Document:

Exhibit 10.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAINREFORM
LTD.

 

and

 

AMERICAN
STOCK TRANSFER & TRUST COMPANY, as

Warrant
Agent

 

 

 

Warrant
Agency Agreement

 

Dated
as of August __, 2020

 

 

 

 

 

 

 

 

 

 

 

 

     

     

    

 

WARRANT
AGENCY AGREEMENT

 

WARRANT
AGENCY AGREEMENT, dated as of August __, 2020 (“Agreement”), between PAINREFORM LTD., a corporation organized
under the laws of Israel (the “Company”), and American Stock Transfer & Trust Company (the “Warrant
Agent”).

 

W
I T N E S S E T H

 

WHEREAS,
pursuant to a registered offering by the Company of ___ Units (the “Offering”), with each Unit consisting of
__ the Company’s ordinary shares par value $0.001 per share (the “Ordinary Shares”) and ___ warrants
(the “Warrants”) to purchase ___ Ordinary Shares (the “Warrant Shares”) at a price of $___
per share (or __% of the price of each Ordinary Share sold in the Offering); and

 

WHEREAS,
the Company granted an over-allotment option to purchase up to fifteen percent (15%) of the aggregate number of Ordinary Shares
and/or Warrants sold, including warrants to purchase an additional __ Ordinary Shares (the “Over-Allotment Option”)
to the Underwriters; and

 

WHEREAS,
upon the terms and subject to the conditions hereinafter set forth and pursuant to an effective registration statement on Form
F-1, as amended (File No. 333-239576) (the “Registration Statement”), and the terms and conditions of the Warrant
Certificate, the Company wishes to issue the Warrants in book entry form entitling the respective holders of the Warrants (the
“Holders,” which term shall include a Holder’s transferees, successors and assigns and “Holder”
shall include, if the Warrants are held in “street name,” a Participant (as defined below) or a designee appointed
by such Participant); and

 

WHEREAS,
the Ordinary Shares and Warrants to be issued in connection with the Offering shall be issued separately, but will be purchased
together in the Offering; and

 

WHEREAS,
the Company wishes the Warrant Agent to act on behalf of the Company, and the Warrant Agent is willing so to act, in connection
with the issuance, registration, transfer, exchange, exercise and replacement of the Warrants and, in the Warrant Agent’s
capacity as the Company’s transfer agent, the delivery of the Warrant Shares (as defined below).

 

NOW,
THEREFORE, in consideration of the premises and the mutual agreements herein set forth, the parties hereby agree as follows:

 

Section
1. Certain Definitions. For purposes of this Agreement, all capitalized terms not herein defined shall have the meanings
hereby indicated:

 

(a)
“Affiliate” has the meaning ascribed to it in Rule 12b-2 under the Securities Exchange Act of 1934, as amended
(the “Exchange Act”).

 

(b)
“Business Day” means any day except any Saturday, any Sunday, any day which is a federal legal holiday in the
United States or any day on which the Nasdaq Stock Market is authorized or required by law or other governmental action to close.

 

(c)
“Close of Business” on any given date means 5:00 p.m., New York City time, on such date; provided, however,
that if such date is not a Business Day it means 5:00 p.m., New York City time, on the next succeeding Business Day.

 

(d)
“Person” means an individual, corporation, association, partnership, limited liability company, joint venture,
trust, unincorporated organization, government or political subdivision thereof or governmental agency or other entity.

 

    2

     

    

 

(e)
“Warrant Certificate” means a certificate in substantially the form attached as Exhibit 1 hereto, representing
such number of Warrant Shares as is indicated therein, provided that any reference to the delivery of a Warrant Certificate in
this Agreement shall include delivery of a Definitive Certificate or a Global Warrant (each as defined below).

 

All
other capitalized terms used but not otherwise defined herein shall have the meaning ascribed to such terms in the Warrant Certificate.

 

Section
2. Appointment of Warrant Agent. The Company hereby appoints the Warrant Agent to act as agent for the Company in accordance
with the terms and conditions hereof, and the Warrant Agent hereby accepts such appointment.

 

Section
3. Global Warrants.

 

(a)
The Warrants shall be registered securities and shall be evidenced by a global warrant (the “Global Warrants”),
in the form of the Warrant Certificate, which shall be deposited with the Warrant Agent and registered in the name of Cede &
Co., a nominee of The Depository Trust Company (the “Depositary”), or as otherwise directed by the Depositary.
Ownership of beneficial interests in the Warrants shall be shown on, and the transfer of such ownership shall be effected through,
records maintained by (i) the Depositary or its nominee for each Global Warrant or (ii) institutions that have accounts with the
Depositary (such institution, with respect to a Warrant in its account, a “Participant”).

 

(b)
If the Depositary subsequently ceases to make its book-entry settlement system available for the Warrants, the Company may instruct
the Warrant Agent regarding other arrangements for book-entry settlement. In the event that the Warrants are not eligible for,
or it is no longer necessary to have the Warrants available in, book-entry form, the Warrant Agent shall provide written instructions
to the Depositary to deliver to the Warrant Agent for cancellation each Global Warrant, and the Company shall instruct the Warrant
Agent to deliver to each Holder a Warrant Certificate.

 

(c)
A Holder has the right to elect at any time or from time to time a Warrant Exchange (as defined below) pursuant to a Warrant Certificate
Request Notice (as defined below). Upon written notice by a Holder to the Company and the Warrant Agent for the exchange of some
or all of such Holder’s Global Warrants for a separate certificate in the form attached hereto as Exhibit 1 (such
separate certificate, a “Definitive Certificate”) evidencing the same number of Warrants, which request shall
be in the form attached hereto as Exhibit 2 (a “Warrant Certificate Request Notice” and the date of
delivery of such Warrant Certificate Request Notice by the Holder, the “Warrant Certificate Request Notice Date”
and the surrender by the Holder to the Warrant Agent of a number of Global Warrants for the same number of Warrants evidenced
by a Warrant Certificate, a “Warrant Exchange”), the Company and the Warrant Agent shall promptly effect the
Warrant Exchange and the Company shall promptly issue and deliver to the Holder a Definitive Certificate for such number of Warrants
in the name set forth in the Warrant Certificate Request Notice. Such Definitive Certificate shall be dated the original issue
date of the Warrants, shall be manually executed by an authorized signatory of the Company, shall be in the form attached hereto
as Exhibit 1 and shall be reasonably acceptable in all respects to such Holder. In connection with a Warrant Exchange,
the Company agrees to deliver the Definitive Certificate to the Holder within ten (10) Business Days of the Warrant Certificate
Request Notice pursuant to the delivery instructions in the Warrant Certificate Request Notice (“Warrant Certificate
Delivery Date”). If the Company fails for any reason to deliver to the Holder the Definitive Certificate subject to
the Warrant Certificate Request Notice by the Warrant Certificate Delivery Date, the Company shall pay to the Holder, in cash,
as liquidated damages and not as a penalty, for each $1,000 of Warrant Shares evidenced by such Definitive Certificate (based
on the VWAP (as defined in the Warrants) of the Ordinary Shares on the Warrant Certificate Request Notice Date), $10 per Business
Day for each Business Day after such Warrant Certificate Delivery Date until such Definitive Certificate is delivered or, prior
to delivery of such Warrant Certificate, the Holder rescinds such Warrant Exchange. The Company covenants and agrees that, upon
the date of delivery of the Warrant Certificate Request Notice, the Holder shall be deemed to be the holder of the Definitive
Certificate and, notwithstanding anything to the contrary set forth herein, the Definitive Certificate shall be deemed for all
purposes to contain all of the terms and conditions of the Warrants evidenced by such Warrant Certificate and the terms of this
Agreement, other than Sections 3(c), 3(d) and 9 herein, shall not apply to the Warrants evidenced by the Definitive Certificate.
Notwithstanding anything herein to the contrary, the Company shall act as warrant agent with respect to any Definitive Certificate
requested and issued pursuant to this section. Notwithstanding anything to the contrary contained in this Agreement, in the event
of inconsistency between any provision in this Agreement and any provision in a Definitive Certificate, as it may from time to
time be amended, the terms of such Definitive Certificate shall control.

 

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(d)
A Holder of a Definitive Certificate (pursuant to a Warrant Exchange or otherwise) has the right to elect at any time or from
time to time a Global Warrants Exchange (as defined below) pursuant to a Global Warrants Request Notice (as defined below). Upon
written notice by a Holder to the Company for the exchange of some or all of such Holder’s Warrants evidenced by a Definitive
Certificate for a beneficial interest in Global Warrants held in book-entry form through the Depositary evidencing the same number
of Warrants, which request shall be in the form attached hereto as Exhibit 3 (a “Global Warrants Request Notice”
and the date of delivery of such Global Warrants Request Notice by the Holder, the “Global Warrants Request Notice Date”
and the surrender upon delivery by the Holder of the Warrants evidenced by Definitive Certificates for the same number of Warrants
evidenced by a beneficial interest in Global Warrants held in book-entry form through the Depositary, a “Global Warrants
Exchange”), the Company shall promptly effect the Global Warrants Exchange and shall promptly direct the Warrant Agent
to issue and deliver to the Holder Global Warrants for such number of Warrants in the Global Warrants Request Notice, which beneficial
interest in such Global Warrants shall be delivered by the Depositary’s Deposit or Withdrawal at Custodian system to the
Holder pursuant to the instructions in the Global Warrants Request Notice. In connection with a Global Warrants Exchange, the
Company shall direct the Warrant Agent to deliver the beneficial interest in such Global Warrants to the Holder within ten (10)
Business Days of the Global Warrants Request Notice pursuant to the delivery instructions in the Global Warrant Request Notice
(“Global Warrants Delivery Date”). If the Company fails for any reason to deliver to the Holder Global Warrants
subject to the Global Warrants Request Notice by the Global Warrants Delivery Date, the Company shall pay to the Holder, in cash,
as liquidated damages and not as a penalty, for each $1,000 of Warrant Shares evidenced by such Global Warrants (based on the
VWAP (as defined in the Warrants) of the Ordinary Shares on the Global Warrants Request Notice Date), $10 per Business Day for
each Business Day after such Global Warrants Delivery Date until such Global Warrants are delivered or, prior to delivery of such
Global Warrants, the Holder rescinds such Global Warrants Exchange. The Company covenants and agrees that, upon the date of delivery
of the Global Warrants Request Notice, the Holder shall be deemed to be the beneficial holder of such Global Warrants.

 

Section
4. Form of Warrant Certificates. The Warrant Certificate, together with the form of election to purchase Ordinary Shares
(“Notice of Exercise”) and the form of assignment to be printed on the reverse thereof, shall be in the form
of Exhibit 1 hereto.

 

Section
5. Countersignature and Registration. The Global Warrant shall be executed on behalf of the Company by its Chief Executive
Officer, Chief Financial Officer or Vice President, by facsimile signature, and have affixed thereto the Company’s seal
or a facsimile thereof which shall be attested by the Secretary or an Assistant Secretary of the Company, by facsimile signature.
The Global Warrant shall be countersigned by the Warrant Agent by facsimile signature and shall not be valid for any purpose unless
so countersigned. In case any officer of the Company who shall have signed any of the Global Warrant shall cease to be such officer
of the Company before countersignature by the Warrant Agent and issuance and delivery by the Company, such Global Warrant, nevertheless,
may be countersigned by the Warrant Agent, issued and delivered with the same force and effect as though the person who signed
such Global Warrant had not ceased to be such officer of the Company; and any Global Warrant may be signed on behalf of the Company
by any person who, at the actual date of the execution of such Global Warrant, shall be a proper officer of the Company to sign
such Global Warrant, although at the date of the execution of this Warrant Agreement any such person was not such an officer.

 

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The
Warrant Agent will keep or cause to be kept, at one of its offices, or at the office of one of its agents, books for registration
and transfer of the Global Warrants issued hereunder. Such books shall show the names and addresses of the respective Holders
of the Global Warrant, the number of warrants evidenced on the face of each of such Global Warrant and the date of each of such
Global Warrant. The Warrant Agent will create a special account for the issuance of Global Warrants. The Company will keep or
cause to be kept at one of its offices, books for the registration and transfer of any Definitive Certificates issued hereunder
and the Warrant Agent shall not have any obligation to keep books and records with respect to any Definitive Warrants. Such Company
books shall show the names and addresses of the respective Holders of the Definitive Certificates, the number of warrants evidenced
on the face of each such Definitive Certificate and the date of each such Definitive Certificate.

