Document:

Exhibit 10.2

 

NEITHER THIS NOTE NOR THE SECURITIES UNDERLYING
THIS NOTE, NOR ANY SECURITIES ISSUABLE UPON ITS CONVERSION, IF ANY, HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED
(THE “ACT’), OR QUALIFIED UNDER APPLICABLE STATE SECURITIES LAWS AND MAY ONLY BE ACQUIRED FOR INVESTMENT PURPOSES ONLY AND
NOT WITH A VIEW TO, OR IN CONNECTION WITH, THE SALE OR DISTRIBUTION HEREOF OR THEREOF. NEITHER THIS NOTE, NOR THE SECURITIES UNDERLYING
THIS NOTE NOR ANY SECURITIES ISSUABLE UPON ITS CONVERSION, IF ANY, MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED OR HYPOTHECATED IN THE ABSENCE
OF AN EFFECTIVE REGISTRATION STATEMENT AS TO SUCH SECURITIES UNDER THE ACT AND QUALIFICATION UNDER APPLICABLE STATE LAW WITHOUT AN OPINION
OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION AND QUALIFICATION ARE NOT REQUIRED UNDER THE ACT OR RECEIPT OF A NO-ACTION
LETTER FROM THE SECURITIES AND EXCHANGE COMMISSION.

 

BRAIN SCIENTIFIC, INC. 

 

CONVERTIBLE PROMISSORY NOTE

 

Dated: __________, 2021 (“Issuance Date”)

 

FOR VALUE RECEIVED BRAIN SCIENTIFIC,
INC., a company organized under the laws of the State of Nevada (the “Company”), hereby promises to pay to [Holder]
(the “Payee”), or its registered assigns, the principal amount of [Principal Amount] ($[Amount]USD) in accordance with
the provisions of this Convertible Promissory Note (as amended, modified and supplemented from time to time, this “Note”
and together with all other Notes issued in the Note Issuance (as defined below) or upon transfer or exchange, the “Notes”).
Capitalized terms not defined in this Note shall have the meaning ascribed to them in the Securities Purchase Agreement, dated as of _________,
2021, among the Company and the purchasers party thereto (the “Purchase Agreement”).

 

Certain capitalized terms are defined in Section 9
hereof.

 

1.
Interest Rate. This Note bears an annualized interest rate of ten percent (10%) payable upon maturity or a conversion of the Note
and shall begin accruing on such date as the initial funds shall have been distributed pursuant to the terms of the Escrow Agreement.
All interest accruing hereunder shall be paid-in-kind on the last day of each calendar month by capitalizing and adding such amount to
the outstanding principal balance of this Note, which amount shall thereafter constitute principal hereunder.

 

2.
Maturity Date. The entire principal amount of this Note shall be due and payable on April 1st, 2023 (such date, the
“Maturity Date”).

 

    1

     

    

 

3.
Conversion.

 

	 	(a)	Mandatory Conversion.

 

(i)
This Note shall automatically convert into shares of Common Stock or Units, as provided herein, immediately upon the earliest to occur
of (a) the listing of the Common Stock on NASDAQ (the “Uplist”), and (b) a Subsequent Qualified Financing Date. For
purposes of this Note, a “Unit” shall mean the combination of Common Stock and warrants to purchase Common Stock offered
by the Company in any financing occurring simultaneously with the Uplist (“Simultaneous Uplist Unit Offering”). For
purposes of this Note, “Subsequent Qualified Financing Date” shall mean the date on which the Company shall have received
proceeds in excess of $5,000,000.00 from a transaction or series of related transactions occurring prior to the Maturity Date, including,
but not limited to, equity financings, business combinations or other issuances of the Company’s equity securities (not including
the transactions contemplated by the Purchase Agreement).

 

(ii) If this Note is being converted in connection with an Uplist, and no Simultaneous Uplist Unit Offering shall have occurred, this Note
shall be convertible into a number of shares of Common Stock equal to the quotient of (I) the outstanding aggregate principal amount of
this Note plus accrued but unpaid interest thereon, divided by (II) the lesser of (a) $0.40 and (b) the greater of (x) $0.20 and
(y) eighty percent (80%) of closing price for the Common Stock on the Trading Day prior to the date of the Uplist.

 

(iii) If this Note is
being converted in connection with an Uplist, and a Simultaneous Uplist Unit Offering shall have occurred, this Note shall be
convertible into a number of Units equal to the quotient of (I) the outstanding aggregate principal amount of this Note plus
accrued but unpaid interest thereon, divided by (II) the lesser of (a) $0.40 and (b) the greater of (x) $0.20 and (y) eighty percent
(80%) of the per Unit price in the Simultaneous Uplist Unit Offering.

 

(iv) If this Note is being
converted upon a Subsequent Qualified Financing Date, this Note shall be convertible into a number of shares of Common Stock equal
to the quotient of (I) the outstanding aggregate principal amount of the Note plus accrued but unpaid interest thereon,
divided by (II) the lesser of (a) $0.40 and (b) the greater of (x) $0.20 and (y) eighty percent (80%) of the VWAP for the Common
Stock for the five (5) consecutive Trading Days immediately preceding such Subsequent Qualified Financing Date.

 

(v) In connection with any conversion of this Note pursuant to this Section 3(a), the Company will deliver a dated and signed notice
of conversion (the “Company Notice of Conversion”), the form of which is attached to this Note as Exhibit A-1,
notifying the Payee of the conversion.

 

    2

     

    

 

	 	(b)	Voluntary Conversion.

 

(i) The Holder shall have
the right (subject to the conversion limitations set forth in Section 3(c)(viii) hereof) from time following the date hereof to convert
all or any part of the outstanding and unpaid principal and interest under this Note into fully paid and non-assessable shares of Common
Stock, as such Common Stock exists on the date hereof, or any shares of capital stock or other securities of the Borrower into which such
Common Stock shall hereafter be changed or reclassified at the Voluntary Conversion Price (as defined below).

 

(ii) If
this Note is being converted pursuant to this Section 3(b), this Note shall be convertible into a number of shares of Common Stock equal
to the quotient of (I) the outstanding aggregate principal amount of the Note plus accrued but unpaid interest thereon, divided by (II)
the lesser of (a) $0.40 and (b) the greater of (x) $0.20 and (y) eighty percent (80%) of the VWAP for the Common Stock for the five (5)
consecutive Trading Days immediately preceding the applicable conversion date (the “Voluntary Conversion Price”).

