Document:

FORM OF RESTRICTED STOCK UNIT AGREEMENT

 Exhibit 10.4 
 RESTRICTED STOCK UNIT AWARD AGREEMENT 
 UNDER THE ARBINET-THEXCHANGE, INC. 
 2004 STOCK INCENTIVE PLAN, AS AMENDED 
 Name of
Participant:                                      
             
 No. of Restricted Stock
Units:                                       
            
 Grant
Date:                                       
            
 Final Acceptance
Date:                                       
            
 Pursuant to the Arbinet-thexchange, Inc. 2004 Stock Incentive Plan
as amended through the date hereof (the “Plan”), Arbinet-thexchange, Inc. (the “Company”) hereby grants the number of Restricted Stock Units (“RSUs”) specified above (the “Award”) to the Participant named
above. The Award represents a promise to pay the Participant one share of common stock, par value $0.001 per share (the “Stock”), of the Company for each RSU, subject to the restrictions and conditions set forth herein and in the Plan.

 1. Acceptance of Award. The Participant shall have no rights with respect to this Award unless he shall have accepted this Award
prior to the close of business on the Final Acceptance Date specified above by signing and delivering to the Company a copy of this Agreement. 
 2. Restrictions. 
 (a) Prior to the vesting of the RSUs as described in Section 3, the Participant shall have no rights
on the RSUs except as specifically provided herein. 
 (b) The RSUs granted herein may not be sold, assigned, transferred, pledged or
otherwise encumbered or disposed of by the Participant prior to vesting. 
 (c) If the Participant ceases to be an employee or director of, or
consultant or advisor to, the Company or a subsidiary (an “Eligible Participant”) for any reason (including death) prior to vesting of the RSUs granted herein, all RSUs shall immediately and automatically be forfeited and become null and
void. 
 3. Vesting of Restricted Stock Units. Upon the vesting of any RSUs, the restrictions and conditions in Section 2 of this
Agreement with respect to such RSUs shall lapse and such RSUs shall become payable to the Participant in shares of Stock on the relevant Vesting Date specified below so long as the Participant remains an Eligible Participant on such Vesting Date. If
a series of Vesting Dates is specified, then the restrictions and conditions in Section 2 shall lapse only with respect to the number RSUs specified as vested on such Date. 

					
	 Number of RSUs Vested
	  	 Vesting Date

	                                  
	 	(    %)	  	                      

	                                  
	 	(    %)	  	                      

	                                  
	 	(    %)	  	                      

	                                  
	 	(    %)	  	                      

	                                  
	 	(    %)	  	                      

 RSUs may be subject to accelerated vesting in accordance with Section 8 below. 
 4. Dividend Equivalents. 
 If on any
date the Company shall pay any cash dividend on shares of Stock of the Company, the number of RSUs credited to the Participant shall, as of such date, be increased by an amount determined by the following formula: 
 W = (X multiplied by Y) divided by Z, where: 
 W = the number of additional RSUs to be credited to the Participant on such dividend payment date; 
 X = the aggregate number of
RSUs (whether vested or unvested) credited to the Participant as of the record date of the dividend; 
 Y = the cash dividend per share
amount; and 
 Z = the Fair Market Value per share of Stock (as determined under the Plan) on the dividend payment date. 
 5. Receipt of Stock Upon Vesting. On the Vesting Date, if the Participant remains an Eligible Participant, he shall receive one share of Stock for
each RSU that vested on such date, subject to tax withholding in accordance with Section 12 below. Shares of Stock acquired pursuant to this Award shall be issued and delivered to the Participant either in actual stock certificates or by
electronic book entry. 
 6. Stockholder Rights. The holder of this Award shall not have any stockholder rights, including voting or
dividend rights, with respect to the shares of Stock subject to the Award until the Participant becomes the record holder of those shares of Stock following their actual issuance upon the Company’s collection of the applicable withholding
taxes. 
 7. Reorganization Event. 
 (a) Upon the occurrence of a Reorganization Event (as defined in the Plan) other than a liquidation or dissolution of the Company, if the Award is assumed or otherwise continued by the Company’s successor, the
rights of the Company under this Award shall inure to the benefit of the Company’s successor and shall apply to the cash, securities or other property which the Stock was converted into or exchanged for pursuant to such Reorganization Event in

  

