Document:

FIRST AMENDMENT TO ACQUISITION AGREEMENT

 

This FIRST AMENDMENT TO ACQUISITION AGREEMENT
amends the Acquisition Agreement, dated as of August 16, 2012, made by and among SurePure Investment Holding AG and SurePure Holding
South Africa (Pty) Ltd. (the “Acquisition Agreement”).

 

The parties to the Acquisition Agreement
hereby agree to amend the Acquisition Agreement as follows:

 

		1.	The date December 31, 2012 referenced in Section 3.1 is hereby amended to read March 31, 2013.

 

		2.	The date December 31, 2012 referenced in Section 6 is hereby amended to read March 31, 2013.

 

		3.	In all other respects the Acquisition Agreement shall remain unamended and in full force and effect between the parties.

 

IN WITNESS WHEREOF, the Parties have signed
this First Amendment to Acquisition Agreement as of November 26, 2012.

 

	SUREPURE INVESTMENT HOLDING AG	 	SUREPURE HOLDINGS SOUTH AFRICA

(PTY) LIMITED	 
	 	 	 	 
	By	/s/ Stephen Robinson	 	By	/s/ Guy Kebble	 
	 	S M Robinson (Director)	 	G R Kebble (Director)SUREPURE INC.

 

2012 NONQUALIFIED STOCK OPTION PLAN

 

ARTICLE I

 

Purpose of Plan

 

This 2012 NONQUALIFIED
STOCK OPTION PLAN (the “Plan”) of SurePure Inc., a Nevada corporation (the “Company”) for persons employed
or associated with the Company, including without limitation any employee, director, general partner, officer, attorney, accountant,
consultant or advisor, is intended to advance the best interests of the Company by providing additional incentive to those persons
who have a substantial responsibility for its management, affairs, and growth by increasing their proprietary interest in the success
of the Company, thereby encouraging them to maintain their relationships with the Company.  Further, the availability
and offering of Stock Options under the Plan supports and increases the Company’s ability to attract, engage and retain individuals
of exceptional talent upon whom, in large measure, the sustained progress growth and profitability of the Company for the shareholders
depends.

 

ARTICLE II

 

Definitions

 

For Plan purposes,
except where the context might clearly indicate otherwise, the following terms shall have the meanings set forth below:

 

“Board”
shall mean the Board of Directors of the Company.

 

“Code” shall
mean the Internal Revenue Code of 1986, as amended, and the rules and regulations promulgated thereunder.

 

“Committee”
shall mean the Compensation Committee, or such other committee appointed by the Board, which shall be designated by the Board to
administer the Plan.  The Committee shall be composed of one or more persons as from time to time are appointed to serve
by the Board and may be members of the Board.

 

    	1

    	 

    

 

“Common Shares”
shall mean the Company’s Common Shares $0.001 par value per share, or, in the event that the outstanding Common Shares are
hereafter changed into or exchanged for different shares or securities of the Company, such other shares or securities.

 

“Company”
shall mean SurePure Inc., a Nevada corporation, and any parent or subsidiary corporation of SurePure Inc., as such terms are defined
in Section 425(e) and 425(f), respectively of the Code.

 

“Optionee”
shall mean any person employed or associated with the affairs of the Company who has been granted one or more Stock Options under
the Plan.

 

“Stock Option”
or “NQSO” shall mean a stock option granted pursuant to the terms of the Plan.

 

“Stock Option Agreement”
shall mean the agreement between the Company and the Optionee under which the Optionee may purchase Common Shares hereunder.

 

ARTICLE III

 

Administration of the Plan

 

1.   The
Committee shall administer the plan and, accordingly, it shall have full power to grant Stock Options, construe and interpret the
Plan, establish rules and regulations and perform all other acts, including the delegation of administrative responsibilities,
it believes reasonable and proper.

