Document:

EX-10.33

Exhibit 10.33

Hudson City Bancorp, Inc.

2006 Stock Incentive Plan

Performance-Based Restricted Stock Award Notice

	 	 	 	 	 
	 
	 	 
	 	                    -                    -                    
	Name of Award Recipient

	 	 	 	Social Security Number

 

Street Address

	 	 	 	 	 	 	 	 	 
	 

City

	 	 
	 	 

State
	 	 
	 	 
ZIP Code

This Performance-Based Restricted Stock Award Notice is intended to set forth the terms and
conditions on which a Performance-Based Restricted Stock Award has been granted under the Hudson
City Bancorp, Inc. 2006 Stock Incentive Plan. Set forth below are the specific terms and
conditions applicable to this Performance-Based Restricted Stock Award. Attached as Exhibit A are
its general terms and conditions.

	 	 	 	 	 	 	 
	Performance-Based Restricted Stock
Award

	 	(A)
	 	(B)
	 	(C)
	Effective Date
	 	 	 	 	 	 
	Class of Shares*

	 	Common
	 	Common
	 	Common
	No. of Awarded
Shares*
	 	 	 	 	 	 
	Type of Award (DRS,
Escrow or Legended
Certificate)
	 	 	 	 	 	 
	Performance Conditions*

	 	See Appendix B to
Exhibit A
	 	See Appendix B to
Exhibit A
	 	See Appendix B to
Exhibit A
	Vesting Date*

	 	1/23/2010
	 	1/23/2011
	 	1/23/1012
	Transfer Restriction Date*

	 	1/23/2012
	 	1/23/2012
	 	1/23/2012

 

			
	*	 	Subject to adjustment as provided in the Plan and Exhibit A.

By signing where indicated below, Hudson City Bancorp, Inc. (the “Company”) grants this
Performance-Based Restricted Stock Award upon the specified terms and conditions, and the Award
Recipient acknowledges receipt of this Performance-Based Restricted Stock Award Notice, including
Exhibit A, and agrees to observe and be bound by the terms and conditions set forth herein.

	 	 	 	 	 	 	 	 	 
	Hudson City Bancorp, Inc.	 	 	 	Award Recipient	 	 
	 
	 	 	 	 	 	 	 	 
	By

	 	 	 	 	 	 	 	 
	 

	 	 
	 	 	 	 	 	 
	 

	 	Name
	 	 	 	Print Name:	 	 
	 

	 	Title:	 	 	 	 	 	 

Instructions: This Performance-Based Restricted Stock Award Notice should be completed by or on
behalf of the Compensation Committee. Any blank space intentionally left blank should be crossed
out. A Performance-Based Restricted Stock Award consists of shares granted with uniform terms and
conditions. Where shares granted under a Performance-Based Restricted Stock Award are awarded on
the same date with varying terms and conditions (for example, varying vesting dates), the awards
should be recorded as a series of grants each with its own uniform terms and conditions.

 

 

EXHIBIT A

Hudson City Bancorp, Inc. 2006 Stock Incentive Plan

Performance-Based Restricted Stock Award Notice

General Terms and Conditions

     Section 1. Size and Type of Award. The shares of Common Stock, par value $.01 per
share, of Hudson City Bancorp, Inc. (“Shares”) covered by this Performance-Based Restricted Stock
Award (“Awarded Shares”) are listed on the Performance-Based Restricted Stock Award Notice. The
Performance-Based Restricted Stock Award Notice designates the Awarded Shares as either “Escrow” or
“Legended Certificate” or “DRS.”

     (a) Legended Certificate. If your Awarded Shares are designated
“Legended Certificate,” a stock certificate evidencing the Awarded Shares will be
issued in your name and held in escrow by the Committee or its designee (“Plan
Trustee”). The stock certificate will bear a legend indicating that it is subject to
all of the terms and conditions of this Performance-Based Restricted Stock Award
Notice and the Hudson City Bancorp, Inc. 2006 Stock Incentive Plan (“Plan”).

     (b) Escrow. If your Awarded Shares are designated “Escrow,” the
Awarded Shares will be held in the name of the Plan Trustee on a pooled basis with
other Awarded Shares that have been designated “Escrow.” You will not be permitted
to elect to be taxed currently on the Fair Market Value of the Awarded Shares and
instead will be subject to income tax on the Awarded Shares as and when they become
vested.

     (c) DRS. If your Awarded Shares are designated “DRS,” your Awarded
Shares are evidenced by a book entry on the Company’s stock transfer records
maintained by its transfer agent’s in a direct registration system. The book entry
will include a notation indicating that it is subject to all of the terms and
conditions of this Performance-Based Restricted Stock Award Notice and the Hudson
City Bancorp, Inc. 2006 Stock Incentive Plan (“Plan”).

     Section 2. Vesting and Transfer Restrictions.

     (a) Vesting Dates. The Vesting Dates for your Awarded Shares are
specified on the Performance-Based Restricted Stock Award Notice. On each Vesting
Date, you will obtain nonforfeitable ownership of the Awarded Shares that vest on
that Vesting Date.

     (b) Vesting Conditions Your Awarded Shares will be vested if and when
you have satisfied BOTH of the following conditions:

     (i) You must remain in the continuous service of the Company, Hudson
City Savings Bank or an affiliate of the Company by which you are employed
(your “Employer”) through the Vesting Date shown in this Performance-Based
Restricted Stock Agreement (“Service Conditions”).

     (ii) Any Performance Condition(s) specified in this Performance-Based
Restricted Stock Agreement must be met as of end of the respective
Performance Measurement Period(s) (“Performance Conditions”).

As a general rule, if you have satisfied BOTH the Service Conditions and the
Performance Conditions, your right to the Awarded Shares will be nonforfeitable.

