 	 	Signature
	 	 	 	 	 
	Title:	 	 	Date: 	 
	 	 	 	 	 
	Date:	 	 	 	 

 

Attachments:
Option Agreement, Notice of Exercise and 2017 Equity Incentive Plan.

  

    	 	2	 

     

    

 

FORM
OF

ADIAL
PHARMACEUTICALS, INC.

OPTION
AGREEMENT

(INCENTIVE
STOCK OPTION OR NONSTATUTORY STOCK OPTION)

 

Pursuant
to your Stock Option Grant Notice (“Grant Notice”) and this Option Agreement, Adial Pharmaceuticals,
Inc. (the “Company”) has granted you an option under its 2017 Equity Incentive Plan (the “Plan”)
to purchase the number of shares of the Company’s Common Stock (the “Company Stock”) indicated
in your Grant Notice at the exercise price indicated in your Grant Notice. Defined terms not explicitly defined in this Option
Agreement but defined in the Plan shall have the same definitions as in the Plan.

 

The
details of your option are as follows:

 

1.          VESTING
SCHEDULE. Your option shall vest and become exercisable at the time or times set forth in the accompanying Grant Notice.  In
the event of a Change in Control, vesting of your option (if any) shall be as set forth in the Plan unless vesting upon a Change
in Control is set forth in the Grant Notice, in which case the Grant Notice will govern the option vesting schedule notwithstanding
the provisions of Section 15 herein.

 

2.          NUMBER
OF SHARES AND EXERCISE PRICE. The number of shares of Company Stock subject to your option and your exercise price per share
referenced in your Grant Notice may be adjusted from time to time for certain events, including such as stock dividends, split
ups, mergers, spin-offs and the other events specified in the Plan.

 

3.          METHOD
OF PAYMENT. Payment of the exercise price is due in full upon exercise of all or any part of your option. You may elect to
make payment of the exercise price in cash or by check or by delivery to the Company of certificates representing shares of outstanding
Company Stock already owned by you that are owned free and clear of any liens, claims, encumbrances or security interests together
with stock powers duly executed and with signature guaranteed. In the event payment is made by delivery of such shares, said shares
shall be deemed to have a per share value equal to the per share market value of the shares on the date of exercise. Notwithstanding
the foregoing, you may not exercise your option by tender to the Company of Company Stock to the extent such tender would violate
the provisions of any law, regulation or agreement restricting the redemption of the Company’s stock.

 

4.          WHOLE
SHARES. You may exercise your option only for whole shares of Company Stock.

 

5.          SECURITIES
LAW COMPLIANCE. Notwithstanding anything to the contrary contained herein, you may not exercise your option unless the shares
of Company Stock issuable upon such exercise are then registered under the Securities Act or, if such shares of Company Stock
are not then so registered, the Company has determined that such exercise and issuance would be exempt from the registration requirements
of the Securities Act. The exercise of your option also must comply with other applicable laws and regulations governing your
option, and you may not exercise your option if the Company determines that such exercise would not be in material compliance
with such laws and regulations.

 

6.          TERM.
You may not exercise your option before the commencement or after the expiration of its term. The term of your option commences
on the Date of Grant and unless otherwise specified in the Grant Notice expires upon the earliest of:

 

(a)          Pursuant
to the terms of your employment or consulting arrangement;

 

(b)          The
Expiration Date indicated in your Grant Notice; or

 

(c)          
The day before the tenth (10th) anniversary of the Date of Grant.         

 

If
your option is an Incentive Stock Option, note that to obtain the federal income tax advantages associated with an Incentive Stock
Option, the Code requires that at all times beginning on the Date of Grant of your option and ending on the day three (3) months
before the date of your option’s exercise, you must be an employee of the Company or an Affiliate (defined as any “parent”
or “subsidiary” of the Company as such terms are defined in Rule 405 of the Securities Act), except in the event of
your death or Disability.

