Document:

Filing

Convertible Secured Debenture Agreement

EX-4.2

NEITHER THIS SECURITY NOR THE SECURITIES INTO WHICH THIS SECURITY IS CONVERTIBLE HAVE BEEN REGISTERED WITH THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.

MOVENTIS CAPITAL, INC.

CONVERTIBLE SECURED DEBENTURE

Debenture No. 2006 -

$____________________________   Original Issuance Date: __________, 2006

FOR VALUE RECEIVED, the undersigned, Moventis Capital, Inc., a Delaware corporation (the “Company”), promises to pay to the order of _______, (the “Holder”), subject to the terms and conditions set forth below, at the Company’s principal business office, or at such other place as the Holder may hereafter designate in writing the principal sum of: _____________________________ ($  )_____ (the “Principal”) on _________________, 2009 (“Maturity Date”).  All dollar references contained herein are to U.S. Dollars.  The Company’ obligations under this Debenture are secured by the grant of a security interest in property more particularly described in a General Security Agreement dated of even date herewith (“GSA”).

1.

Interest. 

a) 

Initial Interest Rate.  From the date hereof through the Maturity Date, the Principal shall accrue interest at an annual rate of ten percent (10%), payable semi-annually, in arrears, on June 30 and December 31 in each year.  Interest shall be calculated on the basis of a 360-day year and shall accrue commencing on the Original Issuance Date until payment in full of the principal sum, together with all accrued and unpaid interest has been made.  Interest will be paid to the person in whose name this Convertible Debenture (“Debenture”) is registered on the records of the Company regarding registration and transfers of this Debenture.  In no event shall interest under this Section 1 exceed the maximum applicable legal rate permitted by law from time to time.

b) 

Increased Interest Rate.  In the event that a third party institutional investor invests within a period of one year from the Original Issuance Date and the investment is in the form of debt and paid at an interest rate that exceeds 10% per annum, this Debenture shall automatically be deemed amended to increase the interest rate hereunder to the rate of interest set forth in the debt with such third party institutional investor thereafter, provided however, that such rate shall not exceed 14% per annum.

c) 

Bonus Interest Rate.  In the event that the VWAP, as hereinafter defined, does not exceed US$0.75 per share for the ten (10) trading days immediately preceding September 30, 2007, then the applicable rate of interest payable under this Debenture shall be increased by 2.0% thereafter.  Notwithstanding the foregoing, if the interest rate applicable hereunder has been previously increased under Section 1(b) above, no 

increase shall be made under this Section 1(c).  For purposes of determining the Bonus Rate, the term “VWAP” shall mean means, for any date, the price determined by the first of the following clauses that applies: 

d) 

(a) if the Company’s Common Shares are then listed or quoted on the American Stock Exchange, the Nasdaq Stock Market, or the New York Stock Exchange (a “Trading Market”), then the daily volume weighted average price of the Common Shares for such date (or the nearest preceding date) on the Trading Market on which the Common Shares is then listed or quoted for trading; (b)  if the OTC Bulletin Board is not a Trading Market, the volume weighted average price of the Common Shares for such date (or the nearest preceding date) on the OTC Bulletin Board; (c) if the Common Shares is not then quoted for trading on the OTC Bulletin Board and if prices for the Common Shares are then reported in the “Pink Sheets” published by Pink Sheets, LLC (or a similar organization or agency succeeding to its functions of reporting prices), the most recent bid price per share of the Common Shares so reported; or (d) in all other cases, the fair market value of a share of Common Shares as determined by an independent appraiser selected in good faith by the Holder and reasonably acceptable to the Company.  

e) 

Late Fee.  All overdue accrued and unpaid interest to be paid hereunder shall entail a late fee at an interest rate equal to the lesser of 14% per annum or the maximum rate permitted by applicable law (“Late Fees”) which shall accrue daily from the date such interest is due hereunder through and including the date of payment in full.  

2. 

Conversion.

a)

 Optional Conversion.  The principal amound outstanding under this note shall be convertible, at any time after the date of issuance and up to 5:00 p.m. California time on the Maturity Date, into fully paid and non-assessable shares of Common Shares of the Company at the Conversion Price (as hereafter defined) then in effect.  The Holder shall effect conversions by delivering to the Company a Notice of Conversion, the form of which is attached hereto as Annex A (a “Notice of Conversion”), specifying therein the principal amount of this Debenture to be converted and the date on which such conversion shall be effected (a “Conversion Date”).  If no Conversion Date is specified in a Notice of Conversion, the Conversion Date shall be the date that such Notice of Conversion is deemed delivered hereunder.  To effect conversions hereunder, the Holder shall not be required to physically surrender this Debenture to the Company unless the entire principal amount of this Debenture has been so converted. Conversions hereunder shall have the effect of lowering the outstanding principal amount of this Debenture in an amount equal to the applicable conversion.  The Holder and the Company shall maintain records showing the principal amount(s) converted and the date of such conversion(s).  The Company may deliver an objection to any Notice of Conversion within one (1) Business Day of delivery of such Notice of Conversion.  In the event of any dispute or discrepancy, the records of the Holder shall be controlling and determinative in the absence of manifest error. The Holder, and any assignee by acceptance of this Debenture, acknowledge and agree that, by reason of the provisions of this paragraph, following conversion of a portion of this Debenture, the unpaid and unconverted principal amount of this Debenture may be less than the amount stated on the face hereof.

                b) 

Conversion Price.  The price at which shares of Common Shares of the Company shall initially be issuable upon conversion of the principal amount outstanding under this Debenture (the “Conversion Price”) is as follows:

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i. The first US$________of principal obligations under this Debenture is convertible at an initial conversion price of $0.65 per share into __________________ Common Shares;

ii. The next US$________ of principal obligations under this Debenture is convertible at an initial conversion price of $0.80 into __________________ Common Shares; and

ii. The remaining US$ ________ of principal obligations under this Debenture is convertible at an initial conversion price of $0.90 into  __________________  Common Shares.

c) 

Conversion Price Adjustments.  The Conversion Price shall be subject to adjustment from time to time as follows:

(1)

Stock Dividends, Subdivisions, Reclassifications or Combinations.  If the Company shall (i) declare a dividend or make a distribution in shares of its Common Shares, (ii) subdivide or reclassify the outstanding shares of Common Shares into a greater number of shares, or (iii) combine (including by way of reverse stock split) or reclassify the outstanding Common Shares into a smaller number of shares, the Conversion Price in effect at the time of the record date for such dividend or distribution or the effective date of such subdivision, combination or reclassification shall be proportionately adjusted so that the Holder hereof shall be entitled to receive the number of shares of Common Shares which the Holder would have owned or been entitled to receive had this Debenture been converted immediately prior to such date.  Successive adjustments in the Conversion Price shall be made whenever any event specified above shall occur.