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the same manner and to the same extent as they applied to the Stock subject to the Award. Upon the occurrence of a Reorganization Event involving the
liquidation or dissolution of the Company, except to the extent specifically provided to the contrary in the instrument evidencing this Award or any other agreement between a Participant and the Company, all restrictions and conditions on this Award
then outstanding shall automatically be deemed terminated or satisfied. 
 (b) This Agreement shall not in any way affect the right of the
Company to adjust, reclassify, reorganize or otherwise change its capital or business structure or to merge, consolidate, dissolve, liquidate or sell or transfer all or any part of its business or assets. 
 8. Change in Control. 
 (a) Any RSUs
subject to this Award at the time of a Change in Control (as defined below) may be assumed by the successor entity or otherwise continued in full force and effect or may be replaced with a cash incentive program of the successor entity which
preserves the fair market value of any unvested shares of Stock subject to the Award at the time of the Change in Control and provides for subsequent payout of that value in accordance with the vesting schedule applicable to the Award. In the event
of such assumption or continuation of the Award or such replacement of the Award with a cash incentive program, no accelerated vesting of the RSUs shall occur at the time of the Change in Control, except to the limited extent otherwise provided in
Section 8(c) below. 
 (b) In the event the Award is assumed or otherwise continued in effect, the RSUs subject to the Award will be
appropriately adjusted immediately after the consummation of the Change in Control so as to apply to the number and class of securities into which the shares of Stock subject to those RSUs immediately prior to the Change in Control would have been
converted in consummation of that Change in Control had those shares of Stock actually been issued and outstanding at that time. To the extent the actual holders of the outstanding Stock receive cash consideration for their Stock in consummation of
the Change in Control, the successor corporation may, in connection with the assumption or continuation of the RSUs subject to the Award at that time, substitute one or more shares of its own common stock with a fair market value equivalent to the
cash consideration paid per share of Stock in the Change in Control transaction, provided such common stock is readily traded on an established securities exchange. 
 (c) Upon the closing of the Change in Control, fifty percent (50%) of the unvested RSUs at the time subject to this Award will immediately vest, and the shares of Stock subject to those vested RSUs will be issued
immediately upon such vesting (or otherwise converted into the right to receive the same consideration per share of Stock payable to the other stockholders of the Company in consummation of that Change in Control), subject to the Company’s
collection of withholding taxes. The remaining unvested RSUs shall continue to vest equally over the remaining vesting term as set forth in Section 3; provided that in the event the Participant ceases to be an Eligible Participant because of
termination of the service relationship by the Company other than for Cause within twelve (12) months following the closing of the Change in Control, then the Participant shall immediately vest in all of the unvested RSUs at the time of such
termination, and the securities or other property subject to those vested RSUs will be issued immediately upon such vesting, subject to the Company’s collection of the applicable withholding taxes pursuant to the provisions of Section 12.

  

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 (d) If the RSUs subject to this Award at the time of the Change in Control are not so assumed or
otherwise continued in effect or replaced with a cash incentive program in accordance with Section 8(a) above, then those RSUs will vest immediately prior to the closing of the Change in Control. The shares of Stock subject to those vested RSUs
will be issued immediately upon such vesting (or otherwise converted into the right to receive the same consideration per share of Stock payable to the other stockholders of the Company in consummation of that Change in Control), subject to the
Company’s collection of the applicable withholding taxes pursuant to the provisions of Section 12. 
 (e) For purposes of this
Agreement, a “Change in Control” of the Company shall mean a change in ownership or control of the Company effected through any of the following transactions: 
 (i) a merger, consolidation or other reorganization approved by the Company’s stockholders, unless securities representing more than 50% of the total combined voting power of the voting securities of the
successor corporation are immediately thereafter beneficially owned, directly or indirectly and in substantially the same proportion, by the persons who beneficially owned the Company’s outstanding voting securities immediately prior to such
transaction, or 
 (ii) a stockholder-approved sale, transfer or other disposition of all or substantially all of the Company’s assets,
or 
 (iii) the closing of any transaction or series of related transactions pursuant to which any person or any group of persons comprising
a “group” within the meaning of Rule 13d-5(b)(1) of the Exchange Act (other than the Company or a person that, prior to such transaction or series of related transactions, directly or indirectly controls, is controlled by or is under
common control with, the Company) becomes directly or indirectly the beneficial owner (within the meaning of Rule 13d-3 of the Exchange Act) of securities possessing (or convertible into or exercisable for securities possessing) more than 50% of the
total combined voting power of the Company’s securities (as measured in terms of the power to vote with respect to the election of members of the board of directors) outstanding immediately after the consummation of such transaction or series
of related transactions, whether such transaction involves a direct issuance from the Company or the acquisition of outstanding securities held by one or more of the Company’s existing stockholders. 
 (f) For purposes of this Agreement, “Cause” shall mean willful misconduct by the Participant or willful failure by the Participant to perform
his responsibilities to the Company (including, without limitation, breach by the Participant of any provision of any employment, consulting, advisory, nondisclosure, non-competition or other similar agreement between the Participant and the
Company), as determined by the Company, which determination shall be conclusive. The Participant shall be considered to have been discharged for “cause” if the Company determines, within 30 days after the Participant’s resignation,
that discharge for cause was warranted. 
  

