Document:

Exhibit 4.1 

 

 

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

 

ASSURE HOLDINGS CORP.

WARRANT TO PURCHASE COMMON STOCK

 

Warrant No.: 2020-________

Number of Shares of Common Stock: _____

Date of Issuance: November __, 2020 (“Issuance Date”)

 

Assure Holdings Corp., a corporation organized
under the laws of the State of Nevada (the “Company”), hereby certifies that, for good and valuable consideration,
the receipt and sufficiency of which are hereby acknowledged, __________________, the registered holder hereof or its permitted
assigns (the “Holder”), is entitled, subject to the terms set forth below, to purchase from the Company, at
the Exercise Price (as defined below) then in effect, upon surrender of this Warrant to Purchase Common Stock (including any Warrants
to Purchase Common Stock issued in exchange, transfer or replacement hereof, the “Warrant”), at any time or
times on or after the Issuance Date (the “Initial Exercise Date”), but not after 11:59 p.m., Eastern time, on
the Expiration Date (as defined below), ______ fully paid and nonassessable shares of Common Stock (as defined below) (the “Warrant
Shares”). Certain capitalized terms used in this Warrant are defined in Section 15. This Warrant is one of the Warrants
to purchase Common Stock (the “SPA Warrants”) issued pursuant to that certain Securities Purchase Agreement,
dated as of November __, 2020 (the “Subscription Date”), by and among the Company and the purchasers (the “Purchasers”)
referred to therein (the “Securities Purchase Agreement”).

 

1.                 
EXERCISE OF WARRANT.

 

(a)               Mechanics
of Exercise. Subject to the terms and conditions hereof, this Warrant may be exercised by the Holder on any day on or
after the Initial Exercise Date but not after 11:59 p.m., Eastern time, on the Expiration Date, in whole or in part, by (i)
delivery of a written notice, in the form attached hereto as Exhibit A (an “Exercise Notice”), of
the Holder’s election to exercise this Warrant and (ii) payment to the Company of an amount equal to the applicable
Exercise Price multiplied by the number of Warrant Shares as to which this Warrant is being exercised (the
 “Aggregate Exercise Price”) in cash or by wire transfer of immediately available funds. The Holder shall
not be required to deliver the original Warrant in order to effect an exercise hereunder. Execution and delivery of the
Exercise Notice with respect to less than all of the Warrant Shares shall have the same effect as cancellation of the
original Warrant and issuance of a new Warrant evidencing the right to purchase the remaining number of Warrant Shares. On or
before the second (2nd) Business Day following the date on which the Company has received each of the Exercise Notice and the
Aggregate Exercise Price (together, the “Exercise Delivery Documents”), the Company shall transmit by
electronic mail an acknowledgment of confirmation of receipt of the Exercise Delivery Documents to the Holder and the
Company’s transfer agent (the “Transfer Agent”). On or before the third (3rd) Business Day following
the date on which the Company has received all of the Exercise Delivery Documents, the Company shall instruct the Transfer
Agent to issue and dispatch by overnight courier to the address as specified in the Exercise Notice, a certificate,
registered in the Company’s share register in the name of the Holder or its designee, for the number of shares of
Common Stock to which the Holder is entitled pursuant to such exercise. Upon delivery of the Exercise Delivery Documents, the
Holder shall be deemed for all corporate purposes to have become the holder of record of the Warrant Shares with respect to
which this Warrant has been exercised, irrespective of the date of delivery of the certificates evidencing such Warrant
Shares. If this Warrant is submitted in connection with any exercise pursuant to this Section 1(a) and the number of Warrant
Shares represented by this Warrant submitted for exercise is greater than the number of Warrant Shares being acquired upon an
exercise, then the Company shall as soon as practicable and in no event later than three (3) Business Days after any exercise
and at its own expense, issue a new Warrant (in accordance with Section 7(d)) representing the right to purchase the number
of Warrant Shares purchasable immediately prior to such exercise under this Warrant, less the number of Warrant Shares with
respect to which are acquired upon such exercise. No fractional shares of Common Stock are to be issued upon the exercise of
this Warrant, but rather the number of shares of Common Stock to be issued shall be rounded down to the nearest whole number.
The Company shall pay any and all taxes which may be payable with respect to the issuance and delivery of Warrant Shares upon
exercise of this Warrant. Upon their issuance, the Warrant Shares will be validly allotted, issued and outstanding as fully
paid and nonassessable Common Stock, and may be subject to certain resale or trade restrictions imposed by applicable
Canadian and U.S. securities laws. In the event that the issuance of the Warrant Shares will cause the Holder to become a
 “control person” (as defined under TSX Venture Exchange Policy 1.1), the Holder acknowledges and agrees that the
Company shall not issue the Warrant Shares until the date on which the stockholders of the Company approve the Holder as a
new control person in accordance with the policies of the TSX Venture Exchange.

 

    

     

    

 

(b)              
Exercise Price. For purposes of this Warrant, “Exercise Price” means $0.78, subject to adjustment
as provided herein.

 

(c)              
Cashless Exercise. Notwithstanding anything contained herein to the contrary, if a registration statement covering
the Warrant Shares that are the subject of the Exercise Notice is not effective under the terms of the Registration Rights Agreement
(the “Unavailable Warrant Shares”) the Holder may, in its sole discretion, exercise this Warrant in whole or
in part and, in lieu of making the cash payment otherwise contemplated to be made to the Company upon such exercise in payment
of the Aggregate Exercise Price, elect instead to receive upon such exercise the “Net Number” of shares of Common Stock
determined according to the following formula (a “Cashless Exercise”):

 

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Net Number = (A x B) - (A x C)

 

B

 

For purposes of the foregoing formula:

 

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

 

		B=	the Closing Sale Price of the shares of Common Stock (as reported by Bloomberg) on the date immediately preceding the date
of the Exercise Notice.

 

		C=	the Exercise Price then in effect for the applicable Warrant Shares at the time of such exercise.

 

(d)              
Disputes. In the case of a dispute as to the determination of the Exercise Price or the arithmetic calculation of
the Warrant Shares, the Company shall promptly issue to the Holder the number of Warrant Shares that are not disputed and resolve
such dispute in accordance with Section 12.

 

(e)              
Covenant Regarding Authorized Shares; Insufficient Authorized Shares. The Company shall at all times while this Warrant
shall be outstanding, reserve and keep available out of its authorized but unissued Common Stock, such number of shares of Common
Stock as shall from time to time be sufficient to effect the exercise of all or any portion of the Warrant Shares (disregarding
for this purpose any and all limitations of any kind on such exercise). If at any time while any of the SPA Warrants remain outstanding
the Company does not have a sufficient number of authorized and otherwise unreserved shares of Common Stock to satisfy its obligation
to reserve for issuance upon exercise of the SPA Warrants at least a number of shares of Common Stock equal to 100% (the “Required
Reserve Amount”) of the number of shares of Common Stock as shall from time to time be necessary to effect the exercise
of all of the SPA Warrants then outstanding (an “Authorized Share Failure”), then the Company shall immediately
take all commercially reasonable action necessary to increase the Company’s authorized shares of Common Stock to an amount
sufficient to allow the Company to reserve the Required Reserve Amount for the SPA Warrants then outstanding. Without limiting
the generality of the foregoing sentence, as soon as practicable after the date of the occurrence of an Authorized Share Failure,
but in no event later than one hundred twenty (120) days after the occurrence of such Authorized Share Failure, the Company shall
hold a meeting of its stockholders for the approval of an increase in the number of authorized shares of Common Stock. In connection
with such meeting, the Company shall provide each stockholder with a proxy statement and shall solicit its stockholders’
approval of such increase in authorized shares of Common Stock and to cause its board of directors (the “Board”)
to recommend to the stockholders that they approve such proposal.

 

(f)                Limitations
on Exercises; Beneficial Ownership. The Company shall not effect the exercise of this Warrant, and the Holder shall not
have the right to exercise this Warrant, to the extent that after giving effect to such exercise, such Holder (together with
such Holder’s affiliates) would beneficially own in excess of 9.99% of the shares of Common Stock outstanding
immediately after giving effect to such exercise. For purposes of the foregoing sentence, the aggregate number of shares of
Common Stock beneficially owned by such Holder and its affiliates shall include the number of shares of Common Stock issuable
upon exercise of this Warrant with respect to which the determination of such sentence is being made, but shall exclude
shares of Common Stock which would be issuable upon (i) exercise of the remaining, unexercised portion of this Warrant
beneficially owned by such Holder and its affiliates and (ii) exercise or conversion of the unexercised or unconverted
portion of any other securities of the Company beneficially owned by such Holder and its affiliates (including, without
limitation, any convertible notes or convertible preferred stock or warrants) subject to a limitation on conversion or
exercise analogous to the limitation contained herein. Except as set forth in the preceding sentence, for purposes of this
paragraph, beneficial ownership shall be calculated in accordance with Section 13(d) of the Securities Exchange Act of 1934,
as amended (the “Exchange Act”). For purposes of this Warrant, in determining the number of outstanding
shares of Common Stock, the Holder may rely on the number of outstanding shares of Common Stock as reflected in (1) the
Company’s most recent Form 10-K, Form 10-Q, Current Report on Form 8-K or other public filing with the U.S. Securities
and Exchange Commission (the “SEC”), as the case may be, (2) a more recent public announcement by the
Company or (3) any other more recent notice by the Company or the Transfer Agent setting forth the number of shares of Common
Stock outstanding. For any reason at any time, upon the written or oral request of the Holder, the Company shall within one
(1) Business Day 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 the SPA Warrants, by the Holder and its affiliates since the date as of which such
number of outstanding shares of Common Stock was reported. This limitation on beneficial ownership (a) may be increased,
decreased or terminated, in the Holder’s sole discretion, upon sixty-one (61) days’ written notice to the Company
by the Holder and (b) shall terminate automatically on the date that is fifteen (15) days prior to expiration of the
Expiration Date.

 

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(g)              
If the Company shall fail for any reason or for no reason to issue to the Holder within three (3) Trading Days of the Exercise
Date a certificate for the number of shares of Common Stock to which the Holder is entitled and register such shares of Common
Stock on the Company’s share register or to credit the Holder’s balance account with DTC for such number of shares
of Common Stock to which the Holder is entitled upon the Holder’s exercise of this Warrant, and if on or after such Trading
Day the Holder purchases, or another Person purchases on the Holder’s behalf or for the Holder’s account (in an open
market transaction or otherwise) shares of Common Stock to deliver in satisfaction of a sale by the Holder of shares of Common
Stock issuable upon such exercise that the Holder anticipated receiving from the Company (a “Buy-In”), then
the Company shall, within three (3) Business Days after the Holder’s written request and in the Holder’s discretion,
either (i) pay cash to the Holder in an amount equal to the Holder’s total purchase price (including brokerage commissions,
if any) for the shares of Common Stock so purchased (the “Buy-In Price”), at which point the Company’s
obligation to deliver such certificate (and to issue such Warrant Shares) shall terminate, or (ii) promptly honor its obligation
to deliver to the Holder a certificate or certificates representing such Warrant Shares and pay cash to the Holder in an amount
equal to the excess (if any) of the Buy-In Price over the product of (A) such number of shares of Common Stock, times (B) the Closing
Bid Price on the date of exercise.

 

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2.                 
 ADJUSTMENT OF EXERCISE PRICE AND NUMBER OF WARRANT SHARES. If the Company at any time on or after the Subscription
Date subdivides (by any stock split, stock dividend, recapitalization or otherwise) one or more classes of its outstanding shares
of Common Stock into a greater number of shares, the Exercise Price in effect immediately prior to such subdivision will be proportionately
reduced and the number of Warrant Shares will be proportionately increased. If the Company at any time on or after the Subscription
Date combines (by combination, reverse stock split or otherwise) one or more classes of its outstanding shares of Common Stock
into a smaller number of shares, the Exercise Price in effect immediately prior to such combination will be proportionately increased
and the number of Warrant Shares will be proportionately decreased. Any adjustment under this Section 2 shall become effective
at the close of business on the date such subdivision or combination becomes effective.