 

Section
6. Transfer, Split Up, Combination and Exchange of Warrant Certificates; Mutilated, Destroyed, Lost or Stolen Warrant Certificates.
With respect to the Global Warrant, subject to the provisions of the Warrant Certificate and the last sentence of this first paragraph
of Section 6 and subject to applicable law, rules or regulations, or any “stop transfer” instructions the Company
may give to the Warrant Agent, at any time after the closing date of the Offering, and at or prior to the Close of Business on
the Termination Date (as such term is defined in the Warrant Certificate), any Global Warrant or Global Warrants may be transferred,
split up, combined or exchanged for another Global Warrant or Global Warrants, entitling the Holder to purchase a like number
of Ordinary Shares as the Global Warrant or Global Warrants surrendered then entitled such Holder to purchase. Any Holder desiring
to transfer, split up, combine or exchange any Global Warrant shall make such request in writing delivered to the Warrant Agent,
and shall surrender the Global Warrant to be transferred, split up, combined or exchanged at the principal office of the Warrant
Agent. Any requested transfer of Warrants, whether in book-entry form or certificate form, shall be accompanied by reasonable
evidence of authority of the party making such request that may be required by the Warrant Agent. Thereupon the Warrant Agent
shall, subject to the last sentence of this first paragraph of Section 6, countersign and deliver to the Person entitled thereto
a Global Warrant or Global Warrants, as the case may be, as so requested. The Company may require payment from the Holder of a
sum sufficient to cover any tax or governmental charge that may be imposed in connection with any transfer, split up, combination
or exchange of Global Warrants. The Company shall compensate the Warrant Agent per the fee schedule mutually agreed upon by the
parties hereto and provided separately on the date hereof.

 

Upon
receipt by the Warrant Agent of evidence reasonably satisfactory to it of the loss, theft, destruction or mutilation of a Warrant
Certificate, which evidence shall include an affidavit of loss, or in the case of mutilated certificates, the certificate or portion
thereof remaining, and, in case of loss, theft or destruction, of indemnity in customary form and amount (but, with respect to
any Definitive Certificates, shall not include the posting of any bond by the Holder), and satisfaction of any other reasonable
requirements established by Section 8-405 of the Uniform Commercial Code as in effect in the State of Delaware, and reimbursement
to the Company and the Warrant Agent of all reasonable expenses incidental thereto, and upon surrender to the Warrant Agent and
cancellation of the Warrant Certificate if mutilated, the Company will make and deliver a new Warrant Certificate of like tenor
to the Warrant Agent for delivery to the Holder in lieu of the Warrant Certificate so lost, stolen, destroyed or mutilated.

 

Section
7. Exercise of Warrants; Exercise Price; Termination Date.

 

(a)
The Warrants shall be exercisable commencing on the Initial Exercise Date. The Warrants shall cease to be exercisable and shall
terminate and become void as set forth in the Warrant Certificate. Subject to the foregoing and to Section 7(b) below, the Holder
of a Warrant may exercise the Warrant in whole or in part upon surrender of the Warrant Certificate, if required, with the executed
Notice of Exercise and payment of the Exercise Price, which may be made, at the option of the Holder, by wire transfer or by certified
or official bank check in United States dollars, to the Warrant Agent at the principal office of the Warrant Agent or to the office
of one of its agents as may be designated by the Warrant Agent from time to time. In the case of the Holder of a Global Warrant,
the Holder shall deliver the executed Notice of Exercise and the payment of the Exercise Price as described herein. Notwithstanding
any other provision in this Agreement, a holder whose interest in a Global Warrant is a beneficial interest in a Global Warrant
held in book-entry form through the Depositary (or another established clearing corporation performing similar functions), shall
effect exercises by delivering to the Depositary (or such other clearing corporation, as applicable) the appropriate instruction
form for exercise, complying with the procedures to effect exercise that are required by the Depositary (or such other clearing
corporation, as applicable). The Company acknowledges that the bank accounts maintained by the Warrant Agent in connection with
the services provided under this Agreement will be in its name and that the Warrant Agent may receive investment earnings in connection
with the investment at Warrant Agent risk and for its benefit of funds held in those accounts from time to time. Neither the Company
nor the Holders will receive interest on any deposits or Exercise Price. No ink-original Notice of Exercise shall be required,
nor shall any medallion guarantee (or other type of guarantee or notarization) of any Notice of Exercise be required. The Company
hereby acknowledges and agrees that, with respect to a holder whose interest in a Global Warrant is a beneficial interest in a
Global Warrant held in book-entry form through the Depositary (or another established clearing corporation performing similar
functions), upon delivery of irrevocable instructions to such holder’s Participant to exercise such warrants, that solely
for purposes of Regulation SHO that such holder shall be deemed to have exercised such warrants.

 

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(b)
Upon receipt of a Notice of Exercise for a Cashless Exercise the Company will promptly calculate and transmit to the Warrant Agent
the number of Warrant Shares issuable in connection with such Cashless Exercise and deliver a copy of the Notice of Exercise to
the Warrant Agent, which shall issue such number of Warrant Shares in connection with such Cashless Exercise.

 

(c)
Upon the exercise of the Warrant Certificate pursuant to the terms of Section 2 of the Warrant Certificate, the Warrant Agent
shall cause the Warrant Shares underlying such Warrant Certificate or Global Warrant to be delivered to or upon the order of the
Holder of such Warrant Certificate or Global Warrant, registered in such name or names as may be designated by such Holder, no
later than the Warrant Share Delivery Date (as such term is defined in the Warrant Certificate). If the Company is then a participant
in the DWAC system of the Depositary and either (A) there is an effective registration statement permitting the issuance of the
Warrant Shares to or resale of the Warrant Shares by Holder or (B) the Warrant is being exercised via Cashless Exercise, then
the certificates for Warrant Shares shall be transmitted by the Warrant Agent to the Holder by crediting the account of the Holder’s
broker with the Depositary through its DWAC system. For the avoidance of doubt, if the Company becomes obligated to pay any amounts
to any Holders pursuant to Section 2(d)(i) or 2(d)(iv) of the Warrant Certificate, such obligation shall be solely that of the
Company and not that of the Warrant Agent. Notwithstanding anything else to the contrary in this Agreement, except in the case
of a Cashless Exercise, if any Holder fails to duly deliver payment to the Warrant Agent of an amount equal to the aggregate Exercise
Price of the Warrant Shares to be purchased upon exercise of such Holder’s Warrant as set forth in Section 7(a) hereof by
the Warrant Share Delivery Date, the Warrant Agent will not obligated to deliver such Warrant Shares (via DWAC or otherwise) until
following receipt of such payment, and the applicable Warrant Share Delivery Date shall be deemed extended by one day for each
day (or part thereof) until such payment is delivered to the Warrant Agent.

 

(d)
The Warrant Agent shall deposit all funds received by it in payment of the Exercise Price for all Warrants in the account of the
Company maintained with the Warrant Agent for such purpose (or to such other account as directed by the Company in writing) and
shall advise the Company via email at the end of each day on which notices of exercise are received or funds for the exercise
of any Warrant are received of the amount so deposited to its account.

 

Section
8. Cancellation and Destruction of Warrant Certificates. All Warrant Certificates surrendered for the purpose of exercise,
transfer, split up, combination or exchange shall, if surrendered to the Company or to any of its agents, be delivered to the
Warrant Agent for cancellation or in canceled form, or, if surrendered to the Warrant Agent, shall be canceled by it, and no Warrant
Certificate shall be issued in lieu thereof except as expressly permitted by any of the provisions of this Agreement. The Company
shall deliver to the Warrant Agent for cancellation and retirement, and the Warrant Agent shall so cancel and retire, any other
Warrant Certificate purchased or acquired by the Company otherwise than upon the exercise thereof. The Warrant Agent shall deliver
all canceled Warrant Certificates to the Company, or shall, at the written request of the Company, destroy such canceled Warrant
Certificates, and in such case shall deliver a certificate of destruction thereof to the Company, subject to any applicable law,
rule or regulation requiring the Warrant Agent to retain such canceled certificates.

 

Section
9. Certain Representations; Reservation and Availability of Ordinary Shares or Cash.

 

(a)
This Agreement has been duly authorized, executed and delivered by the Company and, assuming due authorization, execution and
delivery hereof by the Warrant Agent, constitutes a valid and legally binding obligation of the Company enforceable against the
Company in accordance with its terms, and the Warrants have been duly authorized, executed and issued by the Company and, assuming
due authentication thereof by the Warrant Agent pursuant hereto and payment therefor by the Holders as provided in the Registration
Statement, constitute valid and legally binding obligations of the Company enforceable against the Company in accordance with
their terms and entitled to the benefits hereof; in each case except as enforceability may be limited by bankruptcy, insolvency,
reorganization, moratorium and other similar laws relating to or affecting creditors’ rights generally or by general equitable
principles (regardless of whether such enforceability is considered in a proceeding in equity or at law).

 

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(b)
As of the date hereof, the authorized capital stock of the Company consists of (i) sixteen million six hundred and sixty six thousand
six hundred and sixty six (16,666,666) ordinary shares, of which approximately [ ] Ordinary Shares are issued and outstanding
as of the date of this Agreement, and [ ] Ordinary Shares are reserved for issuance upon exercise of the Warrants, and (ii) [
] million ([ ],000,000) preferred shares, par value $[ ] per share, of which [ ] shares are issued and outstanding. Except as
disclosed in the Registration Statement, there are no other outstanding obligations, warrants, options or other rights to subscribe
for or purchase from the Company any class of capital stock of the Company.

 

(c)
The Company covenants and agrees that it will cause to be reserved and kept available out of its authorized and unissued Ordinary
Shares or its authorized and issued Ordinary Shares held in its treasury, free from preemptive rights, the number of Ordinary
Shares that will be sufficient to permit the exercise in full of all outstanding Warrants.

 

(d)
The Warrant Agent will create a special account for the issuance of Ordinary Shares upon the exercise of Warrants.

 

(e)
The Company further covenants and agrees that it will pay when due and payable any and all federal and state transfer taxes and
charges which may be payable in respect of the original issuance or delivery of the Warrant Certificates or certificates evidencing
Ordinary Shares upon exercise of the Warrants. The Company shall not, however, be required to pay any tax or governmental charge
which may be payable in respect of any transfer involved in the transfer or delivery of Warrant Certificates or the issuance or
delivery of certificates for Ordinary Shares in a name other than that of the Holder of the Warrant Certificate evidencing Warrants
surrendered for exercise or to issue or deliver any certificate for Ordinary Shares upon the exercise of any Warrants until any
such tax or governmental charge shall have been paid (any such tax or governmental charge being payable by the Holder of such
Warrant Certificate at the time of surrender) or until it has been established to the Company’s reasonable satisfaction
that no such tax or governmental charge is due.

 

Section
10. Ordinary Share Record Date. Each Person in whose name any certificate for Ordinary Shares is issued (or to whose broker’s
account is credited Ordinary Shares through the DWAC system) upon the exercise of Warrants shall for all purposes be deemed to
have become the holder of record for the Ordinary Shares represented thereby on, and such certificate shall be dated, the date
on which submission of the Notice of Exercise was made, provided that the Warrant Certificate evidencing such Warrant is duly
surrendered (but only if required herein) and payment of the Exercise Price (and any applicable transfer taxes) is received on
or prior to the Warrant Share Delivery Date; provided, however, that if the date of submission of the Notice of
Exercise is a date upon which the Ordinary Share transfer books of the Company are closed, such Person shall be deemed to have
become the record holder of such shares on, and such certificate shall be dated, the next succeeding day on which the Ordinary
Share transfer books of the Company are open.

 

Section
11. Adjustment of Exercise Price, Number of Ordinary Shares or Number of the Company Warrants. The Exercise Price, the
number of shares covered by each Warrant and the number of Warrants outstanding are subject to adjustment from time to time as
provided in Section 3 of the Warrant Certificate. In the event that at any time, as a result of an adjustment made pursuant to
Section 3 of the Warrant Certificate, the Holder of any Warrant thereafter exercised shall become entitled to receive any shares
of capital stock of the Company other than Ordinary Shares, thereafter the number of such other shares so receivable upon exercise
of any Warrant shall be subject to adjustment from time to time in a manner and on terms as nearly equivalent as practicable to
the provisions with respect to the shares contained in Section 3 of the Warrant Certificate and the provisions of Sections 7,
11 and 12 of this Agreement with respect to the Ordinary Shares shall apply on like terms to any such other shares. All Warrants
originally issued by the Company subsequent to any adjustment made to the Exercise Price pursuant to the Warrant Certificate shall
evidence the right to purchase, at the adjusted Exercise Price, the number of Ordinary Shares purchasable from time to time hereunder
upon exercise of the Warrants, all subject to further adjustment as provided herein.

 

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Section
12. Certification of Adjusted Exercise Price or Number of Ordinary Shares. Whenever the Exercise Price or the number of
Ordinary Shares issuable upon the exercise of each Warrant is adjusted as provided in Section 11 or 13, the Company shall (a)
promptly prepare a certificate setting forth the Exercise Price of each Warrant as so adjusted, and a brief statement of the facts
accounting for such adjustment, (b) promptly file with the Warrant Agent and with each transfer agent for the Ordinary Shares
a copy of such certificate and (c) instruct the Warrant Agent to send a brief summary thereof to each Holder of a Warrant Certificate.

