Document:

MASSROOTS, INC.

SUBSCRIPTION AGREEMENT
FOR THE PURCHASE OF SECURITIES

 

MASSROOTS, INC.,
a Delaware corporation (the “Company”), is offering (this “Offering”) for sale to “accredited
investors” as the term is defined under Regulation D promulgated under the Securities Act of 1933, as amended (the “Act”),
shares of its Common Stock (“Common Stock”) and warrants to purchase Common Stock (“Warrants”,
together with the Common Stock, the “Securities”) for the purchase price noted below. There is no minimum investment
by any one investor.

 

Subscription Procedures

 

	(a)		The undersigned hereby subscribes to purchase ________________ shares of Common Stock
and a Warrant to purchase an amount of Common Stock equal to fifty percent (50%)
of the Common Stock purchased by the undersigned. The undersigned agrees to pay an aggregate of $_____________________
as the subscription amount for the Securities being purchased hereunder (the “Subscription Amount”).

	(b)		To subscribe, the undersigned must:

	(i)		complete and sign this Subscription Agreement; and

	(ii)		complete and sign the accompanying Confidential Prospective Purchaser Questionnare
(Subscription Agreement, together with the Confidential Prospective Purchaser Questionnare collectively referred to as the “Subscription
Documents”);

	(iii)		return the completed and signed Subscription Documents on behalf of the Company at
the following address:

 

MassRoots, Inc. 

2247 Federal Blvd., 

Denver, CO 80211

 

	(iv)		Deliver a check payable to “MassRoots, Inc.” to the address above for
an amount equal to the aggregate amount of Common Stock subscribed for in this offering.

Or wire the funds to:

 

[BANK INFORMATION]:

 

	(c)		Unless terminated earlier, by the Company, in its sole discretion, the Offering is
scheduled to terminate on December 31, 2014, 5:00 p.m., New York time and in the Company’s sole discretion without notice
may be extended until May 31, 2015 (the “Offering Period”).

	(d)		The Company will hold a closing on and issue the Securities upon the receipt and acceptance
of the Subscription Documents and the Subcription Amount (each a “Closing”). The date of each such Closing
is referred to herein as the Closing Date.

	(e)		All subscription proceeds will be deposited into the Company’s bank account
as provided herein. Upon each Closing, the funds, subject to the payment of the expenses and fees incurred in connection with
this Offering, will be immediately available to the Company. In the event that an investor’s subscription is rejected by
the Company, or this Offering is terminated for any reason without a closing, subscription proceeds will be promptly refunded
without interest thereon or deduction therefrom.

 

Prospective
Investors should retain their own professional advisors to review and evaluate the economic, tax, and other consequences of an
investment in the Company.

 

    

    	 

    

THE SECURITIES OFFERED HEREBY,
HAVE NOT BEEN FILED OR REGISTERED WITH OR APPROVED BY THE SECURITIES AND EXCHANGE COMMISSION (THE “COMMISSION”), NOR
HAS THE COMMISSION PASSED UPON THE ACCURACY OR ADEQUACY OF THE OFFERING MATERIALS. NO STATE SECURITIES LAW ADMINISTRATOR HAS PASSED
ON OR ENDORSED THE MERITS OF THIS OFFERING OR THE ACCURACY OR THE ADEQUACY OF THE OFFERING MATERIALS. ANY REPRESENTATION TO THE
CONTRARY IS UNLAWFUL.

 

IT IS INTENDED THAT THE SECURITIES
OFFERED HEREBY WILL BE MADE AVAILABLE TO ACCREDITED INVESTORS, AS DEFINED IN REGULATION D AND RULE 501 PROMULGATED UNDER THE SECURITIES
ACT OF 1933, AS AMENDED (THE “1933 ACT”) AND UP TO THIRTY-FIVE NON-ACCREDITED INVESTORS. THE SECURITIES OFFERED HEREBY
ARE BEING OFFERED PURSUANT TO AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE 1933 ACT AND APPLICABLE STATE SECURITIES
LAWS FOR NONPUBLIC OFFERINGS. SUCH EXEMPTIONS LIMIT THE NUMBER AND TYPES OF INVESTORS TO WHICH THE OFFERING WILL BE MADE AND RESTRICT
SUBSEQUENT TRANSFERS OF THE INTERESTS.

 

THE SECURITIES OFFERED HEREBY
SHOULD BE CONSIDERED ONLY BY PERSONS WHO CAN AFFORD TO SUSTAIN A LOSS OF THEIR ENTIRE INVESTMENT. INVESTORS WILL BE REQUIRED TO
REPRESENT THAT THEY ARE FAMILIAR WITH AND UNDERSTAND THE TERMS OF THIS OFFERING.

 

NO SECURITIES MAY BE RESOLD
OR OTHERWISE DISPOSED OF BY AN INVESTOR UNLESS, IN THE OPINION OF COUNSEL SATISFACTORY TO THE COMPANY, REGISTRATION UNDER THE
APPLICABLE FEDERAL OR STATE SECURITIES LAWS IS NOT REQUIRED OR COMPLIANCE IS MADE WITH SUCH REGISTRATION REQUIREMENTS.

 

THE OFFEREE, BY ACCEPTING
DELIVERY OF THE OFFERING MATERIALS, AGREES TO RETURN THE OFFERING MATERIALS AND ALL ACCOMPANYING OR RELATED DOCUMENTS TO THE COMPANY
UPON REQUEST IF THE OFFEREE DOES NOT AGREE TO PURCHASE ANY OF THE SECURITIES OFFERED HEREBY.

 

ANY OFFERING MATERIALS SUBMITTED
IN CONNECTION WITH THE PRIVATE PLACEMENT OF THE SECURITIES DO NOT CONSTITUTE AN OFFER OR SOLICITATION BY ANYONE IN ANY JURISDICTION
IN WHICH SUCH AN OFFER OR SOLICITATION IS NOT AUTHORIZED. ANY REPRODUCTION OR DISTRIBUTION OF ANY OFFERING MATERIALS IN WHOLE
OR IN PART, OR THE DIVULGENCE OF ANY OF THEIR CONTENTS, WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY, IS PROHIBITED. ANY PERSON
ACTING CONTRARY TO THE FOREGOING RESTRICTIONS MAY PLACE HIM/HERSELF AND THE COMPANY IN VIOLATION OF FEDERAL OR STATE SECURITIES
LAWS.