(2)

Other Distributions.  In case the Company shall fix a record date for the making of a distribution to all holders of shares of its Common Shares (i) of shares of any class other than its Common Shares or (ii) of evidence of indebtedness of the Company or (iii) of assets (excluding cash dividends or distributions, and dividends or distributions referred to in subparagraph 1(c)(1) above), or (iv) of rights or warrants, in each such case the Conversion Price in effect immediately prior thereto shall be reduced immediately thereafter to the price determined by dividing (i) an amount equal to the difference resulting from (A) the number of shares of Common Shares outstanding on such record date multiplied by the Conversion Price per share on such record date, less (B) the fair market value (as determined by the Board of Directors, whose determination shall be conclusive) of said shares or evidences of indebtedness or assets or rights or warrants to be so distributed, by  (ii) the number of shares of Common Shares outstanding on such record date.  Such adjustment shall be made successively whenever such a record date is fixed.  In the event that such distribution is not so made, the Conversion Price then in effect shall be readjusted, effective as of the date when the Board of Directors determines not to distribute such shares, evidences of indebtedness, assets, rights or warrants, as the case may be, to the Conversion Price which would then be in effect if such record date had not been fixed.

(3)

Consolidation, Merger, Sale, Lease or Conveyance.  In any case of any consolidation with or merger of the Company with or into another corporation, or in case of any sale, lease, or conveyance to another corporation of the assets of the Company as an entirety or substantially as an entirety, this Debenture shall after the date of such consolidation, merger, sale, lease or conveyance be convertible into the number of shares of stock or other securities or property (including cash) to which the Common Shares issuable (at the time of such consolidation, merger, sale, lease or conveyance) upon conversion of this Debenture would have been entitled upon such consolidation, merger, sale, lease, or conveyance; and in any such case, if necessary, the provision set forth herein with respect to the rights and interests thereafter of the Holder hereof shall be appropriately adjusted so as to be 

3

applicable, as nearly as may reasonably be, to any shares of stock or other securities or property thereafter deliverable on the conversion hereof.

(4)

Rounding of Calculations; Minimum Adjustment.  All calculations under this subparagraph (c) shall be made to the nearest cent or to the nearest share, as the case may be.  No adjustment in the Conversion Price shall be made if the amount of such adjustment would be less than $0.05, but any such amount shall be carried forward and an adjustment with respect thereto shall be made at the time of and together with any subsequent adjustment which, together with such amount and any other amount or amounts so carried forward, shall aggregate $0.05 or more.

(5)

Statement Regarding Adjustments.  Whenever the Conversion Price shall be adjusted as provided in this subparagraph (c) , the Company shall forthwith, prepare a statement showing in detail the facts requiring such adjustment and the Conversion Price that shall be in effect after such adjustment and cause a copy of such statement to be sent by mail, first class postage prepaid, to the Holder hereof.

d) 

Mechanics of Conversion.  The Holder may exercise the conversion right specified in subparagraph 1(a) by surrendering to the Company this Debenture accompanied by written notice specifying the amount of the Debenture to be converted.  Conversion shall be deemed to have been effected on the date when delivery of notice of an election to convert and this Debenture is made, and such date is referred to herein as the “Conversion Date.”  As promptly as practicable thereafter the Company shall issue and deliver to Holder a certificate or certificates for the number of full shares of Common Shares to which Holder is entitled and a check or cash with respect to any fractional interest in a share of Common Shares.  The Holder shall be deemed to have become a holder of record of the Common Shares issued upon conversion on the applicable Conversion Date.  Upon conversion of only a portion of this Debenture, the Company shall issue and deliver to Holder, at the expense of the Company, a new debenture covering the amount of the unconverted portion of this Debenture.

e) 

Reservation of Shares.  The Company shall reserve at all times so long as any part of this Debenture remains outstanding, free from preemptive rights, out of its treasury stock (if applicable) or its authorized but unissued shares of Common Shares, or both, sufficient shares of Common Shares to provide for the conversion hereof.

3.

Subordination.  The Company and the Holder agree that the Company’s obligations under this Debenture are expressly subordinated to all of the Company’s and the Company’s subsidiaries’ Senior Indebtedness.  The term “Senior Indebtedness” shall mean the principal and interest obligations and indebtedness of the

Debtor

 and its subsidiaries incurred prior to or after the date of this

General Security Agreement: (a

) for money borrowed from any bank, institutional lender or

institutional

investor

 (in each case, a “

Senior Lender

”)

, which is evidenced by notes, bonds, debentures or other written obligations, and such notes

,

 bonds, debentures or other written obligations are interest bearing securities

;

 and (

b

) in connection with any renewals or extensions of any indebtedness described in

a) above.  The term “institutional investor” as used herein means any investor, whether an individual, corporation, partnership or otherwise, which lends more than Cdn $1.0 million to the Company.

Upon request by the Company, the Holder will subordinate and postpone the obligations under this Debenture and the GSA to the prior payment in full of any Senior Indebtedness of a senior lender. The Holder will enter into a written agreement with each senior lender acknowledging and agreeing directly with such senior lender that the obligations secured by the Holder’s GSA shall be subordinated and postponed to the prior payment in full of the Senior Indebtedness.