 

(iii) In
connection with any conversion of this Note pursuant to this Section 3(b), the Holder will deliver to the Company a dated and signed
notice of conversion (the “Holder Notice of Conversion”), the form of which is attached to this Note as Exhibit
A-2, notifying the Company of the proposed conversion. If no date of conversion is specified in a Holder Notice of Conversion, the
date of conversion shall be the date that such Holder Notice of Conversion is deemed delivered hereunder.

 

	 	(c)	General Conversion Provisions.

 

(i)
No fractional shares shall be issued upon a conversion and all fractional shares shall be rounded up to the nearest whole share of Common
Stock.

 

(ii) As soon as
possible after a conversion has been effected (but in any event within five (5) Trading Days), the Company shall deliver to the
Payee a certificate or certificates representing the shares and warrants (in the case of any conversion of this Note into Units)
issuable by reason of such conversion in such name or names and such denomination or denominations as the then Payee has specified
in writing to the Company, or if not so specified, in one (1) certificate and in the name of the then Payee.

 

(iii)     
In lieu of delivering physical certificates representing the Common Stock issuable upon conversion, provided the Company is participating
in the Depository Trust Company (“DTC”) Fast Automated Securities Transfer (“FAST”) program, upon written request
of the then Payee and its compliance with the provisions contained in Section 1.1 and in this Section 3(xii), the Company shall use its
commercially reasonable best efforts to cause its transfer agent to electronically transmit the Common Stock issuable upon conversion
to the Payee by crediting the account of such Payee’s broker with DTC through its Deposit Withdrawal At Custodian (“DWAC”)
system.

 

(iv)
The issuance of Common Stock or Units upon conversion of this Note shall be made without charge to the then Payee in respect thereof or
other cost incurred by the Company in connection with such conversion. Upon conversion of this Note, the Company shall take all such actions
as are necessary to ensure that the Common Stock or warrants (in the case of any conversion of this Note into Units) issuable upon conversion
of the Note shall be validly authorized and available for issue, fully paid and nonassessable.

 

(v) The Company
shall not close its books against the transfer of this Note in any manner which interferes with the timely conversion of this Note.
The Company shall assist and cooperate with any holder of this Note required to make any governmental filings or obtain any
governmental approval prior to or in connection with the conversion of this Note (including, without limitation, making any filings
required to be made by the Company).

 

    3

     

    

 

(vi)
The Company shall at all times reserve and keep available out of its authorized but unissued shares of Common Stock, solely for the purpose
of issuance upon conversion hereunder, such number of shares of Common Stock issuable upon conversion of this Note. All shares of Common
Stock issuable upon conversion of this Note shall, when issued, be duly and validly issued, fully paid and nonassessable and free from
all taxes, liens and charges other than those occurring as a result of the actions or non-actions of the holder. The Company shall take
all such actions as may be reasonably necessary to assure that all such shares of Common Stock may be so issued without violation of any
applicable law or governmental regulation or any requirements of the Trading Market for the Common Stock.

 

(vii) The shares of Common Stock or shares of Common Stock underlying warrants, if any (in the case of any conversion of this Note into Units)
issuable upon conversion of this Note may not be sold or transferred unless (a) such shares or shares underlying the warrants are sold
pursuant to an effective registration statement under the Securities Act of 1933, as amended (the “1933 Act”) or (b) the Company
or its transfer agent shall have been furnished with an opinion of counsel reasonably acceptable to the Company to the effect that the
shares or shares underlying such warrants to be sold or transferred may be sold or transferred pursuant to an exemption from such registration
or (c) such shares or warrants are sold or transferred pursuant to Rule 144 of the 1933 Act, or other applicable exemption. Until such
time as the shares of Common Stock or shares underlying the warrants have been registered under the 1933 Act or otherwise may be sold
pursuant to Rule 144 or other applicable exemption without any restriction including as to the amount of securities as of a particular
date that can then be immediately sold, each certificate for shares of Common Stock or shares underlying warrants that is not included
in an effective registration statement or that have not been sold pursuant to an effective registration statement or an exemption that
permits removal of the legend, shall bear a legend substantially in the following form, as appropriate:

 

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

 

    4

     

    

 

(viii)    
The Company shall not effect any conversion of principal and/or interest of this Note, and a Holder shall not have the right to the conversion
of any principal and/or interest of this Note, to the extent that after giving effect to the conversion set forth on the applicable Notice
of Conversion, the Holder (together with the Holder’s affiliates, and any persons acting as a group together with the Holder or
any of the Holder’s affiliates) would beneficially own in excess of the Beneficial Ownership Limitation (as defined below). For
purposes of the foregoing sentence, the number of shares of Common Stock beneficially owned by the Holder and its affiliates shall include
the number of shares of Common Stock issuable upon conversion of this Note with respect to which such determination is being made, but
shall exclude the number of shares of Common Stock which are issuable upon (i) conversion of the remaining, unconverted principal amount
of this Note beneficially owned by the Holder or any of its affiliates and (ii) exercise or conversion of the unexercised or unconverted
portion of any other securities of the Company subject to a limitation on conversion or exercise analogous to the limitation contained
herein beneficially owned by the Holder or any of its affiliates. Except as set forth in the preceding sentence, for purposes of this
Section 3(c)(viii), beneficial ownership shall be calculated in accordance with Section 13(d) of the Exchange Act and the rules and regulations
promulgated thereunder. In addition, a determination as to any group status as contemplated above shall be determined in accordance with
Section 13(d) of the Exchange Act and the rules and regulations promulgated thereunder. Upon the written or oral request of a Holder,
the Company shall within two Business Days confirm orally and in writing to the Holder the number of shares of Common Stock then outstanding.
In any case, the number of outstanding shares of Common Stock shall be determined after giving effect to the conversion or exercise of
securities of the Company, including this Note, by the Holder or its affiliates since the date as of which such number of outstanding
shares of Common Stock was reported. The “Beneficial Ownership Limitation” shall be 4.99% of the number of shares of the Common
Stock outstanding immediately after giving effect to the issuance of shares of Common Stock issuable upon conversion of this Note held
by the Holder. The Holder, upon not less than 61 days’ prior notice to the Company, may increase or decrease the Beneficial Ownership
Limitation provisions of this Section 3(c)(viii), provided that the Beneficial Ownership Limitation in no event exceeds 9.99% of the number
of shares of the Common Stock outstanding immediately after giving effect to the issuance of shares of Common Stock upon conversion of
this Note held by the Holder and the Beneficial Ownership Limitation provisions of this Section 3(c)(viii), shall continue to apply. Any
such increase or decrease will not be effective until the 61st day after such notice is delivered to the Company. The Beneficial Ownership
Limitation provisions of this paragraph shall be construed and implemented in a manner otherwise than in strict conformity with the terms
of this Section 3(c)(viii), to correct this paragraph (or any portion hereof) which may be defective or inconsistent with the intended
Beneficial Ownership Limitation contained herein or to make changes or supplements necessary or desirable to properly give effect to such
limitation. The limitations contained in this paragraph shall apply to a successor holder of this Note.