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 9. Adjustment in Shares. Should any change be made to the Stock by reason of any stock split,
reverse stock split, stock dividend, recapitalization, combination of shares, reclassification of shares, spin-off or other similar change in capitalization or event, appropriate adjustments shall be made to the total number and/or class of
securities issuable pursuant to this Award in order to reflect such change and thereby preclude a dilution or enlargement of benefits hereunder. 
 10. Incorporation of Plan. Notwithstanding anything herein to the contrary, this Agreement shall be subject to and governed by all the terms and conditions of the Plan. Capitalized terms in this Agreement shall have the meaning
specified in the Plan, unless a different meaning is specified herein. 
 11. Transferability. This Agreement is personal to the
Participant, is non-assignable and is not transferable in any manner, by operation of law or otherwise, other than by will or the laws of descent and distribution. 
 12. Tax Withholding. The Participant shall, not later than the date as of which the receipt of this Award becomes a taxable event for Federal income tax purposes, pay to the Company or make provisions
satisfactory to the Company for payment of any Federal, state, and local taxes required by law to be withheld on account of such taxable event. The Participant may elect to have such tax withholding obligation satisfied, in whole or in part, by
authorizing the Company to withhold from shares of Stock to be issued. 
 13. No Obligation to Continue Employment. Neither the
Company nor any subsidiary is obligated by or as a result of the Plan or this Agreement to continue the Participant in employment and neither the Plan nor this Agreement shall interfere in any way with the right of the Company or any subsidiary to
terminate the employment of the Participant at any time. 
 14. Notices. Notices hereunder shall be mailed or delivered to the Company
at its principal place of business and shall be mailed or delivered to the Participant at the address on file with the Company or, in either case, at such other address as one party may subsequently furnish to the other party in writing. 

15. Amendment. This Agreement may be amended or modified only by a written instrument executed by both the Company and the Participant.

 16. Governing Law. This Agreement shall be construed, interpreted and enforced in accordance with the internal laws of the State of
New Jersey without regard to any applicable conflicts of laws. 
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 17. Participant’s Acknowledgments. The Participant acknowledges that he: (i) has read
this Agreement; (ii) has been represented in the preparation, negotiation and execution of this Agreement by legal counsel of the Participant’s own choice or has voluntarily declined to seek such counsel; (iii) understands the terms
and consequences of this Agreement; and (iv) is fully aware of the legal and binding effect of this Agreement. 
  

			
	ARBINET-THEXCHANGE, INC.
		
	By:	 	  

	Name:	 	
	Title:	 	

 The foregoing Agreement is hereby accepted and the terms and conditions thereof hereby agreed to by the
undersigned. 
  

							
	Dated:	 	  
	 		 	  

		 		 		 	Participant’s Signature
				
		 		 		 	Participant’s name and address:
				
		 		 		 	  

				
		 		 		 	  

				
		 		 		 	  

  

 6FORM OF NON-QUALIFIED STOCK OPTION AGREEMENT

 Exhibit 10.5 
 Arbinet-thexchange, Inc. 
 Non-Qualified Stock Option Agreement  
 Granted Under 2004 Stock Incentive Plan 
  

