Document:

Exhibit 10.3

 

CONVERSION AGREEMENT

 

THIS CONVERSION
AGREEMENT (this “Agreement”), dated as of _________, 2015 (the “Effective Date”), is
by and between the undersigned Series A Preferred Stock Purchase Warrant holder (the “Holder”) and Neurotrope,
Inc., a Nevada corporation (the “Company”). The Company and the Stockholder will sometimes hereinafter be referred
to collectively as the “Parties” or each, individually, as a “Party.”

 

RECITALS

 

A.           The
Company executed that certain Placement Agent Warrant for Series A Convertible Preferred Stock dated as of _________, entitling
the Holder to purchase from the Company _________ shares of Series A Convertible Preferred Stock of the Company at a per share
exercise price of $1.00 (the “Series A Warrant”).

 

B.           The
Holder desires to convert the Series A Warrant into a Common Stock Purchase Warrant entitling the Holder to purchase from the Company
_________ shares of common stock, par value $0.0001, of the Company (“Common Stock”) at a per share exercise
price of $1.00 (the “Common Stock Purchase Warrant”).

 

NOW, THEREFORE,
in consideration of the mutual agreements, covenants, representations and warranties contained in this Agreement, the parties
hereby agree as follows:

 

Article
1

CONVERSION

 

1.1           Conversion.
The Holder hereby exchanges its Series A Warrant for a Common Stock Purchase Warrant in the form attached hereto as Attachment
I. The Holder has enclosed herewith the Series A Warrant for cancellation by the Company as of the Effective Date. The Parties
acknowledge and agree that the Common Stock Purchase Warrant is being acquired by the Holder from the Company solely in exchange
for the Series A Warrant.

 

1.2           Issuance
of Common Stock Purchase Warrant. The Company shall promptly issue, to the Holder, the Common Stock Purchase Warrant.

 

Article
2

REPRESENTATIONS
AND WARRANTIES OF THE HOLDER

 

The Holder represents
and warrants to the Company, as of the Effective Date, as follows:

 

2.1           Existence
and Power. The Holder has full power and authority (i) to enter into this Agreement, to perform its obligations hereunder,
and to consummate the transactions contemplated hereby, and (ii) to convert the Series A Warrant and acquire the Common Stock Purchase
Warrant.

 

    	- 1 -

    	 

    

  

2.2           Series
A Warrant. The Holder has good and marketable title to the Series A Warrant being transferred free and clear of all liens,
claims, charges and encumbrances (except such encumbrances resulting from any applicable securities laws) and has full legal right
to effect the conversion contemplated hereunder. The Series A Warrant being converted by the Holder hereunder constitutes all of
the Series A Warrants of the Company that the Holder owns on the Effective Date.

 

2.3           Enforceability.
This Agreement has been duly and validly executed and delivered by the Holder and constitutes a valid and legally binding obligation
of the Holder, enforceable against the Holder in accordance with its terms.

 

Article
3

REPRESENTATIONS AND WARRANTIES OF THE
COMPANY

 

The Company represents
and warrants to the Holder as of the Effective Date as follows:

 

3.1           Existence
and Power. The Company has full power and authority to enter into this Agreement, to perform its obligations hereunder and
thereunder, and to consummate the transactions contemplated hereby and thereby.

 

3.2           Enforceability.
This Agreement has been duly and validly executed and delivered by the Company and constitutes a valid and legally binding obligation
of the Company, enforceable against the Company in accordance with its terms, except as enforcement may be limited by applicable
bankruptcy, insolvency, reorganization, moratorium and other laws affecting creditors’ rights generally.

 

Article
4

ADDITIONAL COVENANTS

 

4.1           Further
Assurances. Each Party shall (and, if applicable, shall cause its affiliates to) promptly execute, acknowledge and deliver
any other assurances, documents or instruments, and provide assistance, reasonably requested by another Party and necessary for
the requesting Party to satisfy its obligations hereunder or to obtain the benefits of the transactions contemplated hereby.

 

Article
5

MISCELLANEOUS

 

5.1           Amendments
and Waivers. No Party may assign any of its rights or obligations under this Agreement. No provision hereof may be waived,
in whole or in part, except as provided in a written agreement executed and delivered by both Parties.

 

5.2           Indemnification.
Each Holder shall indemnify and hold harmless the Company from and against, and shall reimburse the Company for, any and all damages,
charges, claims, liabilities, costs and expenses (including, without limitation, reasonable attorneys’ fees and other costs
of collection or enforcement) resulting from or occasioned by any breach by such Holder of any of its representations, warranties,
covenants and other agreements set forth in this Agreement.