 

2.   The
determination of those eligible to receive Stock Options, and the amount, price, type and timing of each Stock Option and the terms
and conditions of the respective stock option agreements shall rest in the sole discretion of the Committee, subject to the provisions
of the Plan.

 

3.   The
Committee may cancel any Stock Options awarded under the Plan if an Optionee conducts himself in a manner which the Committee determines
to be inimical to the best interest of the Company and its shareholders as set forth more fully in paragraph 8 of Article X of
the Plan.

 

4.   The
Board, or the Committee, may correct any defect, supply any omission or reconcile any inconsistency in the Plan or in any granted
Stock Option, in the manner and to the extent it shall deem necessary to carry it into effect.

 

    	2

    	 

    

 

5.   Any
decision made, or action taken, by the Committee or the Board arising out of or in connection with the interpretation and administration
of the Plan shall be final and conclusive.

 

6.   Meetings
of the Committee shall be held at such times and places as shall be determined by the Committee.  A majority of the members
of the Committee shall constitute a quorum for the transaction of business, and the vote of a majority of those members present
at any meeting shall decide any question brought before that meeting.  In addition, the Committee may take any action
otherwise proper under the Plan by the affirmative vote, taken without a meeting, of a majority of its members.

 

7.   No member
of the Committee shall be liable for any act or omission of any other member of the Committee or for any act or omission on his/her
own part, including, but not limited to, the exercise of any power or discretion given to him/her under the Plan except those resulting
from his/her own gross negligence or willful misconduct.

 

8.   The
Company, through its management, shall supply full and timely information to the Committee on all matters relating to the eligibility
of Optionees, their duties and performance, and current information on any Optionee’s death, retirement, disability or other
termination of association with the Company, and such other pertinent information as the Committee may require.  The
Company shall furnish the Committee with such clerical and other assistance as is necessary in the performance of its duties hereunder.

 

ARTICLE IV

 

Shares Subject to the Plan

 

1.   The
total number of shares of the Company available for grants of Stock Options under the Plan shall be 3,000,000 Common Shares, subject
to adjustment as herein provided, which shares may be either authorized but unissued or reacquired Common Shares of the Company.

 

2.   If a
Stock Option or portion thereof shall expire or terminate for any reason without having been exercised in full, the unpurchased
shares covered by such NQSO shall be available for future grants of Stock Options.

 

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ARTICLE V

 

Stock Option Terms and Conditions

 

1.   Consistent
with the Plan’s purpose, Stock Options may be granted to any person who is performing or who has been engaged to perform
services of special importance to management in the operation, development and growth of the Company.

 

2.   Determination
of the option price per share for any Stock Option issued hereunder shall rest in the sole and unfettered discretion of the Committee.

 

3.   All
Stock Options granted under the Plan shall be evidenced by agreements which shall be subject to applicable provisions of the Plan,
and such other provisions as the Committee may adopt, including the provisions set forth in paragraphs 2 through 11 of this Article
V.

 

4.   All
Stock Options granted hereunder must be granted within ten years from the date this Plan is adopted.

 

5.   No Stock
Option granted hereunder shall be exercisable after the expiration of ten years from the date such NQSO is granted.  The
Committee, in its discretion, may provide that an option shall be exercisable during such ten year period or during any lesser
period of time.  The Committee may establish installment exercise terms for a Stock Option such that the NQSO becomes
fully exercisable in a series of cumulating portions.  If an Optionee shall not, in any given installment period, purchase
all the Common Shares which such Optionee is entitled to purchase within such installment period, such Optionee’s right to
purchase any Common Shares not purchased in such installment period shall continue until the expiration or sooner termination of
such NQSO.  The Committee may also accelerate the exercise of any NQSO.