 

3.                 
RIGHTS UPON DISTRIBUTION OF ASSETS. If the Company shall declare or make any dividend or other distribution of its
assets (or rights to acquire its assets) to holders of shares of Common Stock, by way of return of capital or otherwise (including,
without limitation, any distribution of cash, stock or other securities, property or options by way of a dividend, spin off, reclassification,
corporate rearrangement, scheme of arrangement or other similar transaction) (a “Distribution”), at any time
after the issuance of this Warrant, then, in each such case:

 

(a)              
any Exercise Price in effect immediately prior to the close of business on the record date fixed for the determination of
holders of shares of Common Stock entitled to receive the Distribution shall be reduced, effective as of the close of business
on such record date, to a price determined by multiplying such Exercise Price by a fraction of which (i) the numerator shall be
the Closing Bid Price of the shares of Common Stock on the Trading Day immediately preceding such record date minus the value of
the Distribution (as determined in good faith by the Board) applicable to one (1) share of Common Stock, and (ii) the denominator
shall be the Closing Bid Price of the shares of Common Stock on the Trading Day immediately preceding such record date; and

 

(b)              
the number of Warrant Shares shall be increased to a number of shares equal to the number of shares of Common Stock obtainable
immediately prior to the close of business on the record date fixed for the determination of holders of shares of Common Stock
entitled to receive the Distribution multiplied by the reciprocal of the fraction set forth in the immediately preceding paragraph
(a); provided that, in the event that the Distribution is of shares of common stock of a company whose common stock is traded on
a national securities exchange or a national automated quotation system (“Other Shares of Common Stock”), then
the Holder may elect to receive a warrant to purchase Other Shares of Common Stock in lieu of an increase in the number of Warrant
Shares, the terms of which shall be identical to those of this Warrant, except that such warrant shall be exercisable into the
number of shares of Other Shares of Common Stock that would have been payable to the Holder pursuant to the Distribution had the
Holder exercised this Warrant immediately prior to such record date and with an aggregate exercise price equal to the product of
the amount by which the exercise price of this Warrant was decreased with respect to the Distribution pursuant to the terms of
the immediately preceding paragraph (a) and the number of Warrant Shares calculated in accordance with the first part of this paragraph
(b).

 

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4.                 
 FUNDAMENTAL TRANSACTIONS. The Company shall not enter into or be party to a Fundamental Transaction unless (A) (i)
the Successor Entity assumes in writing all of the obligations of the Company under this Warrant and the Registration Rights Agreement
in accordance with the provisions of this Section 4 pursuant to written agreements in form and substance reasonably satisfactory
to the Required Holders and approved by the Required Holders prior to the consummation of such Fundamental Transaction, including
agreements to deliver to each holder of SPA Warrants in exchange for such SPA Warrants a security of the Successor Entity evidenced
by a written instrument substantially similar in form and substance to this Warrant, including, without limitation, an adjusted
exercise price equal to the value for the shares of Common Stock reflected by the terms of such Fundamental Transaction, and exercisable
for a corresponding number of shares of capital stock equivalent to the shares of Common Stock acquirable and receivable upon exercise
of this Warrant (without regard to any limitations on the exercise of this Warrant) prior to such Fundamental Transaction, and
reasonably satisfactory to the Required Holders and (ii) the Successor Entity (including its Parent Entity) is a publicly traded
corporation whose common stock is quoted on or listed for trading on an Eligible Market or (B) the Company provides each Holder
with not less than ten (10) Business Days prior notice of the anticipated consummation of such Fundamental Transaction (which notice
may be provided by means of a press release and/or the filing of a Current Report on Form 8-K) and affords each Holder an opportunity
to exercise such Holder’s Warrants prior to the consummation of such Fundamental Transaction, following which each unexercised
Warrant will be null, void and of no further force or effect. Upon the occurrence of any Fundamental Transaction subject to the
provisions of Section 4(A), the Successor Entity shall succeed to, and be substituted for (so that from and after the date of such
Fundamental Transaction, the provisions of this Warrant referring to the “Company” shall refer instead to the Successor
Entity), and may exercise every right and power of the Company and shall assume all of the obligations of the Company under this
Warrant with the same effect as if such Successor Entity had been named as the Company herein. Upon consummation of the Fundamental
Transaction subject to the provisions of Section 4(A), the Successor Entity shall deliver to the Holder confirmation that there
shall be issued upon exercise of this Warrant at any time after the consummation of the Fundamental Transaction, in lieu of the
shares of the Common Stock (or other securities, cash, assets or other property) issuable upon the exercise of the Warrant prior
to such Fundamental Transaction, such shares of the publicly traded common stock (or its equivalent) of the Successor Entity (including
its Parent Entity) which the Holder would have been entitled to receive upon the happening of such Fundamental Transaction had
this Warrant been converted immediately prior to such Fundamental Transaction, as adjusted in accordance with the provisions of
this Warrant. The provisions of this Section 4 shall apply similarly and equally to successive Fundamental Transactions and shall
be applied without regard to any limitations on the exercise of this Warrant.

 

5.                  NONCIRCUMVENTION.
The Company hereby covenants and agrees that the Company will not, by amendment of its Certificate of Incorporation, Bylaws
or through any reorganization, transfer of assets, consolidation, merger, scheme of arrangement, dissolution, issue or sale
of securities, or any other voluntary action, avoid or seek to avoid the observance or performance of any of the terms of
this Warrant, and will at all times in good faith carry out all the provisions of this Warrant and take all commercially
reasonable action as may be required to protect the rights of the Holder hereunder. Without limiting the generality of the
foregoing, the Company shall (i) not increase the par value of any shares of Common Stock receivable upon the exercise of
this Warrant above the Exercise Price then in effect, (ii) take all such actions as may be necessary or appropriate in order
that the Company may validly and legally issue fully paid and nonassessable shares of Common Stock upon the exercise of this
Warrant, and (iii) so long as any of the SPA Warrants are outstanding, take all commercially reasonable action necessary to
reserve and keep available out of its authorized and unissued shares of Common Stock, solely for the purpose of effecting the
exercise of the SPA Warrants, 100% of the number of shares of Common Stock as shall from time to time be necessary to effect
the exercise of the SPA Warrants then outstanding (without regard to any limitations on exercise).

 

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6.                 
WARRANT HOLDER NOT DEEMED A STOCKHOLDER. Except as otherwise specifically provided herein, the Holder, solely in
such Person’s capacity as a Holder of this Warrant, shall not be entitled to vote or receive dividends or be deemed the holder
of capital stock of the Company for any purpose, nor shall anything contained in this Warrant be construed to confer upon the Holder,
solely in such Person’s capacity as the Holder of this Warrant, any of the rights of a stockholder of the Company or any
right to vote, give or withhold consent to any corporate action (whether any reorganization, issue of stock, reclassification of
stock, consolidation, merger, conveyance or otherwise), receive notice of meetings, receive dividends or subscription rights, or
otherwise, prior to the issuance to the Holder of the Warrant Shares which such Person is then entitled to receive upon the due
exercise of this Warrant. In addition, nothing contained in this Warrant shall be construed as imposing any liabilities on the
Holder to purchase any securities (upon exercise of this Warrant or otherwise) or as a stockholder of the Company, whether such
liabilities are asserted by the Company or by creditors of the Company. Notwithstanding this Section 6, the Company shall provide
the Holder with copies of the same notices and other information given to the stockholders of the Company generally, contemporaneously
with the giving thereof to the stockholders; provided, that the Company shall be deemed to have complied with such requirement
by filing any such notices or other information on the SEC’s Electronic Data Gathering Analysis and Retrieval system.

 

7.                 
REISSUANCE OF WARRANTS.

 

(a)              
Transfer of Warrant. If this Warrant is to be transferred, subject to any restrictions on such transfer set forth
in Section 14, or under the Securities Purchase Agreement, Registration Rights Agreement or any other agreement to which the Holder
is party or by which it is bound, the Holder shall surrender this Warrant to the Company, whereupon the Company will forthwith
issue and deliver upon the order of the Holder a new Warrant (in accordance with Section 7(d)), registered as the Holder may request,
representing the right to purchase the number of Warrant Shares being transferred by the Holder and, if less than the total number
of Warrant Shares then underlying this Warrant is being transferred, a new Warrant (in accordance with Section 7(d)) to the Holder
representing the right to purchase the number of Warrant Shares not being transferred.

 

(b)               Lost,
Stolen or Mutilated Warrant. Upon receipt by the Company of evidence reasonably satisfactory to the Company of the loss,
theft, destruction or mutilation of this Warrant, and, in the case of loss, theft or destruction, of any indemnification
undertaking by the Holder to the Company in customary form and, in the case of mutilation, upon surrender and cancellation of
this Warrant, the Company shall execute and deliver to the Holder a new Warrant (in accordance with Section 7(d))
representing the right to purchase the Warrant Shares then underlying this Warrant.

 

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(c)              
Exchangeable for Multiple Warrants. This Warrant is exchangeable, upon the surrender hereof by the Holder at the
principal office of the Company, for a new Warrant or Warrants (in accordance with Section 7(d)) representing in the aggregate
the right to purchase the number of Warrant Shares then underlying this Warrant, and each such new Warrant will represent the right
to purchase such portion of such Warrant Shares as is designated by the Holder at the time of such surrender; provided,
however, that no Warrants for fractional shares of Common Stock shall be given.

 

(d)              
Issuance of New Warrants. Whenever the Company is required to issue a new Warrant pursuant to the terms of this Warrant,
such new Warrant shall (i) be of like tenor with this Warrant, (ii) represent, as indicated on the face of such new Warrant, the
right to purchase the Warrant Shares then underlying this Warrant (or in the case of a new Warrant being issued pursuant to Section
7(a) or Section 7(c), the Warrant Shares designated by the Holder which, when added to the number of shares of Common Stock underlying
the other new Warrants issued in connection with such issuance, does not exceed the number of Warrant Shares then underlying this
Warrant), (iii) have an issuance date, as indicated on the face of such new Warrant which is the same as the Issuance Date, and
(iv) have the same rights and conditions as this Warrant.

 

8.                 
NOTICES. Whenever notice is required to be given under this Warrant, unless otherwise provided herein, such notice
shall be given in accordance with Section 7.5 of the Securities Purchase Agreement. The Company shall provide the Holder with prompt
written notice of all actions taken pursuant to this Warrant, including in reasonable detail a description of such action and the
reason therefore. Without limiting the generality of the foregoing, the Company will give written notice to the Holder (i) reasonably
promptly upon any adjustment of the Exercise Price, setting forth in reasonable detail, and certifying, the calculation of such
adjustment and (ii) at least ten (10) days prior to the date on which the Company closes its books or takes a record (A) with respect
to any dividend or distribution upon the shares of Common Stock, (B) with respect to any grants, issuances or sales of any Options,
Convertible Securities or rights to purchase stock, warrants, securities or other property to holders of shares of Common Stock
or (C) for determining rights to vote with respect to any Fundamental Transaction, dissolution or liquidation, provided in each
case that such information shall be made known to the public prior to or in conjunction with such notice being provided to the
Holder.

 

9.                 
AMENDMENT AND WAIVER. Except as otherwise provided herein, the provisions of this Warrant may be amended or waived
and the Company may take any action herein prohibited, or omit to perform any act herein required to be performed by it, only if
the Company has obtained the written consent of the Required Holders; provided that no such action may (i) increase the exercise
price of any SPA Warrant, (ii) decrease the number of shares or class of stock obtainable upon exercise of any SPA Warrant, (iii)
shorten the Expiration Date, or (iv) amend Sections 1(f) or 2 without the written consent of the Holder. No such amendment shall
be effective to the extent that it applies to less than all of the holders of the SPA Warrants then outstanding.

