Document:

Exhibit 4.3

 

	NUMBER	SHARES
	C-	 
	 	CUSIP 68572M 106

 

SEE REVERSE FOR IMPORTANT NOTICE REGARDING OWNERSHIP
AND TRANSFER RESTRICTIONS 

AND CERTAIN OTHER INFORMATION

orchestra
biomed holdings, inc.

INCORPORATED
UNDER THE LAWS OF THE STATE OF DELAWARE

COMMON STOCK

 

see reverse
for certain defintions

 

This Certifies that ______________________ is the
owner of _______________________

FULLY PAID
AND NON-ASSESSABLE SHARES OF THE PAR VALUE OF $0.0001 EACH OF THE COMMON STOCK OF orchestra biomed holdings, INC.

(THE “COMPANY”)

transferable on the books of the Company by the
holder hereof in person or by duly authorized attorney upon surrender 

of this certificate properly endorsed.

 

This Certificate is not valid unless countersigned
by the Transfer Agent and registered by the Registrar.

 

WITNESS the facsimile signatures of its duly authorized
officers.

	 	 	 
	 	 	 
	Secretary	 	Chief Executive Officer

 

orchestra
biomed holdings, inc.

 

The Company will furnish without charge to each
stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special
rights of each class of stock or series thereof of the Company and the qualifications, limitations, or restrictions of such preferences
and/or rights. This Certificate and the shares represented hereby are issued and shall be held subject to all the provisions of the Certificate
of Incorporation of the Company and all amendments thereto, the Bylaws of the Company and all amendments thereto and resolutions of the
Company’s Board of Directors providing for the issue of securities (copies of which may be obtained from the secretary of the Company),
to all of which the holder of this Certificate by acceptance hereof assents. The following abbreviations, when used in the inscription
on the face of this Certificate, shall be construed as though they were written out in full according to applicable laws or regulations:

 

	TEN COM 	-	as tenants in common	
    UNIF GIFT

    MIN ACT
	-	 	Custodian	 
	 	 	 	 	 	 	 	 
	TEN ENT	-	as tenants by the entireties	 	(Cust)	 	(Minor)
	 	 	 	 	 
	JT TEN	-	as joint tenants with right of survivorship and not as tenants in common	 	under Uniform Gifts to Minors Act
	 	(State)
	TTEE	-	 Trustee under Agreement dated ____________	 	 	 

Additional abbreviations may also be used though
not in the above list.

For value received, ______________ hereby sells,
assigns and transfers unto

	 
	 
	(PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER(S) OF ASSIGNEE(S))
	 
	 
	(PLEASE PRINT OR TYPEWRITE NAME(S) AND ADDRESS(ES), INCLUDING ZIP CODE, OF ASSIGNEE(S))
	 

____________________shares of the Common Stock represented by this
Certificate, and hereby irrevocably constitutes and appoints ________________ Attorney to transfer the said stock on the books of the
within named Company with full power of substitution in the premises.

 

	Dated: 	 	 	 
	 	 	NOTICE: THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.

 

	Signature(s) Guaranteed:	 
	 	 
	By: 	                             	 
	THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO S.E.C. RULE 17Ad-15 (OR ANY SUCCESSOR RULE) UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED).Exhibit
10.21

 

Orchestra
BioMed Holdings, Inc.

Stock Option Grant Notice

(2023 Equity Incentive Plan)

 

Orchestra
BioMed Holdings, Inc. (the “Company”), pursuant to its 2023 Equity Incentive Plan (the “Plan”),
has granted to you (“Optionholder”) an option to purchase the number of shares of the Common Stock set forth
below (the “Option”). Your Option is subject to all of the terms and conditions as set forth herein and in
the Plan and the Stock Option Agreement, all of which are attached hereto and incorporated herein in their entirety. Capitalized terms
not explicitly defined herein, but defined in the Plan or the Stock Option Agreement, shall have the meanings set forth in the Plan or
the Stock Option Agreement, as applicable.

 

Optionholder:
_______________________________

Date
of Grant: _______________________________

Vesting
Commencement Date: _______________________________

Number
of Shares of Common Stock Subject to Option: _________________________

Exercise
Price (Per Share): _______________________________

Total
Exercise Price: _______________________________

Expiration
Date: _______________________________

 

Type
of Grant: [Incentive Stock Option] OR [Nonstatutory Stock Option]

 

Exercise
and

 

Vesting
Schedule: Subject to the Optionholder’s Continuous Service through each applicable vesting date, the Option will vest as follows:

[__________]. Notwithstanding the foregoing, vesting shall terminate upon the Optionholder’s termination of Continuous Service.