 

6.   A Stock
Option, or portion thereof, shall be exercised by delivery of (i) a written notice of exercise to the Company specifying the number
of Common Shares to be purchased, and (ii) payment of the full price of such Common Shares, as fully set forth in paragraph 7 of
this Article V.  No NQSO or installment thereof shall be reusable except with respect to whole shares, and fractional
share interests shall be disregarded.  Not less than 100 Common Shares may be purchased at one time unless the number
purchased is the total number at the time available for purchase under the NQSO.  Until the Common Shares represented
by an exercised NQSO are issued to an Optionee, he/she shall have none of the rights of a shareholder.

 

7.   The
exercise price of a Stock Option, or portion thereof, may be paid:

 

A. In United States dollars, in
cash or by cashier’s check, certified check, bank draft or money order, payable to the order of the Company in an amount
equal to the option price; or,

 

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B. At the discretion of the Committee,
through the delivery of fully paid and nonassessable Common Shares, with an aggregate fair market value (determined as the average
of the highest and lowest reported sales prices on the Common Shares as of the date of exercise of the NQSO, as reported by such
responsible reporting service as the Committee may select, or if there were not transactions in the Common Shares on such day,
then the last preceding day on which transactions took place) as of the date of the NQSO exercise equal to the option price; or

 

C. By a combination
of both A and B above.

 

The Committee shall determine acceptable
methods for tendering Common Shares as payment upon exercise of a Stock Option and may impose such limitations and prohibitions
on the use of Common Shares to exercise an NQSO as it deems appropriate.

 

8.   With
the Optionee’s consent, the Committee may cancel any Stock Option issued under this Plan and issue a new NQSO to such Optionee.

 

9.   Except
by will, the laws of descent and distribution, or with the written consent of the Committee, no right or interest in any Stock
Option granted under the Plan shall be assignable or transferable, and no right or interest of any Optionee shall be liable for,
or subject to, any lien, obligation or liability of the Optionee.  Stock Options shall be exercisable (i) during the
Optionee’s lifetime only by the Optionee or assignees, or the duly appointed legal representative of an incompetent Optionee,
including following an assignment consented to by the Committee herein or (ii) after the Optionee’s lifetime by the duly
appointed legal representative of a deceased Optionee.

 

10. An NQSO shall be
treated as outstanding until it is either exercised in full or expires by reason of lapse of time.

 

11. Any Optionee who
disposes of Common Shares acquired on the exercise of a NQSO by sale or exchange either (i) within two years after the date of
the grant of the NQSO under which the stock was acquired, or (ii) within one year after the acquisition of such Shares, shall notify
the Company of such disposition and of the amount realized upon such disposition.  The transfer of Common Shares may
also be restricted by applicable provisions of the Securities Act of 1933, as amended (the “Securities Act”).

 

ARTICLE VI

 

Adjustments or Changes in Capitalization

 

1. Whenever the outstanding
Common Shares of the Company are hereafter changed into or exchanged for a different number of kinds of shares or other securities
of the Company by reason of merger, consolidation, other reorganization, recapitalization, reclassification, combination of shares,
stock split-up or stock dividend:

 

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A. Prompt, proportionate, equitable,
lawful and adequate adjustment shall be made of the aggregate number and kind of shares subject to Stock Options which may be granted
under the Plan, such that the Optionee shall have the right to purchase such Common Shares as may be issued in exchange for the
Common Shares purchasable on exercise of the NQSO had such merger, consolidation, other reorganization, recapitalization, reclassification,
combination of shares, stock split-up or stock dividend not taken place;

 

B. Rights under unexercised Stock
Options or portions thereof granted prior to any such change, both as to the number or kind of shares and the exercise price per
share, shall be adjusted appropriately, provided, that such adjustments shall be made without change in the total exercise
price applicable to the unexercised portion of such NQSO’s but by an adjustment in the price for each share covered by such
NQSO’s; or

 

C. Upon any dissolution or liquidation
of the Company or any merger or combination in which the Company is not a surviving corporation, each outstanding Stock Option
granted hereunder shall terminate, but the Optionee shall have the right, immediately prior to such dissolution, liquidation, merger
or combination, to exercise his/her NQSO in whole or in part, to the extent that it shall not have been exercised, without regard
to any installment exercise provisions in such NQSO.