If after the date hereof the Company incurs indebtedness for money borrowed from any investor which is not an institutional investor (a “

Pari Passu Lender

”) which is evidenced by notes, bonds, debentures or other written obligations, and such notes, bonds, debentures or other written obligations are interest bearing securities; or in connection with any renewals or extensions of any such indebtedness, upon the request by the Company the Holder will consent to the grant of a

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general security agreement in favour of such Pari Passu Lender and will enter into such written agreements that may be reasonably necessary to provide the Pari Passu Lender with 

pari passu

 priority.

4.

Time.

Time is of the essence in this Debenture.

5. 

Prepayment.

The Company shall have no right to prepay this Debenture in whole or in part at any time prior to September 30, 2007.  Thereafter, upon no less than 30 but no more than 60 days prior written notice to the Holder, the Company may redeem this Debenture in whole or in part upon payment to the Holder of an amount equal to the applicable outstanding principal amount plus accrued and unpaid interest.

6. 

Payment Other Than Cash.

Any check, draft, money order, or other instrument given in payment of all or any portion of this Debenture may be accepted by the Holder, but the same shall not constitute payment hereunder or diminish any rights of the Holder, except to the extent that actual cash proceeds of such instrument are unconditionally received by the Holder and applied to this indebtedness as herein provided.

7. 

Presentment.

Except as otherwise set forth herein, the Company (i) waives grace, presentment, and demand for payment, protest and notice of dishonor and protest, and all other notice of non-payment and diligence in collecting this Debenture, and (ii) consents to any extension or postponement of time of payment of this Debenture and to any other indulgence with respect hereto without notice hereof.

8. 

Restrictions on Transfer.

a)

 Sale Notice. The Holder shall not sell, pledge or otherwise transfer any interest in this Debenture or the shares of stock issuable on conversion of this Debenture (the “Shares”) except pursuant to the provisions of this Section 8.  In the event the Holder desires to sell any interest in this Debenture or the Shares, the Holder shall deliver a written notice (the “Sale Notice”) to the Company.  The Sale Notice shall disclose in reasonable detail the identity of the prospective transferee(s) and the terms and conditions of the proposed transfer.  The Holder agrees not to consummate any such transfer until sixty (60) days after the Sale Notice has been delivered to the Company and the Shareholders, unless the parties to the transfer have been finally determined pursuant to this Section 8 prior to the expiration of such 60-day period.  (The date of the first to occur of such events is referred to herein as the “Authorization Date”).

b)

 First Refusal Rights. The Company may elect to purchase all of this Debenture or the Shares to be transferred upon the same terms and conditions as those set forth in the Sale Notice by delivering a written notice of such election to the Holder within thirty (30) days after the receipt of the Sale Notice by the Company.  If the Company has not elected to purchase all of this Debenture or the Shares specified in the Sale Notice, Holder may transfer this Debenture or the Shares specified in the Sale Notice to the transferee(s) specified in the Sale Notice (or, at the election of the  Holder, to the Company to the extent of its election to purchase and the remainder to the transferee(s) specified in the Sale Notice) at a price and on terms no more favorable to the transferee(s) thereof than specified in the Sale Notice during the 60-day period immediately following the Authorization Date.  Any interest in this Debenture or the Shares not transferred within such 60-day period shall again be subject to the provisions of this Section 8.

c) 

Certain Permitted Transfers. The restrictions contained in Section 8(b) shall not apply with respect to transfers of this Debenture or the Shares among a Holder’s family group; provided that the restrictions contained in this Section 8 shall continue to be applicable to this Debenture or the Shares after any such transfer and the transferee(s) have agreed in writing to be bound by the provisions of this Agreement.  Holder’s “family group” means Holder’s spouse and descendants (whether natural or adopted) and descendants’ spouses or a trust for any of their benefits.

d) 

Termination of Restrictions. The restrictions on transfer set forth in Section 8 shall terminate on the first to occur of (i) the merger or consolidation of the Company into a new surviving Company in which 

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the holders of the Company’s voting securities (on a fully-diluted basis) immediately prior to the merger or consolidation own less than a majority of the ordinary voting power to elect directors of the new surviving company (on a fully diluted basis), or (ii) the sale of all, or substantially all, of the Company’s assets or capital stock in any transaction or series of related transactions.

e) 

Transferability.  Subject to compliance with any applicable securities laws and the conditions set forth in this Section 8 hereof, this Debenture and all rights hereunder (including, without limitation, any registration rights) are transferable, in whole or in part, upon surrender of this Debenture at the principal office of the Company or its designated agent, together with a written assignment of this Debenture substantially in the form attached hereto duly executed by the Holder or its agent or attorney and funds sufficient to pay any transfer taxes payable upon the making of such transfer.  Upon such surrender and, if required, such payment, the Company shall execute and deliver a new Debenture(s) in the name of the assignee or assignees and in the denomination or denominations specified in such instrument of assignment, and shall issue to the assignor a new Debenture evidencing the portion of this Debenture not so assigned, and this Debenture shall promptly be cancelled.  A Debenture, if properly assigned, may be converted by a new holder for the purchase of Shares without having a new Debenture issued. 

f)

New Debenture. This Debenture may be divided or combined with other Debentures upon presentation hereof at the aforesaid office of the Company, together with a written notice specifying the names and denominations in which new Debentures are to be issued, signed by the Holder or its agent or attorney.  Subject to compliance with this Section 8, as to any transfer which may be involved in such division or combination, the Company shall execute and deliver a new Debenture or Debentures in exchange for the Debenture or Debentures to be divided or combined in accordance with such notice.

g) 

Debenture Register. The Company shall register this Debenture, upon records to be maintained by the Company for that purpose (the “Debenture Register”), in the name of the record Holder hereof from time to time.  The Company may deem and treat the registered Holder of this Debenture as the absolute owner hereof for the purpose of any conversion hereof or any distribution to the Holder, and for all other purposes, absent actual notice to the contrary.

h) 

Transfer Restrictions.  