 

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10.             
 GOVERNING LAW. This Warrant shall be governed by and construed and enforced in accordance with, and all questions
concerning the construction, validity, interpretation and performance of this Warrant shall be governed by, the internal laws of
the State of New York, without giving effect to any conflict of law provision or rule (whether of the State of New York or any
other jurisdictions) that would cause the application of the laws of any jurisdictions other than the State of New York.

 

11.              
CONSTRUCTION; HEADINGS. This Warrant shall be deemed to be jointly drafted by the Company and all the Purchasers
and shall not be construed against any person as the drafter hereof. The headings of this Warrant are for convenience of reference
and shall not form part of, or affect the interpretation of, this Warrant.

 

12.              
DISPUTE RESOLUTION. In the case of a dispute as to the determination of the Exercise Price or the arithmetic calculation
of the Warrant Shares, the Company shall submit the disputed determinations or arithmetic calculations via electronic mail within
two (2) Business Days of receipt of the Exercise Notice giving rise to such dispute, as the case may be, to the Holder. If the
Holder and the Company are unable to agree upon such determination or calculation of the Exercise Price or the Warrant Shares within
three (3) Business Days of such disputed determination or arithmetic calculation being submitted to the Holder, then the Company
shall, within two (2) Business Days submit via electronic mail (a) the disputed determination of the Exercise Price to an independent,
reputable investment bank selected by the Company and approved by the Holder or (b) the disputed arithmetic calculation of the
Warrant Shares to the Company’s independent, outside accountant. The Company shall cause at its expense the investment bank
or the accountant, as the case may be, to perform the determinations or calculations and notify the Company and the Holder of the
results no later than ten (10) Business Days from the time it receives the disputed determinations or calculations. Such investment
bank’s or accountant’s determination or calculation, as the case may be, shall be binding upon all parties absent demonstrable
error.

 

13.              
REMEDIES, OTHER OBLIGATIONS, BREACHES AND INJUNCTIVE RELIEF. The remedies provided in this Warrant shall be cumulative
and in addition to all other remedies available under this Warrant and the other Transaction Documents (as defined in the Securities
Purchase Agreement), at law or in equity (including a decree of specific performance and/or other injunctive relief), and nothing
herein shall limit the right of the Holder to pursue actual damages for any failure by the Company to comply with the terms of
this Warrant. The Company acknowledges that a breach by it of its obligations hereunder may cause irreparable harm to the Holder
and that the remedy at law for any such breach may be inadequate. The Company therefore agrees that, in the event of any such breach
or threatened breach, the holder of this Warrant shall be entitled, in addition to all other available remedies, to seek an injunction
restraining any breach, without the necessity of showing economic loss and without any bond or other security being required.

 

14.              
TRANSFER. This Warrant may be offered for sale, sold, transferred or assigned without the consent of the Company
subject to compliance with applicable securities laws.

 

15.              
CERTAIN DEFINITIONS. For purposes of this Warrant, the following terms shall have the following meanings:

 

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(a)              
 “$” means the lawful money of the United States of America.

 

(b)              
 “Bloomberg” means Bloomberg Financial Markets.

 

(c)              
“Business Day” means any day except Saturday, Sunday and any day which shall be a legal holiday or a
day on which banking institutions in the state of New York generally are authorized or required by law or other government actions
to close.

 

(d)              
“Closing Bid Price” and “Closing Sale Price” means, for any security as of any date,
the volume weighted average price at which the applicable security has traded on the TSX Venture Exchange or the Nasdaq Stock Market,
LLC, as reported by Bloomberg, for a period of five (5) consecutive trading days, or, if the TSX Venture Exchange or the Nasdaq
Stock Market, LLC, is not the principal securities exchange or trading market for such security, the last closing bid price or
last trade price, respectively, of such security on the principal securities exchange or trading market where such security is
listed or traded as reported by Bloomberg, or if the foregoing do not apply, the last closing bid price or last trade price, respectively,
of such security in a marketplace operated by the OTC Markets Group, Inc. for such security as reported by Bloomberg. If the Closing
Bid Price or the Closing Sale Price cannot be calculated for a security on a particular date on any of the foregoing bases, the
Closing Bid Price or the Closing Sale Price, as the case may be, of such security on such date shall be the fair market value as
mutually determined by the Company and the Holder. If the Company and the Holder are unable to agree upon the fair market value
of such security, then such dispute shall be resolved pursuant to Section 12. All such determinations to be appropriately adjusted
for any stock dividend, stock split, stock combination or other similar transaction during the applicable calculation period.

 

(e)              
“Common Stock” means (i) the Company’s shares of Common Stock, par value $0.001 per share, and
(ii) any share capital into which such Common Stock shall have been changed or any share capital resulting from a reclassification
of such Common Stock.

 

(f)               
“Convertible Securities” means any stock or securities (other than Options) directly or indirectly convertible
into or exercisable or exchangeable for shares of Common Stock.

 

(g)              
 “Eligible Market” means the New York Stock Exchange, Inc., the Nasdaq Capital Market, the Nasdaq Global
Market, the Nasdaq Global Select Market, the OTCQX or OTCQB marketplaces operated by the OTC Markets Group, Inc. or the TSX Venture
Exchange.

 

(h)              
“Expiration Date” means the date that is five (5) years after the Issuance Date (as defined in the Securities
Purchase Agreement) or, if such date falls on a day other than a Business Day or on which trading does not take place on the Nasdaq
Stock Market, LLC or the New York Stock Exchange, Inc. (a “Holiday”), the next date that is not a Holiday.

 

(i)                 “Fundamental
Transaction” means that the Company shall, directly or indirectly, in one or more related transactions, (i)
consolidate or merge with or into (whether or not the Company is the surviving corporation) another Person, (ii) sell,
assign, transfer, convey or otherwise dispose of all or substantially all of the properties or assets of the Company to
another Person, (iii) allow another Person to make a purchase, tender or exchange offer that is accepted by the holders of
more than the 50% of the outstanding shares of Common Stock (not including any shares of Common Stock held by the Person or
Persons making or party to, or associated or affiliated with the Persons making or party to, such purchase, tender or
exchange offer), (iv) consummate a stock purchase agreement or other business combination (including, without limitation, a
reorganization, recapitalization, spin-off or scheme of arrangement) with another Person whereby such other Person acquires
more than the 50% of the outstanding shares of Common Stock (not including any shares of Common Stock held by the other
Person or other Persons making or party to, or associated or affiliated with the other Persons making or party to, such stock
purchase agreement or other business combination), (v) reorganize, recapitalize or reclassify its Common Stock, or (vi) any
 “person” or “group” (as these terms are used for purposes of Sections 13(d) and 14(d) of the Exchange
Act) is or shall become the “beneficial owner” (as defined in Rule 13d-3 under the Exchange Act), directly or
indirectly, of 50% of the aggregate ordinary voting power represented by issued and outstanding Common Stock.

 

    10

     

    

 

(j)                
“Options” means any rights, warrants or options to subscribe for or purchase shares of Common Stock or
Convertible Securities.

 

(k)               
“Parent Entity” of a Person means an entity that, directly or indirectly, controls the applicable Person
and whose common stock or equivalent equity security is quoted or listed on an Eligible Market, or, if there is more than one such
Person or Parent Entity, the Person or Parent Entity with the largest public market capitalization as of the date of consummation
of the Fundamental Transaction.

 

(l)                
“Person” means an individual, a limited liability company, a partnership, a joint venture, a corporation,
a trust, an unincorporated organization, any other entity and a government or any department or agency thereof.

 

(m)              
“Registration Rights Agreement” means that certain registration rights agreement by and among the Company
and the Purchasers.

 

(n)               
“Required Holders” means (i) any Holder which, together with its Affiliates, beneficially owns at least
9.99% of the SPA Warrants and (ii) the Holders of the SPA Warrants representing at least a majority of shares of Common Stock underlying
the SPA Warrants then outstanding.

 

(o)               
“Successor Entity” means the Person (or, if so elected by the Required Holders, the Parent Entity) formed
by, resulting from or surviving any Fundamental Transaction or the Person (or, if so elected by the Required Holders, the Parent
Entity) with which such Fundamental Transaction shall have been entered into.

 

(p)               
“Trading Day” means a trading day in which trading occurs on the Nasdaq Stock Market, LLC or the New
York Stock Exchange, Inc., or the TSX Venture Exchange Inc.

 

16.               SEVERABILITY.
If any provision of this Warrant is prohibited by law or otherwise determined to be invalid or unenforceable by a court of
competent jurisdiction, the provision that would otherwise be prohibited, invalid or unenforceable shall be deemed amended to
apply to the broadest extent that it would be valid and enforceable, and the invalidity or unenforceability of such provision
shall not affect the validity of the remaining provisions of this Warrant so long as this Warrant as so modified continues to
express, without material change, the original intentions of the parties as to the subject matter hereof and the prohibited
nature, invalidity or unenforceability of the provision(s) in question does not substantially impair the respective
expectations or reciprocal obligations of the parties or the practical realization of the benefits that would otherwise be
conferred upon the parties. The parties will endeavor in good faith negotiations to replace the prohibited, invalid or
unenforceable provision(s) with a valid provision(s), the effect of which comes as close as possible to that of the
prohibited, invalid or unenforceable provision(s).

 

[Signature
Page Follows]

 

    11

     

    

 

IN WITNESS WHEREOF, the Company has
caused this Warrant to Purchase Common Stock to be duly executed as of the Issuance Date set out above.

 

	 	THE COMPANY:
	 	 
	 	
        ASSURE HOLDINGS CORP.

        

	 	 
	 	By:	

	 	 	Name:
	 	 	Title:

 

     

     

    

 

EXHIBIT A

 

EXERCISE NOTICE

 

TO BE EXECUTED BY THE REGISTERED HOLDER
TO EXERCISE THIS WARRANT TO PURCHASE COMMON STOCK

 

The undersigned holder hereby exercises
the right to purchase ___________ of the shares of Common Stock (“Warrant Shares”) of Assure Holdings Corp.,
a corporation organized under the laws of the State of Nevada (the “Company”), evidenced by the attached Warrant
to Purchase Common Stock (the “Warrant”). Capitalized terms used herein and not otherwise defined shall have
the respective meanings set forth in the Warrant.

 

1.                 
Form of Exercise Price. The Holder intends that payment of the Exercise Price shall be made as:

 

 ̈
a “Cash Exercise” with respect to ___________ Warrant Shares; and/or

 

 ̈
a “Cashless Exercise” with respect to___________ Warrant Shares.

 

2.                 
Payment of Exercise Price. In the event that the holder has elected a Cash Exercise with respect to some or all of
the Warrant Shares to be issued pursuant hereto, the holder shall pay the Aggregate Exercise Price in the sum of $_________ to
the Company in accordance with the terms of the Warrant.

 

3.                 
Delivery of Warrant Shares. The Company shall deliver to the holder ____________ Warrant Shares in accordance with
the terms of the Warrant.

 

4.                 
Representations and Warranties. The undersigned holder represents and warrants that all of the representations and
warranties set forth in Article III of the Securities Purchase Agreement are true and correct with respect to the holder as of
the date hereof.

 

	Date:___________ ___, ______	 
	  	 
	Name of Registered Holder	 
	 	 
	By:	               	 
	Name:	 
	Title:Exhibit 4.2

 

UNLESS PERMITTED UNDER SECURITIES LEGISLATION,
THE HOLDER OF THE SECURITIES REPRESENTED BY THIS CONVERTIBLE DEBENTURE CERTIFICATE SHALL NOT TRADE SUCH SECURITIES BEFORE THE DATE
THAT IS 4 MONTHS AND A DAY AFTER ●.