 

4.  
Method of Payments.

 

(i)
Payment. So long as the Payee or any of its registered assigns shall be the holder of this Note, and if this Note has not previously
been converted, the Company will pay all outstanding principal and accrued but unpaid interest becoming due on this Note held by the Payee
or any of its registered assigns not later than 1:00 p.m. New York time, on the date such payment is due hereunder, in immediately available
funds, in accordance with the payment instructions attached hereto on Schedule 4(i), without the presentation or surrender of this
Note or the making of any notation thereon. Any payment made after 4:00 p.m. New York time, on a Business Day will be deemed made on the
next following Business Day. If the due date of any payment in respect of this Note would otherwise fall on a day that is not a Business
Day, such due date shall be extended to the next succeeding Business Day. All amounts payable under this Note shall be paid free and clear
of, and without reduction by reason of, any deduction, set-off or counterclaim. The Company will afford the benefits of this Section to
the Payee and to each other Person holding this Note.

 

    5

     

    

 

(ii) Transfer and
Exchange. Upon surrender of any Note for registration of transfer or for exchange to the Company, in accordance with the terms
hereof, at its principal office, the Company at its sole expense will execute and deliver in exchange therefor a new Note or Notes,
as the case may be, as requested by the holder or transferee, which aggregate principal amount is equal to the unpaid principal
amount of such Note, registered as such holder or transferee may request; provided that this Note may not be transferred by Payee to
any Person other than Payee’s affiliates without the prior written consent of the Company (which consent shall not be
unreasonably withheld or delayed). The issuance of new Notes shall be made without charge to the holder(s) of the surrendered Note
for any issuance tax in respect thereof or other cost incurred by the Company in connection with such issuance, provided that each
Noteholder shall pay any transfer taxes associated therewith. The Company shall be entitled to regard the registered holder of this
Note as the holder of the Note so registered for all purposes until the Company or its agent, as applicable, is required to record a
transfer of this Note on its register.

 

(iii)   Replacement. Upon receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or mutilation of any
Note and, in the case of any such loss, theft or destruction of any Note, upon receipt of an indemnity reasonably satisfactory to the
Company or, in the case of any such mutilation, upon the surrender and cancellation of such Note, the Company, at its expense, will execute
and deliver, in lieu thereof, a new Note of like tenor and dated the date of such lost, stolen, destroyed or mutilated Note.

 

5. Redemption. Prior to
the date of any Uplist or the Maturity Date, this Note may be redeemed in full by the Company following three (3) days’ notice
to the Payee, by paying in full the then outstanding principal amount plus any accrued but unpaid interest owing hereunder without
any premium or other payment.

 

6.
Covenants of the Company. The Company covenants and agrees as follows:

 

(i)
Use of Proceeds. The Company shall use the net proceeds received in the Offering only for working capital purposes and not to redeem
or make any payment on account of any securities of the Company other than as provided in Schedule 1 attached hereto.

 

(ii)       
Notes. All Notes issued under the Purchase Agreement shall be on the same terms and shall be in substantially the same form as
this Note. All cash payments to the holder of any Note shall be made to all holders of Notes, pro rata, based on the outstanding aggregate
principal amount of each such holder’s Note to the aggregate principal amount of all Notes outstanding at such time.

 

7. Events of Default.
If any of the following events take place before or on the Maturity Date or the date of full conversion of this Note (each, an
“Event of Default”), holders owning 50.1% of the aggregate principal amount of all Notes then outstanding may
declare an Event of Default by providing written notice thereof to the Company, all outstanding aggregate principal and accrued but
unpaid interest on this Note and the other Notes outstanding immediately due and payable; provided, however, that this
Note shall automatically become due and payable:

 

(i) Company fails to make payment of the full amount due under this Note upon the tender of such Note following the Maturity Date, which failure
to make payment continues for a period of five (5) days after receipt by the Company of written notice from the Noteholder of such default;
or

 

    6

     

    

 

(ii) Company files any
petition or action for relief under any bankruptcy, reorganization, insolvency or moratorium law or any other law for the relief of,
or relating to, debtors, now or hereafter in effect, or makes any assignment for the benefit of creditors or takes any corporate
action in furtherance of any of the foregoing;

 

(iii) An involuntary
petition is filed against the Company (unless such petition is dismissed or discharged within sixty (60) days) under any bankruptcy
statute then in effect, or a custodian, receiver, trustee, assignee for the benefit of creditors (or other similar person) is
appointed to take possession, custody or control of any property of the Company;

 

(iv) Company
dissolves, liquidates or ceases business activity, or transfers any major portion of its assets other than in the ordinary course of
business; provided that this paragraph (ix) shall not apply to any contemplated real estate transaction; or

 

(v)Company breaches any material covenant or agreement on its part contained herein and such breach has not been remedied within twenty (20)
days after receipt by the Company of written notice from the Noteholder of such breach.

 

8. Definitions.

 

“Business Day”
means a day (other than a Saturday or Sunday) on which banks generally are open in New York, New York for the conduct of substantially
all of their activities.

 

“Common Stock”
means the Company’s common stock, par value $0.001 per share.

 

“Noteholder”
or “Payee” with respect to any Note including this Note, means at any time each Person then the record owner thereof
and “Noteholders” or “Payees” means all of such Noteholders or Payees, collectively.

 

“Note Issuance”
or “Offering” shall mean the private placement by the Company of its 10% Convertible Promissory Notes issued by the
Company to the Payee and other purchasers of Notes (each Note in substantially the form of this Note) in the original principal amount
not to exceed $______ in the aggregate.

 

“Person”
means any person or entity of any nature whatsoever, specifically including an individual, a firm, a company, a corporation, a partnership,
a limited liability company, a trust or other entity.

 

    7

     

    

 

“Trading Day”
means any day that shares of Common Stock are traded on the  Trading Market.

 

“Trading Market”
shall mean the principal securities exchange or trading market where the  Common Stock is listed or traded, including but not limited
to any tier of the OTC Markets, any tier of the NASDAQ Stock Market (including NASDAQ Capital Market), the New York Stock Exchange, or
the NYSE American, or any successor to such markets.