 

Section
13. Fractional Ordinary Shares.

 

(a)
The Company shall not issue fractions of Warrants or distribute Warrant Certificates which evidence fractional Warrants. Whenever
any fractional Warrant would otherwise be required to be issued or distributed, the actual issuance or distribution shall reflect
a rounding of such fraction to the nearest whole Warrant (rounded down).

 

(b)
The Company shall not issue fractions of Ordinary Shares upon exercise of Warrants or distribute stock certificates which evidence
fractional Ordinary Shares. Whenever any fraction of an Ordinary Share would otherwise be required to be issued or distributed,
the actual issuance or distribution in respect thereof shall be made in accordance with Section 2(d)(v) of the Warrant Certificate.

 

Section
14. Conditions of the Warrant Agent’s Obligations. The Warrant Agent accepts its obligations herein set forth upon
the terms and conditions hereof, including the following to all of which the Company agrees and to all of which the rights hereunder
of the Holders from time to time of the Warrant Certificates shall be subject:

 

		(a)	Compensation
                                         and Indemnification. The Company agrees promptly to pay the Warrant Agent the compensation
                                         detailed on Exhibit 4 hereto for all services rendered by the Warrant Agent and
                                         to reimburse the Warrant Agent for reasonable out-of-pocket expenses (including reasonable
                                         counsel fees) incurred without gross negligence or willful misconduct finally adjudicated
                                         to have been directly caused by the Warrant Agent in connection with the services rendered
                                         hereunder by the Warrant Agent. The Company also agrees to indemnify the Warrant Agent
                                         for, and to hold it harmless against, any loss, liability or expense incurred without
                                         gross negligence, or willful misconduct on the part of the Warrant Agent, finally adjudicated
                                         to have been directly caused by Warrant Agent hereunder, including the reasonable costs
                                         and expenses of defending against any claim of such liability. The Warrant Agent shall
                                         be under no obligation to institute or defend any action, suit, or legal proceeding in
                                         connection herewith or to take any other action likely to involve the Warrant Agent in
                                         expense, unless first indemnified to the Warrant Agent’s satisfaction. The indemnities
                                         provided by this paragraph shall survive the resignation or discharge of the Warrant
                                         Agent or the termination of this Agreement. Anything in this Agreement to the contrary
                                         notwithstanding, in no event shall the Warrant Agent be liable under or in connection
                                         with the Agreement for indirect, special, incidental, punitive or consequential losses
                                         or damages of any kind whatsoever, including but not limited to lost profits, whether
                                         or not foreseeable, even if the Warrant Agent has been advised of the possibility thereof
                                         and regardless of the form of action in which such damages are sought, and the Warrant
                                         Agent’s aggregate liability to the Company, or any of the Company’s representatives
                                         or agents, under this Section 14(a) or under any other term or provision of this Agreement,
                                         whether in contract, tort, or otherwise, is expressly limited to, and shall not exceed
                                         in any circumstances, one (1) year’s fees received by the Warrant Agent as fees
                                         and charges under this Agreement, but not including reimbursable expenses previously
                                         reimbursed to the Warrant Agent by the Company hereunder.

 

		(b)	Agent
                                         for the Company. In acting under this Warrant Agreement and in connection with the
                                         Warrant Certificates, the Warrant Agent is acting solely as agent of the Company and
                                         does not assume any obligations or relationship of agency or trust for or with any of
                                         the Holders of Warrant Certificates or beneficial owners of Warrants.

 

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		(c)	Counsel.
                                         The Warrant Agent may consult with counsel satisfactory to it, which may include counsel
                                         for the Company, and the written advice of such counsel shall be full and complete authorization
                                         and protection in respect of any action taken, suffered or omitted by it hereunder in
                                         good faith and in accordance with the advice of such counsel.

 

		(d)	Documents.
                                         The Warrant Agent shall be protected and shall incur no liability for or in respect of
                                         any action taken or omitted by it in reliance upon any Warrant Certificate, notice, direction,
                                         consent, certificate, affidavit, statement or other paper or document reasonably believed
                                         by it to be genuine and to have been presented or signed by the proper parties.

 

		(e)	Certain
                                         Transactions. The Warrant Agent, and its officers, directors and employees, may become
                                         the owner of, or acquire any interest in, Warrants, with the same rights that it or they
                                         would have if it were not the Warrant Agent hereunder, and, to the extent permitted by
                                         applicable law, it or they may engage or be interested in any financial or other transaction
                                         with the Company and may act on, or as depositary, trustee or agent for, any committee
                                         or body of Holders of Warrant Securities or other obligations of the Company as freely
                                         as if it were not the Warrant Agent hereunder. Nothing in this Warrant Agreement shall
                                         be deemed to prevent the Warrant Agent from acting as trustee under any indenture to
                                         which the Company is a party.

 

		(f)	No
                                         Liability for Interest. Unless otherwise agreed with the Company, the Warrant Agent
                                         shall have no liability for interest on any monies at any time received by it pursuant
                                         to any of the provisions of this Agreement or of the Warrant Certificates.

 

		(g)	No
                                         Liability for Invalidity. The Warrant Agent shall have no liability with respect
                                         to any invalidity of this Agreement or the Warrant Certificates (except as to the Warrant
                                         Agent’s countersignature thereon).

 

		(h)	No
                                         Responsibility for Representations. The Warrant Agent shall not be responsible for
                                         any of the recitals or representations herein or in the Warrant Certificate (except as
                                         to the Warrant Agent’s countersignature thereon), all of which are made solely
                                         by the Company.

 

		(i)	No
                                         Implied Obligations. The Warrant Agent shall be obligated to perform only such duties
                                         as are herein and in the Warrant Certificates specifically set forth and no implied duties
                                         or obligations shall be read into this Agreement or the Warrant Certificates against
                                         the Warrant Agent. The Warrant Agent shall not be under any obligation to take any action
                                         hereunder which may tend to involve it in any expense or liability, the payment of which
                                         within a reasonable time is not, in its reasonable opinion, assured to it. The Warrant
                                         Agent shall not be accountable or under any duty or responsibility for the use by the
                                         Company of any of the Warrant Certificates authenticated by the Warrant Agent and delivered
                                         by it to the Company pursuant to this Agreement or for the application by the Company
                                         of the proceeds of the Warrant Certificate. The Warrant Agent shall have no duty or responsibility
                                         in case of any default by the Company in the performance of its covenants or agreements
                                         contained herein or in the Warrant Certificates or in the case of the receipt of any
                                         written demand from a Holder of a Warrant Certificate with respect to such default, including,
                                         without limiting the generality of the foregoing, any duty or responsibility to initiate
                                         or attempt to initiate any proceedings at law.

 

Section
15. Purchase or Consolidation or Change of Name of Warrant Agent. Any corporation into which the Warrant Agent or any successor
Warrant Agent may be merged or with which it may be consolidated, or any corporation resulting from any merger or consolidation
to which the Warrant Agent or any successor Warrant Agent shall be party, or any corporation succeeding to the corporate trust
business of the Warrant Agent or any successor Warrant Agent, shall be the successor to the Warrant Agent under this Agreement
without the execution or filing of any paper or any further act on the part of any of the parties hereto, provided that such corporation
would be eligible for appointment as a successor Warrant Agent under the provisions of Section 17. In case at the time such successor
Warrant Agent shall succeed to the agency created by this Agreement any of the Warrant Certificates shall have been countersigned
but not delivered, any such successor Warrant Agent may adopt the countersignature of the predecessor Warrant Agent and deliver
such Warrant Certificates so countersigned; and in case at that time any of the Warrant Certificates shall not have been countersigned,
any successor Warrant Agent may countersign such Warrant Certificates either in the name of the predecessor Warrant Agent or in
the name of the successor Warrant Agent; and in all such cases such Warrant Certificates shall have the full force provided in
the Warrant Certificates and in this Agreement.

 

    9

     

    

 

In
case at any time the name of the Warrant Agent shall be changed and at such time any of the Warrant Certificates shall have been
countersigned but not delivered, the Warrant Agent may adopt the countersignature under its prior name and deliver such Warrant
Certificates so countersigned; and in case at that time any of the Warrant Certificates shall not have been countersigned, the
Warrant Agent may countersign such Warrant Certificates either in its prior name or in its changed name; and in all such cases
such Warrant Certificates shall have the full force provided in the Warrant Certificates and in this Agreement.

 

Section
16. Duties of Warrant Agent. The Warrant Agent undertakes the duties and obligations imposed by this Agreement upon the
following terms and conditions, by all of which the Company, by its acceptance hereof, shall be bound:

 

(a)
The Warrant Agent may consult with legal counsel reasonably acceptable to the Company (who may be legal counsel for the Company),
and the opinion of such counsel shall be full and complete authorization and protection to the Warrant Agent as to any action
taken or omitted by it in good faith and in accordance with such opinion.

 

(b)
Whenever in the performance of its duties under this Agreement the Warrant Agent shall deem it necessary or desirable that any
fact or matter be proved or established by the Company prior to taking or suffering any action hereunder, such fact or matter
(unless other evidence in respect thereof be herein specifically prescribed) may be deemed to be conclusively proved and established
by a certificate signed by the Chief Executive Officer, Chief Financial Officer or Vice President of the Company; and such certificate
shall be full authentication to the Warrant Agent for any action taken or suffered in good faith by it under the provisions of
this Agreement in reliance upon such certificate.

 

(c)
Subject to the limitation set forth in Section 14, the Warrant Agent shall be liable hereunder only for its own gross negligence
or willful misconduct, or for a breach by it of this Agreement.

 

(d)
The Warrant Agent shall not be liable for or by reason of any of the statements of fact or recitals contained in this Agreement
or in the Warrant Certificate (except its countersignature thereof) by the Company or be required to verify the same, but all
such statements and recitals are and shall be deemed to have been made by the Company only.

 

(e)
The Warrant Agent shall not be under any responsibility in respect of the validity of this Agreement or the execution and delivery
hereof (except the due execution hereof by the Warrant Agent) or in respect of the validity or execution of any Warrant Certificate
(except its countersignature thereof); nor shall it be responsible for any breach by the Company of any covenant or condition
contained in this Agreement or in any Warrant Certificate; nor shall it be responsible for the adjustment of the Exercise Price
or the making of any change in the number of Ordinary Shares required under the provisions of Section 11 or 13 or responsible
for the manner, method or amount of any such change or the ascertaining of the existence of facts that would require any such
adjustment or change (except with respect to the exercise of Warrants evidenced by the Warrant Certificates after actual notice
of any adjustment of the Exercise Price); nor shall it by any act hereunder be deemed to make any representation or warranty as
to the authorization or reservation of any Ordinary Shares to be issued pursuant to this Agreement or any Warrant Certificate
or as to whether any Ordinary Shares will, when issued, be duly authorized, validly issued, fully paid and nonassessable.

 

(f)
Each party hereto agrees that it will perform, execute, acknowledge and deliver or cause to be performed, executed, acknowledged
and delivered all such further and other acts, instruments and assurances as may reasonably be required by the other party hereto
for the carrying out or performing by any party of the provisions of this Agreement.

 

    10

     

    

 

(g)
The Warrant Agent is hereby authorized to accept instructions with respect to the performance of its duties hereunder from the
Chief Executive Officer, Chief Financial Officer or Vice President of the Company, and to apply to such officers for advice or
instructions in connection with its duties, and it shall not be liable and shall be indemnified and held harmless for any action
taken or suffered to be taken by it in good faith in accordance with instructions of any such officer, provided Warrant Agent
carries out such instructions without gross negligence or willful misconduct.

 

(h)
The Warrant Agent and any shareholder, director, officer or employee of the Warrant Agent may buy, sell or deal in any of the
Warrants or other securities of the Company or become pecuniarily interested in any transaction in which the Company may be interested,
or contract with or lend money to the Company or otherwise act as fully and freely as though it were not Warrant Agent under this
Agreement. Nothing herein shall preclude the Warrant Agent from acting in any other capacity for the Company or for any other
legal entity.

 

(i)
The Warrant Agent may execute and exercise any of the rights or powers hereby vested in it or perform any duty hereunder either
itself or by or through its attorney or agents, and the Warrant Agent shall not be answerable or accountable for any act, default,
neglect or misconduct of any such attorney or agents or for any loss to the Company resulting from any such act, default, neglect
or misconduct, provided reasonable care was exercised in the selection and continued employment thereof.