     (c) Accelerated Vesting. Your Awarded Shares that have not previously
vested and that are scheduled to vest during the six-month period beginning on the
date of your termination of service due to your death or Disability (as defined in
the Plan), will become fully and immediately vested, without any further action on
your part, upon your death or Disability before your termination of service with the
Company. In addition, in the event of a Change in Control (as defined in the Plan)
followed by your discharge without Cause (as defined in the Plan) or your
resignation with Good Reason, your Awarded Shares will be fully and immediately
vested on the date your employment with your Employer terminates. You will be
considered to have Good Reason for a voluntary resignation if the effective date of
resignation occurs within ninety (90) days after any of the following: (a) the
failure of your Employer (whether by act or omission of its Board of Directors, or
otherwise) to appoint or re-appoint or elect or re-elect you to the position(s)
which you held immediately prior to the Change in Control (other than to any such
position as an officer of its Board of Directors), or to a more senior office; (b)
if you are or become a member of the Board of Directors of your Employer, the
failure of the shareholders (whether in an election in which you stand as a nominee
or in an election where you are not a nominee) to elect or re-elect you to
membership at the expiration of your term of membership, unless such failure is a
result of your refusal to stand for election; (c) a material failure by your
Employer, whether by amendment of its certificate of incorporation or organization,
by-laws, action of its Board of Directors or otherwise, to vest in you the
functions, duties, or responsibilities prescribed in an employment or retention
agreement (other than such functions, duties or responsibilities associated with a
position as an officer of the Board of Directors); provided that you shall have

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given notice of such failure to the Company and your Employer and your Employer has
not fully cured such
failure within thirty (30) days after such notice is deemed given; (d) any
reduction of your rate of base salary in effect from time to time, whether or not
material, or any failure (other than due to reasonable administrative error that is
cured promptly upon notice) to pay any portion of your compensation as and when due;
(e) any change in the terms and conditions of any compensation or benefit program in
which you participate which, either individually or together with other changes, has
a material adverse effect on the aggregate value of your total compensation package,
disregarding for this purpose any change that results from an across-the-board
reduction that affects all similarly situated employees in a similar manner;
provided that you shall have given notice of such material adverse effect to the
Company and your Employer, and your Employer has not fully cured such failure within
thirty (30) days after such notice is deemed given; (f) any material breach by your
Employer of any material term, condition or covenant contained in an employment or
retention agreement; provided that you shall have given notice of such material
breach to the Company and your Employer, and your Employer has not fully cured such
failure within thirty (30) days after such notice is deemed given; or (g) a change
in your principal place of employment, without your consent, to a place that is not
the principal executive office of your Employer or a relocation of your Employer’s
principal executive office to a location that is both more than twenty-five (25)
miles away from your principal residence and more than twenty-five (25) miles away
from the location of your Employer’s principal executive office on the date of the
Change in Control; or (h) if you are the Chief Executive Officer of the Company
immediately prior to the Change in Control, any event or series of events that
results in your ceasing to be the Chief Executive Officer (or most senior executive
officer, however denominated) of a successor company (I) whose common equity
securities are traded on a national securities exchange and (II) that is the owner
of 100% of the outstanding common stock of Hudson City Savings Bank or its successor
and (III) that is not controlled (within the meaning of the federal Change in Bank
Control Act) by any other person or entity. You do not have to satisfy any
Performance Conditions to qualify for accelerated vesting.

     (d) Forfeitures. If you terminate service with the Company prior to a
Vesting Date, or if any applicable Performance Conditions are not met as of the end
of their respective Performance Measurement Periods, you will forfeit any Awarded
Shares that are scheduled to vest on that Vesting Date, except to the extent the
accelerated vesting provisions apply. When you forfeit Awarded Shares, all of your
interest in the Awarded Shares will be canceled without consideration (other than a
refund in an amount equal to the lesser of the amount (if any) you paid for the
Awarded Shares being forfeited and the Fair Market Value of such Awarded Shares on
the date of forfeiture) and any stock certificate or other evidence of ownership
must be returned to the Plan Trustee to be used for future awards to others. You
agree to take any action and execute and deliver any document that the Company
requests to effect the return of your unvested Awarded Shares. In the event you do
not cooperate with the Company in this regard, you hereby appoint and designate the
Company as your attorney-in-fact for the purpose of taking any action and signing
any document, in your name, which the Company determines is necessary to enforce the
forfeiture.

     (e) Definition of Service. For purposes of determining the vesting of
your Awarded Shares, you will be deemed to be in the service of the Company for so
long as you serve in any capacity as an employee, officer, non-employee director or
consultant of the Company or Hudson City Savings Bank.

     (f) Transfer Restrictions.

     (i) Unvested Shares. Until your Awarded Shares have vested,
you may not sell, transfer, assign, pledge, hypothecate, give away or in any
other manner dispose of the Awarded Shares, any portion thereof or any
interest therein.

     (ii) Vested Shares. After your Awarded Shares have vested,
you generally may not sell, transfer, assign, pledge, hypothecate, give away
or in any other manner dispose of the Awarded Shares, any portion thereof or
any interest therein prior to the Transfer Restriction Date. Prior to the
Transfer Restriction Date, you may, however, with the approval of the
Committee, give vested Awarded Shares to a Family Member. Shares given to
a Family Member may not be further transferred prior to the Transfer
Restriction Date other than by will or the laws of descent and distribution.

     (iii) Beneficiaries. If your Awarded Shares are designated
“Escrow”, you may designate a Beneficiary to receive any Awarded Shares that
vest on account of your death. To name a Beneficiary, complete the attached
Appendix A and file it with the Corporate Secretary of Hudson City Bancorp,
Inc.

     (iv) Testamentary Transfers. If your Awarded Shares are in
the form of Legended Certificate or DRS, they may be transferred upon your
death by will or the laws of descent and distribution.

     Section 3 . Dividends. If your Awarded Shares are in the form of Legended
Certificates or DRS, any dividends declared by the Company with a record date that is after the
Effective Date specified in the Performance-Based Restricted Stock Award Notice will be paid in the
same manner as for other shareholders. If your Awarded Shares are designated “Escrow,” you will
receive the dividends on an unrestricted basis, but they will be paid to you by, and will be
taxable in the same manner as other compensation paid to you by, the Company. By signing this
Performance-Based Restricted Stock Award Notice and accepting its terms, you direct the

Page 2 of 3

 

Plan
Trustee to remit to the Company for payment to you any dividends that may be received as the record
holder of your unvested Awarded Shares. Stock dividends will be added to adminsiterested in the
same manner as other Awarded Shares.

     Section 4. Voting Rights. You shall have the right to control all voting rights
relating to all unvested Awarded Shares. If your Awarded Shares are Legended Certificates or DRS,
you will receive proxy materials for voting in the same manner as other shareholders with Shares in
brokerage accounts. If your unvested Awarded Shares are held by the Plan Trustee, the Plan Trustee
will ask you for voting directions and will follow your directions in voting your unvested Awarded
Shares.