 

NASAA UNIFORM LEGEND

 

IN MAKING AN INVESTMENT DECISION
INVESTORS MUST RELY ON THEIR OWN EXAMINATION OF THE COMPANY AND THE TERMS OF THE OFFERING, INCLUDING THE MERITS AND RISKS INVOLVED.
THESE SECURITIES HAVE NOT BEEN RECOMMENDED BY ANY FEDERAL OR STATE SECURITIES COMMISSION OR REGULATORY AUTHORITY. FURTHERMORE,
THE FOREGOING AUTHORITIES HAVE NOT CONFIRMED THE ACCURACY OR DETERMINED THE ADEQUACY OF THIS DOCUMENT. ANY REPRESENTATION TO THE
CONTRARY IS A CRIMINAL OFFENSE. THESE SECURITIES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY AND RESALE AND MAY NOT BE TRANSFERRED
OR RESOLD EXCEPT AS PERMITTED UNDER THE 1933 ACT, AND THE APPLICABLE STATE SECURITIES LAWS, PURSUANT TO REGISTRATION OR EXEMPTION
THEREFROM. INVESTORS SHOULD BE AWARE THAT THEY WILL BE REQUIRED TO BEAR THE FINANCIAL RISKS OF THIS INVESTMENT FOR AN INDEFINITE
PERIOD OF TIME.

 

    

    	 

    

The undersigned
acknowledges that the Securities will not be registered under the 1933 Act, or the securities laws of any State, that absent an
exemption from registration contained in those laws, the issuance and sale of such Securities would require registration, and
that the Company's reliance upon such exemption is based upon the undersigned's representations, warranties, and agreements contained
in the Offering Materials (as defined below).

 

1.The
undersigned represents, warrants, and agrees as follows:

	(a)		The undersigned agrees that this Subscription Agreement is and shall be irrevocable.

	(b)		The undersigned has carefully read this Subscription Agreement and the Confidential
Prospective Purchaser Questionnaire (collectively the “Offering Materials”), all of which the undersigned acknowledges
have been provided to the undersigned. The undersigned has been given the opportunity to ask questions of, and receive answers
from the Company concerning the terms and conditions of this Offering and the Offering Materials and to obtain such additional
written information, to the extent the Company possesses such information or can acquire it without unreasonable effort or expense,
necessary to verify the accuracy of the same as the undersigned desires in order to evaluate the investment. The undersigned further
acknowledges that the undersigned fully understands the Offering Materials, and the undersigned has had the opportunity to discuss
any questions regarding any of the Offering Materials with the undersigned’s counsel or other advisor. Notwithstanding the
foregoing, the only information upon which the undersigned has relied is that set forth in the Offering Materials and the undersigned’s
own independent investigation. The undersigned acknowledges that the undersigned has received no representations or warranties
from the Company or its employees, director, or agents in making this investment decision other than as set forth in the Offering
Materials.

	(c)		The undersigned is aware that the purchase of the Securities is a speculative investment
involving a high degree of risk and that there is no guarantee that the undersigned will realize any gain from this investment,
and that the undersigned could lose the total amount of the undersigned's investment.

	(d)		The undersigned understands that no federal or state agency has made any finding or
determination regarding the fairness of this Offering of the Securities for investment, or any recommendation or endorsement of
this Offering of the Securities.

	(e)		The Undersigned is an “accredited investor” as that term is defined in
Rule 501(a) of Regulation D under the 1933 Act. The Undersigned has such knowledge and experience in financial and business matters
that it is capable of evaluating the merits and risks of the purchase of the Securities. The Undersigned is not registered as
a broker or dealer under Section 15(a) of the 1934 Act, affiliated with any broker or dealer registered under Section 15(a) of
the Securities Exchange Act of 1934, as amended, or a member of the Financial Industry Regulatory Authority.

	(f)		Each of this Agreement and the Offering Materials have been duly and validly authorized,
executed and delivered on behalf of the Undersigned and is a valid and binding agreement of the Undersigned enforceable against
the Undersigned in accordance with their terms, subject as to enforceability to general principles of equity and to applicable
bankruptcy, insolvency, reorganization, moratorium, liquidation and other similar laws relating to, or affecting generally, the
enforcement of applicable creditors’ rights and remedies. The Undersigned has the requisite corporate power and authority
to enter into and perform its obligations under this Agreement and the Offering Materials and each other agreement entered into
by the parties hereto in connection with the transactions contemplated by this Agreement.

	(g)		The execution, delivery and performance of this Agreement and the Offering Materials
by the Undersigned and the consummation by the Undersigned of the transactions contemplated hereby and thereby will not (i) result
in a violation of the certificate of incorporation, by-laws or other documents of organization of the Undersigned, (ii) conflict
with, or constitute a default (or an event which with notice or lapse of time or both would become a default) under, or give others
any rights of termination, amendment, acceleration or cancellation of, any agreement, indenture or instrument to which the Undersigned
is bound, or (iii) result in a violation of any law, rule, regulation or decree applicable to the Undersigned.

	(h)		The Undersigned understands that there is no public trading market for the Securities,
and the Securities must be held indefinitely unless and until such Securities is registered under the 1933 Act or an exemption
from registration is available. The Undersigned has been advised or is aware of the provisions of Rule 144 promulgated under the
1933 Act.

    

    	 

    
	(i)		The Undersigned understands that the Securities is being offered and sold in reliance
on a transactional exemption from the registration requirements of Federal and state securities laws and that the Company is relying
upon the truth and accuracy of the representations, warranties, agreements, acknowledgments and understandings of the Undersigned
set forth herein in order to determine the applicability of such exemptions and the suitability of the Undersigned to acquire
the Securities.

	(j)		The undersigned is purchasing the Securities for the undersigned's own account, with
the intention of holding the Securities, with no present intention of dividing or allowing others to participate in this investment
or of reselling or otherwise participating, directly or indirectly, in a distribution of the Securities, and shall not make any
sale, transfer, or pledge thereof without registration under the Act and any applicable securities laws of any state or unless
an exemption from registration is available under those laws.

	(k)		The undersigned represents that the undersigned, if an individual, has adequate means
of providing for his or her current needs and personal and family contingencies and has no need for liquidity in this investment
in the Securities. The undersigned has no reason to anticipate any material change in his or her personal financial condition
for the foreseeable future.