 

Section
17. Change of Warrant Agent. The Warrant Agent may resign and be discharged from its duties under this Agreement upon 30
days’ notice in writing sent to the Company and to each transfer agent of the Ordinary Shares, and to the Holders of the
Warrant Certificates. The Company may remove the Warrant Agent or any successor Warrant Agent upon 30 days’ notice in writing,
sent to the Warrant Agent or successor Warrant Agent, as the case may be, and to each transfer agent of the Ordinary Shares, and
to the Holders of the Warrant Certificates. If the Warrant Agent shall resign or be removed or shall otherwise become incapable
of acting, the Company shall appoint a successor to the Warrant Agent. If the Company shall fail to make such appointment within
a period of 30 days after such removal or after it has been notified in writing of such resignation or incapacity by the resigning
or incapacitated Warrant Agent or by the Holder of a Warrant Certificate (who shall, with such notice, submit his Warrant Certificate
for inspection by the Company), then the Holder of any Warrant Certificate may apply to any court of competent jurisdiction for
the appointment of a new Warrant Agent, provided that, for purposes of this Agreement, the Company shall be deemed to be the Warrant
Agent until a new warrant agent is appointed. Any successor Warrant Agent, whether appointed by the Company or by such a court,
shall be a corporation organized and doing business under the laws of the United States or of a state thereof, in good standing,
which is authorized under such laws to exercise corporate trust powers and is subject to supervision or examination by federal
or state authority and which has at the time of its appointment as Warrant Agent a combined capital and surplus of at least $50,000,000.
After appointment, the successor Warrant Agent shall be vested with the same powers, rights, duties and responsibilities as if
it had been originally named as Warrant Agent without further act or deed; but the predecessor Warrant Agent shall deliver and
transfer to the successor Warrant Agent any property at the time held by it hereunder, and execute and deliver any further assurance,
conveyance, act or deed necessary for the purpose. Not later than the effective date of any such appointment, the Company shall
file notice thereof in writing with the predecessor Warrant Agent and each transfer agent of the Ordinary Shares, and mail a notice
thereof in writing to the Holders of the Warrant Certificates. However, failure to give any notice provided for in this Section
17, or any defect therein, shall not affect the legality or validity of the resignation or removal of the Warrant Agent or the
appointment of the successor Warrant Agent, as the case may be.

 

Section
18. Issuance of New Warrant Certificates. Notwithstanding any of the provisions of this Agreement or of the Warrants to
the contrary, the Company may, at its option, issue new Warrant Certificates evidencing Warrants in such form as may be approved
by its Board of Directors to reflect any adjustment or change in the Exercise Price per share and the number or kind or class
of shares of stock or other securities or property purchasable under the several Warrant Certificates made in accordance with
the provisions of this Agreement.

 

    11

     

    

 

Section
19. Notices. Notices or demands authorized by this Agreement to be given or made (i) by the Warrant Agent or by the Holder
of any Warrant Certificate to or on the Company, (ii) subject to the provisions of Section 17, by the Company or by the Holder
of any Warrant Certificate to or on the Warrant Agent or (iii) by the Company or the Warrant Agent to the Holder of any Warrant
Certificate shall be deemed given (a) on the date delivered, if delivered personally, (b) on the first Business Day following
the deposit thereof with Federal Express or another recognized overnight courier, if sent by Federal Express or another recognized
overnight courier, (c) on the fourth Business Day following the mailing thereof with postage prepaid, if mailed by registered
or certified mail (return receipt requested), and (d) the date of transmission, if such notice or communication is delivered via
facsimile or email attachment at or prior to 5:30 p.m. (New York City time) on a Business Day and (e) the next Business Day after
the date of transmission, if such notice or communication is delivered via facsimile or email attachment on a day that is not
a Business Day or later than 5:30 p.m. (New York City time) on any Business Day, in each case to the parties at the following
addresses (or at such other address for a party as shall be specified by like notice):

 

		(a)	If
                                         to the Company, to:

 

PainReform
Ltd.

39
Round Hill Road

Dobbs
Ferry, New York 10522

Attention:
Dr. David E. Weinstein

 

		(b)	If
                                         to the Warrant Agent, to:

 

American
Stock Transfer & Trust Company

6201
15th Avenue

Brooklyn,
New York 11219

 

For
any notice delivered by email to be deemed given or made, such notice must be followed by notice sent by overnight courier service
to be delivered on the next business day following such email, unless the recipient of such email has acknowledged via return
email receipt of such email.

 

(c)
If to the Holder of any Warrant Certificate to the address of such Holder as shown on the registry books of the Company. Any notice
required to be delivered by the Company to the Holder of any Warrant may be given by the Warrant Agent on behalf of the Company.
Notwithstanding any other provision of this Agreement, where this Agreement provides for notice of any event to a Holder of any
Warrant, such notice shall be sufficiently given if given to the Depositary (or its designee) pursuant to the procedures of the
Depositary or its designee.

 

Section
20. Supplements and Amendments.

 

(a)
The Company and the Warrant Agent may from time to time supplement or amend this Agreement without the approval of any Holders
of Global Warrants in order to add to the covenants and agreements of the Company for the benefit of the Holders of the Global
Warrants or to surrender any rights or power reserved to or conferred upon the Company in this Agreement, provided that such addition
or surrender shall not adversely affect the interests of the Holders of the Global Warrants or Warrant Certificates in any material
respect.

 

(b)
In addition to the foregoing, with the consent of Holders of Warrants entitled, upon exercise thereof, to receive not less than
a majority of the Ordinary Shares issuable thereunder, the Company and the Warrant Agent may modify this Agreement for the purpose
of adding any provisions to or changing in any manner or eliminating any of the provisions of this Warrant Agreement or modifying
in any manner the rights of the Holders of the Global Warrants; provided, however, that no modification of the terms
(including but not limited to the adjustments described in Section 11) upon which the Warrants are exercisable or the rights of
holders of Warrants to receive liquidated damages or other payments in cash from the Company or reducing the percentage required
for consent to modification of this Agreement may be made without the consent of the Holder of each outstanding Warrant Certificate
affected thereby; provided further, however, that no amendment hereunder shall affect any terms of any Warrant Certificate
issued in a Warrant Exchange. As a condition precedent to the Warrant Agent’s execution of any amendment, the Company shall
deliver to the Warrant Agent a certificate from a duly authorized officer of the Company that states that the proposed amendment
complies with the terms of this Section 20.

 

    12

     

    

 

Section
21. Successors. All covenants and provisions of this Agreement by or for the benefit of the Company or the Warrant Agent
shall bind and inure to the benefit of their respective successors and assigns hereunder.

 

Section
22. Benefits of this Agreement. Nothing in this Agreement shall be construed to give any Person other than the Company,
the Holders of Warrant Certificates and the Warrant Agent any legal or equitable right, remedy or claim under this Agreement.
This Agreement shall be for the sole and exclusive benefit of the Company, the Warrant Agent and the Holders of the Warrant Certificates.

 

Section
23. Governing Law. This Agreement and each Warrant Certificate and Global Warrant issued hereunder shall be governed by,
and construed in accordance with, the laws of the State of New York, without giving effect to the conflicts of law principles
thereof.

 

Section
24. Counterparts. This Agreement may be executed in any number of counterparts and each of such counterparts shall for
all purposes be deemed to be an original, and all such counterparts shall together constitute but one and the same instrument.

 

Section
25. Captions. The captions of the sections of this Agreement have been inserted for convenience only and shall not control
or affect the meaning or construction of any of the provisions hereof.

 

Section
26. Information. The Company agrees to promptly provide to the Holders of the Warrants any information it provides to the
holders of the Ordinary Shares, except to the extent any such information is publicly available on the EDGAR system (or any successor
thereof) of the Securities and Exchange Commission.

 

[Signature
page to follow]

 

    13

     

    

 

IN
WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed as of the day and year first above written.

 

	 	PAINREFORM LTD.
	 	 
	 	By:	             
	 	Name:	 
	 	Title:	 
	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 
	 	 
	 	AMERICAN STOCK TRANSFER & TRUST COMPANY
	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 

 

    14

     

    

 

Exhibit
1

 

Form
of Warrant Certificate

 

 

    15

     

    

 

Exhibit
2

 

Form
of Warrant Certificate Request Notice

 

WARRANT
CERTIFICATE REQUEST NOTICE

 

To:
American Stock Transfer & Trust Company, as Warrant Agent for PainReform Ltd. (the “Company”)

 

The
undersigned Holder of Ordinary Share Purchase Warrants (“Warrants”) in the form of Global Warrants issued by
the Company hereby elects to receive a Warrant Certificate evidencing the Warrants held by the Holder as specified below:

 

		1.	Name
                                         of Holder of Warrants in form of Global Warrants: _____________________________

 

		2.	Name
                                         of Holder in Warrant Certificate (if different from name of Holder of Warrants in form
                                         of Global Warrants): ________________________________

 

		3.	Number
                                         of Warrants in name of Holder in form of Global Warrants: ___________________

 

		4.	Number
                                         of Warrants for which Warrant Certificate shall be issued: __________________

 

		5.	Number
                                         of Warrants in name of Holder in form of Global Warrants after issuance of Warrant Certificate,
                                         if any: ___________

 

		6.	Warrant
                                         Certificate shall be delivered to the following address:

 

______________________________

 

______________________________

 

______________________________

 

______________________________

 

The
undersigned hereby acknowledges and agrees that, in connection with this Warrant Exchange and the issuance of the Warrant Certificate,
the Holder is deemed to have surrendered the number of Warrants in form of Global Warrants in the name of the Holder equal to
the number of Warrants evidenced by the Warrant Certificate.

 

[SIGNATURE
OF HOLDER]

 

Name
of Investing Entity: ____________________________________________________

 

Signature
of Authorized Signatory of Investing Entity: ______________________________

 

Name
of Authorized Signatory: ________________________________________________

 

Title
of Authorized Signatory: _________________________________________________

 

Date:
_______________________________________________________________

 

    16

     

    

 

Exhibit
3

 

Form
of Global Warrant Request Notice

 

GLOBAL
WARRANT REQUEST NOTICE

 

To:
American Stock Transfer & Trust Company, as Warrant Agent for PainReform Ltd. (the “Company”)

 

The
undersigned Holder of Ordinary Share Purchase Warrants (“Warrants”) in the form of Warrants Certificates issued
by the Company hereby elects to receive a Global Warrant evidencing the Warrants held by the Holder as specified below:

 

		1.	Name
                                         of Holder of Warrants in form of Warrant Certificates: _____________________________

 

		2.	Name
                                         of Holder in Global Warrant (if different from name of Holder of Warrants in form of
                                         Warrant Certificates): ________________________________

 

		3.	Number
                                         of Warrants in name of Holder in form of Warrant Certificates: ___________________

 

		4.	Number
                                         of Warrants for which Global Warrant shall be issued: __________________

 

		5.	Number
                                         of Warrants in name of Holder in form of Warrant Certificates after issuance of Global
                                         Warrant, if any: ___________

 

		6.	Global
                                         Warrant shall be delivered to the following address:

 

______________________________

 

______________________________

 

______________________________

 

______________________________

 

The
undersigned hereby acknowledges and agrees that, in connection with this Global Warrant Exchange and the issuance of the Global
Warrant, the Holder is deemed to have surrendered the number of Warrants in form of Warrant Certificates in the name of the Holder
equal to the number of Warrants evidenced by the Global Warrant.

 

[SIGNATURE
OF HOLDER]

 

Name
of Investing Entity: ____________________________________________________

 

Signature
of Authorized Signatory of Investing Entity: ______________________________

 

Name
of Authorized Signatory: ________________________________________________

 

Title
of Authorized Signatory: _________________________________________________

 

Date:
_______________________________________________________________

 

    17

     

    

 

Exhibit
4

 

Warrant
Agent Fee Schedule

 

    18

     

    

 

FORM OF ORDINARY SHARE PURCHASE WARRANT

 

PAINREFORM
LTD.

 

Warrant Shares: _______Initial Exercise Date: August __,
2020

 

THIS ORDINARY SHARE PURCHASE
WARRANT (the “Warrant”) certifies that, for value received, _____________ or its assigns (the “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 5:00 p.m. (New York City time) on
_______1 (the “Termination Date”)
but not thereafter, to subscribe for and purchase from PainReform Ltd., a company incorporated under the laws of Israel (the “Company”),
up to ___ ordinary shares (as subject to adjustment hereunder, the “Warrant Shares”). The purchase price of
one Ordinary Share under this Warrant shall be equal to the Exercise Price, as defined in Section 2(b). This Warrant shall initially
be issued and maintained in the form of a security held in book-entry form and the Depository Trust Company or its nominee (“DTC”)
shall initially be the sole registered holder of this Warrant, subject to a Holder’s right to elect to receive a Warrant
in certificated form pursuant to the terms of the Warrant Agency Agreement, in which case this sentence shall not apply.