     Section 5. Taxes. The Company, in its discretion, may require that funds needed to
satisfy minimum required federal, state and local income and payroll tax withholding be obtained by
disposition to the Company, on the Vesting Date, of vested Awarded Shares having a Fair Market
Value equal to the amount of tax required to be withheld.

     Section 6. Notices. Any communication required or permitted to be given under the
Plan, including any notice, direction, designation, comment, instruction, objection or waiver,
shall be in writing and shall be deemed to have been given at such time as it is delivered
personally or five (5) days after mailing if mailed, postage prepaid, by registered or certified
mail, return receipt requested, addressed to such party at the address listed below, or at such
other address as one such party may by written notice specify to the other party:

     If to the Company:

Hudson City Bancorp, Inc.

West 80 Century Road

Paramus, New Jersey 07652

Attention: Corporate Secretary

     If to the Recipient, to the Recipient’s address as shown in the Company’s records.

     Section 7. Successors and Assigns. This Performance-Based Restricted Stock Award
Notice shall inure to the benefit of and shall be binding upon the Company and you and the
Company’s and your respective heirs, successors and assigns.

     Section 8. Construction of Language. Whenever appropriate in the Performance-Based
Restricted Stock Award Notice, words used in the singular may be read in the plural, words used in
the plural may be read in the singular, and words importing the masculine gender may be read as
referring equally to the feminine or the neuter. Any reference to a section shall be a reference
to a section of this Performance-Based Restricted Stock Award Notice, unless the context clearly
indicates otherwise. Capitalized terms not specifically defined herein shall have the meanings
assigned to them under the Plan, as amended from time to time.

     Section 9. Governing Law. This Performance-Based Restricted Stock Award Notice shall
be construed, administered and enforced according to the laws of the State of New Jersey without
giving effect to the conflict of laws principles thereof, except to the extent that such laws are
preempted by the federal law. The federal and state courts located in Bergen County, New Jersey
shall have exclusive jurisdiction over any claim, action, complaint or lawsuit brought under the
terms of the Plan. By accepting any Awarded Shares granted under this Performance-Based Restricted
Stock Award Notice, you, and any other person claiming any rights under the Performance-Based
Restricted Stock Award Notice, agree to submit yourself or himself, and any such legal action as
you or he shall bring under the Plan, to the sole jurisdiction of such courts for the adjudication
and resolution of any such disputes.

     Section 10. Amendment. This Performance-Based Restricted Stock Award Notice may be
amended, in whole or in part and in any manner not inconsistent with the provisions of the Plan, at
any time and from time to time, by written agreement between the Company and you. No such
amendment, however, shall be effective unless (a) it is designated as an amendment, (b) it refers
expressly to this Performance-Based Restricted Stock Award Notice and (c) if such amendment would
cause the Awarded Shares or any portion thereof to cease to be regarded as qualified
performance-based compensation for purposes of section 162(m) of the Code, it specifically
acknowledges such effect.

     Section 11. Plan Provisions Control. This Performance-Based Restricted Stock Award
Notice and the rights and obligations created hereunder shall be subject to all of the terms and
conditions of the Plan. In the event of any conflict between the mandatory provisions of the Plan
and the provisions of this Performance-Based Restricted Stock Award Notice, the terms of the Plan,
which are incorporated herein by reference, shall control. In the event of any conflict between
the non-mandatory provisions of the Plan and the provisions of this Performance-Based Restricted
Stock Award Agreement, the provisions of this Performance-Based Restricted Stock Award Agreement
shall control. By signing this Performance-Based Restricted Stock Award Notice, you acknowledge
receipt of a copy of the Plan. You acknowledge that you may not and will not rely on any statement
of account or other communication or document issued in connection with the Plan other than the
Plan, this Performance-Based Restricted Stock Award Notice, and any document signed by an
authorized representative of the Company that is designated as an amendment of the Plan or this
Performance-Based Restricted Stock Award Notice.

Page 3 of 3

 

	Appendix A to Performance-Based Restricted Stock Award Notice
Hudson City Bancorp, Inc. 2006 Stock Incentive Plan
Beneficiary Designation Form — Performance-Based Restricted Stock Award
GENERAL
INFORMATION
Use this form to designate the Beneficiary(ies) who may receive Performance-Based Restricted
Stock Awards that become vested at your death.
Name of Person
Making Designation
Social Security Number ___—___—___
BENEFICIARY
DESIGNATION Complete sections A and B. If no percentage of shares is specified, each Beneficiary in
the same class (primary or contingent) shall have an equal share. If any designated Beneficiary
predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent)
shall be increased proportionately.
A. PRIMARY BENEFICIARY(IES). I hereby designate the following person as my primary Beneficiary
under the Plan, reserving the right to change or revoke this designation at any time prior to my
death as to all outstanding Awarded Shares:
Name Address Relationship Birthdate Share
%
%
%
Total = 100%
B. CONTINGENT BENEFICIARY(IES). I hereby designate the following person(s) as my contingent
Beneficiary(ies) under the Plan to receive benefits only if all of my primary Beneficiaries should
predecease me, reserving the right to change or revoke this designation at any time prior to my
death as to all outstanding Awarded Shares:
Name Address Relationship Birthdate Share
%
%
%
Total = 100%
S
I
G
N H
E
R
E I understand that this Beneficiary Designation shall be effective only if properly completed and
received by the Corporate Secretary of Hudson City Bancorp, Inc. prior to my death, and that it is
subject to all of the terms and conditions of the Plan. I also understand that an effective
Beneficiary designation revokes my prior designation(s) with respect to all outstanding
Performance-Based Restricted Stock Awards.
Your Signature            Date
Internal Use Only
This Beneficiary Designation was received by the Corporate Secretary of Hudson City Bancorp, Inc.
on the date indicated.
By
Authorized Signature            Date
Comments

 

 

Appendix B to Performance-Based Restricted Stock Award Notice

Hudson City Bancorp, Inc. 2006 Stock Incentive Plan

Performance Vesting Conditions

     1. Performance Measurement Period. The Performance Measurement Period shall be the 12-month
period beginning January 1, 2009 and ending December 31, 2009.