 

WITHOUT PRIOR WRITTEN APPROVAL OF
THE TSX VENTURE EXCHANGE AND COMPLIANCE WITH ALL APPLICABLE SECURITIES LEGISLATION, THE SECURITIES REPRESENTED BY THIS
CERTIFICATE AND THE SECURITIES ISSUABLE UPON CONVERSION HEREOF MAY NOT BE SOLD, TRANSFERRED, HYPOTHECATED OR OTHERWISE TRADED
ON OR THROUGH THE FACILITIES OF THE TSX VENTURE EXCHANGE OR OTHERWISE IN CANADA OR TO OR FOR THE BENEFIT OF A CANADIAN
RESIDENT UNTIL ●.

 

THE SECURITIES REPRESENTED BY THIS CERTIFICATE
HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), OR UNDER ANY STATE
SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE OFFERED, SOLD, ASSIGNED, PLEDGED, ENCUMBERED
OR OTHERWISE TRANSFERRED WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS IN THE ABSENCE OF SUCH
REGISTRATION UNLESS SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO, REGISTRATION UNDER THE SECURITIES ACT, AND EXCEPT AS SET
FORTH BELOW.

 

BY ITS ACQUISITION HEREOF, THE
HOLDER AGREES THAT IT WILL NOT OFFER, RESELL OR OTHERWISE TRANSFER THIS SECURITY, EXCEPT (A) PURSUANT TO AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE SECURITIES ACT, (B) TO ASSURE HOLDINGS CORP., (C) IN COMPLIANCE WITH (i) RULE 144A UNDER THE
U.S. SECURITIES ACT TO A PERSON THE SELLER REASONABLY BELIEVES TO BE A QUALIFIED INSTITUTIONAL BUYER (AS DEFINED IN RULE
144A); OR (ii) RULE 144 UNDER THE U.S. SECURITIES ACT (“RULE 144”), IF AVAILABLE (D) OUTSIDE THE UNITED STATES IN
AN OFFSHORE TRANSACTION IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT, OR (E) PURSUANT TO AN EXEMPTION FROM
REGISTRATION UNDER THE SECURITIES ACT AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS.

 

FOR ANY TRANSFER PURSUANT TO REGULATION
S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE AGREES THAT
IT WILL DELIVER TO EACH PERSON TO WHOM THIS SECURITY IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND.

 

FOR ANY TRANSFER PURSUANT TO REGULATION
S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE MUST MAKE
CERTAIN CERTIFICATIONS TO THE COMPANY OR TRANSFER AGENT TO CONFIRM THAT SUCH TRANSFEREE IS NOT A U.S. PERSON UNDER REGULATION S
UNDER THE SECURITIES ACT AND PROVIDE CERTAIN OTHER CERTIFICATIONS AND AGREEMENTS THAT SUCH TRANSFERS ARE BEING MADE PURSUANT TO
AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT.

 

ADDITIONALLY, FOR ANY TRANSFER REFERRED
TO IN CLAUSE (C)(ii) or (E), OR IF REQUESTED BY ASSURE HOLDINGS CORP. OR THE TRANSFER AGENT FOR THE SECURITIES, (D), THE HOLDER
MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE COMPANY OR TRANSFER AGENT SUCH CERTIFICATIONS, LEGAL OPINIONS OR OTHER INFORMATION
AS THE COMPANY OR THE TRANSFER AGENT MAY REASONABLY REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION
FROM OR IN A TRANSACTION NOT SUBJECT TO THE REGISTRATION REQUIREMENT OF THE SECURITIES ACT.

 

THE HOLDER HEREOF AGREES THAT IT WILL
NOT, DIRECTLY OR INDIRECTLY, ENGAGE IN ANY HEDGING TRANSACTION WITH REGARD TO THE SECURITIES EXCEPT AS PERMITTED BY THE SECURITIES
ACT.

 

“RESTRICTION TERMINATION DATE”
AS USED HEREIN SHALL MEAN ONE YEAR AFTER THE LATER TO OCCUR OF THE ACQUISITION OF THE SECURITY EVIDENCED HEREBY FROM (X) ASSURE
HOLDINGS CORP. OR (Y) ANY AFFILIATE OF ASSURE HOLDINGS CORP.”

 

     

     

    

 

	ISSUE DATE: _____________, 2020	PRINCIPAL AMOUNT OF US$_______________
	(hereinafter
referred to as the “Issue Date”)
    	(hereinafter referred to as the “Principal Amount”)

 

NUMBER: CD-2020-                

 

ASSURE HOLDINGS CORP.

(Existing under the laws of the State of Nevada)

 

9% UNSECURED REDEEMABLE CONVERTIBLE DEBENTURE

DUE ·

 

Assure Holdings Corp. (hereinafter referred
to as the “Debtor”), for value received, hereby acknowledges itself indebted and promises to pay to _______________________________________
of _________________________________________________________________ (hereinafter referred to as the “Holder”)
on ·, or such earlier date as the Principal Amount may become due and payable (subject to and in accordance with the terms, conditions
and provisions of Schedule “A” attached hereto and forming a part hereof) (the “Maturity Date”),
the Principal Amount then outstanding in lawful money of Canada at the foregoing address of the Holder, or at such other place
or places as may be designated by the Holder from time to time by notice in writing to the Debtor (together with any accrued and
unpaid interest and all costs and expenses that may become payable to the Holder in accordance with Schedule “A”)
(the whole being the “Maturity Payment Amount”).

 

The Debtor will pay interest on the Principal
Amount outstanding at a rate of 9% per annum, compound annually in arrears (based on a calendar year of 365 days) until maturity
(or such earlier date on which this Debenture may be converted or redeemed), payable in cash on the last day of January of each
year. Notwithstanding the foregoing, the first interest payment will be made on January 31, 2021 and will consist of interest accrued
from and including the date of issuance hereof to January 31, 2021. By its execution of the Subscription Agreement, the Holder
acknowledges and agrees to the terms and conditions hereof, including the terms set out in Schedule “A” hereto.

 

This Debenture issued to the Holder is
one in a series of 9% unsecured redeemable convertible debentures ranking pari-passu issued by the Debtor on or about the
date hereof in connection with a financing (the “Financing”) in the principal amount of up to US$4,000,000,
with the option at the sole discretion of the Debtor to increase the Financing by an additional US$2,000,000. The holders from
time to time of a debenture issued by the Debtor pursuant to the Financing are hereinafter collectively called the “Holders”
and all of the debentures issued to the Holders are hereinafter collectively called the “Debentures” and rank
pari-passu.

 

<<Signature Page Follows>>

 

     

     

    

 

IN WITNESS WHEREOF, the Debtor has executed this Debenture
as of _______________________.

 

	 	ASSURE HOLDINGS CORP.
	 	 
	 	Per:	  
	 	 	Authorized Signing Officer

 

     

    A-1

    

 

SCHEDULE “A”

 

The following terms
and conditions are applicable to the 9% unsecured redeemable convertible debenture of Assure Holdings Corp. made in favour of the
Holder.

 

ARTICLE 1

INTERPRETATION

 

1.1          Definitions

 

Whenever used in this
Debenture, unless there is something in the subject matter or context inconsistent therewith, the following words and terms shall
have the indicated meanings, respectively:

 

“this Debenture”, “the
Debenture”, “Debenture”, “hereto”, “herein”, “hereby”, “hereunder”,
 “hereof” and similar expressions refer to the convertible debenture represented hereby and not to any particular
Article, Section, Subsection, clause, subdivision or other portion hereof and include any and every instrument supplemental or
ancillary hereto and every debenture issued in replacement hereof;

 

"Applicable Securities Legislation"
means applicable securities laws (including rules, regulations, policies and instruments) in each of the applicable provinces
and territories of Canada;

 

“Auditors of the Debtor”
means an independent firm of chartered or certified public accountants duly appointed as auditors of the Debtor;

 

“business day” means
a day that is not a Saturday or Sunday or a civic or statutory holiday in the City of Toronto, Ontario;

 

“Capital Reorganization” has the meaning
ascribed thereto in Subsection 2.5(b);

 

“Change of Control” means:
(i) any transaction (whether by purchase, merger or otherwise) whereby any person, or group of persons "acting jointly or
in concert" within the meaning of Applicable Securities Legislation, directly or indirectly acquires the right to cast, at
a general meeting of the shareholders of the Debtor, more than 50% of the votes attached to the then outstanding Common Shares;
(ii) the Debtor’s amalgamation, consolidation or merger with or into any other Person, any merger of another Person into
the Debtor; or (iii) any conveyance, transfer, sale lease or other disposition of all or substantially all of the Debtor’s
and the Debtor’s subsidiaries’ assets and properties, taken as a whole, to another arm’s length person. A Change
of Control will not include a sale, merger, consolidation, amalgamation, reorganization or other similar transaction if the previous
holders of the Common Shares hold at least 50% of the voting shares of such merged, consolidated, amalgamated, reorganized or other
continuing entity;

 

“Change of Control Purchase Date” has the
meaning ascribed thereto in Section 3.1(a);

 

“Change of Control Notice” has the meaning
ascribed thereto in Section 3.1(a);

 

“Change of Control Purchase Option” has the
meaning ascribed thereto in Section 3.1(a);

 

“Change of Control Purchase Price” has the
meaning ascribed thereto in Section 3.1(a);

 

“Common Share” or “Common
Shares” means the common shares in the capital of the Debtor, as constituted on the date hereof;

 

“Conversion Price” means
US$· per Common Share as adjusted, when necessary, in accordance Section 2.5, in which case such price shall mean the adjusted
price in effect at the applicable time;

 

     

    A-2

    

 

“Date of Conversion” has the meaning ascribed
thereto in Subsection 2.2(b);

 

“Debentures” has the meaning ascribed thereto
on page 2 of this Debenture;

 

“Debtor” means Assure
Holdings Corp., a corporation existing under the laws of the State of Nevada and includes any successor corporation to or of the
Debtor within the meaning of Section 11.1;

 

“Event of Default” means
any event specified in Section 7.1, which has not been waived, cured or remedied;

 

“Financing” has the meaning ascribed thereto
on page 2 of this Debenture;

 

“Holder” has the meaning ascribed thereto
on page 2 of this Debenture;

 

“Holders” has the meaning ascribed thereto
on page 2 of this Debenture;

 

“Issue Date” means the date on which this
Debenture was issued, as set forth on page 2 of this Debenture;

 

“Maturity Date” has the meaning ascribed
thereto on page 2 of this Debenture;

 

“Officer’s Certificate” means a certificate
signed by a senior officer and/or a director of the Debtor;

 

“Person” includes individuals, partnerships,
corporations, companies and other business or legal entities;

 

“Principal Amount” means
the principal amount owing by the Debtor to the Holder from time to time pursuant to this Debenture as set forth on page 2 of this
Debenture;

 

“Redemption Notice” has the meaning ascribed
thereto in Section 4.2;

 

“Redemption Date” has the meaning ascribed
thereto in Section 4.2;

 

“Redemption Price” has the meaning ascribed
thereto in Section 4.1;

 

“Share Reorganization” has the meaning ascribed
thereto in Subsection 2.5(a);

 

“Successor Debtor” has the meaning ascribed
thereto in Section 11.1;

 

“Time of Expiry” has the meaning ascribed
thereto in Subsection 2.1(a)(i);

 

“TSXV” means the TSX Venture Exchange; and

 

“U.S. Securities Act” has the meaning ascribed
thereto in Section 2.11.

 

1.2          Interpretation

 

Whenever used in this
Debenture, words importing the singular number only shall include the plural and vice versa and words importing the masculine gender
shall include the neuter or the feminine gender and vice versa.