 

Optionholder
Acknowledgements: By your signature below, or by electronic acceptance or authentication in a form authorized by the Company, you
understand and agree that:

 

		●	The
                                            Option is governed by this Stock Option Grant Notice, and the provisions of the Plan and
                                            the Stock Option Agreement, all of which are made a part of this document. Unless otherwise
                                            provided in the Plan, this Grant Notice and the Stock Option Agreement (together, the “Option
                                            Agreement”) may not be modified, amended or revised, except in a writing signed
                                            by you and a duly authorized officer of the Company.

 

		●	If
                                            the Option is an Incentive Stock Option, it (plus other outstanding Incentive Stock Options
                                            granted to you) cannot be first exercisable for more than $100,000 in value (measured
                                            by exercise price) in any calendar year. Any excess over $100,000 is a Nonstatutory Stock
                                            Option.

 

		●	You
                                            consent to receive this Grant Notice, the Stock Option Agreement, the Plan, the prospectus
                                            prepared for the Plan (the “Prospectus”) and any other Plan-related
                                            documents by electronic delivery and to participate in the Plan through an on-line or electronic
                                            system established and maintained by the Company or another third party designated by the
                                            Company.

 

     

     

    

 

		●	You
                                            have read and are familiar with the provisions of the Plan, the Stock Option Agreement, and
                                            the Prospectus. In the event of any conflict between the provisions in this Grant Notice,
                                            the Option Agreement, or the Prospectus and the terms of the Plan, the terms of the Plan
                                            shall control.

 

		●	The
                                            Option Agreement sets forth the entire understanding between you and the Company regarding
                                            the acquisition of Common Stock and supersedes all prior oral and written agreements, promises
                                            and/or representations on that subject, with the exception of other equity awards previously
                                            granted to you and any

 

		●	written
                                            employment agreement, offer letter, severance agreement, written severance plan or policy,
                                            or other written agreement between the Company and you in each case that specifies the terms
                                            that should govern this Option.

 

		●	Counterparts
                                            may be delivered via facsimile, electronic mail (including pdf or any electronic signature
                                            complying with the U.S. federal ESIGN Act of 2000, Uniform Electronic Transactions
                                            Act or other applicable law) or other transmission method, and any counterpart so delivered,
                                            will be deemed to have been duly and validly delivered and be valid and effective for all
                                            purposes.

 

	Orchestra
    BioMed Holdings, Inc.	 	Optionholder:
	 	 	 
	By:		 	 
		Signature	 		Signature
	 	 	 	 	 
	Title:	 	 	Date:	 
	Date:	 	 	 	 

 

    2

     

    

 

Orchestra
BioMed Holdings, Inc.

2023 Equity Incentive Plan

Stock Option Agreement

 

As
reflected by your Stock Option Grant Notice (“Grant Notice”) Orchestra BioMed Holdings, Inc. (the “Company”)
has granted you an option under its 2023 Equity Incentive Plan (the “Plan”) to purchase a number of shares
of Common Stock at the exercise price indicated in your Grant Notice (the “Option”). Capitalized terms not
explicitly defined in this Agreement, but defined in the Grant Notice or the Plan, shall have the meanings set forth in the Grant Notice
or Plan, as applicable. The terms of your Option as specified in the Grant Notice and this Stock Option Agreement constitute your Option
Agreement.

 

The
general terms and conditions applicable to your Option are as follows:

 

1.
Governing Plan Document. Your Option is subject to all the provisions of the Plan.
Your Option is further subject to all interpretations, amendments, rules and regulations, which may, from time to time, be promulgated
and adopted pursuant to the Plan. In the event of any conflict between the Option Agreement and the provisions of the Plan, the provisions
of the Plan shall control.

 

2.
Exercise.

 

(a)
You may generally exercise the vested portion of your Option for whole shares of Common Stock at any time during its term by delivery
of payment of the exercise price and applicable withholding taxes and other required documentation to the Plan Administrator in accordance
with the exercise procedures established by the Plan Administrator, which may include an electronic submission. Please review the Plan,
which may restrict or prohibit your ability to exercise your Option during certain periods.

 

(b)
To the extent permitted by Applicable Law, you may pay your Option exercise price as follows:

 

(i)
   cash, check, bank draft or money order;

 

(ii)
subject to Company and/or Committee consent at the time of exercise, pursuant to a “cashless exercise” program as further
described in the Plan, if at the time of exercise the Common Stock is publicly traded;

 

(iii)
subject to Company and/or Committee consent at the time of exercise, by delivery of previously owned shares of Common Stock as further
described in the Plan; or

 

(iv)
subject to Company and/or Committee consent at the time of exercise, if the Option is a Nonstatutory Stock Option, by a “net
exercise” arrangement as further described in the Plan.