	1.	Grant of Option. 

 This Non-Qualified Stock Option
Agreement (the “Agreement”) evidences the grant by Arbinet-thexchange, Inc., a Delaware corporation (the “Company”), on [            ], 200[ ] (the “Grant
Date”) to [            ], an [employee]/[consultant]/[director] of the Company (the “Participant”), of an option to purchase, in whole or in part, on the terms
provided herein and in the Company’s 2004 Stock Incentive Plan, as amended through the date hereof (the “Plan”), a total of [            ] shares (the “Shares”) of
common stock, $0.001 par value per share, of the Company (“Common Stock”) at $[            ] per Share. Unless earlier terminated, this option shall expire at 5:00 p.m., Eastern
time, on [            ] (the “Final Exercise Date”). 
 It is intended
that the option evidenced by this Agreement shall not be an incentive stock option as defined in Section 422 of the Internal Revenue Code of 1986, as amended, and any regulations promulgated thereunder (the “Code”). Except as
otherwise indicated by the context, the term “Participant”, as used in this option, shall be deemed to include any person who acquires the right to exercise this option validly under its terms. 
  

	2.	Vesting Schedule. 

 This option will become
exercisable (“vest”) as to [            ]% of the original number of Shares on the [            ]
anniversary of the Grant Date and pro-rata thereafter on a monthly basis at the end of each successive [            ] following the first anniversary of the Grant Date until the
[            ] anniversary of the Grant Date.  
 The right of
exercise shall be cumulative so that to the extent the option is not exercised in any period to the maximum extent permissible it shall continue to be exercisable, in whole or in part, with respect to all Shares for which it is vested until the
earlier of the Final Exercise Date or the termination of this option under Section 3 hereof or the Plan. 
  

	3.	Exercise of Option. 

 (a) The Participant may
exercise this option only in the following manner: from time to time on or prior to the Final Exercise Date of this option, the Participant may give written notice to the Company of his or her election to purchase some or all of the Shares
purchasable at the time of such notice. This notice shall specify the number of Shares to be purchased. 
 Payment of the purchase price for
the Shares may be made by one or more of the following methods: (i) in cash or by check or, payable to the order of the Company; (ii) by the Participant delivering to the Company a properly executed exercise notice together with
irrevocable instructions to a broker to promptly deliver to the Company cash or a check payable and acceptable to the Company to pay the option purchase price and any required tax withholding; (iii) through the delivery of shares of Common
Stock that have been purchased by the Participant on the open market or that are beneficially owned by the Participant and are not then subject to any restrictions under any Company plan and that otherwise satisfy any holding periods as may be
required by the Board; or (iv) a combination of (i), (ii) and (iii) above. Payment instruments will be received subject to collection. 

 (b) Continuous Relationship with the Company Required. Except as otherwise provided in this
Section 3, this option may not be exercised unless the Participant, at the time he or she exercises this option, is, and has been at all times since the Grant Date, an employee or director of, or consultant or advisor to, the Company or a
subsidiary (an “Eligible Participant”). 
 (c) Termination of Relationship with the Company. If the Participant ceases to be
an Eligible Participant for any reason, then, except as provided in Section 3(d) and (e) below, the right to exercise this option shall terminate three months after such cessation (but in no event after the Final Exercise Date),
provided that this option shall be exercisable only to the extent that the Participant was entitled to exercise this option on the date of such cessation. 
 (d) Exercise Period Upon Death or Disability. If the Participant dies or becomes disabled (within the meaning of Section 22(e)(3) of the Code) prior to the Final Exercise Date while he or she is an
Eligible Participant and the Company has not terminated such relationship for “cause” as specified in Section 3(e) below, this option shall be exercisable, within the period of one year following the date of death or disability of the
Participant, by the Participant (or in the case of death by an authorized transferee), provided that this option shall be exercisable only to the extent that this option was exercisable by the Participant on the date of his or her death or
disability, and further provided that this option shall not be exercisable after the Final Exercise Date. 
 (e) Discharge for Cause.
If the Participant, prior to the Final Exercise Date, is discharged by the Company for “cause” (as defined below), the right to exercise this option shall terminate immediately upon the effective date of such discharge. “Cause”
shall mean willful misconduct by the Participant or willful failure by the Participant to perform his or her responsibilities to the Company (including, without limitation, breach by the Participant of any provision of any employment, consulting,
advisory, nondisclosure, non-competition or other similar agreement between the Participant and the Company), as determined by the Company, which determination shall be conclusive. The Participant shall be considered to have been discharged for
“cause” if the Company determines, within 30 days after the Participant’s resignation, that discharge for cause was warranted. 
 The Board’s determination of the reason for termination of the Participant’s employment shall be conclusive and binding on the Participant and his or her representatives or legatees. 
  