     2. Performance Condition. The average quarterly efficiency ratio of the Company for the
Performance Measurement Period must be below 29 percent. This ratio is determined by dividing
total non-interest expense by the sum of net interest income and total non-interest income. This
calculation will be made based on generally accepted accounting principles as applied in the
preparation of the Company’s financial statements at January 1, 2009. The Committee will adjust
this measure to prevent the enlargement or dilution of rights in such events and in such manner as
is permitted under Internal Revenue Code section 162(m) and the regulations thereunder without
causing the awards to fail to be regarded as “qualified performance-based compensation.”EX-4.1

Exhibit 4.1

Execution Copy

WARRANT

     THE SECURITIES EVIDENCED BY THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES
ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), OR ANY OTHER APPLICABLE SECURITIES LAWS AND
HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES
ACT AND SUCH OTHER SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN
MAY BE REOFFERED, SOLD, ASSIGNED, TRANSFERRED, PLEDGED, ENCUMBERED, HYPOTHECATED OR OTHERWISE
DISPOSED OF, EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR
PURSUANT TO A TRANSACTION WHICH IS EXEMPT FROM, OR NOT SUBJECT TO, SUCH REGISTRATION.

May 7, 2009

     Warrant to Purchase up to 200,000 shares of Common Stock of Electro-Optical Sciences, Inc.
(the “Company”).

     In consideration for Kingsbridge Capital Limited (the “Investor”) agreeing to enter
into that certain Common Stock Purchase Agreement, dated as of the date hereof, between the
Investor and the Company (the “Agreement”), the Company hereby agrees that the Investor or
any other Warrant Holder (as defined below) is entitled, on the terms and conditions set forth
below, to purchase from the Company at any time during the Exercise Period (as defined below) up to
200,000 fully paid and non-assessable shares of common stock, par value $0.001 per share, of the
Company (the “Common Stock”) at the Exercise Price (as defined below), as the same may be
adjusted from time to time pursuant to Section 6 hereof. The resale of the shares of Common Stock
or other securities issuable upon exercise or exchange of this Warrant is subject to the provisions
of the Registration Rights Agreement. Capitalized terms used herein and not otherwise defined
shall have the meanings given them in the Agreement.

     Section 1. Definitions.

          “Affiliate” shall mean any Person that, directly or indirectly through one or more
intermediaries, controls or is controlled by, or is under direct or indirect common control with
any other Person. For the purposes of this definition, “control,” when used with respect
to any Person, means the power to direct the management and policies of such Person, directly or
indirectly, whether through the ownership of voting securities, by contract or otherwise, and the
term “controls” and “controlled” have meanings correlative to the foregoing.

          “Closing Price” as of any particular day shall mean the closing price per share of the
Common Stock as reported by the Principal Market on such day.

          “Exercise Period” shall mean that period beginning six months after the date of this
Warrant and continuing until the earlier of (i) the expiration of the five-year period thereafter,
or (ii) a Funding Default, subject in each case to earlier termination in accordance with Section 6
hereof.

 

 

          “Exercise Price” as of the date hereof shall mean $11.35 per Share, as the same may be
adjusted in accordance with the terms hereof.

          “Funding Default” shall mean a failure by Investor to accept a Draw Down Notice made
by the Company and to acquire and pay for the Shares in accordance therewith within three (3)
Trading Days following the delivery of such Shares to the Investor, provided such Draw Down Notice
was made in accordance with the terms and conditions of the Agreement (including the satisfaction
or waiver of the conditions to the obligation of the Investor to accept a Draw Down set forth in
Article VII of the Agreement), provided further, that such failure was reasonably within the
control of the Investor.

          “Per Share Warrant Value” shall mean the difference resulting from subtracting the
Exercise Price from the average of the Closing Prices on the five Trading Days immediately
preceding the Exercise Date.

          “Person” shall mean an individual, a corporation, a partnership, a limited liability
company, an association, a trust or other entity or organization, including a government or
political subdivision or an agency or instrumentality thereof.

          “Principal Market” shall mean the NASDAQ Global Select Market, the NASDAQ Global
Market, the NASDAQ Capital Market, the American Stock Exchange or the New York Stock Exchange,
whichever is at the time the principal trading exchange or market for the Common Stock.

          “SEC” shall mean the United States Securities and Exchange Commission.

          “Trading Day” shall mean any day other than a Saturday or a Sunday on which the
Principal Market is open for trading in equity securities.

          “Warrant Holder” shall mean the Investor or any permitted assignee or permitted
transferee of all or any portion of this Warrant.

          “Warrant Shares” shall mean those shares of Common Stock received or to be received
upon exercise of this Warrant.

     Section 2. Exercise.

          (a) Method of Exercise. This Warrant may be exercised in whole or in part (but not as
to a fractional share of Common Stock), at any time and from time to time during the Exercise
Period, by the Warrant Holder by surrender of this Warrant, with the form of exercise attached
hereto as Exhibit A completed and duly executed by the Warrant Holder (the “Exercise
Notice”), to the Company at the address set forth in Section 10.4 of the Agreement, accompanied
by payment of the Exercise Price multiplied by the number of shares of Common Stock for which this
Warrant is being exercised (the “Aggregate Exercise Price”). The later of the date on
which an Exercise Notice or payment of the Aggregate Exercise Price (unless this Warrant is
exercised in accordance with Section 2(c) below) is received by the Company in accordance with this
clause (a) shall be deemed an “Exercise Date.”

2

 

          (b) Payment of Aggregate Exercise Price. Subject to paragraph (c) below, payment of
the Aggregate Exercise Price shall be made by wire transfer of immediately available funds to an
account designated by the Company. If the amount of the payment received by the Company is less
than the Aggregate Exercise Price, the Warrant Holder will be notified of the deficiency and shall
make payment in that amount within three (3) Trading Days. In the event the payment exceeds the
Aggregate Exercise Price, the Company will refund the excess to the Warrant Holder within five (5)
Trading Days of receipt.