 

    	 	3	 

     

    

 

7.          EXERCISE.

 

(a)          You
may exercise the vested portion of your option during its term or as set forth in Section 1, if applicable, by delivering the
attached Notice of Exercise together with the exercise price to the Chief Financial Officer of the Company, or to such other person
as the Company may designate, during regular business hours, together with such additional documents as the Company may then require.
Each election to exercise this option shall be in writing, signed by you, and delivered or mailed to the Chief Financial Officer
of the Company at its principal office, 204 E. High Street, Charlottesville, Virginia 22902. The address for and the recipient
of such Notice of Exercise may be changed in the Company’s sole discretion and any such changes will be communicated to
you. In the event an option is exercised by the executor or administrator of your estate, by a Beneficiary, or by the person or
person to whom the option has been transferred by your will or the applicable laws of descent and distribution, the Company shall
be under no obligation to deliver Company Stock thereunder unless and until the Company is satisfied that the person or person
exercising the option is or are your duly appointed executor or administrator or the person to whom the option has been transferred
by your will or by the applicable laws of descent and distribution.

 

(b)          By
exercising your option you agree that, as a condition to any exercise of your option, the Company may require you to enter into
an arrangement providing for the payment by you to the Company of any tax withholding obligation of the Company arising by reason
of (1) the exercise of your option, (2) the lapse of any substantial risk of forfeiture to which the shares of Company Stock are
subject at the time of exercise, or (3) the disposition of shares of Company Stock acquired upon such exercise.

 

(c)          If
your option is an Incentive Stock Option, by exercising your option you agree that you will notify the Company in writing within
fifteen (15) days after the date of any disposition of any of the shares of the Company Stock issued upon exercise of your option
that occurs within two (2) years after the date of your option grant or within one (1) year after such shares of Company Stock
are transferred upon exercise of your option.

 

8.           PAYMENT.

 

(a)          Payment
in full by a certified or bank check should be made for all the shares of which your option is exercised at the time of such exercise,
and no shares shall be delivered until such payment is made.

 

(b)          Alternatively,
payment may be made by delivering to the Company shares of outstanding Company Stock of the Company together with stock powers
duly executed and with signature guaranteed. In the event payment is made in whole or in part by such shares, said shares shall
be deemed to have a per share value equal to the closing price of the shares on the last trading day immediately preceding the
date the shares are then being issued.

 

(c)          The
Company shall not be obligated to deliver any Company Stock unless and until: (1) all applicable Federal and state laws and regulations
have been complied with; and (2) the shares to be delivered have been listed, or authorized to be added to the list by the applicable
exchange where they are listed.

and
(3) all legal matters in connection with the issuance and delivery of the shares of Company Stock have been approved by counsel
for the Company. You shall have no rights as a shareholder until the Company Stock is actually delivered to you.

 

9.         TRANSFERABILITY.

 

(a)          If
your option is an Incentive Stock Option, your option is not transferable, except by will or by the laws of descent and distribution,
and is exercisable during your life only by you. Notwithstanding the foregoing, you shall have the right to designate a Beneficiary
or Beneficiaries who shall be entitled to any rights, payments or other benefits specified under the option following your death,
or in the absence of an authorized Beneficiary designation, by the legatee of the option under your will or by your estate in
accordance with your will or the laws of descent and distribution, in each case in the same manner and to the same extent that
the option was exercisable by you on the date of your death.

 

    	 	4	 

     

    

 

(b)          If
your option is a Nonstatutory Stock Option, your option is not transferable, except (i) by will or by the laws of descent and
distribution, (ii) by instrument to a Beneficiary, (iii) by instrument to an inter vivos or testamentary trust (or other
entity) in which the option is to be passed to your designated beneficiaries; and (iv) with the prior written approval of the
Company, by gift, in a form acceptable by the Company.

 

10.         OPTION
NOT A SERVICE CONTRACT. Your option is not an employment or service contract, and nothing in your option shall be deemed to
create in any way whatsoever any obligation on your part to continue in the employ of the Company or an affiliate, or of the Company
or an affiliate to continue your employment. In addition, nothing in your option shall obligate the Company or an affiliate, their
respective stockholders, Boards of Directors, officers or employees to continue any relationship that you might have as a Director
or consultant for the Company or an affiliate.

 

11.         WITHHOLDING
OBLIGATIONS.

 

(a)          At
the time you exercise your option, in whole or in part, or at any time thereafter as requested by the Company, you hereby authorize
withholding from payroll and any other amounts payable to you, and otherwise agree to make adequate provision for any sums required
to satisfy the federal, state, local and foreign tax withholding obligations of the Company or an affiliate, if any, which arise
in connection with the exercise of your option.