 

1.3          Headings,
Etc.

 

The division of this
Debenture into Articles and Sections and the insertion of headings are for convenience of reference only and shall not affect the
construction or interpretation of this Debenture.

 

     

    A-3

    

 

1.4          Day
Not a Business Day

 

In the event that any
day on or before which any action is required to be taken hereunder is not a business day, then such action shall be required to
be taken on or before the requisite time on the next succeeding day that is a business day.

 

1.5          Currency 

 

All references to currency herein
shall be to lawful money of Canada.

 

ARTICLE 2

CONVERSION OF DEBENTURE

 

2.1          Conversion and Conversion Price 

 

		(a)	Upon and subject to the terms and conditions set out
in this Article 2, and for no additional consideration:

 

		(i)	the Holder shall have the right, at its option at any time beginning on the date that is twelve
(12) months after the date of the issuance of this Debenture, but prior to the earlier of the close of business on: (a) the business
day prior to the Maturity Date; or (b) the business day prior to any Redemption Date or date of purchase of the Debenture (the
 “Time of Expiry”) to convert, in whole or in part, the Principal Amount into fully paid and non-assessable Common
Shares, at the Conversion Price on the Date of Conversion; and

 

		(b)	The Conversion Price, wherever referenced in this Debenture,
shall be subject to adjustment as provided in Section 2.5.

 

		(c)	The right of conversion set forth in Subsections 2.1(a)(i)
shall extend only to the maximum number of whole Common Shares into which the Principal Amount may be converted in accordance with
the foregoing provisions of this Article 2.

 

		(d)	Fractional interests in Common Shares that would otherwise
be issuable upon any conversion of the Principal Amount shall be adjusted in the manner provided in Section 2.6.

 

2.2         
Manner of Exercise of Right to Convert 

 

		(a)	If the Holder wishes to convert the Principal Amount
into Common Shares pursuant to Subsection 2.1(a)(i), the Holder shall, prior to the Time
of Expiry, send written notice, substantially in the form of Exhibit 1 hereto, duly executed by the Holder or its legal representative
or attorney duly appointed by an instrument in writing in form and executed in a manner satisfactory to the Debtor, exercising
its right to convert the Principal Amount into Common Shares.

 

		(b)	For the purposes of Subsection 2.1(a)(i),
the Holder shall be deemed to have converted the Principal Amount then outstanding into Common Shares on the date on which the
notice contemplated by Subsection 2.2(a) above is actually received by the Debtor (the “Date
of Conversion”).

 

     

    A-4

    

 

2.3          Certificates

 

Within seven (7) business
days of Date of Conversion pursuant to this Article 2, the Holder or, subject to the payment of all applicable security transfer
taxes or other governmental charges by the Holder, its nominee(s) or assignee(s), shall be entered in the books of the Debtor (as
of the Date of Conversion) as the holder of the number of Common Shares into which the Principal Amount is so converted and, as
soon as practicable thereafter, the Debtor shall deliver to the Holder or, subject as aforesaid, its nominee(s), or assignee(s),
a certificate or certificates for such Common Shares and, if applicable, a cheque for any amount payable under Section 2.6.

 

2.4          Interest
and Dividends

 

Upon conversion pursuant
to this Article 2, the Holder shall be entitled to receive accrued and unpaid interest in respect thereof up to the Date of Conversion.
Common Shares issued upon conversion of the Principal Amount by the Holder shall only be entitled to receive dividends declared
in favour of shareholders of record on or after the Date of Conversion, from which date such Common Shares will for all purposes
be and be deemed to be issued and outstanding as fully paid and non-assessable Common Shares.

 

2.5          Adjustment
of Conversion Price

 

		(a)	If, and whenever at any time and from time to time the Debtor shall (i) subdivide, redivide
                                                               or change its then outstanding Common Shares into a greater number of Common Shares, (ii)   reduce,
                                                               combine, consolidate or change its then outstanding Common Shares into a lesser number of Common Shares, or (iii) issue
                                                               Common Shares (or securities exchangeable or convertible into Common Shares) to the holders of all or substantially all of
                                                               its then outstanding Common Shares by way of stock dividend or other distribution (other than a dividend in the ordinary
                                                               course paid in Common Shares or securities exchangeable or convertible into Common Shares) (any of such events being herein
                                                               called a “Share Reorganization”), the Conversion Price shall be adjusted effective immediately after the
                                                               effective date or record date for the Share Reorganization, by multiplying the Conversion Price in effect immediately prior
                                                               to such effective date or record date by the quotient obtained when:

 
	 	(i)	the number of Common Shares outstanding on such effective date or record date before giving effect to the Share Reorganization,

 

is divided by

 

		(ii)	the number of Common Shares outstanding immediately after the completion of such Share Reorganization
(but before giving effect to the issue of any Common Shares issued after such record date otherwise than as part of such Share
Reorganization) including, in the case where securities exchangeable or convertible into Common Shares are distributed, the number
of Common Shares that would have been outstanding had such securities been exchanged for or converted into Common Shares on such
record date.

 

     

    A-5

    

 

		(b)	If, and whenever there is a capital reorganization of the Debtor not otherwise provided for in
Subsection 2.5(a) or a consolidation, merger, arrangement or amalgamation (statutory or otherwise) of the Debtor with or into another
body corporate (any such event being called a “Capital Reorganization”), and the Holder has not exercised its
right of conversion prior to the effective date or record date for such Capital Reorganization, then the Holder shall be entitled
to receive and shall accept, upon any conversion of the Principal Amount after the effective date
or record date for such Capital Reorganization, in lieu of the number of Common Shares to which it was theretofore entitled upon
conversion, the aggregate number of Common Shares or other securities of the Debtor or of the corporation or body corporate resulting,
surviving or continuing from the Capital Reorganization that the Holder would have been entitled to receive as a result of such
Capital Reorganization if, on the effective date or record date thereof, it had been the registered holder of the number of Common
Shares to which it was theretofore entitled upon the conversion of the Principal Amount; provided that no such Capital Reorganization
shall be carried into effect unless all necessary steps shall have been taken so that the Holder shall thereafter be entitled to
receive such number of Common Shares or other securities of the Debtor or of the corporation or body corporate resulting, surviving
or continuing from the Capital Reorganization. The foregoing provisions of this Subsection 2.5(b) shall apply mutatis mutandis
in respect of any interest proposed to be paid through the issuance of Common Shares by the Debtor.

 

2.6          No
Requirement to Issue Fractional Common Shares

 

The Debtor shall
not be required to issue fractional Common Shares upon the conversion of the Principal Amount into Common Shares pursuant to
this Article 2. If any fractional interest in a Common Share would, except for the provisions of this Section 2.6, be
deliverable upon the conversion of the Principal Amount or the payment of any accrued and unpaid interest in Common Shares,
the Debtor shall, in lieu of issuing any such fractional interest, satisfy such fractional interest by either, at the
Debtor’s option, (i) issuing to the Holder one full Common Share and delivering a certificate representing such Common
Share to the Holder; or (ii) paying to the Holder an amount of lawful money of Canada equal to the Principal Amount remaining
outstanding after so much of the Principal Amount as may be converted into a whole number of Common Shares has been so
converted.

 

2.7          Cancellation
of Converted Debenture

 

Upon conversion of
the entire Principal Amount, if applicable, pursuant to this Article 2 and payment of all accrued and unpaid interest (whether
in cash or Common Shares), this Debenture shall be cancelled and shall be of no further force or effect.

 

2.8          Certificate
as to Adjustment

 

The Debtor shall from
time to time, immediately after the occurrence of any event that requires an adjustment or readjustment as provided in Section
2.5, deliver an Officer's Certificate to the Holder specifying the nature of the event requiring the same and the amount of the
adjustment necessitated thereby and setting forth in reasonable detail the method of calculation and the facts upon which such
calculation is based, provided, however, that in the event the Holder does not agree with the adjustment as set forth in the Officer's
Certificate, the Debtor shall obtain the certificate or opinion as to the appropriate adjustment from the Auditors of the Debtor,
which certificate or opinion shall be conclusive and binding on the Debtor and the Holder.

 

2.9          Notice
of Special Matters

 

The Debtor
covenants with the Holder that, so long as this Debenture remains outstanding, it will give notice to the Holder, in the
manner provided in Section 10.4 of its intention to fix a record date or an effective date for any event referred to in
Section 2.5 that may give rise to an adjustment in the Conversion Price, and, in each case, such notice shall specify the
particulars of such event and the record date and the effective date for such event; and, if prepared or available as at the
date that such notice is required to be given pursuant to this Section 2.9, such notice shall be accompanied by the material
(i.e. proxy circulars, information booklets etc.) sent to the holders of Common Shares in respect of the event in question,
provided that the Debtor shall only be required to specify in such notice such particulars of such event as shall have been
fixed and determined on the date on which such notice is given. Such notice shall be given not less than seven (7) business
days in each case prior to such applicable record date or effective date.

 

     

    A-6

    

 

2.10        Resale
Restrictions

 

Any Common Shares issued
upon conversion of this Debenture before four (4) months plus one day from the Issue Date, shall bear the following legend:

 

“UNLESS PERMITTED UNDER SECURITIES
LEGISLATION, THE HOLDER OF THE SECURITIES REPRESENTED BY THIS CONVERTIBLE DEBENTURE CERTIFICATE SHALL NOT TRADE SUCH SECURITIES
BEFORE THE DATE THAT IS 4 MONTHS AND A DAY AFTER ●.

 

WITHOUT PRIOR WRITTEN
APPROVAL OF THE TSX VENTURE EXCHANGE AND COMPLIANCE WITH ALL APPLICABLE SECURITIES LEGISLATION, THE SECURITIES REPRESENTED BY
THIS CERTIFICATE AND THE SECURITIES ISSUABLE UPON CONVERSION HEREOF MAY NOT BE SOLD, TRANSFERRED, HYPOTHECATED OR OTHERWISE
TRADED ON OR THROUGH THE FACILITIES OF THE TSX VENTURE EXCHANGE OR OTHERWISE IN CANADA OR TO OR FOR THE BENEFIT OF A CANADIAN
RESIDENT UNTIL ●.”

 

provided that at any
time subsequent to the date which is four (4) months plus one day after the Issue Date any certificate representing such Common
Shares may be exchanged for a certificate bearing no such legend.

 

In addition to the foregoing, any certificate
representing Common Shares issued upon conversion of this Debenture before twelve (12) months from the Issue Date, will bear the
following legends:

 

THE SECURITIES REPRESENTED BY THIS
CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), OR UNDER
ANY STATE SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE OFFERED, SOLD, ASSIGNED, PLEDGED,
ENCUMBERED OR OTHERWISE TRANSFERRED WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS IN THE ABSENCE
OF SUCH REGISTRATION UNLESS SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO, REGISTRATION UNDER THE SECURITIES ACT, AND EXCEPT
AS SET FORTH BELOW.

 

BY ITS ACQUISITION HEREOF, THE
HOLDER AGREES THAT IT WILL NOT OFFER, RESELL OR OTHERWISE TRANSFER THIS SECURITY, EXCEPT (A) PURSUANT TO AN EFFECTIVE REGISTRATION
STATEMENT UNDER THE SECURITIES ACT, (B) TO ASSURE HOLDINGS CORP., (C) IN COMPLIANCE WITH (i) RULE 144A UNDER THE U.S. SECURITIES
ACT TO A PERSON THE SELLER REASONABLY BELIEVES TO BE A QUALIFIED INSTITUTIONAL BUYER (AS DEFINED IN RULE 144A); OR (ii) RULE 144
UNDER THE U.S. SECURITIES ACT (“RULE 144”), IF AVAILABLE (D) OUTSIDE THE UNITED STATES IN AN OFFSHORE TRANSACTION
IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT, OR (E) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES
ACT AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS.