	4.	Withholding. 

 The Participant shall, not later than
the date as of which the exercise of these options becomes a taxable event for Federal income tax purposes, pay to the Company or make arrangements satisfactory to the Committee for payment of any Federal, state, and local taxes required by law to
be withheld on account of such taxable event. The Participant may elect to have such tax withholding obligation satisfied, in whole or in part, by authorizing the Company to withhold from shares of Stock to be issued. 
  

	5.	Nontransferability of Option. 

 This option may not
be sold, assigned, transferred, pledged or otherwise encumbered by the Participant, either voluntarily or by operation of law, except by will or the laws of descent and distribution, and, during the lifetime of the Participant, this option shall be
exercisable only by the Participant. 

	6.	Provisions of the Plan. 

 This option is subject to
the provisions of the Plan, a copy of which is furnished to the Participant with this option. Capitalized terms in this Agreement shall have the meaning specified in the Plan, unless a different meaning is specified herein. However, in applying the
provisions of Section 10(b) of the Plan, the following special terms shall be in effect for this option and shall be controlling with respect to any Reorganization Event (as hereinafter defined), notwithstanding any provision to the contrary in
such Section 10(b) of the Plan: 
 A. For purposes of this option, the term “Reorganization Event” shall mean a change in
ownership or control of the Company effected through any of the following transactions: 
 (i) a merger, consolidation or
other reorganization approved by the Company’s stockholders, unless securities representing more than fifty percent (50%) of the total combined voting power of the voting securities of the successor corporation are immediately
thereafter beneficially owned, directly or indirectly and in substantially the same proportion, by the persons who beneficially owned the Company’s outstanding voting securities immediately prior to such transaction, or 
 (ii) a stockholder-approved sale, transfer or other disposition of all or substantially all of the Company’s assets, or 

(iii) the closing of any transaction or series of related transactions pursuant to which any person or any group of persons comprising
a “group” within the meaning of Rule 13d-5(b)(1) of the Securities Exchange Act of 1934 Act (other than the Company or a person that, prior to such transaction or series of related transactions, directly or indirectly controls, is
controlled by or is under common control with, the Company) becomes directly or indirectly the beneficial owner (within the meaning of Rule 13d-3 of the Securities Exchange Act of 1934) of securities possessing (or convertible into or exercisable
for securities possessing) more than fifty percent (50%) of the total combined voting power of the Company’s securities (as measured in terms of the power to vote with respect to the election of Board members) outstanding immediately after
the consummation of such transaction or series of related transactions, whether such transaction involves a direct issuance from the Company or the acquisition of outstanding securities held by one or more of the Company’s existing
stockholders. 
 B. Should a Reorganization Event occur while the Participant remains in service as an Eligible Participant, then this
option, to the extent outstanding at the time of that Reorganization Event but not otherwise fully vested and exercisable, shall automatically vest on an accelerated basis so that this option shall, immediately prior to the effective date of such
Reorganization Event, vest and become exercisable as to fifty percent (50%) of the Shares for which this option would not otherwise at that time be vested and exercisable in accordance with the normal vesting schedule set forth in
Section 2 of this Agreement and may be exercised for any or all of those accelerated Shares as fully vested shares of Common Stock. This option shall vest and become exercisable for the remaining fifty percent (50%) of the unvested Shares
equally over the remaining vesting term as set forth in Section 2 of this Agreement. However, this option shall, immediately prior to the effective date of a Reorganization Event, vest and become exercisable as to all the Shares at the time
subject to this option and may be exercised for any or all of those accelerated Shares as fully vested shares of Common Stock, if and to the extent: (i) this option is not to be assumed by the successor corporation (or parent thereof) or is not

