Document:

Exhibit 10.74

 

STOCK OPTION AGREEMENT,
made as of the 6th day of April, 2015, between BIORESTORATIVE THERAPIES, INC., a Delaware corporation (the “Company”),
and CHARLES S. RYAN, J.D., PH.D. (the “Optionee”).

 

 

 

WHEREAS, the
Optionee serves as a director of the Company; and

 

WHEREAS, the
Company desires to provide to the Optionee an additional incentive to promote the success of the Company.

 

NOW, THEREFORE,
in consideration of the foregoing, the Company hereby grants to the Optionee the right and option to purchase shares of Common
Stock of the Company under and pursuant to the terms and conditions of the Company’s 2010 Equity Participation Plan (the
“Plan”) and upon and subject to the following terms and conditions:

 

1.          GRANT
OF OPTION. The Company hereby grants to the Optionee the right and option (the “Option”) to purchase up to
Three Hundred Thousand (300,000) shares of Common Stock of the Company (the “Option Shares”) during the following periods:

 

(a)          All
or any part of One Hundred Thousand (100,000) shares of Common Stock may be purchased during the period commencing at 12:01 A.M.
on April 6, 2016 and terminating at 5:00 P.M. on April 6, 2025 (the “Expiration Date”).

 

(b)          All
or any part of One Hundred Thousand (100,000) shares of Common Stock may be purchased during the period commencing at 12:01 A.M.
on April 6, 2017 and terminating at 5:00 P.M. on the Expiration Date.

 

(c)          All
or any part of One Hundred Thousand (100,000) shares of Common Stock may be purchased during the period commencing at 12:01 A.M.
on April 6, 2018 and terminating at 5:00 P.M. on the Expiration Date.

 

2.          NATURE
OF OPTION. The Option is not intended to meet the requirements of Section 422 of the Internal Revenue Code of 1986, as
amended, relating to “incentive stock options”.

 

3.          EXERCISE
PRICE. The exercise price of each of the Option Shares shall be Forty Cents ($0.40) (the “Exercise Price”).
The Company shall pay all original issue or transfer taxes on the exercise of the Option.

 

    	 

    	 

    

 

4.          EXERCISE
OF OPTIONS. (a) The Option shall be exercised in accordance with the provisions of the Plan. As soon as practicable after
the receipt of notice of exercise and payment of the Exercise Price as provided for in the Plan, the Company shall tender to the
Optionee a certificate issued in the Optionee’s name evidencing the number of Option Shares covered thereby.

 

(b)          The
Company agrees that, as contemplated in Section 13(b) of the Plan, the Optionee may elect to have the Company reduce the number
of Option Shares otherwise issuable by a number of Option Shares having a Fair Market Value (as defined in the Plan) equal to the
exercise price of the Option being exercised. In the event of such election, the Company shall issue to the Optionee a number of
Option Shares computed using the following formula:

 

	X	 	=	 	Y (A-B)
	 	 	 	 	A
	 	 	 	 	 
	Where X	 	=	 	the number of Option Shares to be issued to the Optionee
	 	 	 	 	 
	Y	 	=	 	the number of Option Shares subject to this Option (or the
    portion thereof being cancelled)
	 	 	 	 	 
	A	 	=	 	the Fair Market Value of one Option Share
	 	 	 	 	 
	B	 	=	 	the Exercise Price

 

5.          TRANSFERABILITY.
The Option shall not be transferable other than by will or the laws of descent and distribution and, during the Optionee’s
lifetime, shall not be exercisable by any person other than the Optionee.

 

6.          TERMINATION
OF DIRECTORSHIP. To the extent the Option becomes exercisable, the Option shall remain exercisable until twelve (12) months
following any subsequent termination of directorship with the Company or its subsidiaries for any reason whatsoever but in no event
shall the Option be exercisable after the Expiration Date.

 

7.          INCORPORATION
BY REFERENCE. The terms and conditions of the Plan are hereby incorporated by reference and made a part hereof.