 

2.   The
foregoing adjustment and the manner of application of the foregoing provisions shall be determined solely by the Committee, whose
determination as to what adjustments shall be made and the extent thereof, shall be final, binding and conclusive.  No
fractional Shares shall be issued under the Plan on account of any such adjustments.

 

ARTICLE VII

 

Merger, Consolidation or Tender Offer

 

1.   If the
Company shall become a party to a binding agreement to any merger, consolidation or reorganization or sale of substantially all
the assets of the Company, each outstanding Stock Option shall pertain and apply to the securities and/or property which a shareholder
of the number of Common Shares of the Company subject to the NQSO would be entitled to receive pursuant to such merger, consolidation
or reorganization or sale of assets.

 

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2.   Whenever:

 

A. any person other than the Company
shall acquire more than 20% of the Common Shares of the Company through a tender offer, exchange offer or otherwise;

 

B. a change in the “control”
of the Company occurs, as such term is defined in Rule 405 under the Securities Act; or

 

C. there
shall be a sale of all or substantially all of the assets of the Company;

 

then, any then outstanding Stock Option
held by an Optionee, who is deemed by the Committee to be a statutory officer (“insider”) for purposes of Section 16
of the Securities Exchange Act of 1934 shall be entitled to receive, subject to any action by the Committee revoking such an entitlement
as provided for below, in lieu of exercise of such Stock Option, to the extent that it is then exercisable, a cash payment in an
amount equal to the difference between the aggregate exercise price of such NQSO, or portion thereof, and, (i) in the event of
an offer or similar event, the final offer price per share paid for Common Shares, or such lower price as the Committee may determine
to conform an option to preserve its Stock Option status, times the number of Common Shares covered by the NQSO or portion thereof,
or (ii) in the case of an event covered by B or C above, the aggregate fair market value of the Common Shares covered by the Stock
Option, as determined by the Committee at such time.

 

3.   Any
payment which the Company is required to make pursuant to paragraph 2 of this Article VII, shall be made within fifteen (15) business
days, following the event which results in the Optionee’s right to such payment.  In the event of a tender offer
in which fewer than all the shares which are validity tendered in compliance with such offer are purchased or exchanged, then only
that portion of the shares covered by an NQSO as results from multiplying such shares by a fraction, the numerator of which is
the number of Common Shares acquired by purchase in the tender offer and the denominator of which is the number of Common Shares
tendered in compliance with such offer, shall be used to determine the payment thereupon.  To the extent that all or
any portion of a Stock Option shall be affected by this provision, all or such portion of the NQSO shall be terminated.

 

4.   Notwithstanding
paragraphs 1 and 3 of this Article VII, the Company may, by unanimous vote and resolution, unilaterally revoke the benefits of
the above provisions; provided, that such vote is taken no later than ten business days following public announcement of
the intent of an offer of the change of control, whichever occurs earlier.

 

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ARTICLE VIII

 

Amendment and Termination of Plan

 

1.   The
Board may at any time, and from time to time, suspend or terminate the Plan in whole or in part or amend it from time to time in
such respects as the Board may deem appropriate and in the best interest of the Company.

 

2.   No amendment,
suspension or termination of this Plan shall, without the Optionee’s consent, alter or impair any of the rights or obligations
under any Stock Option theretofore granted to him/her under the Plan.

 

3.   The
Board may amend the Plan, subject to the limitations cited above, in such manner as it deems necessary to permit the granting of
Stock Options meeting the requirements of future amendments or issued regulations, if any, to the Code.