 

    	- 2 -

    	 

    

 

 5.3           Counterparts.
This Agreement may be executed in multiple counterparts, each of which when executed and delivered will thereby be deemed to be
an original and all of which counterparts taken together will constitute one and the same instrument.

 

5.4           Entire
Agreement. This Agreement, all documents delivered by a Party pursuant to the terms hereof, and the other documents, instruments
and agreements specifically referred to therein, or delivered pursuant thereto, (a) set forth the entire understanding of
the Parties with respect to the subject matter hereof and thereof and the transactions contemplated hereby and thereby and (b) supersede
any and all previous agreements and understandings between or among the Parties regarding the subject matter hereof or thereof,
whether written or oral.

 

IN WITNESS WHEREOF,
the Parties hereto have duly executed and delivered this Agreement as of the Effective Date.

 

	 	NEUROTROPE, INC.	 
	 	 	 
	 	By:	 	 
	 	 	 	 
	 	Name:	 	 
	 	 	 	 
	 	Title:	 	 
	 	 	 
	 	HOLDER	 
	 	 	 
	 	By:	 	 
	 	 	 
	 	Name:	 	 

  

    	- 3 -

    	 

    

 

ATTACHMENT I

 

COMMON STOCK PURCHASE WARRANT

 

[See Attached]Exhibit 10.4

 

PLACEMENT AGENT WARRANT

 

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 COMPANY.

 

	No. __________	Issue Date: ____________________, 2015

 

NEUROTROPE, INC.

Common Stock Purchase Warrant

 

 

 

WHEREAS, the Company
(as defined below) issued the Holder (as defined below) that certain Placement Agent Warrant for Series A Convertible Preferred
Stock dated as of _________, 2013, entitling the Holder to purchase from the Company _________ shares of Series A Convertible Preferred
Stock of the Company at a per share exercise price of $1.00 (the “Series A Warrant”); and

 

WHEREAS, the Holder
desires to convert the Series A Warrant into a Common Stock Purchase Warrant entitling the Holder to purchase from the Company
_________ shares of Common Stock (as defined below) at a per share exercise price of $1.00; and

 

WHEREAS, this
Common Stock Purchase Warrant is being acquired by the Holder from the Company solely in exchange for the Holder’s Series
A Warrant.

 

THIS CERTIFIES THAT,
for value received, _________, or [his/her/its] registered assigns (the “Holder”), is entitled to subscribe
for and purchase from Neurotrope, Inc., a Nevada corporation (the “Company”), at any time prior to 5:00 p.m.,
Eastern time, on _________, the Shares at the Exercise Price (each as defined in Section 1 below).

 

This Warrant is subject to the following terms
and conditions:

 

1.          Shares.
The Holder has, subject to the terms set forth herein, the right to purchase, at any time during the Warrant Exercise Term, up
to _________ (___) shares (the “Shares” or the “Warrant Shares”) of Common Stock,
par value $0.0001, of the Company (“Common Stock”), at a per share exercise price of $1.00 (the “Exercise
Price”). The Exercise Price is subject to adjustment as provided in Section 3 hereof.

 

    	- 1 -

    	 

    

 

2.           Exercise
of Warrant.

 

(a) Exercise for Cash.
This Warrant may be exercised by the Holder at any time during the Warrant Exercise Term, in whole or in part, by delivering the
notice of exercise attached as Exhibit A hereto (the “Notice of Exercise”), duly executed by the Holder
to the Company at its principal office, or at such other office as the Company may designate, accompanied by payment, in cash or
by wire transfer of immediately available funds or by check payable to the order of the Company, of the amount obtained by multiplying
the number of Shares designated in the Notice of Exercise by the Exercise Price (the “Purchase Price”). For purposes
hereof, “Exercise Date” shall mean the date on which all deliveries required to be made to the Company upon
exercise of this Warrant pursuant to this Section 2(a) shall have been made.