 

Section 1.Definitions.
In addition to the terms defined elsewhere in this Warrant, the following terms have the meanings indicated in this Section 1:

 

“Affiliate”
means any Person that, directly or indirectly through one or more intermediaries, controls or is controlled by or is under common
control with a Person, as such terms are used in and construed under Rule 405 under the Securities Act.

 

“Bid
Price” means, for any date, the price determined by the first of the following clauses that applies: (a) if the Ordinary
Shares are then listed or quoted on a Trading Market, the bid price of the Ordinary Shares for the time in question (or the nearest
preceding date) on the Trading Market on which the Ordinary Shares are then listed or quoted as reported by Bloomberg L.P. (based
on a Trading Day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (b)  if OTCQB or OTCQX is not a Trading
Market, the volume weighted average price of the Ordinary Shares for such date (or the nearest preceding date) on OTCQB or OTCQX
as applicable, (c) if the Ordinary Shares are not then listed or quoted for trading on OTCQB or OTCQX and if prices for the Ordinary
Shares are then reported on the Pink Open Market (or a similar organization or agency succeeding to its functions of reporting
prices), the most recent bid price per Ordinary Share so reported, or (d) in all other cases, the fair market value of an
Ordinary Share as determined by an independent appraiser selected in good faith by the Holders of a majority in interest of the
Warrants then outstanding and reasonably acceptable to the Company, the fees and expenses of which shall be paid by the Company.

 

“Board
of Directors” means the board of directors of the Company.

 

“Business
Day” means any day except any Saturday, any Sunday, any day which is a federal legal holiday in the United States or
any day on which banking institutions in the State of New York are authorized or required by law or other governmental action to
close.

 

“Commission”
means the United States Securities and Exchange Commission.

  

 

		1	Insert the date that is the 5th year anniversary
of the Initial Exercise Date; provided, however, that, if such date is not a Trading Day, insert the immediately following Trading
Day.

 

    19

     

    

 

“Exchange
Act” means the Securities Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder.

 

“Ordinary
Shares” means the ordinary shares of the Company, par value NIS 0.03 per share, and any other class of securities into
which such securities may hereafter be reclassified or changed.

 

“Ordinary
Share Equivalents” means any securities of the Company or the Subsidiaries which would entitle the holder thereof to
acquire at any time Ordinary Shares, including, without limitation, any debt, preferred stock, right, option, warrant or other
instrument that is at any time convertible into or exercisable or exchangeable for, or otherwise entitles the holder thereof to
receive, Ordinary Shares.

 

“Person”
means an individual or corporation, partnership, trust, incorporated or unincorporated association, joint venture, limited liability
company, joint stock company, government (or an agency or subdivision thereof) or other entity of any kind.

 

“Registration
Statement” means the Company’s registration statement on Form F-1, as amended (File No. 333-239576).

 

“Securities
Act” means the Securities Act of 1933, as amended, and the rules and regulations promulgated thereunder.

 

“Trading
Day” means a day on which the Ordinary Shares are traded on a Trading Market.

 

“Trading
Market” means any of the following markets or exchanges on which the Ordinary Shares are listed or quoted for trading
on the date in question: the NYSE American, the Nasdaq Capital Market, the Nasdaq Global Market, the Nasdaq Global Select Market
or the New York Stock Exchange (or any successors to any of the foregoing).

 

“Transfer
Agent” means American Stock Transfer & Trust Company, the current transfer agent of the Company, with a mailing address
of 6201 15th Avenue, Brooklyn, New York 11219, and any successor transfer agent of the Company.

 

“Underwriting
Agreement” means the underwriting agreement, dated as of August __, 2020 among the Company and Maxim Group LLC as representative
of the underwriters named therein, as amended, modified or supplemented from time to time in accordance with its terms.

 

“VWAP”
means, for any date, the price determined by the first of the following clauses that applies: (a) if the Ordinary Shares are then
listed or quoted on a Trading Market, the daily volume weighted average price of the Ordinary Shares for such date (or the nearest
preceding date) on the Trading Market on which the Ordinary Shares are then listed or quoted as reported by Bloomberg L.P. (based
on a Trading Day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (b)  if OTCQB or OTCQX is not a Trading
Market, the volume weighted average price of the Ordinary Shares for such date (or the nearest preceding date) on OTCQB or OTCQX
as applicable, (c) if the Ordinary Shares are not then listed or quoted for trading on OTCQB or OTCQX and if prices for the Ordinary
Shares are then reported on the Pink Open Market (or a similar organization or agency succeeding to its functions of reporting
prices), the most recent bid price per Ordinary Share so reported, or (d) in all other cases, the fair market value of an
Ordinary Share as determined by an independent appraiser selected in good faith by the holders of a majority in interest of the
Warrants then outstanding and reasonably acceptable to the Company, the fees and expenses of which shall be paid by the Company.

 

    20

     

    

 

“Warrant
Agency Agreement” means that certain warrant agency agreement, dated on or about the Initial Exercise Date, between the
Company and the Warrant Agent.

 

“Warrant
Agent” means the Transfer Agent and any successor warrant agent of the Company.

 

“Warrants”
means this Warrant and other Ordinary Share purchase warrants issued by the Company pursuant to the Registration Statement.

 

Section 2.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 delivery to the Company of a duly executed facsimile
copy (or e-mail attachment) of the Notice of Exercise in the form annexed hereto (the “Notice of Exercise“).
Within the earlier of (i) two (2) Trading Days and (ii) the number of Trading Days comprising the Standard Settlement Period (as
defined in Section 2(d)(i) herein) following the date of exercise as aforesaid, the Holder shall deliver the aggregate Exercise
Price for the shares specified in the applicable Notice of Exercise by wire transfer or cashier’s check drawn on a United
States bank unless the cashless exercise procedure specified in Section 2(c) below is specified in the applicable Notice of Exercise.
No ink-original Notice of Exercise shall be required, nor shall any medallion guarantee (or other type of guarantee or notarization)
of any Notice of Exercise be required. 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 three
(3) Trading Days of the date on which 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 within one (1) Business Day of receipt of such notice. 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.

 

Notwithstanding the foregoing
in this Section 2(a), a holder whose interest in this Warrant is a beneficial interest in certificate(s) representing this Warrant
held in book-entry form through DTC (or another established clearing corporation performing similar functions), shall effect exercises
made pursuant to this Section 2(a) by delivering to DTC (or such other clearing corporation, as applicable) the appropriate instruction
form for exercise, complying with the procedures to effect exercise that are required by DTC (or such other clearing corporation,
as applicable), subject to a Holder’s right to elect to receive a Definitive Warrant pursuant to the terms of the Warrant
Agency Agreement, in which case this sentence shall not apply.

 

b) Exercise
Price. The exercise price per Ordinary Share under this Warrant shall be $_____2,
subject to adjustment hereunder (the “Exercise Price”).

 

 

		2	Insert [__]% of the price
of each Ordinary Share sold in the Offering.

 

    21

     

    

 

c) Cashless
Exercise. The Company will use its best efforts to cause the Registration Statement to remain effective with a current prospectus
until the later of nine (9) months from the Execution Date (as defined in the Underwriting Agreement) and the date on which the
Representative Warrants (as defined in the Underwriting Agreement) and this Warrant are no longer outstanding. If at the time of
exercise hereof there is no effective registration statement registering, or the prospectus contained therein is not available
for the issuance of the Warrant Shares to the Holder, then this Warrant may also be exercised, in whole or in part, at such time
by means of a “cashless exercise” in which the Holder shall be entitled to receive a number of Warrant Shares equal
to the quotient obtained by dividing ((A-B)(X)) by (A), where:

 

(A) = as applicable:
(i) the VWAP on the Trading Day immediately preceding the date of the applicable Notice of Exercise if such Notice of Exercise
is (1) both executed and delivered pursuant to Section 2(a) hereof on a day that is not a Trading Day or (2) both executed and
delivered pursuant to Section 2(a) hereof on a Trading Day prior to the opening of “regular trading hours” (as defined
in Rule 600(b)(68) of Regulation NMS promulgated under the federal securities laws) on such Trading Day, (ii) at the option of
the Holder, either (y) the VWAP on the Trading Day immediately preceding the date of the applicable Notice of Exercise or (z) the
Bid Price of the Ordinary Shares on the principal Trading Market as reported by Bloomberg L.P. as of the time of the Holder’s
execution of the applicable Notice of Exercise if such Notice of Exercise is executed during “regular trading hours”
on a Trading Day and is delivered within two (2) hours thereafter (including until two (2) hours after the close of “regular
trading hours” on a Trading Day) pursuant to Section 2(a) hereof or (iii) the VWAP on the date of the applicable Notice of
Exercise if the date of such Notice of Exercise is a Trading Day and such Notice of Exercise is both executed and delivered pursuant
to Section 2(a) hereof after the close of “regular trading hours” on such Trading Day;

 

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

 

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

 

If Warrant
Shares are issued in such a cashless exercise, the parties acknowledge and agree that in accordance with Section 3(a)(9) of the
Securities Act, the Warrant Shares shall take on the registered characteristics of the Warrants being exercised. The Company agrees
not to take any position contrary to this Section 2(c).

 

Notwithstanding
anything herein to the contrary, on the Termination Date, this Warrant shall be automatically exercised via cashless exercise pursuant
to this Section 2(c).

 

    22

     

    

 

d) Mechanics
of Exercise.

 

 i. Delivery of Warrant Shares Upon Exercise. The Company shall cause the Warrant Shares purchased hereunder to be transmitted by the Transfer Agent to the Holder by crediting the account of the Holder’s or its designee’s balance account with The Depository Trust Company through its Deposit or Withdrawal at Custodian system (“DWAC”) if the Company is then a participant in such system and either (A) there is an effective registration statement permitting the issuance of the Warrant Shares to or resale of the Warrant Shares by Holder or (B) this Warrant is being exercised via cashless exercise, and otherwise by physical delivery of a certificate, registered in the Company’s share register in the name of the Holder or its designee, for the number of Warrant Shares to which the Holder is entitled pursuant to such exercise to the address specified by the Holder in the Notice of Exercise by the date that is the earliest of (i) two (2) Trading Days after the delivery to the Company of the Notice of Exercise, (ii) one (1) Trading Day after delivery of the aggregate Exercise Price to the Company and (iii) the number of Trading Days comprising the Standard Settlement Period after the delivery to the Company of the Notice of Exercise (such date, the “Warrant Share Delivery Date”). Upon delivery of the Notice of Exercise, 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 Warrant Shares, provided that payment of the aggregate Exercise Price (other than in the case of a cashless exercise) is received within the earlier of (i) two (2) Trading Days and (ii) the number of Trading Days comprising the Standard Settlement Period following delivery of the Notice of Exercise. If the Company fails for any reason to deliver to the Holder the Warrant Shares subject to a Notice of Exercise by the Warrant Share Delivery Date, the Company shall pay to the Holder, in cash, as liquidated damages and not as a penalty, for each $1,000 of Warrant Shares subject to such exercise (based on the VWAP of the Ordinary Shares on the date of the applicable Notice of Exercise), $10 per Trading Day (increasing to $20 per Trading Day on the fifth Trading Day after such liquidated damages begin to accrue) for each Trading Day after such Warrant Share Delivery Date until such Warrant Shares are delivered or Holder rescinds such exercise. The Company agrees to maintain a transfer agent that is a participant in the FAST program so long as this Warrant remains outstanding and exercisable. As used herein, “Standard Settlement Period” means the standard settlement period, expressed in a number of Trading Days, on the Company’s primary Trading Market with respect to the Ordinary Shares as in effect on the date of delivery of the Notice of Exercise.

 

ii. 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 Warrant Shares, deliver to the Holder a new Warrant
evidencing the rights of the 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.

 

iii. Rescission
Rights. If the Company fails to cause the Transfer Agent to transmit to the Holder the Warrant Shares pursuant to Section 2(d)(i)
by the Warrant Share Delivery Date, then the Holder will have the right to rescind such exercise.