	(l)		The undersigned is financially able to bear the economic risk of this investment,
including the ability to hold the Securities indefinitely or to afford a complete loss of the undersigned’s investment in
the Securities.

	(m)		The undersigned represents that the undersigned's overall commitment to this investment
is not disproportionate to the undersigned's net worth, and the undersigned's investment in the Securities will not cause such
overall commitment to become excessive. The undersigned understands that the statutory basis on which the Securities are being
sold to the undersigned and others would not be available if the undersigned's present intention were to hold the Securities for
a fixed period or until the occurrence of a certain event. The undersigned realizes that in the view of the Commission, a purchase
now with a present intent to resell by reason of a foreseeable specific contingency or any anticipated change in the market value,
or in the condition of the Company, or that of the industry in which the business of the Company is engaged or in connection with
a contemplated liquidation, or settlement of any loan obtained by the undersigned for the acquisition of the Securities, and for
which such Securities may be pledged as security or as donations to religious or charitable institutions for the purpose of securing
a deduction on an income tax return, would, in fact, represent a purchase with an intent inconsistent with the undersigned's representations
to the Company and the Commission would then regard such sale as a sale for which the exemption from registration is not available.
The undersigned will not pledge, transfer, or assign this Subscription Agreement.

	(m)		The undersigned represents that the funds provided for this investment are either
separate property of the undersigned, community property over which the undersigned has the right of control, or are otherwise
funds as to which the undersigned has the sole right of management.

	(n)		FOR PARTNERSHIPS, CORPORATIONS, TRUSTS, OR OTHER ENTITIES ONLY: If the undersigned
is a partnership, corporation, trust, or other entity, (i) the undersigned has enclosed with this Subscription Agreement appropriate
evidence of the authority of the individual executing this Subscription Agreement to act on its behalf (e.g., if a trust, a certified
copy of the trust agreement; if a corporation, a certified corporate resolution authorizing the signature and a certified copy
of the articles of incorporation; or if a partnership, a certified copy of the partnership agreement), (ii) the undersigned represents
and warrants that it was not organized or reorganized for the specific purpose of acquiring the Securities, (iii) the undersigned
has the full power and authority to execute this Subscription Agreement on behalf of such entity and to make the representations
and warranties made herein on its behalf, and (iv) this investment in the Company has been affirmatively authorized, if required,
by the governing board of such entity and is not prohibited by the governing documents of the entity.

	(o)		The address shown under the undersigned's signature at the end of this Subscription
Agreement is the undersigned's principal residence if he or she is an individual, or its principal business address if a corporation
or other entity.

	(p)		The undersigned has such knowledge and experience in financial and business matters
as to be capable of evaluating the merits and risks of an investment in the Securities.

	(q)		The undersigned acknowledges that the certificates for the Securities which the undersigned
will receive will contain a legend substantially as follows:

 

    

    	 

    

“THE SECURITIES
WHICH ARE REPRESENTED HEREBY HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AND MAY NOT BE SOLD,
TRANSFERRED, HYPOTHECATED OR OTHERWISE DISPOSED OF UNTIL A REGISTRATION STATEMENT WITH RESPECT THERETO IS DECLARED EFFECTIVE UNDER
SUCH ACT, OR THE COMPANY RECEIVES AN OPINION OF COUNSEL FOR THE COMPANY THAT AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF
SUCH ACT IS AVAILABLE.”

 

The undersigned
further acknowledges that (i) if the Company’s Common Stock becomes publicly traded, any necessary stop transfer orders
will be placed upon the Company’s Common Stock, in accordance with the Act, and (ii) the Company is under no obligation
to aid the undersigned in obtaining any exemption from the registration requirements.

 

2.The undersigned
expressly acknowledges and agrees that the Company is relying upon the undersigned's representations contained in the Offering
Materials.

 

3.The undersigned
subscriber acknowledges that the undersigned understands the meaning and legal consequences of the representations and warranties
which are contained herein and hereby agrees to indemnify, save and hold harmless the Company and its officers, directors and
counsel, from and against any and all claims or actions arising out of a breach of any representation, warranty or acknowledgment
of the undersigned contained in any of the Offering Materials. Such indemnification shall be deemed to include not only the specific
liabilities or obligations with respect to which such indemnity is provided, but also all reasonable costs, expenses, counsel
fees and expenses of settlement relating thereto, whether or not any such liability or obligation shall have been reduced to judgment.
In addition, the undersigned's representations, warranties, and indemnification contained herein shall survive the undersigned's
purchase of the Securities hereunder. The undersigned specifically acknowledges that he has reviewed the risks set forth in the
Offering Materials, as well as the financial statements included therein.

 

4.The Company
represents that it has been duly and validly incorporated and is validly existing and in good standing as a corporation under
the laws of the State of Delaware. The Company represents that it has all requisite power and authority, and all necessary authorizations,
approvals and orders required as of the date hereof to own its properties and conduct its business and to enter into this Subscription
Agreement and the other Offering Materials and to be bound by the provisions and conditions hereof or therein. The Company further
represents that the securities offered hereby are being offered pursuant to an exemption from the registration requirements of
the 1933 Act and applicable state securities laws for nonpublic offerings.

 

5.The undersigned
agrees and acknowledges that the Company has the right to utilize the services of a placement agent and if utilized, may receive
a cash commission, at a rate that is compatible with industry standards, from the Securities sold by such placement agent.

 

6.Except as
otherwise specifically provided for hereunder, no party shall be deemed to have waived any of his, her, or its rights hereunder
or under any other agreement, instrument, or papers signed by any of them with respect to the subject matter hereof unless such
waiver is in writing and signed by the party waiving said right. Except as otherwise specifically provided for hereunder, no delay
or omission by any party in exercising any right with respect to the subject matter hereof shall operate as a waiver of such right
or of any such other right. A waiver on any one occasion with respect to the subject matter hereof shall not be construed as a
bar to, or waiver of, any right or remedy on any future occasion. All rights and remedies with respect to the subject matter hereof,
whether evidenced hereby or by any other agreement, instrument, or paper, will be cumulative, and may be exercised separately
or concurrently.