 

(b) Cashless Exercise.
In addition to the provisions of Section 2(a) above, at any time, the Holder may, in its sole discretion, exercise all or any part
of this Warrant in a “cashless” or “net-issue” exercise (a “Cashless Exercise”) by delivering
to the Company (i) the Notice of Exercise and (ii) the original Warrant, pursuant to which the Holder shall surrender the right
to receive upon exercise of this Warrant the full number of Warrant Shares set forth in Section 1 hereof and instead, without cash
payment, shall receive a number of Warrant Shares calculated by using the following formula:

 

 

with: X = the number of Warrant
Shares to be issued to the Holder

 

Y = the number of Warrant
Shares with respect to which the Warrant is being exercised

 

A = the fair value per
share of Common Stock on the date of exercise of this Warrant

 

B = the then-current Exercise
Price of the Warrant

 

Solely for the purposes
of this paragraph, “fair value” per share of Common Stock shall mean (A) the average of the closing sales prices, as
quoted on the primary national or regional stock exchange on which the Common Stock is listed, or, if not listed, on the Nasdaq
Market if quoted thereon, or, if not listed or quoted, the OTC Bulletin Board (or any tier of the OTC Markets) if quoted thereon,
on the twenty (20) trading days immediately preceding the date on which the Notice of Exercise is deemed to have been sent to the
Company, or (B) if the Common Stock is not publicly traded as set forth above, as reasonably and in good faith determined by the
Board of Directors of the Company as of the date which the Notice of Exercise is deemed to have been sent to the Company.

 

For purposes of Rule 144
promulgated under the Securities Act, it is intended, understood and acknowledged that the Warrant Shares issued in a cashless
exercise transaction shall be deemed to have been acquired by the Holder, and the holding period for such shares shall be deemed
to have commenced, on the date this Warrant was originally issued.

 

    	 

    	 

    

 

(c) Issuance of Certificates.
As soon as practicable after the exercise of this Warrant, in whole or in part, in accordance with Section 2(a) or (b) hereof,
the Company, at its expense, shall cause to be issued in the name of and delivered to the Holder (i) a certificate or certificates
for the number of fully paid and non-assessable Shares to which the Holder shall be entitled upon such exercise and, if applicable,
(ii) a new warrant of like tenor to purchase all of the Shares that may be purchased pursuant to the portion, if any, of this Warrant
not exercised by the Holder. The Holder shall for all purposes hereof be deemed to have become the Holder of record of such Shares
on the date on which the Notice of Exercise and payment of the Purchase Price in accordance with Section 2(a) were delivered and
made or the date of notice of cashless exercise in accordance with Section 2(b) hereof, respectively, irrespective of the date
of delivery of such certificate or certificates, except that if the date of such delivery, notice and payment is a date when the
stock transfer books of the Company are closed, such person shall be deemed to have become the holder of record of such Shares
at the close of business on the next succeeding date on which the stock transfer books are open.

 

(d) Taxes. The issuance
of the Shares upon the exercise of this Warrant, and the delivery of certificates or other instruments representing such Shares,
shall be made without charge to the Holder for any tax or other charge of whatever nature in respect of such issuance and the Company
shall bear any such taxes in respect of such issuance.

 

3.           Adjustment
of Exercise Price and Number of Shares.

 

(a) Adjustment for Reclassification,
Consolidation or Merger. If while this Warrant, or any portion hereof, remains outstanding and unexpired there shall be (i)
a reorganization or recapitalization (other than a combination, reclassification, exchange or subdivision of shares otherwise provided
for herein), (ii) a merger or consolidation of the Company with or into another corporation or other entity in which the Company
shall not be the surviving entity, or a reverse merger in which the Company shall be the surviving entity but the shares of the
Company’s capital stock outstanding immediately prior to the merger are converted by virtue of the merger into other property,
whether in the form of securities, cash or otherwise, or (iii) a sale or transfer of the Company’s properties and assets
as, or substantially as, an entirety to any other corporation or other entity in one transaction or a series of related transactions,
then, as a part of such reorganization, recapitalization, merger, consolidation, sale or transfer, unless otherwise directed by
the Holder, all necessary or appropriate lawful provisions shall be made so that the Holder shall thereafter be entitled to receive
upon exercise of this Warrant, during the period specified herein and upon payment of the Exercise Price then in effect, the greatest
number of shares of capital stock or other securities or property that a holder of the Shares deliverable upon exercise of this
Warrant would have been entitled to receive in such reorganization, recapitalization, merger, consolidation, sale or transfer if
this Warrant had been exercised immediately prior to such reorganization, recapitalization, merger, consolidation, sale or transfer,
all subject to further adjustment as provided in this Section 3. If the per share consideration payable to the Holder for Shares
in connection with any such transaction is in a form other than cash or marketable securities, then the value of such consideration
shall be determined in good faith by the Company’s Board of Directors (the “Board of Directors”). The
foregoing provisions of this paragraph shall similarly apply to successive reorganizations, recapitalizations, mergers, consolidations,
sales and transfers and to the capital stock or securities of any other corporation that are at the time receivable upon the exercise
of this Warrant. In all events, appropriate adjustment shall be made in the application of the provisions of this Warrant with
respect to the rights and interests of the Holder after the transaction, to the end that the provisions of this Warrant shall be
applicable after that event, as near as reasonably may be, in relation to any shares or other property deliverable or issuable
after such reorganization, recapitalization, merger, consolidation, sale or transfer upon exercise of this Warrant.