If

, at the

time of the surrender of this Debenture in connection with any transfer of this Debenture, the transfer of this Debenture shall not be registered pursuant to an effective

registration

 statement under the Securities Act

 and

under applicable state securities or blue sky laws, the Company may require, as a condition of allowing such transfer (i) that the Holder or transferee of this Debenture, as the case may be, furnish to the Company a written opinion of counsel (which opinion shall be in form, substance and scope customary for opinions of counsel in comparable transactions) to the effect that such transfer may be made without

 registration under

the Securities Act and under applicable state securities or blue sky laws, (ii) that the holder or transferee execute and deliver to the Company an investment letter in form and substance acceptable to the Company and (iii) that the transferee be an “accredited investor” as defined in Rule 501(a)(1), (a)(2), (a)(3), (a)(7), or (a)(8) promulgated under the Securities Act or a “qualified institutional buyer” as defined in Rule 144A(a) under the Securities Act.

9. 

Events of Default.  The occurrence of any of the following events of default shall, at the option of the Holder hereof, make all sums of Principal and interest then remaining unpaid hereon immediately due and payable:

a)

Insolvency; Receiver or Trustee.  The Company shall become insolvent or admit in writing its inability to pay its debts as they mature; or make an assignment for the benefit of creditors; or apply for or consent to the appointment of a receiver or trustee for it or for a substantial part of its property or business; or such a receiver or trustee otherwise shall be appointed.

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b) 

Judgments.  Any material money judgment, writ or similar process shall be entered or filed against the Company or any of its property or other assets and shall remain unvacated, unbonded or unstayed for a period of ten (10) days or in any event later than five (5) days prior to the date of any proposed sale thereunder.

c) 

Bankruptcy.  Bankruptcy, insolvency, reorganization or liquidation proceedings or other proceedings or relief under any bankruptcy law or any law for the relief of debtors shall be instituted by or against the Company.

10.

Severability.  The invalidity, or unenforceability in particular circumstances, of any provision of this Debenture shall not extend beyond such provision or such circumstances and no other provision of this instrument shall be affected thereby.

11.

Governing Law.  This Debenture shall be construed and governed by the laws of the State of Delaware.

12.

Successors and Assigns.  Subject to applicable securities laws, this Debenture and the rights and obligations evidenced hereby shall inure to the benefit of and be binding upon the successors of the Company and the successors and permitted assigns of Holder.  The provisions of this Debenture are intended to be for the benefit of all Holders from time to time of this Debenture and shall be enforceable by any such Holder or holder of Shares.

13.

Amendment.  No provision of this Debenture may be waived, modified, supplemented or amended except in a written instrument signed, in the case of an amendment, by the Company and, so long as purchasers then holding at least 51% of the Debentures then outstanding or, in the case of a waiver, by the party against whom enforcement of any such waived provision is sought.  No waiver of any default with respect to any provision, condition or requirement of this Agreement shall be deemed to be a continuing waiver in the future or a waiver of any subsequent default or a waiver of any other provision, condition or requirement hereof, nor shall any delay or omission of any party to exercise any right hereunder in any manner impair the exercise of any such right.

14.

Notices.  Any and all notices or other communications or deliveries to be provided by the Holder hereunder, including, without limitation, any Notice of Conversion, shall be in writing and delivered personally, by facsimile, or sent by a nationally recognized overnight courier service, addressed to the Company, at the address set forth above, facsimile number (604) 608-4859, Attn: Chief Executive Officer or such other facsimile number or address as the Company may specify for such purpose by notice to the Holder delivered in accordance with the Subscription Agreement.  Any and all notices or other communications or deliveries to be provided by the Company hereunder shall be in writing and delivered personally, by facsimile, or sent by a nationally recognized overnight courier service addressed to each Holder at the facsimile number or address of such Holder appearing on the books of the Company, or if no such facsimile number or address appears, at the principal place of business of the Holder.

15.

Tax Matters.  Each Holder that is not a “U.S. Person” as defined in Section 7701(a)(30) of the Internal Revenue Code of 1986, as amended (the “Code”) (a “Non-U.S. Holder”) shall deliver to the Company a copy of either U.S. Internal Revenue Service Form W-8BEN or Form W-8ECI, or, in the case of a Non-U.S. Holder claiming exemption from U.S. federal withholding tax under Section 871(h) or 881(c) of the Code with respect to payments of “portfolio interest”, properly completed and duly executed by such Non-U.S. Holder claiming complete exemption from, or a reduced rate of, U.S. federal withholding tax on all payments by the Company under this Agreement.  Each Non-U.S. Holder shall promptly notify the Company at any time it determines that it is no longer in a position to provide any previously delivered certificate to the Company (or any other form of certification adopted by the U.S. taxing authorities for such purpose).   Each Holder that is a “U.S. Person” as 

7

defined in Section 7701(a)(30) of the Code (a “U.S. Holder”) shall deliver to the Company a copy of Internal Revenue Service Form W-9, properly completed and duly executed by such U.S. Holder.

IN WITNESS WHEREOF, the undersigned has executed this Debenture in British Columbia, Canada effective as of the date and year first above written.

MOVENTIS CAPITAL, INC.

By: _________________________________

      Blake Ponuick, Chief Executive Officer

HOLDER

By: __________________________________

Its: __________________________________

Address: 

_____________________________________

_____________________________________

Fax: _________________________________

Phone: ________________________________

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ANNEX A

NOTICE OF CONVERSION

The undersigned hereby elects to convert principal under the Convertible Debenture of Moventis Capital, Inc., a Delaware corporation (the “Company”), due on September 30, 2009, into shares of common stock, no par value per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below.  If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith.  No fee will be charged to the holder for any conversion, except for such transfer taxes, if any.

The undersigned agrees to comply with applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock.  

Conversion calculations: _____________________________________________________

  

Date to Effect Conversion: ____________________________________________________

Principal Amount of Debenture to be Converted: ___________________________________

Number of shares of Common Stock to be issued: __________________________________

Signature: 

________________________________

Name:

________________________________

Address:

________________________________

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Schedule 1

CONVERSION SCHEDULE

The Convertible Debentures due on September 30, 2009, in the aggregate principal amount of $____________ issued by Moventis Capital, Inc.  This Conversion Schedule reflects conversions made under above referenced Debenture.