 

“VWAP” means,
for any Trading Day, the price determined by the first of the following clauses that applies: (a) if the Common Stock is then listed or
quoted on a Trading Market, the daily volume weighted average price of the Common Stock for such Trading Day (or the nearest preceding
date) on the Trading Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading Day from
9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (b) if OTCQB or OTCQX is not a Trading Market, the volume weighted
average price of the Common Stock for such date (or the nearest preceding date) on OTCQB or OTCQX as applicable, (c) if the Common Stock
is not then listed or quoted for trading on OTCQB or OTCQX and if prices for the Common Stock are then reported in the “Pink Sheets”
published by OTC Markets Group, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the most recent
bid price per share of the Common Stock so reported, or (d) in all other cases, the fair market value of a share of Common Stock as determined
by an independent appraiser selected by mutual agreement of the Company and Noteholders owning no less than 50.1% of the then aggregate
principal amount of the Notes outstanding.

 

9. Expenses of
Enforcement, etc. The Company agrees to pay all reasonable fees and expenses incurred by the Payee in connection with any
amendments, modifications, waivers, extensions, renewals, renegotiations or “workouts” of the provisions hereof or
incurred by the Payee in connection with the enforcement or protection of its rights in connection with this Note, or in connection
with any pending or threatened action, proceeding, or investigation relating to the foregoing, including but not limited to the
reasonable fees and disbursements of one (1) legal counsel that represents all Noteholders (“Fees and Expenses”). The
Company indemnifies the Payee and its directors, managers, affiliates, partners, members, officers, employees and agents against,
and agrees to hold the Payee and each such person and/or entity harmless from, any and all losses, claims, damages, liabilities and
related expenses, including reasonable counsel fees and expenses, incurred by or asserted against the Payee or any such person
and/or entity arising out of, in any way connected with, or as a result of the consummation of the loan evidenced by this Note and
the use of the proceeds thereof or any claim, litigation, investigation or proceedings relating to any of the foregoing, whether or
not the Payee or any such person and/or entity is a party thereto other than any loss, claim, damage, liability or related expense
incurred or asserted against the payee or any such person on account of the payee’s or such person’s gross negligence or
willful misconduct. Notwithstanding the foregoing, with respect to the indemnification obligations of the Company hereunder, (i) the
Company’s aggregate liability under this Note to the Payee shall not exceed the outstanding aggregate principal amount of this
Note (this limitation does not apply to Fees and Expenses), and (ii) indemnified liabilities shall not include any liability of any
indemnitee arising out of such indemnitee’s gross negligence or willful or intentional misconduct. To the extent that the
foregoing undertaking by the Company may be unenforceable for any reason, the Company shall make the maximum contribution to the
payment and satisfaction of each of the indemnified liabilities which is permissible under applicable law.

 

    8

     

    

 

10.    Amendment
and Waiver. The provisions of this Note may only be modified, amended or waived by the written consent of the Company and the holder
or, whether or not agreed to by the holder, with the written consent of the Company and holders of a majority of the aggregate principal
amount of all Notes then outstanding.

 

11.    Remedies
Cumulative. No remedy herein conferred upon the Payee is intended to be exclusive of any other remedy and each and every such remedy
shall be cumulative and shall be in addition to every other remedy given hereunder or now or hereafter existing at law or in equity or
by statute or otherwise.

 

12.    Remedies
Not Waived. No course of dealing between the Company and the Payee or any delay on the part of the Payee in exercising any rights
hereunder shall operate as a waiver of any right of the Payee.

 

13.    Assignments.
The Payee may assign, participate, transfer or otherwise convey this Note and any of its rights or obligations hereunder to any affiliate
of Payee and to any other Person that the Company consents to (such consent not to be unreasonably withheld or delayed), and this Note
shall inure to the benefit of the Payee’s successors and permitted assigns. The Company shall not assign or delegate this Note or
any of its liabilities or obligations hereunder.

 

14.    Headings.
The headings of the sections and paragraphs of this Note are inserted for convenience only and do not constitute a part of this Note.

 

15.    Severability.
If any provision of this Note is held invalid or unenforceable by any court of competent jurisdiction, the other provisions of this Note
will remain in full force and effect. Any provision of this Note held invalid or unenforceable only in part or degree will remain in full
force and effect to the extent not held invalid or unenforceable.

 

16.    Cancellation.
After all principal, premiums (if any) at any time owed on this Note have been paid in full, or this Note has been converted this Note
will be surrendered to the Company for cancellation and will not be reissued.

 

17.    Governing
Law; Jurisdiction. This Note and the terms and conditions set forth herein, shall be governed by and construed solely and exclusively
in accordance with the internal laws of the State of New York without regard to the conflicts of laws principles thereof. The parties
hereto hereby expressly and irrevocably agree that any suit or proceeding arising directly and/or indirectly pursuant to or under this
Note shall be brought solely in a federal or state court located in the City, County and State of New York. By its execution hereof, the
parties hereto covenant and irrevocably submit to the in personam jurisdiction of the federal and state courts located in the City, County
and State of New York and agree that any process in any such action may be served upon any of them personally, or by certified mail or
registered mail upon them or their agent, return receipt requested, with the same full force and effect as if personally served upon them
in New York, New York. The parties hereto expressly and irrevocably waive any claim that any such jurisdiction is not a convenient forum
for any such suit or proceeding and any defense or lack of in personam jurisdiction with respect thereto. In the event of any such action
or proceeding, the party prevailing therein shall be entitled to payment from the other parties hereto of all of its reasonable counsel
fees and disbursements.

 

    9

     

    

 

18.    Maximum
Legal Rate. If at any time an interest rate applicable hereunder exceeds the maximum rate permitted by law, such rate shall be reduced
to the maximum rate so permitted by law.

 

19.    Place
of Payment. Unless otherwise stated herein, payments of principal and interest shall be delivered to the holder of this Note at the
address provided by the Payee in the Purchase Agreement, or at such other address as such Noteholder has specified by prior written notice
to the Company.

 

20.    Notice.
Where this Note provides for notice of any event or otherwise, such notice shall be given (unless otherwise herein expressly provided)
in writing and either (a) delivered personally, (b) sent by certified, registered or express mail, postage prepaid or (c) sent by facsimile
or other electronic transmission, and shall be deemed given when so delivered personally, sent by facsimile or other electronic transmission
(confirmed in writing) or mailed. Notices shall be addressed, if to the Company, to its then principal office, or if to the Holder, to
its address as provided in the Purchase Agreement or such other address as may be specified by the Holder in a written notice delivered
to the Company under this Section 20.