 

(b)          Upon
your request and subject to approval by the Company, in its sole discretion, and compliance with any applicable legal conditions
or restrictions, the Company may withhold from fully vested shares of Company Stock otherwise issuable to you upon the exercise
of your option a number of whole shares of Company Stock having a fair market value, determined by the Company as of the date
of exercise based on the closing price of the shares on the last trading day immediately preceding the date the shares are then
being issued, not in excess of the minimum amount of tax required to be withheld by law (or such lower amount as may be necessary
to avoid classification of your option as a liability for financial accounting purposes). If the date of determination of any
tax withholding obligation is deferred to a date later than the date of exercise of your option, share withholding pursuant to
the preceding sentence shall not be permitted unless you make a proper and timely election under Section 83(b) of the Code, covering
the aggregate number of shares of Company Stock acquired upon such exercise with respect to which such determination is otherwise
deferred, to accelerate the determination of such tax withholding obligation to the date of exercise of your option. Notwithstanding
the filing of such election, shares of Company Stock shall be withheld solely from fully vested shares of Company Stock determined
as of the date of exercise of your option that are otherwise issuable to you upon such exercise. Any adverse consequences to you
arising in connection with such share withholding procedure shall be your sole responsibility.

 

(c)          You
may not exercise your option unless the tax withholding obligations of the Company and/or any affiliate are satisfied. Accordingly,
you may not be able to exercise your option when desired even though

your
option is vested, and the Company shall have no obligation to issue a certificate for such shares of Company Stock or release
such shares of Company Stock from any escrow provided for herein unless such obligations are satisfied.

 

13.         TAX
CONSEQUENCES. You hereby agree that the Company does not have a duty to design or administer the Plan or its other compensation
programs in a manner that minimizes your tax liabilities. You shall not make any claim against the Company, or any of its officers,
directors, employees or affiliates related to tax liabilities arising from your option or your other compensation. In particular,
you acknowledge that this option is exempt from Section 409A of the Code only if the exercise price per share specified in the
Grant Notice is at least equal to the Fair Market Value per share of the Company Stock on the Date of Grant and there is no other
impermissible deferral of compensation associated with the option.

 

14.         NOTICES.
Any notices provided for in your option or the Plan shall be given in writing and shall be deemed effectively given upon receipt
or, in the case of notices delivered by mail by the Company to you, five (5) days after deposit in the United States mail, postage
prepaid, addressed to you at the last address you provided to the Company.

 

    	 	5	 

     

    

 

15.         GOVERNING
PLAN DOCUMENT. Your option is subject to all the provisions of the Plan, the provisions of which are hereby made a part of
your option, and is further subject to all interpretations, amendments, rules and regulations, which may from time to time be
promulgated and adopted pursuant to the Plan. In the event of any conflict between the provisions of your option and those of
the Plan, the provisions of the Plan shall control.

 

16.         RIGHTS
OF OPTIONEE. This Agreement does not entitle you to any voting rights or, except for the foregoing notice provisions, any
other rights as a stockholder of the Company. No dividends are payable or will accrue on your option or the shares of Company
Stock purchasable under this Agreement until, and except to the extent that, your option are exercised. Upon the surrender of
your option and payment of the Exercise Price as provided above, the person or entity entitled to receive the shares of the Company
Stock issuable upon such exercise shall be treated for all purposes as the record holder of such shares as of the close of business
on the date of the surrender of your option for exercise as provided above. Upon the exercise of your option, you shall have all
of the rights of a stockholder in the Company.

 

17.         GOVERNING
LAW. This Agreement shall be governed by, construed and enforced in accordance with the laws of the State of Delaware without
giving effect to its principles governing conflicts of law.

  

    	 	6	 

     

    

 

NOTICE
OF EXERCISE

 

ADIAL
PHARMACEUTICALS, INC.

 

	 	Date of
    Exercise:	 

 

Ladies
and Gentlemen:

 

This
constitutes notice under my stock option that I elect to purchase the number of shares for the price set forth below.