 

7.The
parties have not made any representations or warranties with respect to the subject matter hereof not set forth herein, and this
Subscription Agreement, together with any instruments executed simultaneously herewith, constitutes the entire agreement between
them with respect to the subject matter hereof. All understandings and agreements heretofore existing between the parties with
respect to the subject matter hereof are merged in this Subscription Agreement and any such instrument, which alone fully and
completely express their agreement.

 

8.This
Subscription Agreement may not be changed, modified, extended, terminated, or discharged orally, but only by an agreement in writing,
which is signed by all of the parties to this Subscription Agreement.

 

    

    	 

    

9.The
parties agree to execute any and all such other and further instruments and documents, and to take any and all such further actions
reasonably required to effectuate this Subscription Agreement and the intent and purposes hereof.

 

10.If
any provision or any portion of any provision of this Subscription Agreement or the application of any such provision or any portion
thereof to any person or circumstance, shall be held invalid or unenforceable, the remaining portion of such provision and the
remaining portion of such provision as is held invalid or unenforceable to persons or circumstances other than those as to which
it is held invalid or unenforceable, shall not be affected thereby.

 

11.This
Subscription Agreement shall be governed by and construed in accordance with the laws of the State of Delaware and the undersigned
hereby consents to the jurisdiction of the courts of the State of Colorado and/or the United States District Court for Colorado.

 

12.Piggyback Registration Rights. If the Company shall determine to prepare
and file with the United States Securities and Exchange Commission a registration statement relating to an offering for its own
account or the account of others under the Securities Act of any of its equity securities, other than on Form S-4 or Form S-8
(each as promulgated under the Securities Act) or any post-effective amendment to existing registration statements or their then
equivalents relating to equity securities to be issued solely in connection with any acquisition of any entity or business or
equity securities issuable in connection with stock option or other employee benefit plans, then the Company shall send to the
Holder a written notice of such determination at least five (5) days prior to the filing of any such registration statement and
shall include in such registration statement all shares of Common Stock purchased pursuant to this Agreement, including the shares
of Common Stock underlying the Warrant; provided, however, that (i) if, at any time after giving written notice of its intention
to register any securities and prior to the effective date of the registration statement filed in connection with such registration,
the Company determines for any reason not to proceed with such registration, the Company will be relieved of its obligation to
register any Common Stock and the Common Stock underlying the Warrant in connection with such registration, and (ii) in case of
a determination by the Company to delay registration of its securities, the Company will be permitted to delay the registration
of the Common Stock and the Common Stock underlying the Warrant for the same period as the delay in registering such other

securities.

 

    

    	 

    

ALL SUBSCRIBERS MUST COMPLETE A COPY OF THIS PAGE

__________________________

(Print Name of Subscriber)

 

IN WITNESS
WHEREOF, the undersigned has executed this Subscription Agreement on this ____ day of ________, 2014.

 

Securities
Subscription Amount $______

 

	1.		|__|Individual

	2.		|__|Joint Tenants with Right of Survivorship

	3.		|__|Community Property

	4.		|__|Tenants in Common

	5.		|__|Corporation/Partnership

	6.		|__|IRA of________________

	7.		|__|Trust
	 	 	Date
Opened ___________

	8.		|__|As A Custodian For________________
	 	 	Under the
Uniform Transfer to Minors Act of the
	 	 	State of ___________ 

	9.		|__|Married with Separate
	 	 	Property

	10.		|__|Keogh of ____________

 

    

    	 

    

EXECUTION BY SUBSCRIBER
WHO IS A NATURAL PERSON

	 	 	 		 	 	 
		 	 	Exact Name in Which Title is to be Held	 	 	 
	 	 	 		 	 	 
		 	 	Signature	 	 	 
	 	 	 	 	 	 	 
		 	 	Name (Please Print)	 	 	 
	 	 	 	 	 	 	 
		 	 	Title of Person Executing Agreement	 	 	 
	 	 	 	 	 	 	 
		 	 	Address: Number and Street	 	 	 
	 	 	 	 	 	 	 
		 	 	City 	State 	Zip Code	 	 	
	 	 	 	 	 	 	 
		 	 	Social Security Number	 	 	 

 

Accepted
this ___ day of _______, 2014, on behalf of MASSROOTS, INC.

 

By: _____________________________

Name:

Title:

    

    	 

    

EXECUTION BY SUBSCRIBER
WHICH IS A CORPORATION,

 

PARTNER, TRUST, ETC.

	 	 	 	 	 	 	 
	 	 	 	Exact Name in Which Title is to
be Held	 	 	 
	 	 	 	 	 	 	 
	 	 	 	(Signature)	 	 	 
	 	 	 	 	 	 	 
	 	 	 	Name (Please Print)	 	 	 
	 	 	 	 	 	 	 
	 	 	 	Title of Person Executing
Agreement	 	 	 
	 	 	 	 	 	 	 
	 	 	 	Address: Number and Street

	 	 	 
	 	 	 	 	 	 	 
	 	 	 	City	State	Zip Code	 	 	 
	 	 	 	 	 	 	 
	 	 	 	Tax Identification Number	 	 	 

Accepted
this ___ day of _______, 2014, on behalf of MASSROOTS, INC.

 

By: ________________________

Name:

Title:WARRANT

 

THESE SECURITIES AND THE SECURITIES ISSUABLE
UPON THEIR EXERCISE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”),
AND MAY NOT BE TRANSFERRED UNLESS PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT, A "NO-ACTION"
LETTER FROM THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION (THE “COMMISSION” OR THE “SEC”)
WITH RESPECT TO SUCH TRANSFER, A TRANSFER MEETING THE REQUIREMENTS OF RULE 144 OF THE COMMISSION, OR AN OPINION OF COUNSEL SATISFACTORY
TO THE ISSUER TO THE EFFECT THAT ANY SUCH TRANSFER IS EXEMPT FROM SUCH REGISTRATION.

 

MassRoots, Inc.