          (c) Cashless Exercise. In the event that the Warrant Shares to be received by the
Warrant Holder upon exercise of the Warrant may not be resold pursuant to an effective registration
statement or an exemption to the registration requirements of the Securities Act and applicable
state laws, the Warrant Holder may, as an alternative to payment of the Aggregate Exercise Price
upon exercise in accordance with paragraph (b) above, elect to effect a cashless exercise by so
indicating on the Exercise Notice and including a calculation of the number of shares of Common
Stock to be issued upon such exercise in accordance with the terms hereof (a “Cashless
Exercise”). If a registration statement on Form S-3 under the Securities Act or such other
form as deemed appropriate by counsel to the Company for the registration for the resale by the
Warrant Holder of (x) the shares of Common Stock of the Company that may be purchased under the
Agreement, (y) the Warrant Shares, or (z) any securities issued or issuable with respect to any of
the foregoing by way of exchange, stock dividend or stock split or in connection with a combination
of shares, recapitalization, merger, consolidation or other reorganization or otherwise, has been
declared effective by the SEC and remains effective, the Company may, in its sole discretion,
permit the Warrant Holder to effect a Cashless Exercise or require the Warrant Holder to pay the
Exercise Price of the Warrant Shares being purchased by the Warrant Holder under this Warrant. In
the event of a Cashless Exercise, the Warrant Holder shall receive that number of shares of Common
Stock determined by (i) multiplying the number of Warrant Shares for which this Warrant is being
exercised by the Per Share Warrant Value and (ii) dividing the product by the average of the
Closing Prices on the five Trading Days immediately preceding the Exercise Date, rounded to the
nearest whole share. The Company shall cancel the total number of Warrant Shares equal to the
excess of the number of the Warrant Shares for which this Warrant is being exercised over the
number of Warrant Shares to be received by the Warrant Holder pursuant to such Cashless Exercise.

          (d) Replacement Warrant. In the event that the Warrant is not exercised in full, the
number of Warrant Shares shall be reduced by the number of such Warrant Shares for which this
Warrant is exercised, and the Company, at its expense, shall forthwith issue and deliver to or upon
the order of the Warrant Holder a new Warrant of like tenor in the name of the Warrant Holder,
reflecting such adjusted number of Warrant Shares.

     Section 3. Ten Percent Limitation. The Warrant Holder may not exercise this Warrant
such that the number of Warrant Shares to be received pursuant to such exercise aggregated with all
other shares of Common Stock that are then beneficially owned or deemed to be beneficially owned by
the Warrant Holder would result in (i) the Warrant Holder owning more than 9.9% of all of such
Common Stock as would be outstanding on such Exercise Date, as determined in accordance with
Section 13(d) of the Exchange Act or (ii) the Company being required to file any notification or
report forms under the Hart Scott Rodino Antitrust

3

 

Improvements Act of 1976, as amended. The Warrant Holder acknowledges and agrees that the
enforcement of the foregoing restriction is not an obligation on the part of the Company and any
breach thereof shall not be deem to be a material breach by the Company.

     Section 4. Delivery of Warrant Shares.

          (a) Subject to the terms and conditions of this Warrant, as soon as practicable after the
exercise of this Warrant in full or in part, and in any event within ten (10) Trading Days
thereafter, the Company at its expense (including, without limitation, the payment by it of any
applicable issue taxes) will cause to be deposited with the Depositary Trust Company via
book-entry, the number of validly issued, fully paid and non-assessable Warrant Shares to which the
Warrant Holder shall be entitled on such exercise, together with any other stock or other
securities or property (including cash, where applicable) to which the Warrant Holder is entitled
upon such exercise in accordance with the provisions hereof.

          (b) This Warrant may not be exercised as to fractional shares of Common Stock. In the event
that the exercise of this Warrant, in full or in part, would result in the issuance of any
fractional share of Common Stock, then in such event the Warrant Holder shall receive the number of
shares rounded down to the nearest whole share.

     Section 5. Representations, Warranties and Covenants of the Company.

          (a) The Warrant Shares, when issued in accordance with the terms hereof, will be duly
authorized and, when paid for and issued in accordance with the terms hereof, shall be validly
issued, fully paid and non-assessable.

          (b) The Company shall take all commercially reasonable action and proceedings as may be
required and permitted by applicable law, rule and regulation for the legal and valid issuance of
this Warrant and the Warrant Shares to the Warrant Holder.

          (c) The Company has authorized and reserved for issuance to the Warrant Holder the requisite
number of shares of Common Stock to be issued pursuant to this Warrant. The Company shall at all
times reserve and keep available, solely for issuance and delivery as Warrant Shares hereunder,
such shares of Common Stock as shall from time to time be issuable as Warrant Shares.

          (d) From the date hereof through the last date on which this Warrant is exercisable, the
Company shall take all commercially reasonable action to ensure that the Common Stock remains
listed or quoted on the Principal Market.

4

 

     Section 6. Adjustment of the Exercise Price. The Exercise Price and, accordingly, the
number of Warrant Shares issuable upon exercise of the Warrant, shall be subject to adjustment from
time to time upon the happening of certain events as follows:

          (a) Reclassification, Consolidation, Merger, Mandatory Share Exchange, Sale or
Transfer.

               (i) Upon occurrence of any of the events specified in subsection (a)(ii) below (the
“Adjustment Events”) while this Warrant is unexpired and not exercised in full, the Warrant
Holder may in its sole discretion require the Company, or any successor or purchasing corporation,
as the case may be, without payment of any additional consideration therefor, upon surrender by the
Warrant Holder of the Warrant to be replaced, to execute and deliver to the Warrant Holder a new
Warrant providing that the Warrant Holder shall have the right to exercise such new Warrant (upon
terms not less favorable to the Warrant Holder than those then applicable to this Warrant) and to
receive upon such exercise, in lieu of each share of Common Stock theretofore issuable upon
exercise of this Warrant, the kind and amount of shares of stock, other securities, money or
property receivable upon such Adjustment Event by the holder of one share of Common Stock issuable
upon exercise of this Warrant had this Warrant been exercised immediately prior to such Adjustment
Event, and the Exercise Price shall be proportionately adjusted, as applicable, such that the
aggregate amount to be paid by the Warrant Holder to acquire all of the Warrant Shares upon
exercise after such Adjustment Event shall be equal to the aggregate amount to be paid by the
Warrant Holder to acquire all of the Warrant Shares upon exercise prior to such Adjustment Event.
Such new Warrant shall provide for adjustments that shall be as nearly equivalent as may be
practicable to the adjustments provided for in this Section 6.