Dated: 

				
	Date of Conversion (or for first entry, Original Issue Date)

	Amount of Conversion

	Aggregate Principal Amount Remaining Subsequent to Conversion (or original Principal Amount)

	Company Attest

	-

	 
	 
	 

	-

	 
	 
	 

	-

	 
	 
	 

10Filing

Common Shares Purchase Warrant Agreement

EX-4.3

NEITHER THIS SECURITY NOR THE SECURITIES INTO WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.  

COMMON SHARES PURCHASE WARRANT NO. 2006 –

Common Shares $0.001 par value of MOVENTIS CAPITAL, INC.

THIS COMMON SHARES PURCHASE WARRANT (the “Warrant”) certifies that, for value received, _______________ “Holder”), is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on or after the date hereof (the “Initial Exercise Date”) and on or prior to the close of business on the third anniversary of the Initial Exercise Date (the “Termination Date”) but not thereafter, to subscribe for and purchase from Moventis Capital, Inc., a Delaware corporation (the “Company”), up to __________________ (the “Warrant Shares”) of Common Shares, $0.001 par value per share (“Common Shares”).  The purchase price of one share of Common Shares under this Warrant shall be equal to the Exercise Price, as defined in Section 1(b).  This Warrant is being issued in connection with the sale of convertible secured debentures to the Holder.

1.

Exercise.

a)

Exercise of Warrant.  Exercise of the purchase rights represented by this Warrant may be made, in whole or in part, at any time or times on or after the Initial Exercise Date and on or before the Termination Date by (i) delivery to the Company of a duly executed facsimile copy of the Notice of Exercise Form annexed hereto (or such other office or agency of the Company as it may designate by notice in writing to the registered Holder at the address of such Holder appearing on the books of the Company); and (ii) delivery, within 3 Trading Days of the date said Notice of Exercise is delivered to the Company, of  payment of the aggregate Exercise Price of the shares thereby purchased by wire transfer or cashier’s check.  Notwithstanding anything herein to the contrary, the Holder shall not be required to physically surrender this Warrant to the Company until the Holder has purchased all of the Warrant Shares available hereunder and the Warrant has been exercised in full, in which case, the Holder shall surrender this Warrant to the Company for cancellation within 3 Trading Days of the date the final Notice of Exercise is delivered to the Company.  Partial exercises of this Warrant resulting in purchases of a portion of the total number of Warrant Shares available hereunder shall have the effect of lowering the outstanding number of Warrant Shares purchasable hereunder in an amount equal to the applicable number of Warrant Shares purchased.  The Holder and the Company shall maintain records showing the number of Warrant Shares purchased and the date of such purchases.  The 

Company shall deliver any objection to any Notice of Exercise Form within 2 Business Days of receipt of such notice.  In the event of any dispute or discrepancy, the records of the Holder shall be controlling and determinative in the absence of manifest error. The Holder and any assignee, by acceptance of this Warrant, acknowledge and agree that, by reason of the provisions of this paragraph, following the purchase of a portion of the Warrant Shares hereunder, the number of Warrant Shares available for purchase hereunder at any given time may be less than the amount stated on the face hereof.

b)

Exercise Price.  The exercise price per share of the Common Shares under this Warrant shall be as follows, subject to adjustment hereunder (the “Exercise Price”):

i. $0.65 for __________ shares

ii. 0.80 for __________ shares

c)

Cashless Exercise.  If at any time after one year from the date of issuance of this Warrant there is no effective Registration Statement registering, or no current prospectus available for, the resale of the Warrant Shares by the Holder, then this Warrant may also be exercised at such time by means of a “cashless exercise” in which the Holder shall be entitled to receive a certificate for the number of Warrant Shares equal to the quotient obtained by dividing [(A-B) (X)] by (A), where:

 (A) = the VWAP on the Trading Day immediately preceding the date of such election.  “VWAP” means, for any date, the price determined by the first of the following clauses that applies: (a) if the Company’s Common Shares are then listed or quoted on the American Stock Exchange, the Nasdaq Stock Market, or the New York Stock Exchange (a “Trading Market”), then the daily volume weighted average price of the Common Shares for such date (or the nearest preceding date) on the Trading Market on which the Common Shares is then listed or quoted for trading; (b)  if the OTC Bulletin Board is not a Trading Market, the volume weighted average price of the Common Shares for such date (or the nearest preceding date) on the OTC Bulletin Board; (c) if the Common Shares is not then quoted for trading on the OTC Bulletin Board and if prices for the Common Shares are then reported in the “Pink Sheets” published by Pink Sheets, LLC (or a similar organization or agency succeeding to its functions of reporting prices), the most recent bid price per share of the Common Shares so reported; or (d) in all other cases, the fair market value of a share of Common Shares as determined by an independent appraiser selected in good faith by the Holder and reasonably acceptable to the Company.;

(B) =  the Exercise Price of this Warrant, as adjusted; and

(X) = the number of Warrant Shares issuable upon exercise of this Warrant in accordance with the terms of this Warrant by means of a cash exercise rather than a cashless exercise.

2

Notwithstanding anything herein to the contrary, on the Termination Date, this Warrant shall be automatically exercised via cashless exercise pursuant to this Section 1(c).

 

d)

Mechanics of Exercise. 

i.

Authorization of Warrant Shares.  The Company covenants that all Warrant Shares which may be issued upon the exercise of the purchase rights represented by this Warrant will, upon exercise of the purchase rights represented by this Warrant, be duly authorized, validly issued, fully paid and nonassessable and free from all taxes, liens and charges created by the Company in respect of the issue thereof (other than taxes in respect of any transfer occurring contemporaneously with such issue).  

ii.