 

	 	Type of
    option (check one):		Incentive
    Stock Option		Nonstatutory
    Stock Option

 

	 	Stock option dated:	 	 
	 	 	 	 
	 	Number
        of shares as to which option

        is
        exercised:
	 	 
	 	 	 	 
	 	Certificates to be
    issued in name of:	 	 
	 	 	 	 
	 	Total
    exercise price:	$	 	 
	 	 	 	 
	 	Cash payment delivered
    herewith:	$	 	 

 

	 	Value of _______ shares
    of 	 	 
	 	Adial Pharmaceuticals,
    Inc.2:	$	                          	 

 

By
this exercise, I agree: (i) to provide such additional documents as you may require pursuant to the terms of the 2017 Equity Incentive
Plan; (ii) to provide for the payment by me to you (in the manner designated by you) of your withholding obligation, if any, relating
to the exercise of this option; and (iii) if this exercise relates to an incentive stock option, to notify you in writing within
fifteen (15) days after the date of any disposition of any of the shares of Company Stock issued upon exercise of this option
that occurs within two (2) years after the date of grant of this option or within one (1) year after such shares of Company Stock
are issued upon exercise of this option.

 

Very
truly yours,

 

 

 

 

 

 

 

2
Shares must be valued in accordance with the terms of the option being exercised, and must be owned free and clear of any
liens, claims, encumbrances or security interests. Certificates must be endorsed or accompanied by an executed assignment separate
from certificate.

 

 

7Exhibit 4.13

 

ADial
Pharmaceuticals, LLC

Option
Agreement

 

	Recipient:	___________________
    (“Recipient”)
	Option
    for:	______________
    Class A Units (the “Units”)
	Exercise
    Price:	$___________________
    per Unit (the “Exercise Price”)
	Effective
    Date:	___________________
    (the “Effective Date”)
	Expiration
    Date:	___________________
    (the “Expiration Date”)

 

THIS
OPTION AGREEMENT (this “Agreement”) is made and entered into effective as the Effective Date by and between ADial
Pharmaceuticals, LLC, a limited liability company organized under the laws of the Commonwealth of Virginia (the “Company”),
and Recipient.

 

All
capitalized terms used herein shall have the same meaning that they have in the Company’s Second Amended and Restated Operating
Agreement dated February 3, 2014 (the “Operating Agreement”), unless otherwise indicated or unless the context otherwise
requires. As used herein, the terms “employ”, “employed”, “employment” refer to and mean the
obligation to provide services to the Company or the holding of office in the Company as a director, officer, employee or consultant,
as applicable. For clarity, if Recipient is a non-employee director, a non-employee officer or a consultant, use of these terms
herein does not confer or imply an employee relationship between the Company and Recipient as that term is used in the context
of labor applications.

 

WITNESSETH:

 

WHEREAS
the Company desires to give its directors, officers, employees and consultants an added incentive to promote the growth of the
Company through the participation in the equity of the Company;

 

WHEREAS,
the Company desires to grant to Recipient an option to purchase the Units, on the terms and conditions hereinafter set forth;

 

NOW,
THEREFORE, for and in consideration of the premises and the mutual agreements and covenants hereinafter set forth and of other
good and valuable consideration, the receipt, adequacy and sufficiency of which are hereby acknowledged, the parties hereto agree
as follows:

 

1.       GRANT
OF OPTION. Subject to the terms and conditions of this Agreement, including the vesting provisions of Section 3 below, the
Company hereby grants to Recipient the right and option (the “Option”) to purchase the Units, subject to the terms herein,
including, without limitation, the vesting provisions set forth in Section 3 herein.

 

The
Units which are subject to the Option are sometimes referred to herein as the “Option Units.”

 

    

    

    

 

2.       OPTION.

 

(a)       Option
Price. The price to purchase each Option Unit shall be the Exercise Price.

 

(b)       Exercise
of Option. Subject to subparagraph (f) hereof, Recipient may exercise this Option with respect to all or any portion of his
vested Option Units at any time prior to the Expiration Date.

 

(c)       Manner
of Exercise. This Option may be exercised by delivering written notice of exercise in the form of the Exercise Letter, a form
of which is at Exhibit A, paying the purchase price set forth herein, and by delivering a completed Member Signature Page, a form
of which is attached as Exhibit B, binding Recipient into the Operating Agreement to the Chief Executive Officer of the Company,
in person, or by mail, postage prepaid, addressed to the attention of the Chief Executive Officer at the location at which the
Company then maintains its principal office, and if so mailed, the date of mailing will be considered the date of exercise.

 

(d)       Person
Who May Exercise Option. During the lifetime of Recipient, this Option shall be exercisable only by Recipient, or if Recipient
is disabled, by his duly appointed guardian or legal representative.