 

     

    A-7

    

 

FOR ANY TRANSFER PURSUANT TO REGULATION
S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE AGREES THAT
IT WILL DELIVER TO EACH PERSON TO WHOM THIS SECURITY IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND.

 

FOR ANY TRANSFER PURSUANT TO REGULATION
S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE MUST MAKE
CERTAIN CERTIFICATIONS TO THE COMPANY OR TRANSFER AGENT TO CONFIRM THAT SUCH TRANSFEREE IS NOT A U.S. PERSON UNDER REGULATION S
UNDER THE SECURITIES ACT AND PROVIDE CERTAIN OTHER CERTIFICATIONS AND AGREEMENTS THAT SUCH TRANSFERS ARE BEING MADE PURSUANT TO
AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT.

 

ADDITIONALLY, FOR ANY TRANSFER
REFERRED TO IN CLAUSE (C)(ii) or (E), OR IF REQUESTED BY ASSURE HOLDINGS CORP. OR THE TRANSFER AGENT FOR THE SECURITIES, (D), THE
HOLDER MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE COMPANY OR TRANSFER AGENT SUCH CERTIFICATIONS, LEGAL OPINIONS OR OTHER INFORMATION
AS THE COMPANY OR THE TRANSFER AGENT MAY REASONABLY REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION
FROM OR IN A TRANSACTION NOT SUBJECT TO THE REGISTRATION REQUIREMENT OF THE SECURITIES ACT.

 

THE HOLDER HEREOF AGREES THAT IT
WILL NOT, DIRECTLY OR INDIRECTLY, ENGAGE IN ANY HEDGING TRANSACTION WITH REGARD TO THE SECURITIES EXCEPT AS PERMITTED BY THE SECURITIES
ACT.

 

“RESTRICTION TERMINATION
DATE” AS USED HEREIN SHALL MEAN ONE YEAR AFTER THE LATER TO OCCUR OF THE ACQUISITION OF THE SECURITY EVIDENCED HEREBY FROM
(X) ASSURE HOLDINGS CORP. OR (Y) ANY AFFILIATE OF ASSURE HOLDINGS CORP.”

 

provided that at any
time subsequent to the date which is twelve (12) months after the date of exercise hereof any certificate representing such Common
Shares may be exchanged for a certificate bearing no such legends.

 

2.11        United
States Securities Law Matters

 

This Debenture and
the Common Shares issuable upon conversion or at maturity or otherwise in connection with this Debenture have not been registered
under the United States Securities Act of 1933, as amended (the “U.S. Securities Act”), or the securities laws
of any state of the United States. This Debenture may not be converted into Common Shares by or for the account or benefit of a
 “U.S. person” or a person in the United States, and the Common Shares may not be delivered to an address within the
United States, unless the Debenture and the underlying Common Shares have been registered under the U.S. Securities Act and any
applicable state securities laws, or an exemption from such registration requirements is available, such as the exemption provided
by Section 3(a)(9) of the U.S. Securities Act. “United States” and “U.S. person” are as defined
by Regulation S under the U.S. Securities Act.

 

     

    A-8

    

 

ARTICLE 3

CHANGE OF CONTROL

 

3.1          Within 30 days following a Change
of Control, and subject to the provisions and conditions of this Article 3, the Debtor shall be obligated to offer to purchase
this Debenture, subject to the exercise of conversion rights of the Holder in accordance with Article 2. The terms and conditions
of such obligation are set forth below:

 

		(a)	Not more than 30 days following the occurrence of a Change of Control, the Debtor shall deliver
to the Holder a notice stating that there has been a Change of Control and specifying the date on which such Change of Control
occurred and the circumstances or events giving rise to such Change of Control substantially in the form of Exhibit 2 hereto (a
 "Change of Control Notice"). Prior to the Change of Control Purchase Date (as defined below), the Holder shall,
in its sole discretion, have the right, by completing and submitting to the Debtor the form attached as Appendix “A”
to Exhibit 2 no later than 20 business days after the Change of Control Notice is delivered to the Holder, failing which the Holder
shall be irrevocably deemed to have elected to continue to hold the Debenture, to require the Debtor to either: (i) purchase the
Debenture in whole or in part (the "Change of Control Purchase Option") at 101% of the Principal Amount thereof
plus accrued and unpaid interest to, but excluding, the Change of Control Purchase Date (the "Change of Control Purchase
Price"); or (ii) convert the Debenture at the Conversion Price in accordance with Article 2. The "Change of Control
Purchase Date" shall be the date that is 30 business days after the date of the Change of Control Notice is delivered
to the Holder.

 

(b)   Unless the Holder has elected to convert the Debenture in whole or in part, the Debtor shall, on or before 5:00 p.m. (Eastern
Standard time) on the Change of Control Purchase Date, pay to the Holder the Change of Control Purchase Price for the Debenture
to be purchased by the Debtor on the Change of Control Purchase Date (less any tax required by law to be deducted in respect of
accrued and unpaid interest), with a cheque or bank draft for such amounts.

 

(c)    In
the event that the Debenture is purchased in part only, upon surrender of such Debenture for payment of the Change of Control
Purchase Price, the Debtor shall execute and deliver, without charge to the Holder, a new Debenture for the portion of the
Principal Amount of the Debentures not so purchased.

 

(d)   If
the Holder accepts the Change of Control Purchase Option, the Debenture shall become due and payable at the Change of Control
Purchase Price on the Change of Control Purchase Date, in the same manner and with the same effect as if it were the date of maturity
specified in such Debenture, anything therein or herein to the contrary notwithstanding, and, from and after the Change of Control
Purchase Date, if the money necessary to purchase or redeem, the Debenture shall have been paid as provided in this Article 3,
interest on the Debenture shall cease.

 

		(e)	In case the Holder shall fail on or before the Change of Control Purchase Date to surrender the
Debenture or shall not within such time accept payment of the monies payable, or give such receipt therefor, if any, as the Debtor
may require, such monies may be set aside in trust, without interest, and such setting aside shall for all purposes be deemed a
payment to the Holder of the sum and the Holder shall have no other right except to receive payment of the monies so paid and deposited
upon surrender and delivery the Holder's Debenture.

 

     

    A-9

    

 

ARTICLE 4

REDEMPTION AND
PURCHASE OF DEBENTURE

 

4.1          Subject
to regulatory approval and the right of the Holder to convert the Debenture under Article 2, the Debtor shall have the right,
at its option, at any time beginning on the date that is twelve (12) months after the date of the issuance of this Debenture,
to redeem all or part of the Debenture, including the entire Principal Amount and any accrued and unpaid interest thereunder,
by payment to the Holder, on not more than 60 days' and not less than 30 days' notice, of 100% of the Principal Amount, plus
interest accrued up to the Redemption Date (the “Redemption Price”).

 

4.2          Notice
of redemption (the "Redemption Notice") of the Debenture shall be given to the Holder not more than 60 days
nor less than 30 days prior to the date fixed for redemption (the "Redemption Date") substantially in the
form of Exhibit 3. Such notice shall specify the aggregate Principal Amount of the Debenture called for redemption, the
Redemption Date, the Redemption Price and the place of payment and shall state that interest upon the portion of the
Principal Amount of the Debenture called for redemption shall cease to be payable from and after the Redemption Date. In
addition, the Redemption Notice shall specify the portion of the Principal Amount to be redeemed.

 

4.3          Notice having been given as aforesaid, the Debenture shall thereupon be and become due and payable at the relevant Redemption
Price, together with accrued and unpaid interest up to and including the Redemption Date, on the Redemption Date specified in such
notice, in the same manner and with the same effect as if it were the date of maturity specified in the Debenture, anything therein
or herein to the contrary notwithstanding, and from and after such Redemption Date, if the monies necessary to redeem such Debentures
shall have been paid as herein provided, interest on the Debenture will cease.

 

4.4         The
Redemption Price shall be paid by the Debtor on or before 5:00 p.m. (Eastern Standard Time) on the Redemption Date specified in
the Redemption Notice, upon surrender of the Debenture.

 

4.5          In case the Holder shall fail on or before the Redemption Date to surrender such the Debenture, or shall not within
such time accept payment of the redemption monies payable, or give such receipt therefor, if any, as the Debtor may require, such
redemption monies may be set aside in trust, and such setting aside shall for all purposes be deemed a payment to the Holder of
the sum so set aside and, to that extent, the Debenture shall thereafter not be considered as outstanding hereunder and the Holder
shall have no other right except to receive payment out of the monies so set aside, upon surrender and delivery of the Debenture,
plus any accrued but unpaid interest thereon up to and including the Redemption Date.

 

4.6          If the Debenture is redeemed in part it shall be cancelled and the Debtor shall issue a new Debenture to the Holder,
on identical terms except for the Principal Amount, in a principal amount equal to the Principal Amount not so redeemed.

 

4.7          The Debtor may, if it is not at the time in default under the Debenture, at any time and from time to time, offer to
purchase the Debenture in whole or in part in the market by tender or by contract, at any price.

 

ARTICLE 5

REPRESENTATIONS AND WARRANTIES

 

5.1          The Debtor hereby represents and warrants to the Holder that:

 

(a)          
Corporate Power and Qualification – The Debtor:

 

		(i)	is organized and validly subsisting under the laws of Nevada,

 

     

    A-10

    

 

		(ii)	has full corporate power and capacity to own or lease its properties and to carry on its business
as conducted on the date hereof,

 

		(iii)	is duly qualified to do business under the laws of each jurisdiction in which it carries on business
or holds property to the extent required by such laws, and

 

		(iv)	holds all licences and authorizations from regulatory and governmental authorities or agencies
required in order to permit it to carry on its business as conducted on the date hereof;

 

(b)          
Corporate Authority – The Debtor has full power, legal right and corporate authority to enter into this Debenture
and any other agreement contemplated hereby to which it is a party and to do all acts and things as are required or contemplated
hereunder or thereunder to be done, observed and performed by it;

 

(c)          
Valid Authorization – The Debtor has, or will have as of the date hereof, taken all necessary corporate action
to authorize the execution, delivery and performance of this Debenture and any other agreement contemplated hereby to which it
is a party and the performance by it of all acts and things as are required or contemplated hereunder or thereunder to be done,
observed and performed by it; and

 

(d)           Enforceability – Each of this Debenture and any other agreement contemplated hereby to which the Debtor is
a party constitutes a valid and legally binding obligation of the Debtor enforceable against it in accordance with the terms thereof,
except (i) to the extent that enforceability may be limited by applicable bankruptcy or insolvency or other laws affecting creditors'
rights generally and (ii) to the extent that the remedies of specific performance and injunction, being equitable remedies, may
only be granted in the discretion of a court.

 

ARTICLE 6

COVENANTS

 

The Debtor hereby covenants and agrees with the Holder
as follows:

 

6.1          To
Pay Principal and Interest

 

The Debtor will duly
and punctually pay or cause to be paid to the Holder the principal of and interest accrued on this Debenture on the dates, at the
places and in the manner mentioned in this Debenture.

 

6.2          To
Carry on Business

 

Subject to the express
provisions hereof, the Debtor will carry on and conduct its business in a proper and efficient manner consistent with past practice
and, subject to the express provisions hereof, it will do or cause to be done all things necessary to preserve and keep in full
force and effect its corporate existence and rights.

 

6.3          To
Maintain Accurate Books and Records

 

The Debtor will keep
and maintain proper books of account and records accurately covering all material aspects of the business affairs of the Debtor.

 

6.4          Notice
of Event of Default

 

The Debtor will give
notice in writing forthwith to the Holder of the occurrence of any Event of Default or other event that, with the lapse of time
and/or giving of notice or otherwise, would be an Event of Default, forthwith upon becoming aware thereof and specifying the nature
of such default and/or Event of Default and the steps taken to remedy the same.