 

4.   No NQSO
may be granted during any suspension of the Plan or after termination of the Plan.

 

ARTICLE IX

 

Government and Other Regulations

 

The obligation of the
Company to issue, transfer and deliver Common Shares for Stock Options exercised under the Plan shall be subject to all applicable
laws, regulations, rules, orders and approval which shall then be in effect and required by the relevant stock exchanges on which
the Common Shares are traded and by government entities as set forth below or as the Committee in its sole discretion shall deem
necessary or advisable.  Specifically, in connection with the Securities Act, upon exercise of any Stock Option, the
Company shall not be required to issue Common Shares unless the Committee has received evidence satisfactory to it to the effect
that the Optionee will not transfer such shares except pursuant to a registration statement in effect under such Act or unless
an opinion of counsel satisfactory to the Company has been received by the Company to the effect that such registration is not
required.  Any determination in this connection by the Committee shall be final, binding and conclusive.  The
Company may, but shall in no event be obligated to take any other affirmative action in order to cause the exercise of a Stock
Option or the issuance of Common Shares purchased thereto to comply with any law or regulation of any government authority.

 

ARTICLE X

 

Miscellaneous Provisions

 

1.   No person
shall have any claim or right to be granted a Stock Option under the Plan, and the grant of an NQSO under the Plan shall not be
construed as giving an Optionee the right to be retained by the Company.  Furthermore, the Company expressly reserves
the right at any time to terminate its relationship with an Optionee with or without cause, free from any liability, or any claim
under the Plan, except as provided herein, in any option agreement, or in any agreement between the Company and the Optionee.

 

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2.   Any
expenses of administering this Plan shall be borne by the Company.

 

3.   The
payment received from Optionee from the exercise of Stock Options under the Plan shall be used for the general corporate purposes
of the Company.

 

4.   The
place of administration of the Plan shall be in the State of Nevada and the validity, contraction, interpretation, administration
and effect of the Plan and its rules and regulations, and rights relating to the Plan, shall be determined solely in accordance
with the laws of the State of Nevada.

 

5.   Without
amending the Plan, grants may be made to persons who are foreign nationals or employed outside the United States, or both, on such
terms and conditions, consistent with the Plan’s purpose, different from those specified in the Plan as may, in the judgment
of the Committee, be necessary or desirable to create equitable opportunities given differences in tax laws in other countries.

 

6.   In addition
to such other rights of indemnification as they may have as members of the Board or Committee, the members of the Committee shall
be indemnified by the Company against all costs and expenses reasonably incurred by them in connection with any action, suit or
proceeding to which they or any of them may be party by reason of any action taken or failure to act under or in connection with
the Plan or any Stock Option granted thereunder, and against all amounts paid by them in settlement thereof (provided, that
such settlement is approved by independent legal counsel selected by the Company) or paid by them in satisfaction of a judgment
in any such action, suit or proceeding, except a judgment based upon a finding of bad faith; provided, that upon the institution
of any such action, suit or proceeding a Committee member shall in writing, give the Company notice thereof and an opportunity,
at its own expense, to handle and defend the same before such Committee member undertakes to handle and defend it on his/her own
behalf.

 

7.   Stock
Options may be granted under this Plan from time to time, in substitution for stock options held by employees of other corporations
who are about to become employees of the Company as the result of a merger or consolidation of the employing corporation with the
Company or the acquisition by the Company of the assets of the employing corporation or the acquisition by the Company of stock
of the employing corporation as a result of which it become a subsidiary of the Company.  The terms and conditions of
such substitute stock options so granted my vary from the terms and conditions set forth in this Plan to such extent as the Board
of Director of the Company at the time of grant may deem appropriate to conform, in whole or in part, to the provisions of the
stock options in substitution for which they are granted, but no such variations shall be such as to affect the status of any such
substitute stock options as a stock option under Section 422A of the Code.