               (ii) The Adjustment Events shall be (1) any reclassification or change of Common Stock (other
than a change in par value, as a result of a subdivision or combination of Common Stock or in
connection with an Excluded Merger or Sale), and (2) any consolidation, merger or mandatory share
exchange of the Company with or into another corporation (other than a merger or mandatory share
exchange with another corporation in which the Company is a continuing corporation and which does
not result in any reclassification or change other than a change in par value or as a result of a
subdivision or combination of Common Stock), other than (each of the following referred to as an
“Excluded Merger or Sale”) a transaction involving (A) sale of all or substantially all of
the assets of the Company, (B) any merger, consolidation or similar transaction where the
consideration payable to the stockholders of the Company by the acquiring Person consists
substantially of cash or publicly traded securities, or a combination thereof, or where the
acquiring Person does not agree to assume the obligations of the Company under outstanding warrants
(including this Warrant). In the event of an Excluded Merger or Sale, the Company shall deliver a
notice to the Warrant Holder at least 10 days before the consummation of such Excluded Merger or
Sale, the Warrant Holder may exercise this Warrant at any time before the consummation of such
Excluded Merger or Sale (and such exercise may be made contingent upon the consummation of such
Excluded Merger or Sale), and any portion of this Warrant that has not been exercised before
consummation of such Excluded Merger or Sale shall terminate and expire, and shall no longer be
outstanding.

5

 

          (b) Subdivision or Combination of Shares. If the Company, at any time while this
Warrant is unexpired and not exercised in full, shall subdivide its Common Stock, the Exercise
Price shall be proportionately reduced as of the effective date of such subdivision, or, if the
Company shall take a record of holders of its Common Stock for the purpose of so subdividing its
Common Stock, as of such record date, whichever is earlier. If the Company, at any time while this
Warrant is unexpired and not exercised in full, shall combine its Common Stock, the Exercise Price
shall be proportionately increased as of the effective date of such combination, or, if the Company
shall take a record of holders of its Common Stock for the purpose of so combining its Common
Stock, as of such record date, whichever is earlier.

          (c) Stock Dividends. If the Company, at any time while this Warrant is unexpired and
not exercised in full, shall pay a dividend or other distribution in shares of Common Stock to all
holders of Common Stock, then the Exercise Price shall be adjusted, as of the date the Company
shall take a record of the holders of its Common Stock for the purpose of receiving such dividend
or other distribution (or if no such record is taken, as at the date of such payment or other
distribution), to that price determined by multiplying the Exercise Price in effect immediately
prior to such payment or other distribution by a fraction: (i) the numerator of which shall be the
total number of shares of Common Stock outstanding immediately prior to such dividend or
distribution, and (ii) the denominator of which shall be the total number of shares of Common Stock
outstanding immediately after such dividend or distribution. The provisions of this subsection
(c) shall not apply under any of the circumstances for which an adjustment is provided in
subsections (a) or (b).

          (d) Liquidating Dividends, Etc. If the Company, at any time while this Warrant is
unexpired and not exercised in full, makes a distribution of its assets or evidences of
indebtedness to the holders of its Common Stock as a dividend in liquidation or by way of return of
capital or other than as a dividend payable out of earnings or surplus legally available for
dividends under applicable law or any distribution to such holders made in respect of the sale of
all or substantially all of the Company’s assets (other than under the circumstances provided for
in the foregoing subsections (a) through (c)), then the Warrant Holder shall be entitled to receive
upon exercise of this Warrant in addition to the Warrant Shares receivable in connection therewith,
and without payment of any consideration other than the Exercise Price, the kind and amount of such
distribution per share of Common Stock multiplied by the number of Warrant Shares that, on the
record date for such distribution, are issuable upon such exercise of the Warrant (with no further
adjustment being made following any event which causes a subsequent adjustment in the number of
Warrant Shares issuable), and an appropriate provision therefor shall be made a part of any such
distribution. The value of a distribution that is paid in other than cash shall be determined in
good faith by the Board of Directors of the Company. Notwithstanding the foregoing, in the event
of a proposed dividend in liquidation or distribution to the stockholders made in respect of the
sale of all or substantially all of the Company’s assets, the Company shall deliver a notice to the
Warrant Holder at least 10 days before the date on which the Company shall take a record of the
holders of its Common Stock for the purpose of receiving such dividend or other distribution (or if
no such record is taken, at least 10 days before the date of such payment or other distribution),
the Warrant Holder may exercise this Warrant at any time before such record date or the date of
such payment or other distribution, as applicable, (and such exercise may be made contingent upon
such payment or other distribution), and any

6

 

portion of this Warrant that has not been exercised before such record date or the date of
such payment or other distribution, as applicable, shall terminate and expire, and shall no longer
be outstanding.

          (e) Adjustment for Spin Off. If, for any reason, prior to the exercise of this
Warrant in full, the Company spins off or otherwise divests itself of a part of its business or
operations or disposes all or a part of its assets in a transaction (a “Spin Off”) in which
the Company does not receive compensation for such business, operations or assets, but causes
securities of another entity (“Spin Off Securities”) to be issued to all or substantially
all holders of Common Stock, then the Company shall cause (i) to be reserved Spin Off Securities
equal to the number thereof which would have been issued to the Warrant Holder in the event that
the entire unexercised portion of this Warrant outstanding on the record date (the “Record
Date”) for determining the number of Spin Off Securities to be issued to holders of Common
Stock had been exercised by the Warrant Holder as of the close of business on the Trading Day
immediately prior to the Record Date (the “Reserved Spin Off Shares”), and (ii) to be
issued to the Warrant Holder on the exercise of all or any unexercised portion of this Warrant,
such amount of the Reserved Spin Off Shares equal to (x) the Reserved Spin Off Shares multiplied by
(y) a fraction, of which (I) the numerator is the unexercised portion of this Warrant then being
exercised, and (II) the denominator is the aggregate amount of the unexercised portion of this
Warrant.