 

     

    A-11

    

 

ARTICLE 7

EVENTS OF DEFAULT

 

7.1          Events
of Default

 

The happening of any
one or more of the following events shall be considered an event of default (each an “Event of Default”):

 

	 	(a)	if the Debtor defaults in the payment of the Principal Amount of this Debenture when the same becomes due and payable under
any provision hereof;
	 	 	 
	 	(b)	if the Debtor defaults in the payment of any interest or other monies due pursuant to this Debenture and such default continues
for a period of sixty (60) business days;
	 	 	 
	 	(c)	if any representation or warranty made in this Debenture is proven to have been materially false or misleading on the date
when made; or
	 	 	 
		(d)	if the Debtor neglects to observe or perform any other covenant or condition herein contained on
its part to be observed or performed and after notice in writing has been given by the Holder to the Debtor specifying such default
and requiring the Debtor to rectify the same, the Debtor fails to make good such default within a period of sixty (60) business
days unless the Holder (having regard to the subject matter of the default) shall have agreed to a longer period and in such event
within the period agreed to by the Holder.

 

If any one or more
of the foregoing Events of Default shall occur, the Holder may, at its option, declare the principal amount of this Debenture and
interest accrued thereon, to be immediately due and payable.

 

7.2          Waiver

 

The Holder may waive
any breach by the Debtor of any of the provisions contained herein or any other document that the Debtor is a party or a default
by the Debtor in the observance or performance of any covenant or condition required to be observed or performed by the Debtor
under the terms hereof, provided always that no act or omission of the Holder shall extend to or be taken in any manner whatsoever
to affect any subsequent breach or default or the rights resulting therefrom.

 

ARTICLE 8

ENFORCEMENT

 

8.1          Enforcement

 

Upon the
occurrence and during the continuance of any Event of Default which has not been waived or cured, the Holder will be entitled
to enforce its remedies to the full extent permitted by applicable law, this Debenture and for any of such purposes, commence
such legal action or proceedings as, in its sole discretion, it may deem expedient all without any notice, presentation,
further demand, protest, notice of protest, entering into possession of any of the undertaking, property or assets of
the Debtor or any other action, notice of all of which are hereby expressly waived by the Debtor except to the extent set
forth herein.

 

     

    A-12

    

 

ARTICLE 9

PRESENTMENT

 

9.1          Presentment

 

The Debtor hereby expressly
waives demand for payment, presentment, protest and notice of dishonour of this Debenture. Any failure or omission by the Holder
to present this Debenture for payment, protest or provide notice of dishonour will not invalidate or adversely affect in any way
any demand for payment or any enforcement proceeding taken under this Debenture.

 

ARTICLE 10

MISCELLANEOUS

 

10.1        Discharge

 

Upon payment (including
by conversion) by the Debtor to the Holder of the Principal Amount, interest thereon and other monies payable by the Debtor under
this Debenture, the Holder shall execute and deliver to the Debtor any such deeds and other documents as the Debtor may reasonably
require in order to evidence the release and discharge of this Debenture.

 

10.2        Severability

 

If any covenant or
provision herein is determined to be illegal, unenforceable or prohibited by applicable law such illegality, unenforceability or
prohibition shall not affect or impair the validity of any other covenant or provision herein.

 

10.3        Laws
of Ontario

 

This Debenture shall
be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein.
The Holder hereby irrevocably submits to the jurisdiction of the courts of Ontario in respect of any action, suit or any other
proceeding arising out of or relating to this Debenture and any other agreement or instrument mentioned herein and any of the transactions
contemplated thereby.

 

10.4        Notices

 

All notices, reports
or other communications required or permitted by this Debenture must be in writing and either delivered by hand, mail or by any
form of electronic communication by means of which a written or typed copy is produced at the address of the recipient and is effective
on actual receipt unless sent (i) by mail in which case it shall be deemed to have been received and be effective on the date that
is three (3) business days following the date of mailing, or (ii) by electronic means in which case it is effective on the business
day, next following the date of transmission, addressed to the relevant party, as follows:

 

		(e)	if to the Debtor:

 

Assure Holdings Corp.

4600 South Ulster Street

Denver,
Colorado 80237

Attention: John Farlinger, CEO

Email: john.farlinger@assureiom.com

 

		(f)	if to the Holder, at the address specified on page 2
hereof,

 

or the last address or telecopier number
of the addressee, notice of which was given in accordance with this Section 10.4.

 

     

    A-13

    

 

10.5       Enurement

 

This Debenture and
all its provisions shall enure to the benefit of the Holder, its successors and assigns and shall be binding upon the Debtor and
its successors and assigns. This Debenture cancels and supersedes any prior agreements or understandings between the Holder and
the Debtor concerning the subject matter hereof, other than the Subscription Agreement entered into by the Debtor and the Holder,
which survives with the exception of Exhibit “A” thereof which is superseded and more particularly it supersedes the
term sheet attached to such Subscription Agreement.

 

10.6       
Time of the Essence 

 

Time shall be of the essence
of this Agreement.

 

10.7       
Maximum Rate Permitted by Law 

 

Under no circumstances
shall the Holder be entitled to receive nor shall it in fact receive a payment or partial payment of interest, fees or other amounts
under or in relation to this Debenture at a rate that is prohibited by applicable law. Accordingly, notwithstanding anything herein
or elsewhere contained, if and to the extent that under any circumstances, the effective annual rate of “interest”
(as defined in Section 347 of the Criminal Code of Canada) received or to be received by a Holder (determined in accordance with
such section) on any amount of “credit advanced” (as defined in that section) pursuant to these presents or any agreement
or arrangement collateral hereto entered into in consequence or implementation hereof would, but for this Section 10.7, be a rate
that is prohibited by applicable law, then the effective annual rate of interest, as so determined, received or to be received
by the Holder on such amount of credit advanced shall be and be deemed to be adjusted to a rate that is one whole percentage point
less than the lowest effective annual rate of interest that is so prohibited (the “adjusted rate”); and, if the Holder
has received a payment or partial payment which would, but for this Section 10.7, be so prohibited then any amount or amounts so
received by the Holder in excess of the lowest effective annual rate that is so prohibited shall and shall be deemed to have comprised
a credit to be applied to subsequent payments on account of interest, fees or other amounts due to the Holder at the adjusted rate.

 

10.8       Transferability

 

Subject to applicable
statutory resale restrictions, this Debenture may be assigned and transferred by the Holder upon providing written notice of such
transfer to the Debtor. The Debtor, acting reasonably, may require the Holder to furnish to the Debtor an opinion of counsel, of
recognized standing reasonably satisfactory to the Debtor, confirming that any such assignment and transfer is permissible under
applicable securities laws.

 

ARTICLE 11 

SUCCESSOR CORPORATION

 

11.1       Certain
Requirements

 

The Debtor shall
not, directly or indirectly, sell, lease, transfer or otherwise dispose of all or substantially all of its property and
assets as an entirety to any other corporation or entity (any such other corporation or entity being herein referred to as a
 “Successor Debtor”) or consummate a Change of Control transaction that results in a Successor Debtor
succeeding to all or substantially all of the property and assets of the Debtor unless, in each case, such Successor Debtor
shall execute, prior to or contemporaneously with the consummation of any such transaction, an agreement together with such
other instruments as are, in the opinion of counsel, necessary or advisable to evidence the assumption by the Successor
Debtor of the due and punctual payment of this Debenture and the interest thereon and all other moneys payable hereunder and
its agreement to observe and perform all the covenants and obligations of the Debtor under this Debenture on a basis that is
economically equivalent to the Debenture.

 

     

    1

    

 

EXHIBIT 1

 

OPTIONAL CONVERSION NOTICE

 

To:Assure Holdings
Corp. (the “Debtor”)

 

The undersigned registered Holder of
a 9% Unsecured Redeemable Convertible Debenture due · issued on the         of                    ,
2020 (the “Issue Date”) by the Debtor (the “Debenture”) hereby irrevocably elects to convert
US$            of principal amount of the Debenture into common
shares in the capital of the Debtor (the “Common Shares”) in accordance with the terms of the Debenture and
directs that the Common Shares issuable and deliverable upon such conversion be issued and delivered to the Holder (or person
indicated below)*.

 

In the event that the conversion described
above represents the entire Principal Amount (as defined in the Debenture) owing and outstanding to the Holder, such undersigned
Holder shall execute and deliver to the Debtor any such deeds and other documents as the Debtor may reasonably require in order
to evidence the release and discharge of the Debenture, without recourse.

 

By executing this conversion notice, the undersigned hereby
acknowledges, represents and warrants:

 

		(1)	That the following legends will be placed on the certificates representing the Common Shares being
acquired if the Debenture is converted prior to four months plus one day from the Issue Date:

 

“UNLESS PERMITTED
UNDER SECURITIES LEGISLATION, THE HOLDER OF THE SECURITIES REPRESENTED BY THIS CONVERTIBLE DEBENTURE CERTIFICATE SHALL NOT
TRADE SUCH SECURITIES BEFORE THE DATE THAT IS 4 MONTHS AND A DAY AFTER ●.

 

WITHOUT PRIOR WRITTEN APPROVAL
OF THE TSX VENTURE EXCHANGE AND COMPLIANCE WITH ALL APPLICABLE SECURITIES LEGISLATION, THE SECURITIES REPRESENTED BY THIS CERTIFICATE
AND THE SECURITIES ISSUABLE UPON CONVERSION HEREOF MAY NOT BE SOLD, TRANSFERRED, HYPOTHECATED OR OTHERWISE TRADED ON OR THROUGH
THE FACILITIES OF THE TSX VENTURE EXCHANGE OR OTHERWISE IN CANADA OR TO OR FOR THE BENEFIT OF A CANADIAN RESIDENT UNTIL ●.”

 

and in addition to the foregoing
legends, the following legends will be placed on the certificates representing the Common Shares if the Debenture is converted
prior to twelve months from the Issue Date:

 

THE SECURITIES REPRESENTED BY
THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"),
OR UNDER ANY STATE SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE OFFERED, SOLD, ASSIGNED,
PLEDGED, ENCUMBERED OR OTHERWISE TRANSFERRED WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS IN
THE ABSENCE OF SUCH REGISTRATION UNLESS SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO, REGISTRATION UNDER THE SECURITIES
ACT, AND EXCEPT AS SET FORTH BELOW.

 

     

    2

    

 

BY ITS ACQUISITION HEREOF, THE
HOLDER AGREES THAT IT WILL NOT OFFER, RESELL OR OTHERWISE TRANSFER THIS SECURITY, EXCEPT (A) PURSUANT TO AN EFFECTIVE REGISTRATION
STATEMENT UNDER THE SECURITIES ACT, (B) TO ASSURE HOLDINGS CORP., (C) IN COMPLIANCE WITH (i) RULE 144A UNDER THE U.S. SECURITIES
ACT TO A PERSON THE SELLER REASONABLY BELIEVES TO BE A QUALIFIED INSTITUTIONAL BUYER (AS DEFINED IN RULE 144A); OR (ii) RULE 144
UNDER THE U.S. SECURITIES ACT (“RULE 144”), IF AVAILABLE (D) OUTSIDE THE UNITED STATES IN AN OFFSHORE TRANSACTION IN
COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT, OR (E) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT
AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS.

 

FOR ANY TRANSFER PURSUANT TO
REGULATION S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE
AGREES THAT IT WILL DELIVER TO EACH PERSON TO WHOM THIS SECURITY IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND.

 

FOR ANY TRANSFER PURSUANT TO
REGULATION S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE
MUST MAKE CERTAIN CERTIFICATIONS TO THE COMPANY OR TRANSFER AGENT TO CONFIRM THAT SUCH TRANSFEREE IS NOT A U.S. PERSON UNDER REGULATION
S UNDER THE SECURITIES ACT AND PROVIDE CERTAIN OTHER CERTIFICATIONS AND AGREEMENTS THAT SUCH TRANSFERS ARE BEING MADE PURSUANT
TO AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT.