 

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8.   Notwithstanding
anything to the contrary in the Plan, if the Committee finds by a majority vote, after full consideration of the facts presented
on behalf of both the Company the Optionee, that the Optionee has been engaged in fraud, embezzlement, theft, commission of a felony
or proven dishonesty in the course of his/her association with the Company or any subsidiary corporation which damaged the Company
or any subsidiary corporation, or for disclosing trade secrets of the Company or any subsidiary corporation, the Optionee shall
forfeit all unexercised Stock Options and all exercised NQSO’s under which the Company has not yet delivered the certificates
and which have been earlier granted the Optionee by the Committee.  The decision of the Committee as to the case of an
Optionee’s discharge and the damage done to the Company shall be final.  No decision of the Committee, however,
shall affect the finality of the discharge of such Optionee by the Company or any subsidiary corporation in any manner.  Further,
if Optionee voluntarily terminates employment with the Company or the Company terminates the Optionee’s employment for any
reason, the Optionee shall forfeit all unexercised stock options.

 

ARTICLE XI

 

Securities Regulations

 

The securities issued
pursuant to this Plan may not be resold except in compliance with the Securities Act.

 

ARTICLE XII

 

Written Agreement

 

Each Stock Option granted
hereunder shall be embodied in a written Stock Option Agreement which shall be subject to the terms and conditions prescribed above
and shall be signed by the Optionee and by the President or any Vice President of the Company, for and in the name and on behalf
of the Company.  Such Stock Option Agreement shall contain such other provisions as the Committee, in its discretion
shall deem advisable.

 

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ARTICLE XIII

 

Effective Date

 

This Plan shall become
unconditionally effective as of the date of approval of the Plan by the Board of Directors of the Company.  No Stock
Option may be granted later than ten (10) years from the effective date of the Plan; provided, that the Plan and all outstanding
Stock Options shall remain in effect until such NQSO’s have expired or until such options are canceled.

 

	Number of Shares:	 	 	Date of Grant:	 

 

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NONQUALIFIED STOCK OPTION AGREEMENT

 

AGREEMENT made this
_____ day of _____________, 20___, between _________________ _____________ (the “Optionee”), and SurePure
Inc., a Nevada corporation (the “Company”).

 

1.   Grant
of Option.  The Company, pursuant to the provisions of the SurePure Inc. 2012 Nonqualified Stock Option Plan (the
“2012 Stock Plan”), set forth as Attachment A hereto, hereby grants to the Optionee, subject to the terms and conditions
set forth or incorporated herein, an Option to purchase from the Company all or any part of an aggregate of ___________________
Common Shares, as such Common Shares are now constituted, at the purchase price of $________ per share.  The provisions
of the 2012 Stock Plan governing the terms and conditions of the Option granted hereby are incorporated in full herein by reference.

 

2.   Exercise.  The
Option evidenced hereby shall be exercisable in whole or in part (but only in multiples of 100 Shares unless such exercise is as
to the remaining balance of this Option) on or after _______________ and on or before _______________, provided that the cumulative
number of Common Shares as to which this Option may be exercised (except as provided in paragraph 1 of Article VI of this 2012
Stock Plan) shall not exceed the following amounts:

 

 

	 	Cumulative Number	 	 	Prior to Date	 
	 	 	 	 	 	 
	 	of Shares	 	 	(Not Inclusive of)	 
	 	 	 	 	 	 
	 	 	 	 	 	 
	 	 	 	 	 	 

 

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The Option evidenced hereby shall be exercisable
by the delivery to and receipt by the Company of (i) a written notice of election to exercise, in the form set forth in Attachment
B hereto, specifying the number of shares to be purchased; (ii) accompanied by payment of the full purchase price thereof in case
or certified check payable to the order of the Company, or by fully-paid and nonassessable Common Shares of the Company properly
endorsed over to the Company, or by a combination thereof; and, (iii) by return of this Stock Option Agreement for endorsement
of exercise by the Company on Schedule I hereof.  In the event fully paid and nonassessable Common Shares are submitted
as whole or partial payment for Shares to be purchased hereunder, such Common Shares will be valued at their Fair Market Value
(as defined in the 2012 Stock Plan) on the date such Shares are received by the Company and applied to payment of the exercise
price.