     Section 7. Notice of Adjustments. Whenever the Exercise Price or number of Warrant
Shares shall be adjusted pursuant to Section 6 hereof, the Company shall promptly prepare a
certificate signed by its Chief Executive Officer or Chief Financial Officer setting forth in
reasonable detail the event requiring the adjustment, the amount of the adjustment, the method by
which such adjustment was calculated (including a description of the basis on which the Company’s
Board of Directors made any determination hereunder), and the Exercise Price and number of Warrant
Shares purchasable at that Exercise Price after giving effect to such adjustment, and shall
promptly cause copies of such certificate to be delivered to the Warrant Holder by a means set
forth in Section 10.4 of the Agreement.

     Section 8. No Impairment. The Company will not, by amendment of its Charter or Bylaws
or through any reorganization, transfer of assets, consolidation, merger, dissolution or issue or
sale of securities, willfully 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 action as may be necessary or appropriate in order to protect
the rights of the Warrant Holder against wrongful impairment. Without limiting the generality of
the foregoing, the Company (a) will not increase the par value of any Warrant Shares above the
amount payable therefor on such exercise, and (b) will take all such action as may be reasonably
necessary or appropriate in order that the Company may validly and legally issue fully paid and
non-assessable Warrant Shares on the exercise of this Warrant. Notwithstanding the foregoing,
nothing in this Section 8 shall restrict or impair the Company’s right to effect any changes to the
rights, preferences, privileges or restrictions associated with the Warrant Shares so long as such
changes do not affect the rights, preferences, privileges or restrictions associated with the
Warrant Shares in a manner adversely different from the effect

7

 

that such changes have generally on the rights, preferences, privileges or restrictions
associated with all other shares of Common Stock.

     Section 9. Rights As Stockholder. Except as set forth in Section 6 above, prior to
exercise of this Warrant, the Warrant Holder shall not be entitled to any rights as a stockholder
of the Company with respect to the Warrant Shares, including (without limitation) the right to vote
such shares, receive dividends or other distributions thereon or be notified of stockholder
meetings.

     Section 10. Replacement of Warrant. Upon receipt of evidence reasonably satisfactory
to the Company of the loss, theft, destruction or mutilation of the Warrant and, in the case of any
such loss, theft or destruction of the Warrant, upon delivery of an indemnity agreement or security
reasonably satisfactory in form and amount to the Company or, in the case of any such mutilation,
on surrender and cancellation of such Warrant, the Company at its expense will execute and deliver,
in lieu thereof, a new Warrant of like tenor.

     Section 11. Choice of Law. This Warrant shall be construed under the laws of the
State of New York.

     Section 12. Entire Agreement; Amendments. Except for any written instrument
concurrent or subsequent to the date hereof executed by the Company and the Investor, this Warrant,
the Agreement and the Registration Rights Agreement contain the entire understanding of the parties
with respect to the matters covered hereby and thereby. No provision of this Warrant may be waived
or amended other than by a written instrument signed by the party against whom enforcement of any
such amendment or waiver is sought.

     Section 13. Restricted Securities.

          (a) Registration or Exemption Required. This Warrant has been issued in a transaction
exempt from the registration requirements of the Securities Act in reliance upon the provisions of
Section 4(2) thereof and Regulation D promulgated thereunder, and/or upon such other exemption from
the registration requirements of the Securities Act as may be available with respect to this
Warrant. This Warrant and the Warrant Shares issuable upon exercise of this Warrant may not be
resold except pursuant to an effective registration statement or an exemption to the registration
requirements of the Securities Act and applicable state laws.

          (b) Legend. Any replacement Warrants issued pursuant to Section 2 and Section 10
hereof and, unless a registration statement has been declared effective by the SEC and remains
effective in accordance with the Securities Act with respect thereto, any Warrant Shares issued
upon exercise hereof, shall bear the following legend:

“THE SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES
ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), OR ANY OTHER APPLICABLE SECURITIES LAWS
AND HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE
SECURITIES ACT AND SUCH OTHER SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR

8

 

PARTICIPATION HEREIN MAY BE REOFFERED, SOLD, ASSIGNED, TRANSFERRED, PLEDGED, ENCUMBERED,
HYPOTHECATED OR OTHERWISE DISPOSED OF, EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
UNDER THE SECURITIES ACT OR PURSUANT TO A TRANSACTION WHICH IS EXEMPT FROM, OR NOT SUBJECT TO,
SUCH REGISTRATION.”

          (c) No Other Legend or Stock Transfer Restrictions. No legend other than the one
specified in Section 13(b) has been or shall be placed on the share certificates representing the
Warrant Shares and no instructions or “stop transfer orders” (so called “stock transfer
restrictions”) or other restrictions have been or shall be given to the Company’s transfer
agent with respect thereto other than as expressly set forth in this Section 13.

          (d) Assignment. Assuming the conditions of Section 13(a) above regarding registration
or exemption have been satisfied, the Warrant Holder may sell, transfer, assign, pledge or
otherwise dispose of this Warrant (each of the foregoing, a “Transfer”), in whole or in
part, but only to an Affiliate of the Warrant Holder. The Warrant Holder shall deliver a written
notice to the Company, substantially in the form of the Assignment attached hereto as
Exhibit B, indicating the person or persons to whom the Warrant shall be Transferred and
the respective number of Warrant Shares to be covered by the warrants to be Transferred to each
assignee. The Company shall effect the Transfer within ten (10) days, and shall deliver to the
Transferee(s) designated by the Warrant Holder a Warrant or Warrants of like tenor and terms for
the appropriate number of shares. In connection with and as a condition of any such proposed
Transfer, the Company may require (i) the Warrant Holder to provide an opinion of counsel to the
Warrant Holder in form and substance reasonably satisfactory to the Company to the effect that the
proposed Transfer complies with all applicable federal and state securities laws and (ii) any such
Transferee to provide customary representations and warranties attendant to the acquisition of
unregistered securities, including without limitation the Transferee’s investment intent and status
as an “accredited investor” within the meaning of Regulation D.

          (e) Investor’s Compliance. Nothing in this Section 13 shall affect in any way the
Investor’s obligations under any agreement to comply with all applicable securities laws upon
resale of the Common Stock.

     Section 14. Notices. All notices, demands, requests, consents, approvals, and other
communications required or permitted hereunder shall be given in accordance with Section 10.4 of
the Agreement.

     Section 15. Miscellaneous. The headings in this Warrant are for purposes of reference
only, and shall not limit or otherwise affect any of the terms hereof. The invalidity or
unenforceability of any provision hereof shall in no way affect the validity or enforceability of
any other provision.