 

(e)       Operating
Agreement. In accordance with the Company’s Operating Agreement, all Units of the Company are subject to certain restrictions.
Upon the exercise of an Option, Recipient (or his or her guardian, legal representative or personal representative, as applicable)
agrees to execute and be bound by the terms and conditions of such Operating Agreement, as a precondition of being issued any
Units.

 

(f)       Termination
of Option. Notwithstanding any other provisions to the contrary, this Option, to the extent that it has not previously been
exercised or that Recipient’s employment has been terminated for any reason, including termination by resignation or by
reason of death or disability, prior to vesting (which will terminate this Option), will terminate upon the Expiration Date hereof.

 

3.       VESTING.
The Option granted hereunder will vest as follows: while Recipient is employed by that Company, 1/6th will vest on
the first day of the month that begins on or after the date 6 months after the Effective Date (the “Initial Vesting Date”),
and, thereafter 1/36th will vest monthly on the first day of each month following the Initial Vesting Date for 30 months
in equal 1/36th increments so that the Option will be fully vested on the first day of the month that begins on or
after the date 36 months after the Effective Date. In the event of a Liquidity Event (defined below), the Option shall fully vest
simultaneously with such Liquidity Event unless such Liquidity Event is as part of an Adjusting Event (defined in Section 5 below)
with the intent of facilitating a public offering of securities of the Company. For purposes of this Agreement a “Liquidity
Event” means (i) any transaction or series of related transactions by the Company or its equity holders in which a majority
of the voting power of the members is transferred to one or more persons who were not previously equity holders of the Company,
(ii) any merger or consolidation of the Company with or into any other entity, after which the members of the Company do not hold,
either directly or indirectly, a majority of the voting equity of the surviving entity, or (iii) a sale of all or substantially
all of the operating assets of the Company.

 

    2

    

    

 

4.       TRANSFERABILITY.
This Agreement and any rights hereunder shall be nontransferable and nonassignable by Recipient, except that it may be transferred
in the event of Recipient’s death to Recipient’s heirs.

 

5.       ADJUSTMENT
OF UNITS. In the event of any recapitalization, reclassification, split-up or consolidation of, or other change in, the Units,
or an exchange of the outstanding Units of the Company, in connection with a merger, consolidation, reincorporation or other reorganization
of the Company for a different number of Units or for shares of stock or other securities of the Company or for Units or other
securities of the other company (an “Adjusting Event”), then the Board of Directors shall, in such manner as they
shall determine in their sole discretion, appropriately adjust the number of the Option Units or the number of Units or other
securities that shall then be subject to this Option and/or the Exercise Price per Unit or share that must be paid thereafter
upon exercise of this Option and may, in such manner as they shall determine in their sole discretion, modify this agreement to
take into account the new structure and entity, including, without limitation, potentially binding the Option under an option
plan as then approved or placing restrictions on the sale and/or registration of securities acquired under this Agreement.

 

6.       INVESTMENT
REPRESENTATION. Recipient hereby represents, warrants and agrees that:

 

(a)       He
understands the offer of Units under this Agreement is made pursuant to a claim of exemption from the registration provisions
of the Securities Act of 1933, as amended (the “Act”) and applicable state securities law;

 

(b)       The
Company is not obligated to issue Units upon exercise of this Option until there has been compliance with any Federal or state
laws or regulations that the Company may deem applicable;

 

(c)       The
Option Units will be purchased for his own account for investment purposes only and not with a view to resale or distribution
thereof;

 

(d)       The
Option Units may be unregistered and, if so, will be required to be held indefinitely, unless such Units are subsequently registered
or an exemption from registration is then available; and

 

(e)       The
Company is under no obligation to register the Option Units, to comply with any such exemption or to supply Recipient with any
information necessary to enable him to make routine sales of such Units under Rule 144 or any other rule or regulation of the
Securities and Exchange Commission.

 

7.       NO
RIGHTS AS MEMBER OR TO EMPLOYMENT. The Recipient shall not have any interest in or membership rights with respect to any Units
that are subject to this Option until such Units have been issued and delivered to Recipient pursuant to the exercise of this
Option. Furthermore, this Option does not confer upon Recipient any rights of employment with the Company, including without limitation
any right to continue in the employ of the Company, nor does it affect the right of the Company to terminate the services provided
by Recipient as a Director of the Company at any time, with or without cause, or to continue or alter the terms of such services.