 

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iv. Compensation
for Buy-In on Failure to Timely Deliver Warrant Shares Upon Exercise. In addition to any other rights available to the
Holder, if the Company fails to cause the Transfer Agent to transmit to the Holder the Warrant Shares in accordance with the
provisions of Section 2(d)(i) above pursuant to an exercise on or before the Warrant Share Delivery Date, and if after such
date the Holder is required by its broker to purchase (in an open market transaction or otherwise) or the Holder’s
brokerage firm otherwise purchases, Ordinary Shares to deliver in satisfaction of a sale by the Holder of the Warrant Shares
which the Holder anticipated receiving upon such exercise (a “Buy-In”), then the Company shall (A) pay in
cash to the Holder the amount, if any, by which (x) the Holder’s total purchase price (including brokerage commissions,
if any) for the Ordinary Shares so purchased exceeds (y) the amount obtained by multiplying (1) the number of Warrant Shares
that the Company was required to deliver to the Holder in connection with the exercise at issue times (2) the price at which
the sell order giving rise to such purchase obligation was executed, and (B) at the option of the Holder, either reinstate
the portion of the Warrant and equivalent number of Warrant Shares for which such exercise was not honored (in which case
such exercise shall be deemed rescinded) or deliver to the Holder the number of Ordinary Shares that would have been issued
had the Company timely complied with its exercise and delivery obligations hereunder. For example, if the Holder purchases
Ordinary Shares having a total purchase price of $11,000 to cover a Buy-In with respect to an attempted exercise of Ordinary
Shares with an aggregate sale price giving rise to such purchase obligation of $10,000, under clause (A) of the immediately
preceding sentence the Company shall be required to pay the Holder $1,000. The Holder shall provide the Company written
notice indicating the amounts payable to the Holder in respect of the Buy-In and, upon request of the Company, evidence of
the amount of such loss. Nothing herein shall limit a Holder’s right to pursue any other remedies available to it
hereunder, at law or in equity including, without limitation, a decree of specific performance and/or injunctive relief with
respect to the Company’s failure to timely deliver Ordinary Shares upon exercise of the Warrant as required pursuant to
the terms hereof.

 

v. 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 the 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.

 

vi. Charges,
Taxes and Expenses. Issuance of 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 Warrant Shares, all of which taxes and expenses shall be paid by the
Company, and such Warrant Shares 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 that 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. The Company shall pay all Transfer Agent fees required for same-day processing of any Notice of Exercise and all fees
to the Depository Trust Company (or another established clearing corporation performing similar functions) required for same-day
electronic delivery of the Warrant Shares.

 

vii. Closing
of Books. The Company will not close its shareholder books or records in any manner which prevents the timely exercise of this
Warrant, pursuant to the terms hereof.

 

    24

     

    

 

e) Holder’s
Exercise Limitations. The Company shall not effect any exercise of this Warrant, and a Holder shall not have the right to
exercise any portion of this Warrant, pursuant to Section 2 or otherwise, to the extent that after giving effect to such
issuance after exercise as set forth on the applicable Notice of Exercise, the Holder (together with the Holder’s
Affiliates, and any other Persons acting as a group together with the Holder or any of the Holder’s Affiliates (such
Persons, “Attribution Parties”)), would beneficially own in excess of the Beneficial Ownership Limitation (as
defined below).  For purposes of the foregoing sentence, the number of Ordinary Shares beneficially owned by the Holder
and its Affiliates and Attribution Parties shall include the number of Ordinary Shares issuable upon exercise of this Warrant
with respect to which such determination is being made, but shall exclude the number of Ordinary Shares which would be
issuable upon (i) exercise of the remaining, nonexercised portion of this Warrant beneficially owned by the Holder or any of
its Affiliates or Attribution Parties and (ii) exercise or conversion of the unexercised or nonconverted portion of any other
securities of the Company (including, without limitation, any other Ordinary Share Equivalents) subject to a limitation on
conversion or exercise analogous to the limitation contained herein beneficially owned by the Holder or any of its Affiliates
or Attribution Parties.  Except as set forth in the preceding sentence, for purposes of this Section 2(e), beneficial
ownership shall be calculated in accordance with Section 13(d) of the Exchange Act and the rules and regulations promulgated
thereunder, it being acknowledged by the Holder that the Company is not representing to the Holder that such calculation is
in compliance with Section 13(d) of the Exchange Act and the Holder is solely responsible for any schedules required to be
filed in accordance therewith. To the extent that the limitation contained in this Section 2(e) applies, the determination of
whether this Warrant is exercisable (in relation to other securities owned by the Holder together with any Affiliates and
Attribution Parties) and of which portion of this Warrant is exercisable shall be in the sole discretion of the Holder, and
the submission of a Notice of Exercise shall be deemed to be the Holder’s determination of whether this Warrant is
exercisable (in relation to other securities owned by the Holder together with any Affiliates and Attribution Parties) and of
which portion of this Warrant is exercisable, in each case subject to the Beneficial Ownership Limitation, and the Company
shall have no obligation to verify or confirm the accuracy of such determination. In addition, a determination as to any
group status as contemplated above shall be determined in accordance with Section 13(d) of the Exchange Act and the rules and
regulations promulgated thereunder. For purposes of this Section 2(e), in determining the number of outstanding Ordinary
Shares, a Holder may rely on the number of outstanding Ordinary Shares as reflected in (A) the Company’s most recent
periodic or annual report filed with the Commission, as the case may be, (B) a more recent public announcement by the Company
or (C) a more recent written notice by the Company or the Transfer Agent setting forth the number of Ordinary Shares
outstanding.  Upon the written or oral request of a Holder, the Company shall within one Trading Day confirm orally and
in writing to the Holder the number of Ordinary Shares then outstanding.  In any case, the number of outstanding
Ordinary Shares shall be determined after giving effect to the conversion or exercise of securities of the Company, including
this Warrant, by the Holder or its Affiliates or Attribution Parties since the date as of which such number of outstanding
Ordinary Shares was reported. The “Beneficial Ownership Limitation” shall be 4.99% (or, upon election by a
Holder prior to the issuance of any Warrants, 9.99%) of the number of Ordinary Shares outstanding immediately after giving
effect to the issuance of Ordinary Shares issuable upon exercise of this Warrant. The Holder, upon notice to the Company, may
increase or decrease the Beneficial Ownership Limitation provisions of this Section 2(e), provided that the Beneficial
Ownership Limitation in no event exceeds 9.99% of the number of Ordinary Shares outstanding immediately after giving effect
to the issuance of Ordinary Shares upon exercise of this Warrant held by the Holder and the provisions of this Section 2(e)
shall continue to apply. Any increase in the Beneficial Ownership Limitation will not be effective until the 61st
day after such notice is delivered to the Company. The provisions of this paragraph shall be construed and implemented in a
manner otherwise than in strict conformity with the terms of this Section 2(e) to correct this paragraph (or any portion
hereof) which may be defective or inconsistent with the intended Beneficial Ownership Limitation herein contained or to make
changes or supplements necessary or desirable to properly give effect to such limitation. The limitations contained in this
paragraph shall apply to a successor holder of this Warrant.

 

    25

     

    

 

Section 3.Certain
Adjustments.

 

a) Share
Dividends and Splits. If the Company, at any time while this Warrant is outstanding: (i) pays a share dividend or otherwise
makes a distribution or distributions on its Ordinary Shares or any other equity or equity equivalent securities payable in Ordinary
Shares (which, for avoidance of doubt, shall not include any Ordinary Shares issued by the Company upon exercise of this Warrant),
(ii) subdivides outstanding Ordinary Shares into a larger number of shares, (iii) combines (including by way of reverse share split)
outstanding Ordinary Shares into a smaller number of shares, or (iv) issues by reclassification of Ordinary Shares any shares of
capital stock of the Company, then in each case the Exercise Price shall be multiplied by a fraction of which the numerator shall
be the number of Ordinary Shares (excluding treasury shares, if any) outstanding immediately before such event and of which the
denominator shall be the number of Ordinary Shares outstanding immediately after such event, and the number of shares issuable
upon exercise of this Warrant shall be proportionately adjusted such that the aggregate Exercise Price of this Warrant shall remain
unchanged. Any adjustment made pursuant to this Section 3(a) shall become effective immediately after the record date for the determination
of shareholders entitled to receive such dividend or distribution and shall become effective immediately after the effective date
in the case of a subdivision, combination or re-classification.

 

b) Subsequent
Rights Offerings. In addition to any adjustments pursuant to Section 3(a) above, if at any time the Company grants, issues
or sells any Ordinary Share Equivalents or rights to purchase stock, warrants, securities or other property pro rata to the record
holders of any class of Ordinary Shares (the “Purchase Rights”), then the Holder will be entitled to acquire,
upon the terms applicable to such Purchase Rights, the aggregate Purchase Rights which the Holder could have acquired if the Holder
had held the number of Ordinary Shares acquirable upon complete exercise of this Warrant (without regard to any limitations on
exercise hereof, including without limitation, the Beneficial Ownership Limitation) immediately before the date on which a record
is taken for the grant, issuance or sale of such Purchase Rights, or, if no such record is taken, the date as of which the record
holders of Ordinary Shares are to be determined for the grant, issue or sale of such Purchase Rights (provided, however, to the
extent that the Holder’s right to participate in any such Purchase Right would result in the Holder exceeding the Beneficial
Ownership Limitation, then the Holder shall not be entitled to participate in such Purchase Right to such extent (or beneficial
ownership of such Ordinary Shares as a result of such Purchase Right to such extent) and such Purchase Right to such extent shall
be held in abeyance for the Holder until such time, if ever, as its right thereto would not result in the Holder exceeding the
Beneficial Ownership Limitation).

 

c) Pro
Rata Distributions. During such time as this Warrant is outstanding, if the Company shall declare or make any dividend or
other distribution of its assets (or rights to acquire its assets) to holders of Ordinary Shares, 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, the Holder shall
be entitled to participate in such Distribution to the same extent that the Holder would have participated therein if the
Holder had held the number of Ordinary Shares acquirable upon complete exercise of this Warrant (without regard to any
limitations on exercise hereof, including without limitation, the Beneficial Ownership Limitation) immediately before the
date of which a record is taken for such Distribution, or, if no such record is taken, the date as of which the record
holders of Ordinary Shares are to be determined for the participation in such Distribution (provided, however,
to the extent that the Holder’s right to participate in any such Distribution would result in the Holder exceeding the
Beneficial Ownership Limitation, then the Holder shall not be entitled to participate in such Distribution to such extent (or
in the beneficial ownership of any Ordinary Shares as a result of such Distribution to such extent) and the portion of such
Distribution shall be held in abeyance for the benefit of the Holder until such time, if ever, as its right thereto would not
result in the Holder exceeding the Beneficial Ownership Limitation).

 

    26

     

    

 