 
otherwise to be continued in full force and effect after the Reorganization Event or (ii) this option is not to be replaced with a program of the
successor corporation which preserves the spread existing at the time of the Reorganization Event on any Shares as to which this option is not otherwise at that time vested and exercisable (the excess of the fair market value of those unvested
Shares over the aggregate Exercise Price payable for such Shares) and provides for subsequent payout of that spread in accordance with the same vesting schedule for those Shares as set forth in Section 2 of this Agreement. At the effective time
of the Reorganization Event, this option shall terminate and cease to be outstanding, except to the extent assumed by the successor corporation (or parent thereof) or otherwise continued in effect after the Reorganization Event. Notwithstanding
anything to the contrary herein, the Company shall have the right, but not the obligation, in connection with a Reorganization Event, to make or provide for a cash payment to the Participant, in exchange for the cancellation of this option, in an
amount equal to the difference between (x) the value as determined by the Board of the consideration payable or otherwise to be received by the Company’s stockholders, per share of Common Stock, in connection with the Reorganization Event,
multiplied by the number of Shares subject to the option and (y) the aggregate exercise prices of Shares subject to the option. 
 C. To
the extent this option does not, at the time of the Reorganization Event, vest and become exercisable as to all the Shares at that time subject to this option, then this option shall be subject to accelerated vesting in accordance with the following
provision: 
 - Should the Participant’s service as an Eligible Participant be terminated by the Company other than for
Cause on or within twelve (12) months after the effective date of that Reorganization Event, then this option shall immediately vest and become exercisable as to all the Shares at the time subject to this option and may be exercised for any or
all of those accelerated Shares as fully vested shares of Common Stock until the earlier of (i) the Final Exercise Date or (ii) the sooner termination of this option pursuant to Paragraph 3 of this Agreement. 
 If the option is replaced with a program of the successor corporation as set forth above, the accelerated vesting provided by this Paragraph 6.C shall
apply equally to the replacement cash incentive program. 
 D. If this option is assumed in connection with a Reorganization Event or
otherwise continued in effect, then this option shall be appropriately adjusted, immediately after such Reorganization Event, to apply to the number and class of securities which would have been issuable to Participant in consummation of such
Reorganization Event had the option been exercised immediately prior to such Reorganization Event, and appropriate adjustments shall also be made to the Exercise Price, provided the aggregate Exercise Price shall remain the same. To the extent the
actual holders of the Company’s outstanding Common Stock receive cash consideration for their Common Stock in consummation of the Reorganization Event, the successor corporation may, in connection with the assumption or continuation of this
option, substitute one or more shares of its own common stock with a fair market value equivalent to the cash consideration paid per share of Common Stock in such Reorganization Event, provided such common stock is readily tradable on an established
U.S. securities exchange or market. 
  

	7.	No Obligation to Continue Employment. 

 Neither the
Company nor any subsidiary is obligated by or as a result of the Plan or this Agreement to continue the Participant in employment and neither the Plan nor this Agreement shall interfere in any way with the right of the Company or any subsidiary to
terminate the employment of the Participant at any time. 

	8.	Notices. 

 Notices hereunder shall be mailed or
delivered to the Company at its principal place of business and shall be mailed or delivered to the Participant at the address on file with the Company or, in either case, at such other address as one party may subsequently furnish to the other
party in writing. 
  

	9.	Amendment. 

 This Agreement may be amended or
modified only by a written instrument executed by both the Company and the Participant. 
  

	10.	Governing Law. 

 This Agreement shall be construed,
interpreted and enforced in accordance with the internal laws of the State of New Jersey without regard to any applicable conflicts of laws. 
  

	11.	Participant’s Acknowledgments. 

 The
Participant acknowledges that he: (i) has read this Agreement; (ii) has been represented in the preparation, negotiation and execution of this Agreement by legal counsel of the Participant’s own choice or has voluntarily declined to
seek such counsel; (iii) understands the terms and consequences of this Agreement; and (iv) is fully aware of the legal and binding effect of this Agreement. 
 [remainder of page intentionally left blank] 

 IN WITNESS WHEREOF, the Company has caused this option to be executed under its corporate seal by its
duly authorized officer. This option shall take effect as a sealed instrument. 
  

							
		 		 	ARBINET-THEXCHANGE, INC.
				
	Dated:                         	 		 	By:	 	  

		 		 	Name:	 	  

		 		 	Title:	 	  

 PARTICIPANT’S ACCEPTANCE 
 The undersigned hereby accepts the foregoing option and agrees to the terms and conditions thereof. The undersigned hereby acknowledges receipt of a copy
of the Company’s 2004 Stock Incentive Plan, as amended. 
  

							
		 		 	PARTICIPANT:
			
		 		 	  

				
		 		 	Address:

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