Delivery of Certificates Upon Exercise.  Certificates for shares purchased hereunder shall be transmitted by the transfer agent of the Company to the Holder by physical delivery to the address specified by the Holder in the Notice of Exercise within 3 Trading Days from the delivery to the Company of the Notice of Exercise Form, surrender of this Warrant (if required) and payment of the aggregate Exercise Price as set forth above (“Warrant Share Delivery Date”).  This Warrant shall be deemed to have been exercised on the date the Exercise Price is received by the Company.  The Warrant Shares shall be deemed to have been issued, and Holder or any other person so designated to be named therein shall be deemed to have become a holder of record of such shares for all purposes, as of the date the Warrant has been exercised by payment to the Company of the Exercise Price (or by cashless exercise, if permitted) and all taxes required to be paid by the Holder, if any, pursuant to Section 1(d)(v) prior to the issuance of such shares, have been paid.  

iii.

Delivery of New Warrants Upon Exercise.  If this Warrant shall have been exercised in part, the Company shall, at the request of a Holder and upon surrender of this Warrant certificate, at the time of delivery of the certificate or certificates representing Warrant Shares, deliver to Holder a new Warrant evidencing the rights of Holder to purchase the unpurchased Warrant Shares called for by this Warrant, which new Warrant shall in all other respects be identical with this Warrant.

iv. 

No Fractional Shares or Scrip.  No fractional shares or scrip representing fractional shares shall be issued upon the exercise of this Warrant.  As to any fraction of a share which Holder would otherwise be entitled to purchase upon such exercise, the Company shall at its election, either pay a cash adjustment in respect of such final fraction in an amount equal to such fraction multiplied by the Exercise Price or round up to the next whole share.

v. 

Charges, Taxes and Expenses.  Issuance of certificates for Warrant Shares shall be made without charge to the Holder for any issue or transfer tax or other incidental expense in respect of the issuance of such certificate, all of which taxes and expenses shall be paid by the Company, and such certificates shall be issued in the name of the Holder or in such name or names as may be directed by the Holder; provided, however, that in the event certificates for Warrant Shares are to be issued in a name other than the name of the Holder, this Warrant when surrendered for exercise shall be accompanied by the Assignment Form attached hereto duly executed by the Holder; and the Company may require, as a condition thereto, the payment of a sum sufficient to reimburse it for any transfer tax incidental thereto.

3

2.

Certain Adjustments.

a) 

Stock Dividends, Subdivisions, Reclassifications or Combinations.  If the Company shall (i) declare a dividend or make a distribution in shares of its Common Shares, (ii) subdivide or reclassify the outstanding shares of Common Shares into a greater number of shares, or (iii) combine (including by way of reverse stock split) or reclassify the outstanding Common Shares into a smaller number of shares, the Exercise Price in effect at the time of the record date for such dividend or distribution or the effective date of such subdivision, combination or reclassification shall be proportionately adjusted so that the Holder hereof shall be entitled to receive the number of shares of Common Shares which the Holder would have owned or been entitled to receive had this Warrant been exercised immediately prior to such date.  Successive adjustments in the Exercise Price shall be made whenever any event specified above shall occur.

b) 

Other Distributions.  In case the Company shall fix a record date for the making of a distribution to all holders of shares of its Common Shares (i) of shares of any class other than its Common Shares or (ii) of evidence of indebtedness of the Company or (iii) of assets (excluding cash dividends or distributions, and dividends or distributions referred to in subparagraph 2(a) above), or (iv) of rights or warrants, in each such case the Conversion Price in effect immediately prior thereto shall be reduced immediately thereafter to the price determined by dividing (i) an amount equal to the difference resulting from (A) the number of shares of Common Shares outstanding on such record date multiplied by the Conversion Price per share on such record date, less (B) the fair market value (as determined by the Board of Directors, whose determination shall be conclusive) of said shares or evidences of indebtedness or assets or rights or warrants to be so distributed, by  (ii) the number of shares of Common Shares outstanding on such record date.  Such adjustment shall be made successively whenever such a record date is fixed.  In the event that such distribution is not so made, the Conversion Price then in effect shall be readjusted, effective as of the date when the Board of Directors determines not to distribute such shares, evidences of indebtedness, assets, rights or warrants, as the case may be, to the Conversion Price which would then be in effect if such record date had not been fixed.

c) 

Consolidation, Merger, Sale, Lease or Conveyance.  In any case of any consolidation with or merger of the Company with or into another corporation, or in case of any sale, lease, or conveyance to another corporation of the assets of the Company as an entirety or substantially as an entirety, this Warrant shall after the date of such consolidation, merger, sale, lease or conveyance be convertible into the number of shares of stock or other securities or property (including cash) to which the Common Shares issuable (at the time of such consolidation, merger, sale, lease or conveyance) upon conversion of this Warrant would have been entitled upon such consolidation, merger, sale, lease, or conveyance; and in any such case, if necessary, the provision set forth herein with respect to the rights and interests thereafter of the Holder hereof shall be appropriately adjusted so as to be applicable, as nearly as may reasonably be, to any shares of stock or other securities or property thereafter deliverable on the conversion hereof.

d) 

Calculations. All calculations under this Section 2 shall be made to the nearest cent or the nearest 1/100th of a share, as the case may be. For purposes of this Section 2, the 

4

number of Common Shares deemed to be issued and outstanding as of a given date shall be the sum of the number of Common Shares (excluding treasury shares, if any) issued and outstanding.

e) 

Notice to Holders.  

i.

Adjustment to Exercise Price. Whenever the Exercise Price is adjusted pursuant to any provision of this Section 2, the Company shall promptly mail to each Holder a notice setting forth the Exercise Price after such adjustment and setting forth a brief statement of the facts requiring such adjustment.

ii.