 

ADDITIONALLY, FOR ANY TRANSFER
REFERRED TO IN CLAUSE (C)(ii) or (E), OR IF REQUESTED BY ASSURE HOLDINGS CORP. OR THE TRANSFER AGENT FOR THE SECURITIES, (D), THE
HOLDER MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE COMPANY OR TRANSFER AGENT SUCH CERTIFICATIONS, LEGAL OPINIONS OR OTHER INFORMATION
AS THE COMPANY OR THE TRANSFER AGENT MAY REASONABLY REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION
FROM OR IN A TRANSACTION NOT SUBJECT TO THE REGISTRATION REQUIREMENT OF THE SECURITIES ACT.

 

THE HOLDER HEREOF AGREES THAT
IT WILL NOT, DIRECTLY OR INDIRECTLY, ENGAGE IN ANY HEDGING TRANSACTION WITH REGARD TO THE SECURITIES EXCEPT AS PERMITTED BY THE
SECURITIES ACT.

 

“RESTRICTION TERMINATION
DATE” AS USED HEREIN SHALL MEAN ONE YEAR AFTER THE LATER TO OCCUR OF THE ACQUISITION OF THE SECURITY EVIDENCED HEREBY FROM
(X) ASSURE HOLDINGS CORP. OR (Y) ANY AFFILIATE OF ASSURE HOLDINGS CORP.”

 

		(2)	That the undersigned is not a U.S. Person, or a Person in the United States, and
                                                                                                 is not acquiring any of the Common Shares issuable upon the conversion of the Debentures for the account or benefit of, a
                                                                                                 U.S. Person or Person in the United States and none of the persons listed above is a U.S. Person or a Person in the United
                                                                                                 States. For purposes hereof, (a) "United States" means the United States of America, its territories or
                                                                                                 possessions, any state thereof or the District of Columbia and (b) a "U.S. Person" means any natural person
                                                                                                 resident in the United States, any partnership or corporation organized or incorporated under the laws of the United States,
                                                                                                 any estate of which any executor or administrator is a U.S. Person, any trust of which any trustee is a U.S. Person, any
                                                                                                 agency or branch of a foreign entity located in the United States, any non-discretionary account or similar account (other
                                                                                                 than an estate or trust) held by a dealer or other fiduciary for the benefit or account of a U.S. Person, any discretionary
                                                                                                 account or similar account (other than an estate or trust) held by a dealer or other fiduciary organized or incorporated, or,
                                                                                                 if an individual, resident, in the United States or any partnership or corporation organized or incorporated under the laws
                                                                                                 of a country other than the United States if formed by a U.S. Person principally for the purpose of investing in securities
                                                                                                 not registered under the United States Securities Act of 1933, as amended.

 

<<Signature page to follow>>

 

     

    3

    

 

	DATED ________________________, 20___.	 
	 	 
	 	(Signature of Registered Holder)
	 	 

 

	Name:	            	 
	 	 
	 	 
	(Address)	 
	 	 
	(City and State/Province)	 
	 	 
	(Zip/Postal Code)	 
	 	 

 

* The signature of the registered holder
must be guaranteed by a Canadian chartered bank, Medallion Guarantee or other entity acceptable to Assure Holdings Corp., if this
form is in the name of anyone other than the registered holder of the Debenture.

 

     

    4

    

 

EXHIBIT 2

 

CHANGE OF CONTROL NOTICE

 

•, 20          

 

To:                                    (the
 “Holder”)

 

Assure Holdings Corp. (the
 “Debtor”) hereby notifies the Holder of the 9% Unsecured Redeemable Convertible Debenture due ·
(the “Debenture”) issued on the           of                        ,
2020 (the “Issue Date”) by the Debtor that a “Change of Control” (as defined in the Debenture)
occurred in respect of the Debtor on                          ,
20   . Details of the Change of Control are set forth below:

 

 

 

 

 

In accordance with the terms and conditions
of the Debenture, you have the right, at your option, to require the Debtor to either: (i) purchase the Debenture at a price equal
to 101% of the Principal Amount then outstanding plus accrued and unpaid interest, to but excluding the Change of Control Purchase
Date; or (ii) convert the Debenture at the Conversion Price in accordance with Article 2 of the Debenture.

 

In order to make the election, you must
complete and submit to the Debtor the form attached to this Exhibit 2 as Appendix “A” no later than 20 business days
after this Change of Control Notice is delivered to you, failing which you shall be irrevocably deemed to have elected to continue
to hold the Debenture.

 

By electing to convert the Debenture at
the Conversion Price in accordance with Article 2 of the Debenture, you acknowledge that the following legends will be placed on
the certificates representing the Common Shares being acquired if the Debenture is converted prior to four months plus one day
from the Issue Date:

 

“UNLESS PERMITTED UNDER
SECURITIES LEGISLATION, THE HOLDER OF THE SECURITIES REPRESENTED BY THIS CONVERTIBLE DEBENTURE CERTIFICATE SHALL NOT TRADE SUCH
SECURITIES BEFORE THE DATE THAT IS 4 MONTHS AND A DAY AFTER ●.

 

WITHOUT PRIOR WRITTEN
APPROVAL OF THE TSX VENTURE EXCHANGE AND COMPLIANCE WITH ALL APPLICABLE SECURITIES LEGISLATION, THE SECURITIES REPRESENTED BY
THIS CERTIFICATE AND THE SECURITIES ISSUABLE UPON CONVERSION HEREOF MAY NOT BE SOLD, TRANSFERRED, HYPOTHECATED OR OTHERWISE
TRADED ON OR THROUGH THE FACILITIES OF THE TSX VENTURE EXCHANGE OR OTHERWISE IN CANADA OR TO OR FOR THE BENEFIT OF A CANADIAN
RESIDENT UNTIL ●.”

 

and in addition to the foregoing legends, the following legends
will be placed on the certificates representing the Common Shares if the Debenture is converted prior to twelve months from the
Issue Date:

 

“THE SECURITIES REPRESENTED
BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"),
OR UNDER ANY STATE SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE OFFERED, SOLD, ASSIGNED,
PLEDGED, ENCUMBERED OR OTHERWISE TRANSFERRED WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS IN
THE ABSENCE OF SUCH REGISTRATION UNLESS SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO, REGISTRATION UNDER THE SECURITIES
ACT, AND EXCEPT AS SET FORTH BELOW.

 

     

    5

    

 

BY ITS ACQUISITION HEREOF, THE
HOLDER AGREES THAT IT WILL NOT OFFER, RESELL OR OTHERWISE TRANSFER THIS SECURITY, EXCEPT (A) PURSUANT TO AN EFFECTIVE REGISTRATION
STATEMENT UNDER THE SECURITIES ACT, (B) TO ASSURE HOLDINGS CORP., (C) IN COMPLIANCE WITH (i) RULE 144A UNDER THE U.S. SECURITIES
ACT TO A PERSON THE SELLER REASONABLY BELIEVES TO BE A QUALIFIED INSTITUTIONAL BUYER (AS DEFINED IN RULE 144A); OR (ii) RULE 144
UNDER THE U.S. SECURITIES ACT (“RULE 144”), IF AVAILABLE (D) OUTSIDE THE UNITED STATES IN AN OFFSHORE TRANSACTION IN
COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT, OR (E) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT
AND IN COMPLIANCE WITH ANY APPLICABLE STATE SECURITIES LAWS.

 

FOR ANY TRANSFER PURSUANT TO
REGULATION S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE
AGREES THAT IT WILL DELIVER TO EACH PERSON TO WHOM THIS SECURITY IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND.

 

FOR ANY TRANSFER PURSUANT TO
REGULATION S UNDER THE SECURITIES ACT OF THE SECURITY EVIDENCED HEREBY PRIOR TO THE RESTRICTION TERMINATION DATE, THE TRANSFEREE
MUST MAKE CERTAIN CERTIFICATIONS TO THE COMPANY OR TRANSFER AGENT TO CONFIRM THAT SUCH TRANSFEREE IS NOT A U.S. PERSON UNDER REGULATION
S UNDER THE SECURITIES ACT AND PROVIDE CERTAIN OTHER CERTIFICATIONS AND AGREEMENTS THAT SUCH TRANSFERS ARE BEING MADE PURSUANT
TO AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT.

 

ADDITIONALLY, FOR ANY TRANSFER
REFERRED TO IN CLAUSE (C)(ii) or (E), OR IF REQUESTED BY ASSURE HOLDINGS CORP. OR THE TRANSFER AGENT FOR THE SECURITIES, (D), THE
HOLDER MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE COMPANY OR TRANSFER AGENT SUCH CERTIFICATIONS, LEGAL OPINIONS OR OTHER INFORMATION
AS THE COMPANY OR THE TRANSFER AGENT MAY REASONABLY REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION
FROM OR IN A TRANSACTION NOT SUBJECT TO THE REGISTRATION REQUIREMENT OF THE SECURITIES ACT.

 

THE HOLDER HEREOF AGREES THAT
IT WILL NOT, DIRECTLY OR INDIRECTLY, ENGAGE IN ANY HEDGING TRANSACTION WITH REGARD TO THE SECURITIES EXCEPT AS PERMITTED BY THE
SECURITIES ACT.

 

“RESTRICTION TERMINATION
DATE” AS USED HEREIN SHALL MEAN ONE YEAR AFTER THE LATER TO OCCUR OF THE ACQUISITION OF THE SECURITY EVIDENCED HEREBY FROM
(X) ASSURE HOLDINGS CORP. OR (Y) ANY AFFILIATE OF ASSURE HOLDINGS CORP.”

 

     

    6

    

 

	 	ASSURE HOLDINGS CORP.
	 	 
	 	Per:	          
	 	 	Name:
	 	 	Title:

 

     

    7

    

 

APPENDIX “A”

 

CHANGE OF CONTROL EXERCISE NOTICE

 

To:Assure Holdings
Corp. (the “Debtor”)

 

The undersigned holder (the
 “Holder”) of a 9% Unsecured Redeemable Convertible Debenture due ·
issued by the Debtor (the “Debenture”) acknowledges receipt of the Change of Control Notice of the Debtor dated                        ,
20    and hereby elects, in accordance with the terms and conditions of the Debenture, as follows:

 

	 ̈ 	-	To require the Debtor to purchase the Debenture

 

	 ̈ 	-	To
    require conversion of the Debenture

 

(please place an “X” in the applicable box)

 	 	 
	(Insert Date)	 
	 	 
	(Name of Holder – please print)	 
	 	 
	(Signature of the Holder)	 

 

     

    8

    

 

	EXHIBIT 3
	 
	REDEMPTION NOTICE
	 	 	●, 20        
	To:	 	(the “Holder”)	 

 

Assure Holdings Corp. (the “Debtor”)
hereby notifies the Holder pursuant to the terms and conditions of a 9% Unsecured Redeemable Convertible Debenture due ● issued by the Debtor (the “Debenture”) that it intends to redeem US$                              
of the Principal Amount of such Debenture on                         ,
20       (the “Redemption Date”) at Denver, Colorado at a price of            %
of the Principal Amount then outstanding. Interest on such redeemed Principal Amount shall cease to be payable from and after
the Redemption Date. The Holder must surrender its Debenture to the Debtor at the following address in order to receive the redemption
proceeds:

 

Assure Holdings Corp.

4600 South Ulster Street

Denver, Colorado 80237

 

Attention:

Email:

 

Capitalized terms used herein but not
otherwise defined shall have the meanings ascribed thereto in the Debenture. 

 

	 	ASSURE HOLDINGS CORP.
	 	 
	 	Per:	 
	 	 	Name:
	 	 	Title:

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