 

WARRANT NO. SEPTEMBER 2014 1-__

 

Dated: September __, 2014

 

MassRoots, Inc., a corporation organized
under the laws of the State of Delaware (the “Company”), hereby certifies that, for value received from ____________,
a [insert state of incorporation or state of residence] (the “Holder”), is entitled, subject to the
terms set forth below, to purchase from the Company up to a total of ________ shares of the common stock , $0.001 par value per
share (the “Common Stock”), of the Company (the “Warrant Shares”), at an exercise price
equal to one dollar ($1.00) per share (the “Exercise Price”). This Warrant may be exercised any time after
issuance through and including the third (3rd) anniversary of its original issuance as noted above (the “Expiration Date”),
subject to the following terms and conditions:

 

	1.		Registration of Warrant. The Company shall, from time to time and whenever
requested by the Holder, register this Warrant in conformity with records to be maintained by the Company for such purpose (the
“Warrant Register”) in the name of the Holder. The Company shall treat the registered Holder of this Warrant
as the absolute owner hereof for any and all purposes, including the exercise hereof or any distribution to the Holder, and the
Company shall not be affected by notice to the contrary.

	2.		Registration of Transfers and Exchanges.

	(a)		The Company or the transfer agent shall enter or record the transfer of all or any
portion of this Warrant in the Warrant Register, upon surrender of this Warrant to the Company at the office specified herein
or pursuant to Section 11 hereof. Upon any such registration or transfer, a new warrant to purchase Common Stock, in substantially
the form of this Warrant (any such new warrant hereinafter referred to as a “New Warrant”), evidencing the
portion of this Warrant so transferred shall be issued to the transferee and a New Warrant evidencing the remaining portion of
this Warrant not so transferred, if any, shall be issued to the Holder. The acceptance of the New Warrant by the transferee thereof
shall be deemed the acceptance of such transferee of all of the rights and obligations of a holder of a Warrant.

	(b)		This Warrant is exchangeable, upon the surrender hereof by the Holder to the office
of the Company specified herein or pursuant to Section 3(b) hereof for one or more New Warrants, evidencing in the aggregate
the right to purchase the number of Warrant Shares which may then be purchased hereunder. Any such New Warrant shall be dated
as of the date of such exchange.

	3.		Duration and Exercise of Warrants.

	(a)		This Warrant shall be exercisable by the registered Holder on any business day before
5:00 P.M., Boston time, at any time and from time to time on or after the date hereof to and including the Expiration Date. At
5:00 P.M., Boston time on the Expiration Date, the portion of this Warrant not exercised prior thereto shall be and become void
and of no value. Prior to the Expiration Date, the Company may not call or otherwise redeem this Warrant without the prior written
consent of the Holder, which consent shall be given or withheld at the sole and absolute discretion of the Holder.

    

    	 

    
	(b)		Subject to Section 2(b), Section 6 and Section 10 hereof, upon:
(x) surrender of this Warrant, together with the Form of Election to Purchase attached hereto duly completed and signed, to the
Company at its address for notice set forth in Section 11 hereof; and (y) payment of the Exercise Price multiplied by the
number of Warrant Shares that the Holder intends to purchase hereunder, in the manner provided hereunder, all as specified by
the Holder in the Form of Election to Purchase, the Company shall promptly (but in no event later than five (5) business days
after the Date of Exercise (as defined below)) issue or cause to be issued and cause to be delivered to the Holder in such name(s)
as the Holder may designate, a certificate for the Warrant Shares issuable upon such exercise and free of restrictive legends
unless (i) a registration statement covering the resale of the Warrant Shares and naming the Holder as a selling stockholder thereunder
is not then effective or the Warrant Shares are not freely transferable without volume restrictions pursuant to Rule 144(k) promulgated
under the Securities Act then the Warrant Shares will bear a Securities Act restrictive legend, or (ii) this Warrant shall have
been issued pursuant to a written agreement between the original Holder and the Company, as required by such agreement. Any person
so designated by the Holder to receive Warrant Shares shall be deemed to have become holder of record of such Warrant Shares as
of the Date of Exercise of this Warrant. A “Date of Exercise” means the date on which the Company shall have
received (I) this Warrant (or any New Warrant, as applicable), together with the Form of Election to Purchase attached hereto
(or attached to such New Warrant) appropriately completed and duly signed; and (II) payment of the Exercise Price for the number
of Warrant Shares so indicated by the holder hereof to be purchased.

	(c)		This Warrant shall be exercisable in its entirety or, from time to time, for a portion
of the number of Warrant Shares. If less than all of the Warrant Shares which may be purchased under this Warrant are exercised
at any time, the Company shall issue or cause to be issued, at its expense, a New Warrant evidencing the right to purchase the
remaining number of Warrant Shares for which no exercise has been evidenced by this Warrant. In the event the Common Stock representing
the Warrant Shares is not delivered per the written instructions of the Holder within ten (10) business days after the Notice
of Election and Warrant is received by the Company (the “Delivery Date”), then the Company shall pay to Holder
in cash two percent (2.0%) of the dollar value of the Warrant Shares to be issued for the first day after the Delivery Date that
the Warrant Shares are not delivered, and an additional two percent (2.0%) of the dollar value of the Warrant Shares to be issued
after the Delivery Date for every thirty (30) days thereafter that the Warrant Shares are not delivered. The Company acknowledges
that its failure to deliver the Warrant Shares by the Delivery Date will cause the Holder to suffer damages in an amount that
will be difficult to ascertain. Accordingly, the parties hereto agree that it is appropriate to include in this Warrant this provision
for liquidated damages. The parties hereto acknowledge and agree that the liquidated damages provision set forth in this section
represents the parties’ good faith effort to quantify such damages and therefore agree that the form and amount of such
liquidated damages are reasonable and will not constitute a penalty. Notwithstanding the foregoing, the payment of liquidated
damages shall not relieve the Company from its obligations to deliver the Common Stock pursuant to the terms of this Warrant.
The Company shall make any payments incurred under this Section 3 in immediately available funds within ten (10) business
days from the date of issuance of the applicable Warrant Shares. Nothing herein shall limit Holder’s right to pursue actual
damages or cancel the Notice of Election for the Company’s failure to issue and deliver Common Stock to the Holder within
ten (10) business days following the Delivery Date.

	5.		Payment of Taxes. Upon the exercise of this Warrant, the Company will pay all
documentary stamp taxes attributable to the issuance of Warrant Shares; provided, however, that the Company shall not be required
to pay any tax that may be payable in respect of any transfer involved in the registration of any certificates for Warrant Shares
or Warrants in a name other than that of the Holder. The Holder shall be responsible for all other tax liability that may arise
as a result of holding or transferring this Warrant or receiving Warrant Shares upon exercise hereof.