d) Fundamental
Transaction. If, at any time while this Warrant is outstanding, (i) the Company, directly or indirectly, in one or more
related transactions effects any merger or consolidation of the Company with or into another Person, (ii) the Company,
directly or indirectly, effects any sale, lease, license, assignment, transfer, conveyance or other disposition of all or
substantially all of its assets in one or a series of related transactions, (iii) any, direct or indirect, purchase offer,
tender offer or exchange offer (whether by the Company or another Person) is completed pursuant to which holders of Ordinary
Shares are permitted to sell, tender or exchange their shares for other securities, cash or property and has been accepted by
the holders of 50% or more of the outstanding Ordinary Shares, (iv) the Company, directly or indirectly, in one or more
related transactions effects any reclassification, reorganization or recapitalization of the Ordinary Shares or any
compulsory share exchange pursuant to which the Ordinary Shares is effectively converted into or exchanged for other
securities, cash or property, or (v) the Company, directly or indirectly, in one or more related transactions consummates a
stock or share purchase agreement or other business combination (including, without limitation, a reorganization,
recapitalization, spin-off or scheme of arrangement) with another Person or group of Persons whereby such other Person or
group acquires more than 50% of the outstanding Ordinary Shares (not including any Ordinary Shares 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 or
share purchase agreement or other business combination) (each a “Fundamental Transaction”), then, upon any
subsequent exercise of this Warrant, the Holder shall have the right to receive, for each Warrant Share that would have been
issuable upon such exercise immediately prior to the occurrence of such Fundamental Transaction, at the option of the Holder
(without regard to any limitation in Section 2(e) on the exercise of this Warrant), the number of Ordinary Shares of the
successor or acquiring corporation or of the Company, if it is the surviving corporation, and any additional consideration
(the “Alternate Consideration”) receivable as a result of such Fundamental Transaction by a holder of the
number of Ordinary Shares for which this Warrant is exercisable immediately prior to such Fundamental Transaction (without
regard to any limitation in Section 2(e) on the exercise of this Warrant). For purposes of any such exercise, the
determination of the Exercise Price shall be appropriately adjusted to apply to such Alternate Consideration based on the
amount of Alternate Consideration issuable in respect of one Ordinary Share in such Fundamental Transaction, and the Company
shall apportion the Exercise Price among the Alternate Consideration in a reasonable manner reflecting the relative value of
any different components of the Alternate Consideration. If holders of Ordinary Shares are given any choice as to the
securities, cash or property to be received in a Fundamental Transaction, then the Holder shall be given the same choice as
to the Alternate Consideration it receives upon any exercise of this Warrant following such Fundamental Transaction.
Notwithstanding anything to the contrary, in the event of a Fundamental Transaction, the Company or any Successor Entity (as
defined below) shall, at the Holder’s option, exercisable at any time concurrently with, or within 30 days after, the
consummation of the Fundamental Transaction (or, if later, the date of the public announcement of the applicable Fundamental
Transaction), purchase this Warrant from the Holder by paying to the Holder an amount of cash equal to the Black Scholes
Value of the remaining unexercised portion of this Warrant on the date of the consummation of such Fundamental
Transaction; provided, however, if the Fundamental Transaction is not within the Company’s control,
including not approved by the Company’s Board of Directors, the Holder shall only be entitled to receive from the Company or
any Successor Entity, as of the date of consummation of such Fundamental Transaction, the same type or form of consideration
(and in the same proportion), at the Black Scholes Value of the unexercised portion of this Warrant, that is being offered
and paid to the holders of Ordinary Shares of the Company in connection with the
Fundamental Transaction, whether that consideration be in the form of cash, stock or any combination thereof, or whether the
holders of Ordinary Shares are given the choice to receive from among alternative forms
of consideration in connection with the Fundamental Transaction. “Black Scholes
Value” means the value of this Warrant based on the Black and Scholes Option Pricing Model obtained from the
“OV” function on Bloomberg, L.P. (“Bloomberg“) determined as of the day of consummation of the
applicable Fundamental Transaction for pricing purposes and reflecting (A) a risk-free interest rate corresponding to the
U.S. Treasury rate for a period equal to the time between the date of the public announcement of the applicable Fundamental
Transaction and the Termination Date, (B) an expected volatility equal to the greater of 100% and the 100 day volatility
obtained from the HVT function on Bloomberg as of the Trading Day immediately following the public announcement of the
applicable Fundamental Transaction, (C) the underlying price per share used in such calculation shall be the greater of (i)
the sum of the price per share being offered in cash, if any, plus the value of any non-cash consideration, if any, being
offered in such Fundamental Transaction and (ii) the greater of (x) the last VWAP immediately prior to the public
announcement of such Fundamental Transaction and (y) the last VWAP immediately prior to the consummation of such Fundamental
Transaction and (D) a remaining option time equal to the time between the date of the public announcement of the applicable
Fundamental Transaction and the Termination Date. The payment of the Black Scholes Value will be made by wire transfer of
immediately available funds within five Business Days of the Holder’s election (or, if later, on the effective date of
the Fundamental Transaction). The Company shall cause any successor entity in a Fundamental Transaction in which the Company
is not the survivor (the “Successor Entity”) to assume in writing all of the obligations of the Company
under this Warrant in accordance with the provisions of this Section 3(e) pursuant to written agreements in form and
substance reasonably satisfactory to the Holder and approved by the Holder (without unreasonable delay) prior to such
Fundamental Transaction and shall, at the option of the Holder, deliver to the Holder in exchange for this Warrant a security
of the Successor Entity evidenced by a written instrument substantially similar in form and substance to this Warrant which
is exercisable for a corresponding number of shares of capital stock of such Successor Entity (or its parent entity)
equivalent to the Ordinary Shares 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 with an exercise price which applies the exercise
price hereunder to such shares of capital stock (but taking into account the relative value of the Ordinary Shares pursuant
to such Fundamental Transaction and the value of such shares of capital stock, such number of shares of capital stock and
such exercise price being for the purpose of protecting the economic value of this Warrant immediately prior to the
consummation of such Fundamental Transaction), and which is reasonably satisfactory in form and substance to the Holder. Upon
the occurrence of any such Fundamental Transaction, 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.

 

    27

     

    

 

e) Calculations.
All calculations under this Section 3 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 3, the number of Ordinary Shares deemed to be issued and outstanding as of a given date shall be the
sum of the number of Ordinary Shares (excluding treasury shares, if any) issued and outstanding.

 

f) Notice
to Holder.

 

i. Adjustment
to Exercise Price. Whenever the Exercise Price is adjusted pursuant to any provision of this Section 3, the Company shall
promptly deliver to the Holder by facsimile or email a notice setting forth the Exercise Price after such adjustment and any
resulting adjustment to the number of Warrant Shares 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
Ordinary Shares, (B) the Company shall declare a special nonrecurring cash dividend on or a redemption of the Ordinary Shares,
(C) the Company shall authorize the granting to all holders of the Ordinary 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 shareholders of the Company shall be required
in connection with any reclassification of the Ordinary 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, or any compulsory share exchange whereby the Ordinary
Shares are converted into other securities, cash or property, or (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 delivered by facsimile
or email to the Holder at its last facsimile number or email 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 Ordinary 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
Ordinary Shares of record shall be entitled to exchange their Ordinary Shares for securities, cash or other property deliverable
upon such reclassification, consolidation, merger, sale, transfer or share exchange; provided that the failure to deliver such
notice or any defect therein or in the delivery thereof shall not affect the validity of the corporate action required to be specified
in such notice. To the extent that any notice provided in this Warrant constitutes, or contains, material, non-public information
regarding the Company or any of the Subsidiaries, the Company shall simultaneously file such notice with the Commission pursuant
to a Current Report on Form 8-K. The Holder shall remain entitled to exercise this Warrant during the period commencing on the
date of such notice to the effective date of the event triggering such notice except as may otherwise be expressly set forth herein.

 

g) Voluntary
Adjustment by Company. Subject to the rules and regulations of the Trading Market, the Company may at any time during the term
of this Warrant reduce the then current Exercise Price to any amount and for any period of time deemed appropriate by the Board
of Directors.

 

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Section 4.Transfer
of Warrant.

 

a) Transferability.
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, as applicable, 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. Notwithstanding anything herein to the contrary, the Holder shall not be required to physically surrender this
Warrant to the Company unless the Holder has assigned this Warrant in full, in which case, the Holder shall surrender this
Warrant to the Company within three (3) Trading Days of the date on which the Holder delivers an assignment form to the
Company assigning this Warrant in full. The Warrant, if properly assigned in accordance herewith, may be exercised by a new
holder for the purchase of Warrant Shares without having a new Warrant issued.

 

b) 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 4(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. All Warrants issued on transfers or exchanges shall be dated the initial
issuance date of this Warrant and shall be identical with this Warrant except as to the number of Warrant Shares issuable pursuant
thereto.

 

c) Warrant
Register. The Warrant Agent (or, in the event a Holder elects to receive a Definitive Certificate (as defined in the Warrant
Agency Agreement), the Company) shall register this Warrant, upon records to be maintained by the Warrant Agent (or, in the event
a Holder elects to receive a Definitive Certificate, the Company) for that purpose (the “Warrant Register”),
in the name of the record Holder hereof from time to time. The Company and the Warrant Agent 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.

 

Section 5.Miscellaneous.

 

a) No
Rights as Shareholder Until Exercise. This Warrant does not entitle the Holder to any voting rights, dividends or other rights
as a shareholder of the Company prior to the exercise hereof as set forth in Section 2(d)(i), except as expressly set forth in
Section 3.

 

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.

 

    29

     

    

 

d) Authorized
Shares.

 

The Company
covenants that, during the period the Warrant is outstanding, it will reserve from its authorized and unissued Ordinary
Shares a sufficient number of shares to provide for the issuance of the Warrant Shares upon the exercise of any purchase
rights under this Warrant. The Company further covenants that its issuance of this Warrant shall constitute full authority to
its officers who are charged with the duty of issuing the necessary Warrant Shares upon the exercise of the purchase rights
under this Warrant. The Company will take all such reasonable action as may be necessary to assure that such Warrant Shares
may be issued as provided herein without violation of any applicable law or regulation, or of any requirements of the Trading
Market upon which the Ordinary Shares may be listed. 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 and payment for such Warrant Shares in accordance herewith, 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).

 

Except and
to the extent as waived or consented to by the Holder, the Company shall not by any action, including, without limitation, amending
its certificate of incorporation or through any reorganization, transfer of assets, consolidation, merger, 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, but will at all times in good faith assist in the carrying out of all such terms and in the taking of all such actions
as may be necessary or appropriate to protect the rights of Holder as set forth in this Warrant against impairment. Without limiting
the generality of the foregoing, the Company will (i) not increase the par value of any Warrant Shares above the amount payable
therefor upon such exercise immediately prior to such increase in par value, (ii) take all such action as may be necessary or appropriate
in order that the Company may validly and legally issue fully paid and nonassessable Warrant Shares upon the exercise of this Warrant
and (iii) use commercially reasonable efforts to obtain all such authorizations, exemptions or consents from any public regulatory
body having jurisdiction thereof, as may be, necessary to enable the Company to perform its obligations under this Warrant.

 

Before taking
any action which would result in an adjustment in the number of Warrant Shares for which this Warrant is exercisable or in the
Exercise Price, the Company shall obtain all such authorizations or exemptions thereof, or consents thereto, as may be necessary
from any public regulatory body or bodies having jurisdiction thereof.

 

e) Governing
Law. All questions concerning the construction, validity, enforcement and interpretation of this Warrant shall be
governed by and construed and enforced in accordance with the internal laws of the State of New York, without regard to the
principles of conflicts of law thereof. Each party agrees that all legal proceedings concerning the interpretations,
enforcement and defense of the transactions contemplated by this Warrant (whether brought against a party hereto or their
respective affiliates, directors, officers, shareholders, partners, members, employees or agents) shall be commenced
exclusively in the state and federal courts sitting in the City of New York. Each party hereby irrevocably submits to the
exclusive jurisdiction of the state and federal courts sitting in the City of New York, Borough of Manhattan for the
adjudication of any dispute hereunder or in connection herewith or with any transaction contemplated hereby or discussed
herein, and hereby irrevocably waives, and agrees not to assert in any suit, action or proceeding, any claim that it is not
personally subject to the jurisdiction of any such court, that such suit, action or proceeding is improper or is an
inconvenient venue for such proceeding. Each party hereby irrevocably waives personal service of process and consents to
process being served in any such suit, action or proceeding by mailing a copy thereof via registered or certified mail or
overnight delivery (with evidence of delivery) to such party at the address in effect for notices to it under this Warrant
and agrees that such service shall constitute good and sufficient service of process and notice thereof. Nothing contained
herein shall be deemed to limit in any way any right to serve process in any other manner permitted by law. If either party
shall commence an action, suit or proceeding to enforce any provisions of this Warrant, the prevailing party in such action,
suit or proceeding shall be reimbursed by the other party for their reasonable attorneys’ fees and other costs and
expenses incurred with the investigation, preparation and prosecution of such action or proceeding.

 

    30

     

    

 

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

 

g) Nonwaiver
and Expenses. No course of dealing or any delay or failure to exercise any right hereunder on the part of Holder shall operate
as a waiver of such right or otherwise prejudice the Holder’s rights, powers or remedies. Without limiting any other provision
of this Warrant, if the Company willfully and knowingly fails to comply with any provision of this Warrant, which results in any
material damages to the Holder, the Company shall pay to the Holder such amounts as shall be sufficient to cover any costs and
expenses including, but not limited to, reasonable attorneys’ fees, including those of appellate proceedings, incurred by
the Holder in collecting any amounts due pursuant hereto or in otherwise enforcing any of its rights, powers or remedies hereunder.

 

h) Notices.
Any and all notices or other communications or deliveries to be provided by the Holders hereunder including, without limitation,
any Notice of Exercise, shall be in writing and delivered personally, or e-mail, or sent by a nationally recognized overnight courier
service, addressed to:

 

If to the Company,
to:

 

PainReform Ltd.

39 Round Hill Road

Dobbs Ferry, New York 10522

Attention: Dr. David E. Weinstein

 

If to the Warrant Agent,
to:

 

American Stock Transfer & Trust Company

6201 15th Avenue

Brooklyn, New York 11219

 

or such other facsimile number,
email address or address as the Company may specify for such purposes by notice to the Holders. 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 e-mail, or
sent by a nationally recognized overnight courier service addressed to each Holder at the facsimile number, e-mail address or address
of such Holder appearing on the books of the Company. Any notice or other communication or deliveries hereunder shall be deemed
given and effective on the earliest of (i) the date of transmission, if such notice or communication is delivered via facsimile
at the facsimile number or via e-mail at the e-mail address set forth in this Section prior to 5:30 p.m. (New York City time) on
any date, (ii) the next Trading Day after the date of transmission, if such notice or communication is delivered via facsimile
at the facsimile number or via e-mail at the e-mail address set forth in this Section on a day that is not a Trading Day or later
than 5:30 p.m. (New York City time) on any Trading Day, (iii) the second Trading Day following the date of mailing, if sent by
U.S. nationally recognized overnight courier service, or (iv) upon actual receipt by the party to whom such notice is required
to be given. To the extent that any notice provided hereunder constitutes, or contains, material, non-public information regarding
the Company or any subsidiaries, the Company shall simultaneously file such notice with the Commission pursuant to a Current Report
on Form 8-K.