 

21.    WAIVER
OF JURY TRIAL. THE PAYEE AND THE COMPANY EACH HEREBY WAIVES ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION
DIRECTLY OR INDIRECTLY ARISING OUT OF, UNDER OR IN CONNECTION WITH THIS NOTE AND/OR THE TRANSACTIONS CONTEMPLATED HEREUNDER.

 

22.    No Recourse Against
Others. The obligations of the Company under this Note are solely obligations of the Company and no officer, employee,
stockholder or director of the Company shall be liable for any failure by the Company to pay amounts on this Note when due or
perform any other obligation.

 

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

 

    10

     

    

 

IN WITNESS WHEREOF, the Company has executed and
delivered this Promissory Note on the date first written above.

 

	 	COMPANY:
	 	 	 
	 	BRAIN SCIENTIFIC, INC.
	 	 	 
	 	By:	              
	 	Name:	 
	 	Title:	 

 

	ACCEPTED AND AGREED TO BY PAYEE 	 
	ON THE DATE FIRST WRITTEN ABOVE	 
	 	 
	Print Name of Payee	 
	 	 
	Signature	 

 

    11

     

    

 

EXHIBIT A-1

 

COMPANY NOTICE OF CONVERSION

 

 

[Payee]

[Address]

 

Brain Scientific, Inc. (the
“Company”), the issuer of that certain 10% Convertible Promissory Note, issued on September 9, 2021 (the “Note”),
hereby notifies you as holder of such Note that in accordance with Section 3(a) thereof the outstanding principal balance of the Note
plus accrued but unpaid interest thereon in the aggregate amount of $  will be converted into [_______ shares of common stock,
par value $0.001 of the Company][Units of the Company consisting of [_______ ] shares of common stock, par value $0.001, and warrants
entitling you to purchase [_______ ] shares of common stock, par value $0.001 at a per share price of $__ and expiring on [date]] and
issued to you in satisfaction in full of all amounts owing under the Note. Upon receipt of such [shares][Units] (including in book-entry
form at the Company’s transfer agent), the Note shall be cancelled.

 

	Dated:	 	 
	 	 	 
	Brain Scientific, Inc. 	 
	 	 	 
	By:	            	 
	Name:	 	 
	Title:	 	 

 

    12

     

    

 

EXHIBIT A-2

 

HOLDER NOTICE OF CONVERSION

 

 

Brain Scientific, Inc.

6700 Professional Parkway

Lakewood Ranch, Florida

Attention: Bonnie-Jeanne Gerety

Email: Bjgerety@piezomotion.com

 

The undersigned, ______________________,
as holder of that certain 10% Convertible Promissory Note, issued by Brain Scientific, Inc. (the “Company”) on October
1st, 2021 (the “Note”), hereby notifies the Company that in accordance with Section 3(b) thereof, that it
wishes to convert $________________ of the outstanding principal balance of the Note and $________________ of accrued but unpaid interest
thereon, into ___________ shares of common stock, par value $0.001 of the Company, at a per share price of $_________ , in satisfaction
of such amount owing under the Note. Upon receipt of such shares (including in book-entry form at the Company’s transfer agent),
the portion of the Note being so converted shall be cancelled.

 

	Dated:	 	 
	 	 	 
	 	 	 
	Company:	 	 
	By:	            	 
	Name:	 	 
	Title:	 	 

 

 

13Exhibit 10.3

 

receiNEITHER THE ISSUANCE AND SALE OF THE SECURITIES
REPRESENTED BY THIS CERTIFICATE NOR THE SECURITIES INTO WHICH THESE SECURITIES ARE EXERCISABLE HAVE BEEN REGISTERED UNDER THE SECURITIES
ACT OF 1933, AS AMENDED, OR APPLICABLE STATE SECURITIES LAWS. THE SECURITIES MAY NOT BE OFFERED FOR SALE, SOLD, TRANSFERRED OR ASSIGNED
(I) IN THE ABSENCE OF (A) AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR (B)
AN OPINION OF COUNSEL OF THE HOLDER, IN A GENERALLY ACCEPTABLE FORM, THAT REGISTRATION IS NOT REQUIRED UNDER SAID ACT OR (II) UNLESS SOLD
PURSUANT TO RULE 144 OR RULE 144A UNDER SAID ACT. NOTWITHSTANDING THE FOREGOING, THE SECURITIES MAY BE PLEDGED IN CONNECTION WITH A BONA
FIDE MARGIN ACCOUNT OR OTHER LOAN OR FINANCING ARRANGEMENT SECURED BY THE SECURITIES.

 

	 	Right to Purchase 1______ shares of Common Stock of Brain Scientific, Inc. (subject to adjustment as provided herein)

 

COMMON STOCK PURCHASE WARRANT

 

	No.: PPW-___ 	Issue Date:

 

BRAIN SCIENTIFIC, INC., a corporation organized
under the laws of the State of Nevada (the “Company”), hereby certifies that, for value received, _________________________,
with an address at ___________________________________________________, or its assigns (the “Holder”), is entitled,
subject to the terms set forth below, to purchase from the Company at any time from the Issue Date until 5:00 p.m. E.D.T. on the [fourth]
anniversary of the Issue Date (the “Expiration Date”), up to _______________2 fully paid and non-assessable
shares of the Company’s common stock, par value $0.001 per share (the “Common Stock”) at a per share purchase price
equal to the Exercise Price. The aforedescribed purchase price per share, as adjusted from time to time as herein provided, is referred
to herein as the “Purchase Price.” The number of such shares of Common Stock and the Purchase Price are subject to
adjustment as provided herein. The Company may reduce the Purchase Price for some or all of the Warrants, temporarily or permanently,
provided such reduction is made as to all outstanding Warrants. This warrant (this “Warrant”) is one of
a series of substantially similar Warrants issued by the Company together with its 10% convertible promissory notes to the Holder and
other purchasers of such securities in a private placement pursuant to the Securities Purchase Agreement between the Company and purchasers
therein including the Holder (the “Purchase Agreement”). Capitalized terms used and not otherwise defined herein shall
have the meanings set forth in the Purchase Agreement. In the event that an aggregate Purchase Price equal to $5,000,000 shall not have
been sold in accordance with the terms of the Purchase Agreement by October 1st, 2021, this Warrant shall be cancelled.

 

As used herein the following
terms, unless the context otherwise requires, have the following respective meanings:

 

(a) The term “Company”
shall mean Brain Scientific, Inc., a Nevada corporation.

 

(b) The term “Common
Stock” includes (i) the Company’s Common Stock, $0.001 par value per share and (ii) any Other Securities into which or
for which any of the securities described in (i) may be converted or exchanged pursuant to a plan of recapitalization, reorganization,
merger, sale of assets or otherwise.