Notice to Allow Exercise by Holder. If (A) the Company shall declare a dividend (or any other distribution in whatever form) on the Common Shares; (B) the Company shall declare a special nonrecurring cash dividend on or a redemption of the Common Shares; (C) the Company shall authorize the granting to all holders of the Common Shares rights or warrants to subscribe for or purchase any shares of capital stock of any class or of any rights; (D) the approval of any stockholders of the Company shall be required in connection with any reclassification of the Common Shares, any consolidation or merger to which the Company is a party, any sale or transfer of all or substantially all of the assets of the Company, of any compulsory share exchange whereby the Common Shares is converted into other securities, cash or property; (E) the Company shall authorize the voluntary or involuntary dissolution, liquidation or winding up of the affairs of the Company; then, in each case, the Company shall cause to be mailed to the Holder at its last address as it shall appear upon the Warrant Register of the Company, at least 20 calendar days prior to the applicable record or effective date hereinafter specified, a notice stating (x) the date on which a record is to be taken for the purpose of such dividend, distribution, redemption, rights or warrants, or if a record is not to be taken, the date as of which the holders of the Common Shares of record to be entitled to such dividend, distributions, redemption, rights or warrants are to be determined or (y) the date on which such reclassification, consolidation, merger, sale, transfer or share exchange is expected to become effective or close, and the date as of which it is expected that holders of the Common Shares of record shall be entitled to exchange their shares of the Common Shares for securities, cash or other property deliverable upon such reclassification, consolidation, merger, sale, transfer or share exchange; provided that the failure to mail such notice or any defect therein or in the mailing thereof shall not affect the validity of the corporate action required to be specified in such notice.  The Holder is entitled to exercise this Warrant during the 20-day period commencing on the date of such notice to the effective date of the event triggering such notice.

3.

Transfer of Warrant.

a)

Sale Notice.  The  Holder shall not sell, pledge or otherwise transfer any interest in this Warrant or the Warrant Shares except pursuant to the provisions of this Section 3.  In the event the Holder desires to sell any interest in this Warrant or the Warrant Shares, the Holder shall deliver a written notice (the “Sale Notice”) to the Company.  The Sale Notice shall disclose in reasonable detail the identity of the prospective transferee(s) and the terms and conditions of the proposed transfer.  The Holder agrees not to consummate any such transfer until sixty (60) days after the Sale Notice has been delivered to the Company and the Shareholders, unless the parties to the transfer have been finally determined pursuant to this Section 3 prior to the 

5

expiration of such 60-day period.  (The date of the first to occur of such events is referred to herein as the “Authorization Date”).

b)

First Refusal Rights. The Company may elect to purchase all of this Warrant or the Warrant Shares to be transferred upon the same terms and conditions as those set forth in the Sale Notice by delivering a written notice of such election to the Holder within thirty (30) days after the receipt of the Sale Notice by the Company.  If the Company has not elected to purchase all of this Warrant or the Warrant Shares specified in the Sale Notice, Holder may transfer this Warrant or the Warrant Shares specified in the Sale Notice to the transferee(s) specified in the Sale Notice (or, at the election of the  Holder, to the Company to the extent of its election to purchase and the remainder to the transferee(s) specified in the Sale Notice) at a price and on terms no more favorable to the transferee(s) thereof than specified in the Sale Notice during the 60-day period immediately following the Authorization Date.  Any interest in this Warrant or the Warrant Shares not transferred within such 60-day period shall again be subject to the provisions of this Section 3.

c)

Transferability.  Subject to compliance with any applicable securities laws and the conditions set forth in Section 3 hereof, this Warrant and all rights hereunder (including, without limitation, any registration rights) are transferable, in whole or in part, upon surrender of this Warrant at the principal office of the Company or its designated agent, together with a written assignment of this Warrant substantially in the form attached hereto duly executed by the Holder or its agent or attorney and funds sufficient to pay any transfer taxes payable upon the making of such transfer.  Upon such surrender and, if required, such payment, the Company shall execute and deliver a new Warrant or Warrants in the name of the assignee or assignees and in the denomination or denominations specified in such instrument of assignment, and shall issue to the assignor a new Warrant evidencing the portion of this Warrant not so assigned, and this Warrant shall promptly be cancelled.  A Warrant, if properly assigned, may be exercised by a new holder for the purchase of Warrant Shares without having a new Warrant issued.  

d)

New Warrants. This Warrant may be divided or combined with other Warrants upon presentation hereof at the aforesaid office of the Company, together with a written notice specifying the names and denominations in which new Warrants are to be issued, signed by the Holder or its agent or attorney.  Subject to compliance with Section 3(a), as to any transfer which may be involved in such division or combination, the Company shall execute and deliver a new Warrant or Warrants in exchange for the Warrant or Warrants to be divided or combined in accordance with such notice.

e)

Warrant Register. The Company shall register this Warrant, upon records to be maintained by the Company for that purpose (the “Warrant Register”), in the name of the record Holder hereof from time to time.  The Company may deem and treat the registered Holder of this Warrant as the absolute owner hereof for the purpose of any exercise hereof or any distribution to the Holder, and for all other purposes, absent actual notice to the contrary.

f)

Transfer Restrictions.

If

, at the

time of the surrender of this Warrant in connection with any transfer of this Warrant, the transfer of this Warrant shall not be registered pursuant to an effective

registration

 statement under the Securities Act

 and

under applicable state securities or blue sky laws, the Company may require, as a condition of allowing such transfer (i) that the

6

Holder or transferee of this Warrant, as the case may be, furnish to the Company a written opinion of counsel (which opinion shall be in form, substance and scope customary for opinions of counsel in comparable transactions) to the effect that such transfer may be made without registration under

the Securities Act and under applicable state securities or blue sky laws, (ii) that the holder or transferee execute and deliver to the Company an investment letter in form and substance acceptable to the Company and (iii) that the transferee be an “accredited investor” as defined in Rule 501(a)(1), (a)(2), (a)(3), (a)(7), or (a)(8) promulgated under the Securities Act or a “qualified institutional buyer” as defined in Rule 144A(a) under the Securities Act.

g)

Certain Permitted Transfers.The restrictions contained in this Section 3 shall not apply with respect to transfers of this Warrant or the Warrant Shares among a Holder’s family group; provided that the restrictions contained in this Section 3 shall continue to be applicable to this Warrant or the Warrant Shares after any such transfer and the transferee(s) have agreed in writing to be bound by the provisions of this Agreement.  Holder’s “family group” means Holder’s spouse and descendants (whether natural or adopted) and descendants’ spouses or a trust for any of their benefits.

h)

Termination of Restrictions. The restrictions on transfer set forth in this Section 3 shall terminate on the first to occur of (i) the merger or consolidation of the Company into a new surviving Company in which the holders of the Company’s voting securities (on a fully-diluted basis) immediately prior to the merger or consolidation own less than a majority of the ordinary voting power to elect directors of the new surviving company (on a fully diluted basis), or (ii) the sale of all, or substantially all, of the Company’s assets or capital stock in any transaction or series of related transactions.