	6.		Replacement of Warrant. If this Warrant is mutilated, lost, stolen or destroyed,
the Company shall issue or cause to be issued in exchange and substitution for and upon cancellation hereof, or in lieu of and
substitution for this Warrant, a New Warrant, but only upon receipt of evidence reasonably satisfactory to the Company of such
loss, theft or destruction and indemnity, if requested, satisfactory to it. Applicants for a New Warrant under such circumstances
shall comply with such other reasonable regulations and procedures and pay such other reasonable charges as the Company may prescribe.

    

    	 

    
	7.		Reservation of Warrant Shares. The Company covenants that it will at all times
reserve and keep available out of the aggregate of its authorized but unissued Common Stock, solely for the purpose of enabling
it to issue Warrant Shares upon exercise of this Warrant as herein provided, the number of Warrant Shares which are then issuable
and deliverable upon the exercise of this entire Warrant, free from preemptive rights or any other actual contingent purchase
rights of persons other than the Holder (taking into account the adjustments and restrictions of Section 8 hereof). The
Company covenants that all Warrant Shares that shall be so issuable and deliverable shall, upon issuance and the payment of the
applicable Exercise Price in accordance with the terms hereof, be duly and validly authorized, issued and fully paid and nonassessable.
If the Company does not have a sufficient amount of Common Stock authorized to reserve for the Warrant Shares, it shall, as soon
as reasonably practicable, use its best efforts to increase the number of its authorized shares such that the Company will have
a sufficient amount of Common Stock authorized to reserve for the Warrant Shares.

	8.		Certain Adjustments. The Exercise Price and number of Warrant Shares issuable
upon exercise of this Warrant are subject to adjustment from time to time as set forth in this Section 8. Upon each such
adjustment of the Exercise Price pursuant to this Section 8, the Holder shall thereafter but prior to the Expiration Date
be entitled to purchase, at the Exercise Price resulting from such adjustment, the number of Warrant Shares obtained by multiplying
the Exercise Price in effect immediately prior to such adjustment by the number of Warrant Shares issuable upon exercise of this
Warrant immediately prior to such adjustment and dividing the product thereof by the Exercise Price resulting from such adjustment.

	(a)		An adjustment shall be made, if the Company, at any time while this Warrant is outstanding
(i) pays a stock dividend (except scheduled dividends paid on outstanding preferred stock as of the date hereof which contain
a stated dividend rate) or otherwise make distribution(s) on shares of its Common Stock or on any other class of capital stock
and not the Common Stock payable in shares of Common Stock; (ii) subdivides outstanding shares of Common Stock into a larger number
of shares; or (iii) combines outstanding shares of Common Stock into a smaller number of shares. If either (i), (ii) or (iii)
above occurs, the Exercise Price shall be multiplied by a fraction of which the numerator shall be the number of shares of Common
Stock (excluding treasury shares, if any) outstanding before such event and of which the denominator shall be the number of shares
of Common Stock (excluding treasury shares, if any) outstanding after such event. Any adjustment made pursuant to this Section
shall become effective immediately after the record date for the determination of stockholders entitled to receive such dividend
or distribution and shall become effective immediately after the effective date in the case of a subdivision or combination, and
shall apply to successive subdivisions and combinations.

	(b)		In case of any reclassification of the Common Stock, any consolidation or merger of
the Company with or into another entity, the sale or transfer of all or substantially all of the assets of the Company, or any
compulsory share exchange pursuant to which the Common Stock is converted into other securities, cash or property, then the Holder
shall have the right thereafter to exercise this Warrant only into the shares of stock and other securities and property receivable
upon or deemed to be held by holders of Common Stock following such reclassification, consolidation, merger, sale, transfer or
share exchange, and the Holder shall be entitled upon such event to receive such amount of securities or property equal to the
amount of Warrant Shares such Holder would have been entitled to had such Holder exercised this Warrant immediately prior to such
reclassification, consolidation, merger, sale, transfer or share exchange. The terms of any such consolidation, merger, sale,
transfer or share exchange shall include such terms so as to continue to give to the Holder the right to receive the securities
or property set forth in this Section 8(b) upon any exercise following any such reclassification, consolidation, merger,
sale, transfer or share exchange.

	(c)		At any time while this Warrant is outstanding, if the Company distributes to all holders
of Common Stock (and not to holders of this Warrant) evidence of its indebtedness or assets or rights or warrants to subscribe
for or purchase any security (excluding those referred to in Section 8(a), Section 8(b) and Section 8(d)
hereof), then in each such case the Exercise Price shall be determined by multiplying the Exercise Price in effect immediately
prior to the record date fixed for determination of stockholders entitled to receive such distribution by a fraction of which
the denominator shall be the Exercise Price determined as of the record date mentioned above, and of which the numerator shall
be such Exercise Price on such record date less the then fair market value at such record date of the portion of such assets or
evidence of indebtedness so distributed applicable to one outstanding share of Common Stock as determined by the Company's independent
certified public accountants that regularly examines the financial statements of the Company (the “Appraiser”).

    

    	 

    
	(d)		If, at any time while this Warrant is outstanding, the Company shall issue or cause
to be issued rights or warrants to acquire or otherwise sell or distribute shares of Common Stock for a consideration per share
less than the lower of the Exercise Price then in effect and the then fair market value of the Common Stock, then, forthwith upon
such issue or sale, the Exercise Price shall be reduced to the price (calculated to the nearest one hundredth of a cent) determined
by multiplying the Exercise Price in effect immediately prior thereto by a fraction, the numerator of which shall be the sum of
(i) the number of shares of Common Stock outstanding immediately prior to such issuance, and (ii) the number of shares of Common
Stock which the aggregate consideration received (or to be received, assuming exercise or conversion in full of such rights, warrants
and convertible securities) for the issuance of such additional shares of Common Stock would purchase at the Exercise Price, and
the denominator of which shall be the sum of the number of shares of Common Stock outstanding immediately after the issuance of
such additional shares. Such adjustment shall be made successively whenever such an issuance is made.