 

    31

     

    

 

i) Limitation
of Liability. No provision hereof, in the absence of any affirmative action by the Holder to exercise this Warrant to purchase
Warrant Shares, and no enumeration herein of the rights or privileges of the Holder, shall give rise to any liability of the Holder
for the purchase price of any Ordinary Share or as a shareholder of the Company, whether such liability is asserted by the Company
or by creditors of the Company.

 

j) Remedies.
The Holder, in addition to being entitled to exercise all rights granted by law, including recovery of damages, will be entitled
to specific performance of its rights under this Warrant. The Company agrees that monetary damages would not be adequate compensation
for any loss incurred by reason of a breach by it of the provisions of this Warrant and hereby agrees to waive and not to assert
the defense in any action for specific performance that a remedy at law would be adequate.

 

k) 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 and permitted assigns of the Company and the successors and permitted assigns
of Holder. The provisions of this Warrant are intended to be for the benefit of any Holder from time to time of this Warrant and
shall be enforceable by the Holder or holder of Warrant Shares.

 

l) Amendment.
This Warrant may be modified or amended or the provisions hereof waived with the written consent of the Company, on the one hand,
and the Holder or the beneficial owner of this Warrant, on the other hand.

 

m) 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.

 

n) Headings.
The headings used in this Warrant are for the convenience of reference only and shall not, for any purpose, be deemed a part of
this Warrant.

 

o) Warrant
Agency Agreement. If this Warrant is held in global form through DTC (or any successor depositary), this Warrant is issued
subject to the Warrant Agency Agreement. To the extent any provision of this Warrant conflicts with the express provisions of the
Warrant Agency Agreement, the provisions of this Warrant shall govern and be controlling.

 

[Signature Page Follows]

 

    32

     

    

 

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

 

	 	PAINREFORM LTD.
	 	 
	 	By:	 
	 	 	Name:
	 	 	Title:

 

    33

     

    

 

 

NOTICE OF EXERCISE

 

To:PainReform
ltd.

 

(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 2(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 2(c).

 

(3) Please
issue said Warrant Shares in the name of the undersigned or in such other name as is specified below:

 

 

 

 

The Warrant Shares shall be delivered to
the following DWAC Account Number:

 

	DTC Number: 	 	 

 

	Account name: 	 	 

 

	Account number: 	 	 

 

[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 purchase shares.)

 

FOR VALUE RECEIVED,
the foregoing Warrant and all rights evidenced thereby are hereby assigned to

 

	Name:	 	 
	 	 	(Please Print)
	 	 	 
	Address:	 	
	 	 	(Please Print)

 

	Phone Number:	 	 
	 	 	 
	Email Address:	 	 

 

	Dated: _______________ __, ______	 	 

 

	Holder’s Signature:	 	 

 

	Holder’s Address:EXHIBIT
10.1

 

USA
Equities Corp CONSULTING AGREEMENT

 

This
Consulting Agreement (this “Agreement”) is made and entered into August 24, 2020 (the “Effective
Date”) by and between USA Equities Corp a Delaware Corporation (the “Company”), and Jesus Davila, an
individual (“Consultant”).

 

WHEREAS,
Consultant has been selected based on Consultant’s business, technical and other knowledge and experience related to the
Company’s business. Consultant is willing to provide Services (as defined below) to the Company and the Company desires
to receive such Services provided by Consultant under the terms and subject to the conditions described herein.

 

NOW,
THEREFORE, the Company and Consultant agree to the following:

 

1.
Consulting Services. Commencing on date hereof, the Company retains Consultant, and Consultant hereby agrees to serve,
as a consultant to the Company. Consultant agrees, on a best efforts basis, to provide the following services to and for the benefit
of the Company: (a) provide guidance and strategic guidance in the expansion of the Company’s physician network in conjunction
with the Company’s automated cloud-based Software as a Medical Device (SaMD); (b) develop, review and comment on the
Company’s communication strategies for corporate, shareholder and investor awareness and relations, as well as its related
presentations and materials; (c) specifically, communicate directly with potential investors, strategic partners and potential
customers of the Company by telephone, electronic mail, direct mail and in person; (d) develop a database of potential investors,
strategic partners and potential customers for the Company and (e) provide consulting services to the Company at its request,
including a reasonable amount of informal consultation in person, over the telephone, by email, or otherwise as requested by the
Company. For purposes of this Agreement, the “Business of the Company” shall mean the development and commercialization
of proprietary software tools and approaches, providing more granular, timely and specific clinical decision-making information
for practicing physicians and other health care providers to address today’s obese, diabetic and chronic disease population.
The Company is developing a high-level, fully automated cloud-based Software as a Medical Device (SaMD) system named the Quality
Health Score Lab Expert System (“QHSLab”) which will provide physicians and other healthcare organizations with an
advanced platform to securely capture and store patient information electronically in a secure database. The patients’ data
is intelligently filtered, analyzed and processed according to specific and proprietary algorithms.

 

2.
Performance of Services. The manner in which the Services are to be performed and the specific hours to be worked by
Consultant shall be within Consultant’s control, Consultant will provide as many hours of the Services as may be reasonably
necessary to fulfill Consultant’s obligations under this Agreement.

 

3.
Reimbursement and Compensation.

 

(a)
The Company will reimburse Consultant for reasonable out-of-pocket expenses incurred by Consultant in providing Services at the
Company’s request from time to time, provided that such expenses conform to the Company’s policies and have been approved
in advance by an officer of the Company.

 

(b)
Share Payment. The Company shall pay a onetime stock payment of 100,000 shares of rule 144 restricted common stock of the Company
(the “Share Payment”). One Hundred Thousand shares common stock will be issued by the Company, within 30 days after
this agreement is signed and will be fully earned as of the date of issuance. Consultant acknowledges that the 100,000 shares
have not been registered under the Securities Act of 1933, as amended (the “Securities Act”), will be subject to a
Rule 144 stop transfer order and restrictive legend and may only be sold if registered or in accordance with an exemption from
the registration requirements of the Securities Act.

 

4.
Independent Contractor. Consultant’s relationship with the Company is that of an independent contractor and not
that of an employee. Consultant has no authority to obligate the Company by contract or otherwise. Consultant will not be eligible
for any employee benefits, nor will the Company make deductions from Consultant’s fees for taxes (except as otherwise required
by applicable law or regulation). Any taxes imposed on Consultant due to activities performed or payments or grants received hereunder
will be the sole responsibility of Consultant.

 

    	 	 	 

    	 	 	 

    

 

5.
Confidentiality. Consultant agrees as follows:

 

(a)
At all times during the term of Consultant’s association with the Company and thereafter, Consultant will hold in strictest
confidence and will not disclose, use, lecture upon or publish any of the Company’s Confidential Company Information (as
defined below), except to the extent such disclosure, use or publication may be required in direct connection with Consultant’s
performing requested Services for the Company or is expressly authorized in writing by an officer of the Company.

 

(b)
The term “Confidential Company Information” shall mean any and all trade secrets, confidential knowledge, know-how,
data or other proprietary information or materials of the Company or entrusted to it in confidence by third parties. By way of
illustration but not limitation, Confidential Company Information includes: (i) any and all inventions, ideas, software, data
bases, customer and patient information, samples, specimens, media, prototypes, processes, formulas, data, know-how, improvements,
discoveries, developments, designs and techniques, as well as procedures and formulations for producing or testing any thereof;
and (ii) information regarding research or development plans, protocols or results; new products and product plans; marketing
and selling plans and results; business plans; unpublished budgets and financial information; non-public information about licenses,
collaborations, prices, costs, suppliers or customers, in each case whether actual or prospective.

 

(c)
Consultant’s agreements in this Section 5 are intended to be for the benefit of the Company and any third party that has
entrusted information or physical material to the Company in confidence.

 

6.
Noncompetition and Nonsolicitation of Employees.

 

(a)
During the term of this Agreement, Consultant promptly will notify the Company of any activity that Consultant is engaged in,
or anticipates engaging in, which competes in any way with the Business of the Company. In the event that Consultant is engaged,
or intends to engage, in any activity that competes with the Business of the Company, the Company may elect to terminate Consultant’s
Services immediately.

 

(b)
During the term of this Agreement and for one (1) year after its termination or expiration, Consultant will not recruit, solicit
or induce any employee of the Company to terminate his or her employment with the Company, nor encourage or assist others to do
so. During the term of this Agreement and for one (1) year after its termination or expiration, Consultant will not solicit or
induce any customer of the Company to cease conducting business with the Company or seek similar services from a competitor of
the Company, nor encourage or assist others to do so.

 

(c)
If any restriction set forth in Section 5(a) or 5(b) above is found by any court of competent jurisdiction to be unenforceable
because it extends for too long a period of time or over too great a range of activities or in too broad a geographic area, it
shall be interpreted to extend only over the maximum period of time, range of activities and geographic area as to which it may
be enforceable.

 

7.
No Violation of Third-Party Rights. Consultant represents and warrants that the Services to be performed by Consultant
under this Agreement will not misappropriate any intellectual property or other rights of any third party. Consultant agrees not
to bring to the Company or to use in the performance of Services any confidential information of any third party, unless Consultant
has authorization from such third party for the possession and unrestricted use thereof.

 

8.
Term and Termination.

 

(a)
Unless sooner terminated as provided herein, the term of Consultant’s appointment and Services under this Agreement shall
be one (1) year starting on the Effective Date, and renewing automatically thereafter for an additional one year period (the “Term”).
Either Consultant or the Company may terminate the Term at any time upon fifteen (15) days’ prior notice, with or without
cause.

 

    	 	 	 

    	 	 	 

    

 

(b)
The obligations set forth in Sections 4, 5(b), 6, 8, 10 and 11 will survive any termination or expiration of this Agreement. Upon
termination or expiration of this Agreement, Consultant will promptly deliver to the Company all documents and other materials
of any nature pertaining to the Services, together with all documents and other items containing or pertaining to any Confidential
Company Information.

 

9.
Limitation of Liability; Indemnification. The Consultant shall have no liability or obligations to the Company whatsoever
for any actions or omissions taken in his capacities as such. In the event Consultant is made, or threatened to be made, a party
to any threatened, pending, or contemplated action or proceeding, whether civil, criminal, administrative, or investigative, arising
out of or related to the Services, Consultant shall be indemnified by the Company, and the Company shall advance to Consultant
related expenses incurred in defense of such action, to the fullest extent permitted by applicable law (including, but not limited
to, under the applicable laws of the State of Delaware). The Company acknowledges that the foregoing indemnification is a material
inducement to Consultant to provide the Services and that Consultant would not agree to serve on the Consultancy in the absence
of the foregoing indemnification.

 

10.
Assignment; Third-Party Beneficiary. This Agreement shall bind and benefit the parties and their respective successors,
heirs, executors, and administrators; provided, however, that Consultant shall not subcontract, assign or delegate Consultant’s
obligations under this Agreement, either in whole or in part, and any attempt to do so will be void.

 

11.
Remedies. Because the Services are personal and unique and because Consultant may have access to and become acquainted
with the Confidential Company Information, the Company shall have the right to enforce this Agreement and any of its provisions
by injunction, specific performance or other equitable relief, without having to post any bond that might otherwise have to be
provided, without prejudice to any other rights and remedies that the Company may have for a breach of this Agreement.

 

12.
Miscellaneous. This Agreement shall be governed by and construed according to the laws of the state of Florida, without
regard to any conflicts of laws rules to the contrary. This Agreement is intended to supplement, and not to supersede, any rights
the Company may have in law or equity with respect to the protection of trade secrets or confidential or proprietary information.
This Agreement constitutes the final, exclusive, and complete understanding and agreement of the parties with respect to its subject
matter and supersedes all prior and contemporaneous understandings and agreements regarding that subject matter. This Agreement
may be amended or modified only in a writing signed by both parties. No waiver hereunder shall be enforceable unless in a written
document signed by the party to be bound, nor shall any waiver in one instance constitute a waiver of any other breach of the
same or any other provision of this Agreement. Any notices required or permitted hereunder shall be directed to the addresses
listed on the signature page of this Agreement, or to such other address as the intended recipient shall specify in writing pursuant
to this notice provision. Notices shall be deemed given upon actual delivery or three (3) days after the date of mailing if sent
by certified or registered mail. This Agreement may be executed in one or more counterparts, each of which will be deemed an original,
but all of which together shall constitute one and the same instrument.

 

    	 	 	 

    	 	 	 

    

 

In
Witness Whereof,
Consultant and the Company have executed
this Agreement as of the Effective Date.

 

	USA
    Equities Corp	 	CONSULTANT
	 	 	 
	By:	 	 	 	
	Name:	Troy
    Grogan	 	Name:	Jesus Davila

                                                                     

	Title:	President	 	 	 
	 	 	 	 	 
	Address:	901
        Northpoint Parkway, Suite 302 West Palm

        Beach
        FLORIDA 33407
	 	Address:

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