4.

Miscellaneous.

a)

No Rights as Shareholder Until Exercise.  This Warrant does not entitle the Holder to any voting rights or other rights as a shareholder of the Company prior to the exercise hereof as set forth in Section 1(d)(ii).  

b)

Loss, Theft, Destruction or Mutilation of Warrant. The Company covenants that upon receipt by the Company of evidence reasonably satisfactory to it of the loss, theft, destruction or mutilation of this Warrant or any stock certificate relating to the Warrant Shares, and in case of loss, theft or destruction, of indemnity or security reasonably satisfactory to it (which, in the case of the Warrant, shall not include the posting of any bond), and upon surrender and cancellation of such Warrant or stock certificate, if mutilated, the Company will make and deliver a new Warrant or stock certificate of like tenor and dated as of such cancellation, in lieu of such Warrant or stock certificate.

c)

Saturdays, Sundays, Holidays, etc.  If the last or appointed day for the taking of any action or the expiration of any right required or granted herein shall not be a Business Day, then such action may be taken or such right may be exercised on the next succeeding Business Day.

d)

Authorized Shares.  The Company covenants that during the period the Warrant is outstanding, it will reserve from its authorized and unissued Common Shares a sufficient number 

7

of shares to provide for the issuance of the Warrant Shares upon the exercise of any purchase rights under this Warrant.  

e)

Restrictions.  The Holder acknowledges that the Warrant Shares acquired upon the exercise of this Warrant, if not registered, will have restrictions upon resale imposed by state and federal securities laws.

f)

Notices.  Any and all notices or other communications or deliveries to be provided by the Holder hereunder, including, without limitation, any Notice of Exercise, shall be in writing and delivered personally, by facsimile, or sent by a nationally recognized overnight courier service, addressed to the Company, at the address set forth above, facsimile number (604) 608-4859, Attn: Chief Executive Officer or such other facsimile number or address as the Company may specify for such purpose by notice to the Holder delivered to the Company in the Subscription Agreement.  Any and all notices or other communications or deliveries to be provided by the Company hereunder shall be in writing and delivered personally, by facsimile, or sent by a nationally recognized overnight courier service addressed to each Holder at the facsimile number or address of such Holder appearing on the books of the Company, or if no such facsimile number or address appears, at the principal place of business of the Holder

g)

Successors and Assigns.  Subject to applicable securities laws, this Warrant and the rights and obligations evidenced hereby shall inure to the benefit of and be binding upon the successors of the Company and the successors and permitted assigns of Holder.  The provisions of this Warrant are intended to be for the benefit of all Holders from time to time of this Warrant and shall be enforceable by any such Holder or holder of Warrant Shares.

h)

Amendment.  No provision of this Warrant may be waived, modified, supplemented or amended except in a written instrument signed, in the case of an amendment, by the Company and, so long as purchasers then holding at least 51% of the Warrants then outstanding or, in the case of a waiver, by the party against whom enforcement of any such waived provision is sought.  No waiver of any default with respect to any provision, condition or requirement of this Agreement shall be deemed to be a continuing waiver in the future or a waiver of any subsequent default or a waiver of any other provision, condition or requirement hereof, nor shall any delay or omission of any party to exercise any right hereunder in any manner impair the exercise of any such right.

i)

Severability.  Wherever possible, each provision of this Warrant shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this Warrant shall be prohibited by or invalid under applicable law, such provision shall be ineffective to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions or the remaining provisions of this Warrant.

j)

Governing Law.   This Agreement shall be governed by and construed under the laws of the State of Delaware.

8

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

Dated:  September ____, 2006

 

	
	MOVENTIS CAPITAL, INC.

	By:________________________

     Name: Blake Ponuick

     Title: Chief Executive Officer

HOLDER:

By: ____________________________________

Its: ____________________________________

Address:

________________________________________

________________________________________

Fax: ____________________________________

Phone: __________________________________

9

NOTICE OF EXERCISE

TO:

[_______________________

(1)

The undersigned hereby elects to purchase ________ Warrant Shares of the Company pursuant to the terms of the attached Warrant (only if exercised in full), and tenders herewith payment of the exercise price in full, together with all applicable transfer taxes, if any.

(2)

Payment shall take the form of (check applicable box):

[  ] in lawful money of the United States; or

[ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 1(c), to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 1(c).

(3)

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

_______________________________

The Warrant Shares shall be delivered by physical delivery of a certificate to:

_______________________________

_______________________________

_______________________________

(4)  Accredited Investor.  The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of 1933, as amended.

[SIGNATURE OF HOLDER]

Name of Investing Entity: ________________________________________________________________________

Signature of Authorized Signatory of Investing Entity: _________________________________________________

Name of Authorized Signatory: ___________________________________________________________________

Title of Authorized Signatory: ____________________________________________________________________

Date: ________________________________________________________________________________________

ASSIGNMENT FORM

(To assign the foregoing warrant, execute

this form and supply required information. 

Do not use this form to exercise the warrant.)

FOR VALUE RECEIVED, [____] all of or [_______] shares of the foregoing Warrant and all rights evidenced thereby are hereby assigned to

_______________________________________________ whose address is

_______________________________________________________________.

_______________________________________________________________

Dated:  ______________, _______

Holder’s Signature:

_____________________________

Holder’s Address:

_____________________________

_____________________________

Signature Guaranteed:  ___________________________________________

NOTE:  The signature to this Assignment Form must correspond with the name as it appears on the face of the Warrant, without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank or trust company.  Officers of corporations and those acting in a fiduciary or other representative capacity should file proper evidence of authority to assign the foregoing Warrant.

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