	(e)		For the purposes of this Section 8, the following clauses shall also be applicable:

	(i)		Record Date. In case the Company shall take a record of the holders of its
Common Stock for the purpose of entitling them (A) to receive a dividend or other distribution payable in Common Stock or in securities
convertible or exchangeable into shares of Common Stock, or (B) to subscribe for or purchase Common Stock or securities convertible
or exchangeable into shares of Common Stock, then such record date shall be deemed to be the date of the issue or sale of the
shares of Common Stock deemed to have been issued or sold upon the declaration of such dividend or the making of such other distribution
or the date of the granting of such right of subscription or purchase, as the case may be.

	(ii)		Treasury Shares. The number of shares of Common Stock outstanding at any given
time shall not include shares owned or held by or for the account of the Company, and the disposition of any such shares shall
be considered an issue or sale of Common Stock.

	(f)		All calculations under this Section 8 shall be made to the nearest cent or
the nearest 1/100th of a share, as the case may be.

	(g)		Whenever the Exercise Price is adjusted pursuant to Section 8(c) hereof, the
Holder, after receipt of the determination by the Appraiser, shall have the right to select an additional appraiser (which shall
be a nationally recognized accounting firm), in which case the adjustment shall be equal to the average of the adjustments recommended
by each of the Appraiser and such additional appraiser appointed under this Section 8(g). The Holder shall promptly mail
or cause to be mailed to the Company, a notice setting forth the Exercise Price after such adjustment and setting forth a brief
statement of the facts requiring such adjustment. Such adjustment shall become effective immediately after the record date mentioned
above, if:

	(i)		the Company shall declare a dividend (or any other distribution) on its Common Stock;

	(ii)		the Company shall declare a special nonrecurring cash dividend on or a redemption
of its Common Stock;

	(iii)		the Company shall authorize the granting to all holders of the Common Stock rights
or warrants to subscribe for or purchase any shares of capital stock of any class or of any rights;

	(iv)		the approval of any stockholders of the Company shall be required in connection with
any reclassification of the Common Stock of the Company, any consolidation or merger to which the Company is a party, any sale
or transfer of all or substantially all of the assets of the Company, or any compulsory share exchange whereby the Common Stock
is converted into other securities, cash or property; or

    

    	 

    
	(v)		the Company shall authorize the voluntary dissolution, liquidation or winding up of
the affairs of the Company, then the Company shall cause to be mailed to the Holder at their last addresses as they shall appear
upon the Warrant Register, at least thirty (30) calendar days prior to the applicable record or effective date hereinafter specified,
a notice stating (x) the date on which a record is to be taken for the purpose of such dividend, distribution, redemption, rights
or warrants, or if a record is not to be taken, the date as of which the holders of Common Stock of record to be entitled to such
dividend, distributions, redemption, rights or warrants are to be determined, or (y) the date on which such reclassification,
consolidation, merger, sale, transfer or share exchange is expected to become effective or close, and the date as of which it
is expected that holders of Common Stock of record shall be entitled to exchange their shares of Common Stock for securities,
cash or other property deliverable upon such reclassification, consolidation, merger, sale, transfer, share exchange, dissolution,
liquidation or winding up; provided, however, that the failure to mail such notice or any defect therein or in the mailing thereof
shall not affect the validity of the corporate action required to be specified in such notice.

	9.		Payment of Exercise Price. The Holder, at its sole election, may pay the Exercise
Price in one of the following manners:

	(a)		Cash Exercise. The Holder shall deliver immediately available funds; or

	(b)		Cashless Exercise. If at any time after one year from the date of issuance
of this Warrant there is no effective Registration Statement registering the resale of the Warrant Shares by the Holder at such
time, this Warrant may also be exercised at such time by means of a cashless exercise. In such event, the Holder shall surrender
this Warrant to the Company, together with a notice of cashless exercise, and the Company shall issue to the Holder the number
of Warrant Shares determined as follows:

 

X = Y (A-B)/A

 

where:

X = the number of Warrant
Shares to be issuedto the Holder.

 

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

 

A = the average closing bid price
of the Common Stock for the five (5) trading days immediately prior to the Date of Exercise.

 

B = the Exercise Price.

 

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

 

	(c)		Notwithstanding anything in this Warrant to the contrary, the Holder is limited in
the amount of this Warrant it may exercise. In no event shall the Holder be entitled to exercise any amount of this Warrant in
excess of that amount upon exercise of which the sum of (1) the number of shares of Common Stock beneficially owned (as such term
is defined under Section 13(d) and Rule 13d-3 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”))
by the Holder, and (2) the number of Warrant Shares issuable upon the exercise of any Warrants then owned by Holder, would result
in beneficial ownership by the Holder of more than four and ninety-nine one hundredths percent (4.99%) of the outstanding shares
of Common Stock of the Company, as determined in accordance with Rule13d-1(j) of the Exchange Act. Furthermore, the Company shall
not process any exercise that would result in beneficial ownership by the Holder of more than four and ninety-nine one hundredths
percent (4.99%) of the outstanding shares of Common Stock of the Company.

    

    	 

    
	10.		Fractional Shares. The Company shall not be required to issue or cause to be
issued fractional Warrant Shares on the exercise of this Warrant. The number of full Warrant Shares which shall be issuable upon
the exercise of this Warrant shall be computed on the basis of the aggregate number of Warrant Shares purchasable on exercise
of this Warrant so presented. If any fraction of a Warrant Share would, except for the provisions of this Section 10, be
issuable on the exercise of this Warrant, the Company shall pay an amount in cash equal to the Exercise Price multiplied by such
fraction.

	11.		Notices. Any and all notices or other communications or deliveries hereunder
shall be in writing and shall be deemed given and effective on the earliest of (i) the date of transmission, if such notice or
communication is delivered via facsimile at the facsimile telephone number specified in this Section prior to 5:00 p.m. Boston
time on a business day, (ii) the business day after the date of transmission, if such notice or communication is delivered via
facsimile at the facsimile telephone number specified in this Section later than 5:00 p.m. Boston time on any date and earlier
than 11:59 p.m. Boston time on such date, (iii) the business day following the date of mailing, if sent by nationally recognized
overnight courier service, or (iv) upon actual receipt by the party to whom such notice is required to be given. The addresses
for such communications shall be:

 

If to the Company:

 

MassRoots, Inc.