 

    	 

    	 

    

 

(b) Adjustments for Split,
Subdivision or Combination of Shares. If the Company shall at any time subdivide (by any stock split, stock dividend, recapitalization,
reorganization, reclassification or otherwise) the shares of Common Stock subject to acquisition hereunder, then, after the date
of record for effecting such subdivision, the Exercise Price in effect immediately prior to such subdivision will be proportionately
reduced and the number of shares of Common Stock subject to acquisition upon exercise of the Warrant will be proportionately increased.
If the Company at any time combines (by reverse stock split, recapitalization, reorganization, reclassification or otherwise) the
shares of Common Stock subject to acquisition hereunder, then, after the record date for effecting such combination, the Exercise
Price in effect immediately prior to such combination will be proportionately increased and the number of shares of Common Stock
subject to acquisition upon exercise of the Warrant will be proportionately decreased.

 

(c) Adjustments for Dividends
in Stock or Other Securities or Property. If while this Warrant, or any portion hereof, remains outstanding and unexpired,
the holders of any class of securities as to which purchase rights under this Warrant exist at the time shall have received or,
on or after the record date fixed for the determination of eligible stockholders, shall have become entitled to receive, without
payment therefor, other or additional stock or other securities or property (other than cash) of the Company by way of dividend,
then and in each case, this Warrant shall represent the right to acquire, in addition to the number of shares of such class of
security receivable upon exercise of this Warrant, and without payment of any additional consideration therefor, the amount of
such other or additional stock or other securities or property (other than cash) of the Company that such holder would hold on
the date of such exercise had it been the holder of record of the class of security receivable upon exercise of this Warrant on
the date hereof and had thereafter, during the period from the date hereof to and including the date of such exercise, retained
such shares and/or all other additional stock available to it as aforesaid during said period, giving effect to all adjustments
called for during such period by the provisions of this Section 3.

 

(d) Notice of Adjustments.
Upon any adjustment of the Exercise Price and any increase or decrease in the number of Shares purchasable upon the exercise of
this Warrant, then, and in each such case, the Company, within 30 days thereafter, shall give written notice thereof to the Holder
at the address of such Holder as shown on the books of the Company, which notice shall state the Exercise Price as adjusted and,
if applicable, the increased or decreased number of Shares purchasable upon the exercise of this Warrant, setting forth in reasonable
detail the method of calculation of each.

 

4.           Notices.
All notices, requests, consents and other communications required or permitted under this Warrant shall be in writing and shall
be deemed delivered (a) three business days after being sent by registered or certified mail, return receipt requested, postage
prepaid or (b) one business day after being sent via a reputable nationwide overnight courier service guaranteeing next business
day delivery or (c) on the business day of delivery if sent by facsimile transmission, in each case to the intended recipient as
set forth below:

 

    	 

    	 

    

 

If to the Company to:

 

Neurotrope, Inc.

50 Park Place, Suite 1401

Newark, New Jersey 07102

Attn: Charles S. Ramat, President
and Chief Executive Officer

Facsimile: 973.242.0009

 

With a copy (that shall
not constitute notice) to:

 

Reed Smith, LLP

136 Main Street, Suite 250

Princeton, NJ 08540

Attention: Nanette W. Mantell

Facsimile: (609) 951-0824

 

If to the Holder to:

 

The contact information

listed on the attached

Warrant Contact Information
Sheet

 

Either party may give any
notice, request, consent or other communication under this Warrant using any other means (including personal delivery, messenger
service, facsimile transmission, first class mail or electronic mail), but no such notice, request, consent or other communication
shall be deemed to have been duly given unless and until it is actually received by the party for whom it is intended. Either party
may change the address to which notices, requests, consents or other communications hereunder are to be delivered by giving the
other party notice in the manner set forth in this Section 4.