 

8.          NOTICES.
Any notice or other communication given hereunder shall be deemed sufficient if in writing and hand delivered or sent by registered
or certified mail, return receipt requested, addressed to the Company, 40 Marcus Drive, Suite One, Melville, New York 11747, Attention:
Chief Executive Officer, and to the Optionee at the address indicated below. Notices shall be deemed to have been given on the
date of hand delivery or mailing, except notices of change of address, which shall be deemed to have been given when received.

 

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9.          BINDING
EFFECT. This Stock Option Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective
legal representatives, successors and assigns.

 

10.         ENTIRE
AGREEMENT. This Stock Option Agreement, together with the Plan, contains the entire understanding of the parties hereto
with respect to the subject matter hereof and may be modified only by an instrument executed by the party sought to be charged.

 

11.         GOVERNING
LAW. This Stock Option Agreement shall be governed by, and construed in accordance with, the laws of the State of Delaware,
excluding choice of law rules thereof.

 

12.         EXECUTION
IN COUNTERPARTS. This Stock Option Agreement may be executed in counterparts, each of which shall be deemed to be an original,
but both of which together shall constitute one and the same instrument.

 

13.         FACSIMILE
SIGNATURES. Signatures hereon which are transmitted via facsimile, or other electronic image, shall be deemed original
signatures.

 

14.         INTERPRETATION;
HEADINGS. The provisions of this Stock Option Agreement shall be interpreted in a reasonable manner to give effect to the
intent of the parties hereto. The headings and captions under sections and paragraphs of this Stock Option Agreement are for convenience
of reference only and do not in any way modify, interpret or construe the intent of the parties or affect any of the provisions
of this Stock Option Agreement.

 

[Remainder of page
intentionally left blank; signature page follows]

 

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IN WITNESS WHEREOF, the
parties have executed this Stock Option Agreement as of the day and year first above written.

 

	 	BIORESTORATIVE THERAPIES, INC.
	 	 	 
	 	By:	 
	 	 	Name: Mark Weinreb
	 	 	Title: Chief Executive Officer
	 	 	 
	 	 	 
	 	 	Signature of Optionee
	 	 	 
	 	 	Charles S. Ryan
	 	 	Name of Optionee 
	 	 	 
	 	 	 
	 	 	Address of Optionee

 

    	4Exhibit 10.75

 

EXCHANGE AGREEMENT

 

EXCHANGE AGREEMENT,
dated as of the 27st day of May, 2015 (“Agreement”), by and between BIORESTORATIVE THERAPIES, INC.,
a Delaware corporation (the “Company”), and WESTBURY (BERMUDA) LTD., a Bermuda corporation (the “Holder”).

 

WHEREAS, the
Holder is the holder of Promissory Notes, dated as of the dates set forth on the signature page hereof and issued by Stem Cell
Cayman Ltd., a wholly-owned subsidiary of the Company, in the outstanding aggregate principal amount set forth on the signature
page hereof (collectively, the “Notes”).

 

WHEREAS, pursuant
to the Notes, in addition to the outstanding aggregate principal amount, interest, as set forth on the signature page, is payable.

 

WHEREAS, the
Company has offered to issue shares of Common Stock of the Company and a warrant for the purchase of shares of Common Stock of
the Company in exchange for all amounts due pursuant to the Notes (the “Exchange Offer”).

 

WHEREAS, the
Holder desires to exchange the Notes for shares of Common Stock of the Company and a warrant for the purchase of shares of Common
Stock of the Company pursuant to the Exchange Offer.

 

NOW, THEREFORE,
the parties agree as follows:

 

1.          Exchange.  

 

1.1           The
Company shall issue to the Holder, in exchange for all of the Holder’s right, title and interest in, to and under the Notes,
(a) the number of shares of Common Stock of the Company set forth on the signature page hereof (the “Exchange Shares”)
at an exchange price of thirty cents ($0.30) per Exchange Share and (b) a warrant, in the form attached hereto as Exhibit A, for
the purchase of the number of shares of Common Stock of the Company set forth on the signature page hereof (the “Warrant
Shares”) (the “Warrant” and together with the Exchange Shares, the “Exchange Securities”).  

 

1.2           Simultaneously
herewith, the Notes are being returned to the Company for cancellation.

 

1.3           The
certificates evidencing the Exchange Shares and the Warrant acquired by the Holder will be delivered by the Company to the Holder
within a reasonable period of time following receipt of the Notes by the Company.