 

 

 

		1	Insert number of shares determined in accordance with Section
1(c) of the Purchase Agreement

		2	Insert number of shares determined in accordance with Section
1(c) of the Purchase Agreement

 

     

     

    

 

(c) The term “Exercise
Price” shall mean3.

 

(d) The term “Other
Securities” refers to any stock (other than Common Stock) and other securities of the Company or any other person (corporate
or otherwise) which the holder of the Warrant at any time shall be entitled to receive, or shall have received, on the exercise of the
Warrant, in lieu of or in addition to Common Stock, or which at any time shall be issuable or shall have been issued in exchange for or
in replacement of Common Stock or Other Securities pursuant to Section 5 hereof or otherwise.

 

(e) The term “Trading
Day” shall mean any day that shares of Common Stock are traded on the Trading Market.

 

(f) The term “Trading
Market” shall mean the principal securities exchange or trading market where the Common Stock is listed or traded, including
but not limited to any tier of the OTC Markets, any tier of the NASDAQ Stock Market (including NASDAQ Capital Market), the New York Stock
Exchange, or the NYSE American, or any successor to such markets.

 

(g) [The term “VWAP”
means, for any Trading Day, the price determined by the first of the following clauses that applies: (i) if the Common Stock is then listed
or quoted on a Trading Market, the daily volume weighted average price of the Common Stock for such Trading Day (or the nearest preceding
date) on the Trading Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading Day from
9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (ii) if OTCQB or OTCQX is not a Trading Market, the volume weighted
average price of the Common Stock for such date (or the nearest preceding date) on OTCQB or OTCQX as applicable, (iii) if the Common Stock
is not then listed or quoted for trading on OTCQB or OTCQX and if prices for the Common Stock are then reported in the “Pink Sheets”
published by OTC Markets Group, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the most recent
bid price per share of the Common Stock so reported, or (iv) in all other cases, the fair market value of a share of Common Stock as determined
by an independent appraiser selected by mutual agreement of the Company and the holders owning no less than 50.1% of the then Warrants
outstanding.]4

 

(h) The term “Warrant
Shares” shall mean the Common Stock issuable upon exercise of this Warrant.

  

1. Exercise of Warrant.

 

1.1. Number of Shares Issuable
upon Exercise. From and after the Issue Date through and including the Expiration Date, the Holder shall be entitled to receive, upon
exercise of this Warrant in whole in accordance with the terms of Section 1.2 hereof or upon exercise of this Warrant in part in
accordance with Section 1.3 hereof, shares of Common Stock of the Company, subject to adjustment pursuant to Section 3 hereof.

 

1.2. Full Exercise. This
Warrant may be exercised in full by the Holder hereof by delivery to the Company of an original or facsimile copy of the Form of Exercise
attached as Exhibit A hereto (the “Exercise Form”) duly executed by such Holder and delivered within two (2)
business days thereafter of payment, in cash, wire transfer or by certified or official bank check payable to the order of the Company,
in the amount obtained by multiplying the number of shares of Common Stock for which this Warrant is then exercisable by the Purchase
Price then in effect. The original Warrant is not required to be surrendered to the Company until it has been fully exercised.

 

 

 

		3	If this warrant has been issued upon the listing of the Company’s
Common Stock on NASDAQ (the “Uplist”), insert as the Exercise Price an actual price equal to the greater of (A) $0.20, and
(B) eighty percent (80%) of closing price for the Common Stock on the Trading Day prior to the date of the Uplist. If this warrant has
been issued otherwise than upon the occasion of an Uplist, then insert the following bracketed language as the Exercise Price [the lesser
of (A) $0.40, and (B) and the greater of (x) $0.20 and (y) eighty percent (80%) of the average VWAP for the Common Stock over the five
(5) consecutive Trading Days immediately preceding the exercise date of this Warrant.]

		4	If this warrant is issued upon the occurrence of the Uplist,
then delete this definition of VWAP since it will not be necessary. If this warrant issued otherwise then upon the occasion of an Uplist
remove brackets around the definition of VWAP.

 

    2

     

    

 

1.3. Partial Exercise.
This Warrant may be exercised in part (but not for a fractional share) by delivery of a Exercise Form in the manner and at the place provided
in Section 1.2 hereof, except that the amount payable by the Holder on such partial exercise shall be the amount obtained by multiplying
(a) the number of whole shares of Common Stock designated by the Holder in the Exercise Form by (b) the Purchase Price then in effect.
On any such partial exercise, upon the written request of the Holder, provided the Holder has surrendered the original Warrant, the Company,
at its expense, will forthwith issue and deliver to or upon the order of the Holder a new Warrant of like tenor, in the name of the Holder
hereof or as such Holder (upon payment by such Holder of any applicable transfer taxes) may request, the whole number of shares of Common
Stock for which such Warrant may still be exercised.

  

1.4. Reserved

 

1.5. Company Acknowledgment.
The Company will, at the time of the exercise of the Warrant, upon the request of the Holder hereof, acknowledge in writing its continuing
obligation to afford to such Holder any rights to which such Holder shall continue to be entitled after such exercise in accordance with
the provisions of this Warrant. If the Holder shall fail to make any such request, such failure shall not affect the continuing obligation
of the Company to afford to such Holder any such rights.

 

1.6. Delivery of Stock Certificates,
etc. on Exercise. The Company agrees that, provided the purchase price listed in the Exercise Form is received as specified in Section
2 hereof, the shares of Common Stock purchased upon exercise of this Warrant shall be deemed to be issued to the Holder hereof as
the record owner of such shares as of the close of business on the date on which delivery of a Exercise Form shall have occurred and payment
made for such shares as aforesaid. As soon as practicable after the exercise of this Warrant in full or in part and the payment is made,
and in any event within five (5) business days thereafter (“Warrant Share Delivery Date”), the Company, at its expense
(including the payment by it of any applicable issue taxes), will cause to be issued in the name of, and delivered to, the Holder hereof,
or as such Holder (upon payment by such Holder of any applicable transfer taxes) may direct in compliance with applicable securities laws,
a certificate or certificates for the number of duly and validly issued, fully paid and non-assessable shares of Common Stock to which
such Holder shall be entitled on such exercise, plus, in lieu of any fractional share to which such Holder would otherwise be entitled,
cash equal to such fraction multiplied by the then Purchase Price of one full share of Common Stock, together with any other stock or
other securities and property (including cash, where applicable) to which such Holder is entitled upon such exercise pursuant to Section
1 hereof or otherwise.