 

5.           Legends.
Each certificate evidencing the Shares issued upon exercise of this Warrant shall be stamped or imprinted with a legend substantially
in the following form:

 

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 COMPANY.

 

    	 

    	 

    

 

6.           Removal
of Legend. Upon request of a holder of a certificate with the legends required by Section 5 hereof, the Company shall issue
to such holder a new certificate therefor free of any transfer legend, if, with such request, the Company shall have received an
opinion of counsel satisfactory to the Company in form and substance to the effect that any transfer by such holder of the Shares
evidenced by such certificate will not violate the Act or any applicable state securities laws.

 

7.           Fractional
Shares. No fractional Shares will be issued in connection with any exercise hereunder. Instead, the Company shall round up,
as nearly as practicable to the nearest whole Share, the number of Shares to be issued.

 

8.           Rights
of Stockholders. Except as expressly provided in Section 3(c) hereof, the Holder, as such, shall not be entitled to vote or
receive dividends or be deemed the holder of the Shares or any other securities of the Company that may at any time be issuable
on the exercise hereof for any purpose, nor shall anything contained herein be construed to confer upon the Holder, as such, any
of the rights of a stockholder of the Company or any right to vote for the election of directors or upon any matter submitted to
stockholders at any meeting thereof, or to give or withhold consent to any corporate action (whether upon any recapitalization,
issuance of stock, reclassification of stock, change of par value, consolidation, merger, conveyance, or otherwise) or to receive
notice of meetings, or otherwise until this Warrant shall have been exercised and the Shares purchasable upon the exercise hereof
shall have been issued, as provided herein.

 

9.           Transfers
and Assignments. Subject to compliance with applicable securities laws, this Warrant, and the rights evidenced hereby, may
be transferred by any registered holder hereof (a “Transferor”). On the surrender for exchange of this Warrant,
with the Transferor’s endorsement in the form of Exhibit B attached hereto (the “Transferor Endorsement Form”)
and together with an opinion of counsel reasonably satisfactory to the Company that the transfer of this Warrant will be in compliance
with applicable securities laws, the Company will issue and deliver to or on the order of the Transferor thereof a new Warrant
or Warrants of like tenor, in the name of the Transferor and/or the transferee(s) specified in such Transferor Endorsement Form
(each a “Transferee”), calling in the aggregate on the face or faces thereof for the number of shares of Common
Stock called for on the face or faces of the Warrant so surrendered by the Transferor.

 

10.         Miscellaneous.

 

(a) This Warrant and disputes
arising hereunder shall be governed by and construed and enforced in accordance with the laws of the State of Nevada applicable
to agreements made and to be performed wholly within such State, without regard to its conflict of law rules.

 

(b) The headings in this
Warrant are for purposes of reference only, and shall not limit or otherwise affect any of the terms hereof.

 

(c) The covenants of the
respective parties contained herein shall survive the execution and delivery of this Warrant.

 

    	 

    	 

    

 

(d) The terms of this Warrant
shall be binding upon and shall inure to the benefit of any successors or permitted assigns of the Company and of the Holder and
of the Shares issued or issuable upon the exercise hereof.

 

(e) This Warrant and the
other documents delivered pursuant hereto constitute the full and entire understanding and agreement between the parties with regard
to the subject hereof.

 

(f) The Company shall not,
by amendment of the Certificate of Incorporation or Bylaws, or through any other means, directly or indirectly, avoid or seek to
avoid the observance or performance of any of the terms of this Warrant and shall at all times in good faith assist in the carrying
out of all such terms and in the taking of all such action as may be necessary or appropriate in order to protect the rights of
the Holder contained herein against impairment.

 

(g) Upon receipt of evidence
reasonably satisfactory to the Company of the loss, theft, destruction or mutilation of this Warrant and, in the case of any such
loss, theft or destruction, upon delivery of an indemnity agreement reasonably satisfactory in form and amount to the Company,
or, in the case of any such mutilation, upon surrender and cancellation of such Warrant, the Company, at its expense, will execute
and deliver to the Holder, in lieu thereof, a new Warrant of like date and tenor.

 

(h) This Warrant and any
provision hereof may be amended, waived or terminated only by an instrument in writing signed by the Company and the Holder.

 

IN WITNESS WHEREOF, the
Company has caused this Warrant to be signed by its duly authorized officer.

 

	 	NEUROTROPE, INC.
	 	 	 