 

    3

     

    

 

3.
Term. You may not exercise your Option before the commencement of its term or after
its term expires. The term of your option commences on the Date of Grant and expires upon the earliest of the following:

 

(a)
immediately upon the termination of your Continuous Service for Cause;

 

(b)
three months after the termination of your Continuous Service for any reason other than Cause, Disability or death;

 

(c)
 12 months after the termination of your Continuous Service due to your Disability;

 

(d)
18 months after your death if you die during your Continuous Service;

 

(e) immediately upon a Corporate Transaction if the Board has determined that the Option will terminate in connection with a Corporate
Transaction,

 

(f)
 the Expiration Date indicated in your Grant Notice; or

 

(g)
the day before the 10th anniversary of the Date of Grant.

 

Notwithstanding
the foregoing, if you die during the period provided in Section 3(b) or 3(c) above, the term of your Option shall not expire
until the earlier of (i) 18 months after your death, (ii) upon any termination of the Option in connection with a Corporate
Transaction, (iii) the Expiration Date indicated in your Grant Notice, or (iv) the day before the 10th anniversary of the Date
of Grant. Additionally, the Post-Termination Exercise Period of your Option may be extended as provided in the Plan.

 

To
obtain the federal income tax advantages associated with an Incentive Stock Option, the Code requires that at all times beginning on
the date of grant of your Option, and ending on the day three months before the date of your Option’s exercise, you must be an
employee of the Company or an Affiliate, except in the event of your death or Disability. If the Company provides for the extended exercisability
of your Option under certain circumstances for your benefit, your Option will not necessarily be treated as an Incentive Stock Option
if you exercise your Option more than three months after the date your employment terminates.

 

4.
Withholding Obligations.

 

(a)
Regardless of any action taken by the Company or, if different, the Affiliate to which you provide Continuous Service (the “Service
Recipient”) with respect to any income tax, social insurance, payroll tax, fringe benefits tax, payment on account, or
other tax-related items associated with the grant, vesting or exercise of the Option or sale of the underlying Common Stock or other
tax-related items related to your participation in the Plan and legally applicable to you (the “Tax Liability”),
you hereby acknowledge and agree that the Tax Liability is your ultimate responsibility and may exceed the amount, if any, actually withheld
by the Company or the Service Recipient. You further acknowledge that the Company and the Service Recipient (i) make no representations
or undertakings regarding any Tax Liability in connection with any aspect of this Option, including, but not limited to, the grant, vesting
or exercise of the Option, the issuance of Common Stock pursuant to such exercise, the subsequent sale of shares of Common Stock, and
the payment of any dividends on the shares; and (ii) do not commit to, and are under no obligation to structure the terms of the
grant or any aspect of the Option to reduce or eliminate your Tax Liability or achieve a particular tax result. Further, if you are subject
to Tax Liability in more than one jurisdiction, you acknowledge that the Company and/or the Service Recipient (or former service recipient,
as applicable) may be required to withhold or account for Tax Liability in more than one jurisdiction.

 

    4

     

    

 

(b)
Prior to any relevant taxable or tax withholding event, as applicable, you agree to make adequate arrangements satisfactory to the
Company and/or the Service Recipient to satisfy all Tax Liability. As further provided in Section 8 of the Plan, you hereby authorize
the Company and any applicable Service Recipient to satisfy any applicable withholding obligations with regard to the Tax Liability by
one or a combination of the following methods: (i) causing you to pay any portion of the Tax Liability in cash or cash equivalent
in a form acceptable to the Company; (ii) withholding from any compensation otherwise payable to you by the Company or the Service
Recipient; (iii) withholding from the proceeds of the sale of shares of Common Stock issued upon exercise of the Option (including
by means of a “cashless exercise” pursuant to a program developed under Regulation T as promulgated by the Federal Reserve
Board to the extent permitted by the Company, or by means of the Company acting as your agent to sell sufficient shares of Common Stock
for the proceeds to settle such withholding requirements, on your behalf pursuant to this authorization without further consent); (iv) withholding
shares of Common Stock otherwise issuable to you upon the exercise of the Option, provided that to the extent necessary to qualify for
an exemption from application of Section 16(b) of the Exchange Act, if applicable, such share withholding procedure will be subject
to the express prior approval of the Board or the Company’s Compensation Committee; and/or (v) any other method determined
by the Company to be in compliance with Applicable Law. Furthermore, you agree to pay the Company or the Service Recipient any amount
the Company or the Service Recipient may be required to withhold, collect or pay as a result of your participation in the Plan or that
cannot be satisfied by the means previously described. In the event it is determined that the amount of the Tax Liability was greater
than the amount withheld by the Company or the Service Recipient, you agree to indemnify and hold the Company and/or the Service Recipient
(as applicable) harmless from any failure by the Company or the applicable Service Recipient to withhold the proper amount.