 

 

2. Payment of Purchase
Price; Cashless Exercise.

 

(a) Payment upon exercise may
be made at the written option of the Holder either in (i) cash, wire transfer or by certified or official bank check payable to the order
of the Company equal to the applicable aggregate Purchase Price, (ii) by delivery of Common Stock issuable upon exercise of the Warrants
in accordance with Section (b) below or (iii) by a combination of any of the foregoing methods, in each case accompanied by delivery of
a properly endorsed Exercise Form, for the number of Common Stock specified in such form (as such exercise number shall be adjusted to
reflect any adjustment in the total number of shares of Common Stock issuable to the Holder per the terms of this Warrant) and the Holder
shall thereupon be entitled to receive the number of duly authorized, validly issued, fully-paid and non-assessable shares of Common Stock
determined as provided herein. Notwithstanding the immediately preceding sentence, payment upon exercise may be made in the manner described
in Section 2(b) below only with respect to Warrant Shares not included for unrestricted public resale in an effective registration
statement on the date notice of exercise is given by the Holder.

 

    3

     

    

 

(b) In lieu of exercising this
Warrant for cash, the Holder, may elect to receive shares equal to the value (as determined below) of this Warrant (or the portion thereof
being cancelled) by delivery of a properly endorsed Exercise Form delivered to the Company by any means described in Section 13
hereof, in which event the Company shall issue to the holder the “Net Number” of shares of Common Stock computed using the
following formula:

 

Net Number = A - (A x B)

 

For purposes of the foregoing formula:

 

A = the total number of shares with respect to
which this Warrant is then being exercised.

 

B = Purchase Price (as adjusted for stock splits, stock dividends,
stock combinations, recapitalizations, and similar events) 

 

For purposes of Rule 144 promulgated
under the 1933 Act, it is intended, understood and acknowledged that the Warrant Shares issued in a cashless exercise transaction in the
manner described above shall be deemed to have been acquired by the Holder, and the holding period for the underlying shares of Common
Stock shall be deemed to have commenced, on the date this Warrant was originally issued.

  

3. Adjustment for Reorganization,
Consolidation, Merger, etc..

 

3.1. Continuation of Terms.
Upon any reorganization, consolidation, merger or transfer (and any dissolution following any transfer) referred to in this Section
3 hereof, this Warrant shall continue in full force and effect and the terms hereof shall be applicable to the Other Securities and
property receivable on the exercise of this Warrant after the consummation of such reorganization, consolidation or merger or the effective
date of dissolution following any such transfer, as the case may be, and shall be binding upon the issuer of any Other Securities, including,
in the case of any such transfer, the person acquiring all or substantially all of the properties or assets of the Company, whether or
not such person shall have expressly assumed the terms of this Warrant as provided in Section 5 hereof.

 

4. Registration Rights.
The Holder of this Warrant shall have such registration rights for the Warrant Shares as are contained in the Purchase Agreement, if any.

 

5. Extraordinary Events
Regarding Common Stock. In the event that the Company shall (a) issue additional shares of Common Stock as a dividend or other distribution
on outstanding Common Stock, (b) subdivide its outstanding shares of Common Stock, or (c) combine its outstanding shares of the Common
Stock into a smaller number of shares of Common Stock, then, in each such event, the Purchase Price shall, simultaneously with the happening
of such event, be adjusted by multiplying the then Purchase Price by a fraction, the numerator of which shall be the number of shares
of Common Stock outstanding immediately prior to such event and the denominator of which shall be the number of shares of Common Stock
outstanding immediately after such event, and the product so obtained shall thereafter be the Purchase Price then in effect. The Purchase
Price, as so adjusted, shall be readjusted in the same manner upon the happening of any successive event or events described in this Section
5. The number of shares of Common Stock that the Holder of this Warrant shall thereafter, on the exercise hereof, be entitled to receive
shall be adjusted to a number determined by multiplying the number of shares of Common Stock that would otherwise (but for the provisions
of this Section 5) be issuable on such exercise by a fraction of which (a) the numerator is the Purchase Price that would otherwise
(but for the provisions of this Section 5) be in effect, and (b) the denominator is the Purchase Price in effect on the date of
such exercise.

 

6. Certificate as to Adjustments.
In each case of any adjustment or readjustment in the shares of Common Stock issuable on the exercise of the Warrants or in the Purchase
Price, the Company at its expense will promptly cause its Chief Financial Officer or other appropriate designee to compute such adjustment
or readjustment in accordance with the terms of the Warrant and prepare a certificate setting forth such adjustment or readjustment and
showing in detail the facts upon which such adjustment or readjustment is based, including a statement of (a) the consideration received
or receivable by the Company for any additional shares of Common Stock issued or sold or deemed to have been issued or sold, (b) the number
of shares of Common Stock outstanding or deemed to be outstanding, and (c) the Purchase Price and the number of shares of Common Stock
to be received upon exercise of this Warrant, in effect immediately prior to such adjustment or readjustment and as adjusted or readjusted
as provided in this Warrant. The Company will forthwith mail a copy of each such certificate to the Holder. Holder will be entitled to
the benefit of the adjustment regardless of the giving of such notice. The timely giving of such notice to Holder is a material obligation
of the Company.

  

    4

     

    

 

7. Reservation of Stock,
etc. Issuable on Exercise of Warrant; Financial Statements. The Company will at all times reserve and keep available, solely for issuance
and delivery on the exercise of the Warrants, all shares of Common Stock (or Other Securities) from time to time issuable on the exercise
of the Warrant. This Warrant entitles the Holder hereof, upon written request, to receive copies of all financial and other information
distributed or required to be distributed to the holders of the Company’s Common Stock.

 

8. Assignment; Exchange
of Warrant. 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.

 

9. Replacement of Warrant.
On 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 of this Warrant, on delivery of an indemnity agreement or security reasonably satisfactory
in form and amount to the Company or, in the case of any such mutilation, on surrender and cancellation of this Warrant, the Company at
its expense, twice only, will execute and deliver, in lieu thereof, a new Warrant of like tenor.

 

10. Maximum Exercise.
The Holder shall not be entitled to exercise this Warrant on an exercise date, in connection with that number of shares of Common Stock
which would be in excess of the sum of (i) the number of shares of Common Stock beneficially owned by the Holder and its Affiliates on
an exercise date, and (ii) the number of shares of Common Stock issuable upon the exercise of this Warrant with respect to which the determination
of this limitation is being made on an exercise date, which would result in beneficial ownership by the Holder and its Affiliates of more
than 4.99% of the outstanding shares of Common Stock on such date. For the purposes of the immediately preceding sentence, beneficial
ownership shall be determined in accordance with Section 13(d) of the 1934 Act and Rule 13d-3 thereunder. Subject to the foregoing, the
Holder shall not be limited to aggregate exercises which would result in the issuance of more than 4.99%. The Holder may allocate which
of the equity of the Company deemed beneficially owned by the Holder shall be included in the 4.99% amount described above and which shall
be allocated to the excess above 4.99%. The restriction described in this paragraph may be waived, in whole or in part, upon sixty-one
(61) days’ prior notice from the Holder to the Company to increase such percentage.