	 	By:	 
	 	Name:
	 	Title:

  

    	 

    	 

    

 

WARRANT CONTACT INFORMATION SHEET

 

Holder Name: __________________________________

 

Address: ________________________________________________________

 

Fax Number: ______________________

 

Email:____________________________ 

 

    	 

    	 

    

Exhibit A

 

NOTICE OF EXERCISE

 

TO:       Neurotrope, Inc.

Attention: President and
Chief Executive Officer

 

The undersigned hereby
elects to purchase __________ shares (the “Shares”) of Common Stock of Neurotrope, Inc. (the “Company”)
pursuant to the terms of the attached Warrant, and delivers herewith:

 

(1) $__________ (in cash
as provided for in the foregoing Warrant) and any applicable taxes payable by the undersigned pursuant to such Warrant; and

 

(2) __________ shares of
Common Stock underlying the attached Warrant (pursuant to a Cashless Exercise in accordance with Section 2(b) of the Warrant) (check
here if the undersigned desires to deliver a Warrant for an unspecified number of shares equal to the number sufficient to affect
a Cashless Exercise [ _____ ]).

 

Please issue a certificate
or certificates representing said shares in the name of the undersigned or in such other name as is specified below:

 

	 
	(Name)
	 
	 
	 
	 
	(Address)

 

If the shares issuable upon this exercise of
the Warrant are not all of the Shares which the Holder is entitled to acquire upon the exercise of the Warrant, the undersigned
requests that a new Warrant evidencing the rights not so exercised be issued in the name of and delivered to:

 

	 
	(Name)
	 
	 
	 
	 
	(Address)

 

The undersigned hereby
represents and warrants the following:

 

(a) He/she/it has such
knowledge and experience in financial and business affairs that he/she/it is capable of evaluating the merits and risks involved
in purchasing the Shares, (ii) is able to bear the economic risks involved in purchasing the Shares, and (iii) is an “accredited
investor,” as defined in Rule 501(a) of Regulation D promulgated under the Securities Act of 1933, as amended;

 

    	A - 1

    	 

    

 

(b) In making the decision
to purchase the Shares, he/she/it has relied solely on independent investigations made by it and has had the opportunity to ask
questions of, and receive answers from, the Company concerning the Shares, the financial condition, prospective business and operations
of the Company and has otherwise had an opportunity to obtain any additional information, to the extent that the Company possess
such information or could acquire it without unreasonable effort or expense;

 

(c) The overall commitment
of the undersigned to investments that are not readily marketable is not disproportionate to his/hers/its net worth and income,
and the purchase/acquisition of the Shares will not cause such overall commitment to become disproportionate; it can afford to
bear the loss of the purchase price of the Shares;

 

(d) He/she/it has no present
need for liquidity in its investment in the Shares; and

 

(e) He/she/it acknowledges
that the transaction contemplated in connection with the purchase/acquisition of the Shares has not been reviewed or approved by
the Securities and Exchange Commission or by any administrative agency charged with the administration of the securities laws of
any state, and that no such agency has passed on or made any recommendation or endorsement of any of the securities contemplated
hereby.

 

	 	 
	 	(Signature and Date)
	 	 	 
	 	Name (print): 	 

  

    	A - 2

    	 

    

 

Exhibit B

 

FORM OF TRANSFEROR ENDORSEMENT

(To be signed only on transfer of Warrant)

 

FOR VALUE RECEIVED,
the undersigned hereby sells, assigns, and transfers unto the person(s) named below under the heading “Transferees”
the right represented by the within Warrant to purchase the percentage and number of shares of Common Stock of NEUROTROPE, INC.
to which the within Warrant relates specified under the headings “Percentage Transferred” and “Number Transferred,”
respectively, opposite the name(s) of such person(s) and appoints each such person Attorney to transfer its respective right on
the books of NEUROTROPE, INC. with full power of substitution in the premises.

 

	Transferees	Percentage Transferred	Number Transferred
	 	 	 
	 	 	 
	 	 	 

 

If the total of the Shares are not all of the
Shares evidenced by the foregoing Warrant, the undersigned Transferor requests that a new Warrant evidencing the right to acquire
the Shares not so transferred assigned be issued in the name of and delivered to the undersigned Transferor.

 

	Dated: __________, _____	 	 
	 	 	(Signature must conform to name of holder
	 	 	as specified on the face of the Warrant)
	 	 	 
	Signed in the presence of:	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	(Name)	 	(Address)
	 	 	 
	ACCEPTED AND AGREED:	 	 
	[TRANSFEREE]	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	(Name)	 	(Address)

 

    	B - 1

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