 

    3

    

    

 

8.       DRAG-ALONG
PROVISIONS. The Company shall have the right, but not the obligation, to “call”, effective immediately prior to
a Liquidity Event (defined below), any and all unexercised portions of the Option, as fully vested in accordance with Section
3 above, and to issue, subject to all terms and conditions of the Operating Agreement, to Recipient such Units to which Recipient
would be entitled upon Recipient’s exercise of the fully vested Option. Upon the Company’s exercise of such call right,
the Exercise Price under this Agreement for such Units shall be immediately due and payable to the Company, and the Company shall
be entitled (i) to deduct such price from any amounts due to Recipient or (ii) to effect a redemption of such number of Units
at fair market value (reasonably determined in the discretion of the Board of Directors) as shall be necessary to pay such purchase
price. Notwithstanding any other provision of this Agreement, the purchase price of Units issued upon exercise of the Company’s
call right shall be no greater than the fair market value of such Units. The Recipient agrees to execute such documentation as
is reasonably requested to document the issuance of Units to Recipient, including, but not limited to, the Operating Agreement
then in effect.

 

9.       WITHHOLDING
TAXES. As a condition of exercise of this Option, the Company may, in its sole discretion, withhold or require Recipient to
pay or reimburse the Company for any taxes which the Company determines are required to be withheld in connection with the grant
or any exercise of this Option. The Recipient understands that the Option granted hereunder does not qualify for favorable tax
treatment under Section 422 of the Internal Revenue Code as an “incentive stock option.”

 

10.       HEIRS
AND SUCCESSORS. This Agreement and all terms and conditions hereof shall be binding upon the Company and its successors and
assigns, and upon Recipient and his or her heirs, legatees and legal representatives.

 

11.       GOVERNING
LAW. This Agreement shall be interpreted, governed, and enforced in accordance with the laws of the Commonwealth of Virginia,
notwithstanding its choice of law principles. The invalidity or unenforceability of any portion hereof shall in no way affect
the validity or enforceability of any other portion of this Agreement, and any portion held to be invalid or unenforceable shall
be deemed modified, restricted, or omitted to the extent necessary to make this Agreement enforceable.

 

IN
WITNESS WHEREOF, the Company has caused this Agreement to be executed by its duly authorized representative and Recipient has
executed this Agreement, all as of the date and year first above written.

 

	ADial Pharmaceuticals, LLC	 	Recipient
	 	 	 	 	 
	By: 	 	 	By: 	 
	 	William B. Stilley, CEO	 	 	[NAME]

 

    4

    

    

 

Exhibit A

 

Option
Exercise Letter

 

_____________,
20__

 

ADial
Pharmaceuticals, L.L.C.

204
E. High St.

Charlottesville,
VA 22902

Attention:
CEO

 

Gentlemen:

 

In
connection with my purchase of ______________ membership units (the “Units”) of ADial Pharmaceuticals, L.L.C., a Virginia
limited liability company (the “Company”) pursuant and subject to the terms and conditions of the option agreement
between me and the Company dated __________________, (the “Option Agreement”) and the Company’s Operating Agreement
of __________________, as amended (the “Operating Agreement”), I am delivering this investment letter. Unless otherwise
defined herein, capitalized terms used in this investment letter shall have the same meanings ascribed to them in the Operating
Agreement.

 

In
connection with my acquisition of Units in the Company, I represent and warrant the following:

 

(1)       I
understand that by virtue of this investment, I will have acquired a Membership Interest in the Company. Furthermore, I acknowledge
that I have received a copy of the Operating Agreement and agree to be bound by the terms and conditions therein.

 

(2)       I
have sufficient knowledge and experience in financial and business matters to be capable of evaluating the merits and risks of
this investment and understand and acknowledge that my rights and privileges with respect to the Units, including, without limitation,
any rights to transfer the Units, are all subject to the provisions of the Articles of Organization and the Operating Agreement
of the Company, as the same may be amended from time to time.

 

(3)       I
understand that this investment involves a high degree of risk because the Company has a limited operating history and that there
is no guarantee of profitability or continued operation of the Company.