     Section 16. Company Call Right.

          (a) If a Funding Default occurs, the Company shall have the right to demand the surrender of
this Warrant or any remaining portion thereof, Warrant Shares and/or cash from the Investor as
follows (the “Call Right”):

9

 

               (i) If the Investor has not previously exercised this Warrant in full, then the Company shall
have a right to demand the surrender of this Warrant, or remaining portion thereof, from the
Investor without compensation, and the Investor shall promptly surrender this Warrant, or remaining
portion thereof. Following such demand for surrender, this Warrant shall automatically be deemed
to have been canceled and shall have no further force or effect.

               (ii) If, prior to receiving a Call Right Notice (as defined below), the Investor has
previously exercised this Warrant with respect to some or all of the Warrant Shares, and the
Investor has not previously sold such Warrant Shares, then Company shall have a right to purchase
from the Investor that number of shares of Common Stock equal to the number of shares of Common
Stock issued in connection with the exercise(s) of the Warrant, at a repurchase price per share
equal to the price per share paid by the Investor in connection with such exercise(s). For greater
certainty, (a) if Warrant Shares were exercised for cash, the purchase price per share under the
Call Right shall be equal to the Exercise Price, (b) if Warrant Shares were exercised on a cashless
exercise basis, the purchase price per share for such Warrant Shares under the Call Right shall be
zero, and (c) if such Warrant Shares were exercised on both a cash and cashless exercise basis, the
purchase price per share under the Call Right shall be equal to the total amount of cash paid in
connection with such cash exercise(s) divided by the total number of shares of Common Stock issued
in connection with all exercises of the Warrant (whether on a cash or cashless exercise basis).

               (iii) If, prior to receiving a Call Right Notice, the Investor has previously exercised this
Warrant with respect to some or all of the Warrant Shares, and the Investor subsequently sold such
Warrant Shares, then the Investor shall remit to the Company the excess, if any, of (x) the
proceeds received by the Investor through the sale of such Warrant Shares, over (y) the aggregate
Exercise Price for such Warrant Shares. In the event that the Investor obtained such Warrant
Shares through a Cashless Exercise, then the Investor shall instead remit to the Company all
proceeds received by the Investor through the sale of such Warrant Shares. For the avoidance of
doubt, in the event that the Investor has sold some or all of the Warrant Shares prior to receiving
a Call Right Notice, then the right set forth in this paragraph (iii) shall constitute the sole
Call Right of the Company with respect to such Warrant Shares which have been sold.

          (b) The Company may exercise the Call Right by delivering a notice (the “Call Right
Notice”) to the Investor within thirty (30) days after the occurrence of a Funding Default. On
the tenth (10th) Trading Day following delivery of the Call Right Notice to the Investor, the
Company shall tender the purchase price, if any, and Investor shall tender shares of Common Stock,
if any, to be sold to the Company pursuant to the Call Right Notice, immediately following which
the Company and the Investor shall consummate such purchase and sale. The Call Right shall survive
both the assignment of the Warrant by the Investor and the disposition of the Warrant Shares by the
Investor following exercise of the Warrant.

[Remainder of Page Intentionally Left Blank. Signature Page Follows.]

10

 

IN WITNESS WHEREOF, this Warrant was duly executed by the undersigned, thereunto duly authorized,
as of the date first set forth above.

	 	 	 	 	 
	 	ELECTRO-OPTICAL SCIENCES, INC.

 	 
	 	By:  	 	 
	 	 	Joseph V. Gulfo, M.D. 	 
	 	 	Chief Executive Officer 	 
	 

Investor acknowledges and agrees to the terms and conditions of this Warrant.

	 	 	 	 	 
	 	KINGSBRIDGE CAPITAL LIMITED

 	 
	 	By:  	 	 
	 	 	Antony Gardner-Hillman 	 
	 	 	Director 	 
	 

 

 

EXHIBIT A TO THE WARRANT

EXERCISE FORM

ELECTRO-OPTICAL SCIENCES, INC.

The undersigned hereby irrevocably exercises the right to purchase                     shares of Common
Stock of Electro-Optical Sciences, Inc., a Delaware corporation (the “Company”), evidenced
by the attached Warrant, and (CIRCLE EITHER (i) or (ii)) (i) tenders herewith payment of the
Aggregate Exercise Price with respect to such shares in full, in the amount of $___, in
cash, by certified or official bank check or by wire transfer for the account of the Company or
(ii) elects, pursuant to Section 2(c) of the Warrant, to convert such Warrant into shares of Common
Stock of the Company on a cashless exercise basis, all in accordance with the conditions and
provisions of said Warrant.

The undersigned requests that stock certificates for such Warrant Shares be issued, and a Warrant
representing any unexercised portion hereof be issued, pursuant to this Warrant, in the name of the
registered Warrant Holder and delivered to the undersigned at the address set forth below.

	 	 	 	 	 	 	 
	 

	 	Dated:	 	 	 	 
	 

	 	 	 	 

	 	 

	 	 	 
	 

Signature of Registered Holder

	 	 
	 
	 	 
	 

Name of Registered Holder (Print)

	 	 
	 
	 	 
	 

Address

	 	 

 

 

EXHIBIT B TO THE WARRANT

ASSIGNMENT

(To be executed by the registered Warrant Holder desiring to transfer the Warrant)

FOR VALUED RECEIVED, the undersigned Warrant Holder of the attached Warrant hereby sells, assigns
and transfers unto the persons below named the right to purchase                     shares of Common
Stock of Electro-Optical Sciences, Inc. (the “Company”) evidenced by the attached Warrant
and does hereby irrevocably constitute and appoint                      attorney to transfer the said
Warrant on the books of the Company, with full power of substitution in the premises.

	 	 	 	 	 	 	 
	 

	 	Dated:	 	 	 	 
	 

	 	 	 	 

	 	 

	 	 	 	 	 
	 

Signature

	 	 	 	 
	 
	 	 	 	 
	Fill in for new Registration of Warrant:	 	 
	 
	 	 	 	 
	 

Name

	 	 	 	 
	 
	 	 	 	 
	 

Address

	 	 	 	 
	 
	 	 	 	 
	 

	 	 	 	 
	Please print name and address of assignee (including zip code number)

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