 

3.   Transferability.  The
Option evidenced hereby is NOT assignable or transferable by the Optionee other than by the Optionee’s will, by the laws
of descent and distribution, as provided in paragraph 9 of Article V of the 2012 Stock Plan.  The Option shall be exercisable
only by the Optionee during his/her lifetime.

 

	 	 	SUREPURE INC.
	 	 	 
	 	BY:	 
	 	 	 
	 	 	______________, President

 

	ATTEST:	 
	 	 
	 	 
	Secretary	 

 

Optionee hereby acknowledges receipt of
a copy of the 2012 Stock Plan, attached hereto and accepts this Option subject to each and every term and provision of such Plan.  Optionee
hereby agrees to accept as binding, conclusive and final, all decisions or interpretations of the Compensation Committee of the
Board of Directors administering the 2012 Stock Plan on any questions arising under such Plan.  Optionee recognizes that
if Optionee’s employment with the Company or any subsidiary thereof shall be terminated with cause, or by the Optionee, all
of the Optionee’s rights hereunder shall thereupon terminate; and that, pursuant to paragraph 10 of Article V of the 2012
Stock Plan, this Option may not be exercised while there is outstanding to Optionee any unexercised Stock Option, granted to Optionee
before the date of grant of this Option, to purchase Common Shares of the Company or any parent or subsidiary thereof.

 

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	Dated:	 	 	 
	 	 	 	Optionee
	 	 	 	 
	 	 	 	 
	 	 	 	Type or Print Name
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	Address
	 	 	 	 
	 	 	 	 
	 	 	 	Social Security No.

 

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Attachment B

 

(Suggested form of letter to be used for
notification of election to exercise.)

 

Date:   __________________

 

Secretary

SurePure Inc.

122 North Curry Street

Carson City, NV 89703

 

Dear Sir/Madame:

 

In accordance with paragraph 2 of the Nonqualified
Stock Option Agreement evidencing the Option granted to me on _______________ under the SurePure Inc. 2012 Nonqualified Stock Option
Plan, I hereby elect to exercise this Option to the extent of _______________ Common Shares.

 

Enclosed are (i) Certificate(s) No.(s)
_______________ representing fully-paid Common Shares of SurePure Inc. endorsed to the Company with signature guaranteed, and/or
a certified check payable to the order of SurePure Inc. in the amount of $________ as the balance of the purchase price of $________
for the Shares which I have elected to purchase and (ii) the original Stock Option Agreement for endorsement by the Company as
to exercise on Schedule I thereof.  I acknowledge that the Common Shares (if any) submitted as part payment for the exercise
price due hereunder will be valued by the Company at their Fair Market Value (as defined in the 2012 Stock Plan) on the date this
Option exercise is effected by the Company.  In the event I hereafter sell any Common Shares issued pursuant to this
option exercise within one year from the date of exercise or within two years after the date of grant of this Option, I agree to
notify the Company promptly of the amount of taxable compensation realized by me by reason of such sale for federal income tax
purposes.

 

When the certificate for Common Shares
which I have elected to purchase has been issued, please deliver it to me, along with my endorsed Stock Option Agreement in the
event there remains an unexercised balance of Shares under the Option, at the following address:

 

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	 	 	 	Signature of Optionee
	 	 	 	 
	 	 	 	 
	 	 	 	Type or Print Name

 

	Optionee	 	Date of Grant
	 	 	 
	 	 	 

 

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SCHEDULE I

 

	 	 	 	Unexercised	Issuing
	 	 	 	 	 
	 	Shares	Payment	Shares	Officer
	 	 	 	 	 
	Date	Purchased	Received	Remaining	Initials
	 	 	 	 	 
	 	 	 	 	 

 

    	17

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