 

(4)       I
am acquiring the Units pursuant to the terms of the Option Agreement entered into in connection with my serving as a Director
of the Company. I acknowledge that I am able to bear the economic risk of this investment, and that I might have to hold the Units
for an indefinite period of time, since the Units have not been registered. Furthermore, I acknowledge that I might have to bear
a complete economic loss, in the event that the business does not succeed.

 

(5)       In
making my decision to acquire Units of the Company, I have relied upon independent investigations made by me. I have taken the
opportunity to examine any and all documents and, to the extent I have deemed necessary, to ask pertinent questions and receive
answers, concerning the terms and conditions of my acquisition of such Units or any other matter pertaining to such investment,
and to obtain any additional information necessary to verify the accuracy of the information given to me.

 

    5

    

    

 

Exhibit A

 

(6)       I
understand that the Units will not be registered under the Securities Act of 1933, as amended (the “Act”), and that
the Units that I acquire cannot be sold to any person except pursuant to the terms of the Operating Agreement and in full compliance
with all applicable federal and state securities laws.

 

(7)       I
understand that no federal or state agency has passed upon the Units or made any finding or determination concerning the fairness
of this investment.

 

(8)       I
am acquiring the Units for my own investment account and have no intention, agreement or arrangement to redistribute, divide,
assign or transfer the Units or to sell them to any other person.

 

(9)       I
have reviewed with my own tax advisors the immediate and prospective federal, state, local and foreign tax consequences of this
investment, and I am relying solely on the statements of such advisors and not on the statements or representations of the Company
or any of its agents with respect to such tax consequences or any other matter. I have not relied on any advice given by the Company’s
legal counsel.

 

(10)       I
have adequate net worth and means of providing for my current and future needs and possible contingencies and have no need for
liquidity in this investment. My commitment to investments that are not readily marketable is not disproportionate to my net worth
and my investment in the Units covered by this letter and will not cause my overall commitment to become excessive.

 

(11)       The
foregoing representations and warranties shall survive my acquisition of the Units in the Company, and I agree to indemnify and
hold harmless the Company and its directors, officers, agents and representatives, for and from any and all losses, liabilities,
claims, damages and expenses, including, without limitation, attorneys fees and dispute costs, caused by my breach of any agreement,
representation or warranty contained herein or as a result of the reliance of the Company or any other indemnities on such agreement,
representation or warranty.

 

	 	Sincerely,	 
	 	 	 
	 	Signature:	 
	 	 	 
	 	Printed Name:	 

 

    6

    

    

 

Exhibit B

 

ADIAL
PHARMACEUTICALS, L.L.C.

MEMBER
SIGNATURE PAGE

 

In
consideration for the sale of LLC Units in ADial Pharmaceuticals, L.L.C., a Virginia limited liability company (the “LLC”),
by the LLC to the undersigned, the undersigned hereby approves and consents to, and agrees to be bound by, the terms of that certain
operating agreement of the ADial Pharmaceuticals, L.L.C. effective _________________, as may be amended and/or restated from time
to time (the “Operating Agreement”) and concurrently herewith enters into the Operating Agreement with all existing
members of the LLC by executing and delivering to the LLC this Member Signature Page.

 

Upon
the undersigned’s execution and delivery of this Member Signature Page, the undersigned’s delivery of all monies and/or
other items required by management of the LLC, and acceptance of this Member Signature Page by the LLC, the undersigned shall
become a Member of the LLC.

 

If
the undersigned is purchasing LLC Units jointly with another, all such joint owners must execute this Member Signature Page.

 

Effective
Date: ________________, 2017.

 

	Member Name:	 	 	Co-Member Name (if applicable):
	 	 	 	 	 
	 	 	 
	 	 	 	 	 
	Signed: 	 	 	Signed: 	 
	Print: 	 	 	Print: 	 
	
        Title (if required):
	 	 	
        Title (if required):
	 
	 	 	 	 	 
	 	 	 
	Fed.
Tax ID/Social Security Number

	 	Fed.
Tax ID/Social Security Number

	 	 	 
	
        Address:
	 	 	
        Address:
	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 	 	 
	Email Address:	 	 	Email Address:	 
	 	 	 	 	 
	 	 	 

 

	 	Accepted on behalf of ADial Pharmaceuticals, L.L.C.
	 	 	 
	 	By: 	 
	 	 	William B. Stilley
	 	 	CEO

 

 

7

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