 

(c)
 The Company may withhold or account for your Tax Liability by considering statutory withholding amounts or other withholding
rates applicable in your jurisdiction(s), including (i) maximum applicable rates in your jurisdiction(s), in which case you may
receive a refund of any over-withheld amount in cash (whether from applicable tax authorities or the Company) and you will have no entitlement
to the equivalent amount in Common Stock or (ii) minimum or such other applicable rates in your jurisdiction(s), in which case,
you may be solely responsible for paying any additional Tax Liability to the applicable tax authorities or to the Company and/or the
Service Recipient. If the Tax Liability withholding obligation is satisfied by withholding shares of Common Stock, for tax purposes,
you are deemed to have been issued the full number of shares of Common Stock subject to the exercised portion of the Option, notwithstanding
that a number of the shares of Common Stock is held back solely for the purpose of paying such Tax Liability.

 

(d)
You acknowledge that you may not be able to exercise your Option, even though the Option is vested, and that the Company shall have
no obligation to issue shares of Common Stock, in each case, unless, and until you have fully satisfied any applicable Tax Liability,
as determined by the Company. Unless any withholding obligation for the Tax Liability is satisfied, the Company shall have no obligation
to deliver to you any Common Stock in respect of the Option.

 

    5

     

    

 

5.
Incentive Stock Option Disposition Requirement. If your option is an Incentive Stock
Option, you must notify the Company in writing within 15 days after the date of any disposition of any of the shares of the
Common Stock issued upon exercise of your option that occurs within two years after the date of your option grant or within one year
after such shares of Common Stock are transferred upon exercise of your option.

 

6.
Transferability. Except as otherwise provided in the Plan, your Option is not transferable,
except by will or by the applicable laws of descent and distribution, and is exercisable during your life only by you.

 

7.
Corporate Transaction. Your Option is subject to the terms of any agreement governing
a Corporate Transaction involving the Company, including, without limitation, a provision for the appointment of a stockholder representative
that is authorized to act on your behalf with respect to any escrow, indemnities and any contingent consideration.

 

8.
No Liability for Taxes. As a condition to accepting the Option, you hereby (a) agree
to not make any claim against the Company, or any of its Officers, Directors, Employees or Affiliates related to tax liabilities arising
from the Option or other Company compensation and (b) acknowledge that you were advised to consult with your own personal tax, financial
and other legal advisors regarding the tax consequences of the Option, and have either done so, or knowingly and voluntarily declined
to do so. Additionally, you acknowledge that the Option is exempt from Section 409A, only if the exercise price is at least equal
to the “fair market value” of the Common Stock on the date of grant as determined by the Internal Revenue Service, and there
is no other impermissible deferral of compensation associated with the Option. Additionally, as a condition to accepting the Option,
you agree not make any claim against the Company, or any of its Officers, Directors, Employees or Affiliates in the event that the Internal
Revenue Service asserts that such exercise is less than the “fair market value” of the Common Stock on the date of grant
as subsequently determined by the Internal Revenue Service.

 

9.
Obligations; Recoupment. You hereby acknowledge that the grant of your Option is additional
consideration for any obligations (whether during or after employment) that you have to the Company not to compete, not to solicit its
customers, clients or employees, not to disclose or misuse confidential information or similar obligations. Accordingly, if the Company
reasonably determines that you breached such obligations, in addition to any other available remedy, the Company may, to the extent permitted
by Applicable Law, recoup any income realized by you with respect to the exercise of your Option within two years of such breach. In
addition, to the extent permitted by Applicable Law, this right to recoupment by the Company applies in the event that your employment
is terminated for Cause, or if the Company reasonably determines that circumstances existed that it could have terminated your employment
for Cause.

 

10.
 Severability. If any part of this Option Agreement or the Plan is declared by
any court or governmental authority to be unlawful or invalid, such unlawfulness or invalidity will not invalidate any portion of this
Option Agreement or the Plan not declared to be unlawful or invalid. Any Section of this Option Agreement (or part of such a Section)
so declared to be unlawful or invalid, will, if possible, be construed in a manner which will give effect to the terms of such Section
or part of a Section to the fullest extent possible, while remaining lawful and valid.

 

11.
 Indebtedness to the Company. In the event that you have any loans, draws, advances
or any other indebtedness owing to the Company at the time of exercise of all or a portion of the Option, the Company may deduct and
not deliver that number of shares of Common Stock with a Fair Market Value subject to the Option equal to such indebtedness to satisfy
all or a portion of such indebtedness, to the extent permitted by law and in a manner consistent with Section 409A of the Code,
if applicable.

 

12.
Other Documents. You hereby acknowledge receipt of, or the right to receive
a document providing the information required by Rule 428(b)(1) promulgated under the Securities Act, which includes the Prospectus.
In addition, you acknowledge receipt of the Company’s Trading Policy.

 

13.
 Questions. If you have questions regarding these or any other terms and conditions
applicable to your Option, including a summary of the applicable federal income tax consequences, please see the Prospectus.

 

*
* * *

 

 

6

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