2247 Federal Blvd.,

Denver, CO 80211

 

If to the Holder:

[Insert Name and Address here] 

 

	12.		Warrant Agent. The Company shall serve as warrant agent under this Warrant.
Upon thirty (30) days notice to the Holder, the Company may appoint a new warrant agent. Any corporation into which the Company
or any new warrant agent may be merged or any corporation resulting from any consolidation to which the Company or any new warrant
agent shall be a party or any corporation to which the Company or any new warrant agent transfers substantially all of its corporate
trust or shareholders services business shall be a successor warrant agent under this Warrant without any further action. Any
such successor warrant agent shall promptly cause notice of its succession as warrant agent to be mailed (by first class mail,
postage prepaid) to the Holder at the Holder's last address as shown on the Warrant Register.

	13.		Miscellaneous.

	(a)		This Warrant shall be binding on and inure to the benefit of the parties hereto. This
Warrant may be amended only in writing signed by the Company and the Holder.

	(b)		Nothing in this Warrant shall be construed to give to any person or corporation other
than the Company and the Holder any legal or equitable right, remedy or cause under this Warrant. This Warrant shall inure to
the sole and exclusive benefit of the Company and the Holder

	(c)		This Warrant shall be governed by and construed and enforced in accordance with the
laws of the Commonwealth of Massachusetts without regard to the principles of conflicts of law thereof.

	(d)		The headings herein are for convenience only, do not constitute a part of this Warrant
and shall not be deemed to limit or affect any of the provisions hereof.

	(e)		In case any one or more of the provisions of this Warrant shall be invalid or unenforceable
in any respect, the validity and enforceability of the remaining terms and provisions of this Warrant shall not in any way be
affected or impaired thereby and the parties will attempt in good faith to agree upon a valid and enforceable provision which
shall be a commercially reasonable substitute therefor, and upon so agreeing, shall incorporate such substitute provision in this
Warrant.

    

    	 

    
	(f)		The Company hereby represent and warrants to the Holder that: (i) it is voluntarily
issuing this Warrant of its own freewill, (ii) it is not issuing this Warrant under economic duress, (iii) the terms of this Warrant
are reasonable and fair to the Company, and (iv) the Company has had independent legal counsel of its own choosing review this
Warrant, advise the Company with respect to this Warrant, and represent the Company in connection with its issuance of this Warrant.

	(g)		Any capitalized term used but not defined in this Warrant shall have the meaning ascribed
to it in the Subscription Agreement, of even date herewith, by and between the Company and the Holder.

	(h)		This Warrant may be executed in any number of counterparts, each of which when so
executed shall be deemed to be an original and, all of which taken together shall constitute one and the same Warrant. In the
event that any signature is delivered by facsimile transmission, such signature shall create a valid binding obligation of the
party executing (or on whose behalf such signature is executed) the same with the same force and effect as if such facsimile signature
were the original thereof.

	(i)		This Warrant and the obligations of the Company hereunder shall not be assignable
by the Company.

	(j)		Notwithstanding anything in this Warrant to the contrary, the parties hereto hereby
acknowledge and agree to the following: (i) the Holder makes no representations or covenants that it will not engage in trading
in the securities of the Company; (ii) the Company shall, by 8:30 a.m. Boston Time on the trading day following the date hereof,
file a current report on Form 8-K disclosing the material terms of the transactions contemplated hereby and in the other Transaction
Documents ; (iii) the Company has not and shall not provide material non-public information to the Holder unless prior thereto
the Holder Party shall have executed a written agreement regarding the confidentiality and use of such information; and (iv) the
Company understands and confirms that the Holder will be relying on the acknowledgements set forth in clauses (i) through (iii)
above if the Holder effects any transactions in the securities of the Company.

	14.		Disputes Under This Agreement.

All disputes arising under
this Warrant shall be governed by and interpreted in accordance with the laws of the State of Delaware, without regard to principles
of conflict of laws. The parties hereto will submit all disputes arising under this Agreement to arbitration in Denver, Colorado
before a single arbitrator of the American Arbitration Association (the “AAA”). The arbitrator shall be selected
by application of the rules of the AAA, or by mutual agreement of the parties, except that such arbitrator shall be an attorney
admitted to practice law in the State of Colorado. No party hereto will challenge the jurisdiction or venue provisions provided
in this Section 14. Nothing in this Section 14 shall limit the Holder's right to obtain an injunction for a breach
of this Agreement from a court of law. Any injunction obtained shall remain in full force and effect until the arbitrator, as
set forth in this Section 14 fully adjudicates the dispute.

 

 

[Signature on Following
Page]

    

    	 

    

 

IN WITNESS WHEREOF, the
Company has caused this Warrant to be duly executed by its authorized officer as of the date first indicated above.

 

 

MassRoots,
Inc. 

 

By:_________________

Name:Isaac Dietrich

Title: CEO

    

    	 

    

EXHIBIT A 

FORM OF ELECTION TO PURCHASE

MassRoots, Inc.

 

Re: Intention to Exercise Right to
Purchase Shares of Common Stock Under the Warrant

 

Gentlemen:

 

In accordance with
the Warrant enclosed with this Form of Election to Purchase, the undersigned hereby irrevocably elects to purchase _________________shares
of Common Stock, $0.001 par value per share, of MassRoots, Inc.. and, if such Holder is not utilizing the cashless exercise provisions
set forth in the Warrant, encloses herewith $________ in cash, certified or official bank check(s), which sum represents
the aggregate Exercise Price for the number of shares of Common Stock to which this Form of Election to Purchase relates, together
with any applicable taxes payable by the undersigned pursuant to the Warrant. Any capitalized terms used but not defined in this
Form of Election to Purchase shall have the meaning ascribed to them in the accompanying Warrant.

 

The undersigned requests
that certificates for the shares of Common Stock issuable upon this exercise be issued in the name of:

 

	 		 
	 	(Please insert SS# or FEIN #)	 
	 		 
	 	(Please
print name and address)	 

 

If the number of shares
of Common Stock issuable upon this exercise shall not be all of the shares of Common Stock which the undersigned is entitled to
purchase in accordance with the enclosed Warrant, the undersigned requests that a New Warrant evidencing the right to purchase
the shares of Common Stock not issuable pursuant to the exercise evidenced hereby be issued in the name of and delivered to:

 

	 	 	 
	 	(Please
print name and address)	 
	Dated:	 	 
	 	Name of Holder:	
	 	Signed:	
	 	Printed Name:	
	 	Title:	

 

(Signature must conform in
all respects to name of Holder as specified on the face of the Warrant)

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