  

11. Transfer on the Company’s
Books. Until this Warrant is transferred on the books of the Company, the Company may treat the registered holder hereof as the absolute
owner hereof for all purposes, notwithstanding any notice to the contrary.

  

12. Notices. All notices,
demands, requests, consents, approvals, and other communications required or permitted hereunder shall be in writing and, unless otherwise
specified herein, shall be (i) personally served, (ii) deposited in the mail, registered or certified, return receipt requested, postage
prepaid, (iii) delivered by reputable air courier service with charges prepaid, or (iv) transmitted by hand delivery, telegram, or facsimile
addressed as set forth below or to such other address as such party shall have specified most recently by written notice. Any notice or
other communication required or permitted to be given hereunder shall be deemed effective (a) upon hand delivery or delivery by facsimile,
with accurate confirmation generated by the transmitting facsimile machine, at the address or number designated below (if delivered on
a business day during normal business hours where such notice is to be received), or the first business day following such delivery (if
delivered other than on a business day during normal business hours where such notice is to be received), or (b) on the second business
day following the date of mailing by express courier service, fully prepaid, addressed to such address, or upon actual receipt of such
mailing, whichever shall first occur. The addresses for such communications shall be: (i) if to the Company, to Brain Scientific, Inc.,
6700 Professional Parkway, Lakewood Ranch, Florida, Attn: Bonnie-Jeanne Gerety, with a copy by fax only to (which shall not constitute
notice) Lucosky Brookman LLP, 101 Wood Avenue South, 5th Floor, Iselin, NJ 08830, Attn: Lawrence Metelitsa, Esq., facsimile: (732) 395-4401,
and (ii) if to the Holder, to the address and facsimile number listed on the first paragraph of this Warrant.

 

    5

     

    

 

13. Governing Law; Jurisdiction
Etc. This Warrant and the terms and conditions set forth herein, shall be governed by and construed solely and exclusively in accordance
with the internal laws of the State of New York without regard to the conflicts of laws principles thereof. The parties hereto hereby
expressly and irrevocably agree that any suit or proceeding arising directly and/or indirectly pursuant to or under this Warrant shall
be brought solely in a federal or state court located in the City, County and State of New York. By its execution hereof, the parties
hereto covenant and irrevocably submit to the in personam jurisdiction of the federal and state courts located in the City, County and
State of New York and agree that any process in any such action may be served upon any of them personally, or by certified mail or registered
mail upon them or their agent, return receipt requested, with the same full force and effect as if personally served upon them in New
York, New York. The parties hereto expressly and irrevocably waive any claim that any such jurisdiction is not a convenient forum for
any such suit or proceeding and any defense or lack of in personam jurisdiction with respect thereto. In the event of any such action
or proceeding, the party prevailing therein shall be entitled to payment from the other parties hereto of all of its reasonable counsel
fees and disbursements.

 

14. WAIVER OF JURY TRIAL.
THE PAYEE AND THE COMPANY EACH HEREBY WAIVES ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION DIRECTLY OR INDIRECTLY
ARISING OUT OF, UNDER OR IN CONNECTION WITH THIS NOTE AND/OR THE TRANSACTIONS CONTEMPLATED HEREUNDER.

  

[-Signature Page Follows-]

 

    6

     

    

 

IN WITNESS WHEREOF, the Company has executed this
Warrant as of the date first written above.

 

	 	BRAIN SCIENTIFIC, INC.

 

	 	By:	 
	 	Name: 	 
	 	Title: 	 

 

ACCEPTED AND AGREED TO BY HOLDER 

ON THE DATE FIRST WRITTEN ABOVE

 

		 
	Print Name of Holder	 
	 	 
	 	 
		 
	Signature of Holder	 

 

    7

     

    

 

Exhibit A

 

FORM OF EXERCISE

(to be signed only on exercise of Warrant)

 

TO: BRAIN SCIENTIFIC, INC.

 

The undersigned, pursuant to the provisions set
forth in the attached Warrant (No.____), hereby irrevocably elects to purchase (check applicable box):

 

___ ________ shares of the Common Stock covered
by such Warrant; or

 

		☐	the
maximum number of shares of Common Stock covered by such Warrant pursuant to the cashless exercise procedure set forth in Section 2 of
the Warrant.

 

The undersigned herewith makes payment of the
full purchase price for such shares at the price per share provided for in such Warrant, which is $______. Such payment takes the form
of (check applicable box or boxes):

 

		☐	$__________ in lawful money of the United States; and/or

 

		☐	the
cancellation of such portion of the attached Warrant as is exercisable for a total of _______ shares of Common Stock; and/or

 

		☐	the
cancellation of such number of shares of Common Stock as is necessary, in accordance with the formula set forth in Section 2 of the Warrant,
to exercise this Warrant with respect to the maximum number of shares of Common Stock purchasable pursuant to the cashless exercise procedure
set forth in Section 2.

 

After application of the cashless exercise feature
as described above, _____________ shares of Common Stock are required to be delivered pursuant to the instructions below.

 

The undersigned requests that the certificates
for such shares be issued in the name of, and delivered to __________________________________________, whose address is ___________________________.
_______________________________________________________________________________________________.

 

The undersigned represents and warrants that all
offers and sales by the undersigned of the securities issuable upon exercise of the within Warrant shall be made pursuant to registration
of the Common Stock under the Securities Act of 1933, as amended (the “Securities Act”), or pursuant to an exemption from
registration under the Securities Act.

 

    8

     

    

 

	Dated:___________________	 
	 	
    (Signature must conform to name of holder as

    specified on the face of the Warrant)

	 	 
	 	 
	 	 
	 	 
	 	(Address)

 

    9

     

    

 

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 BRAIN SCIENTIFIC, 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 BRAIN SCIENTIFIC,
INC., with full power of substitution in the premises.

 

	Transferees	 	Percentage Transferred	 	Number Transferred
	 	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 

 

	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]	 	 
	 	 	(address)
	 	 	 
	 	 	 
	(Name)	 	 

 

 

10

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00338-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00338-of-00352.parquet"}]]