 

1.4           In
consideration of the Holder’s acceptance of the Exchange Offer, the Company agrees that the expiration date of the Warrant,
dated December 31, 2013, issued to the Holder for the purchase of 800,000 shares of Common Stock of the Company is extended from
December 31, 2015 to December 31, 2017.

 

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2.          Representations
by Holder.

 

The Holder understands
and agrees that the Company is relying and may rely upon the following representations, warranties, acknowledgements, consents,
confirmations and covenants made by the Holder in entering into this Agreement:

 

2.1           The
Holder recognizes that the acquisition of the Exchange Securities and, in the event of the exercise of the Warrant, the Warrant
Shares involves a high degree of risk and is suitable only for persons of adequate financial means who have no need for liquidity
with respect to the Exchange Securities in that (a) the Holder may not be able to liquidate the Exchange Securities in the event
of emergency; (b) transferability is extremely limited; and (c) the Holder could sustain a complete loss of its investment.

 

2.2           The
Holder represents and warrants that it (a) is competent to understand and does understand the nature of the Exchange Offer; and
(b) is able to bear the economic risk of an acquisition of the Exchange Securities.

 

2.3           The
Holder represents and warrants that it is an “accredited investor,” as such term is defined in Rule 501 of Regulation
D promulgated under the Securities Act of 1933, as amended (the “Act”).  The Holder meets the requirements
of at least one of the suitability standards for an “accredited investor” as set forth on the Accredited Investor Certification
contained herein.  

 

2.4           The
Holder represents and warrants that it has significant prior investment experience, including investment in restricted securities,
and that it has read this Agreement and the Warrant in order to evaluate the merits and risks of the Exchange Offer.

 

2.5           The
Holder represents and warrants that it has reviewed all reports, statements and other documents filed by the Company with the Securities
and Exchange Commission (collectively, the “SEC Reports”), including the risk factors set forth therein.  The
Holder also represents and warrants that it has been furnished by the Company with all information regarding the Company which
it had requested or desired to know; that all documents which could be reasonably provided have been made available for its inspection
and review; that it has been afforded the opportunity to ask questions of and receive answers from duly authorized representatives
of the Company concerning the terms and conditions of the Exchange Offer, and any additional information which it had requested;
and that it has had the opportunity to consult with its own tax or financial advisor concerning an acquisition of the Exchange
Securities.  The Holder confirms that no oral representations have been made or oral information furnished to the Holder
or its advisers in connection with the Exchange Offer that are inconsistent in any respect with the SEC Reports, this Agreement
or the Warrant.

 

2.6           The
Holder acknowledges that this Exchange Offer has not been reviewed by the Securities and Exchange Commission (the “SEC”)
because it is intended to be either (a) a non-public offering pursuant to Section 4(a)(2) of the Act and Rule 506 of Regulation
D promulgated thereunder or (b) exempt from the registration requirements of the Act pursuant to Section 3(a)(9) thereof or (c)
exempt from the registration requirements of the Act pursuant to Regulation S promulgated under the Act (“Regulation S”).  The
Holder represents that the Exchange Securities are being and will be acquired for its own account, for investment and not for distribution
to others.  The Holder agrees that it will not sell, transfer or otherwise dispose of the Exchange Securities, or any
portion thereof, unless they are registered under the Act or unless an exemption from such registration is available.

 

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2.7           The
Holder consents that the Company may, if it desires, permit the transfer of the Exchange Securities by the Holder out of its name
only when its request for transfer is accompanied by an opinion of counsel satisfactory to the Company that neither the sale nor
the proposed transfer results in a violation of the Act or any applicable state “blue sky” laws (collectively, “Securities
Laws”).  The Holder agrees to be bound by any requirements of such Securities Laws.  

 

2.8           The
Holder acknowledges and agrees that the Company is relying on the Holder’s representations and warranties contained in this
Agreement in determining whether to enter into this Agreement.

 

2.9           The
Holder consents to the placement of a legend on the Exchange Securities stating that they have not been registered under the Act
and setting forth or referring to the restrictions on transferability and sale thereof.  The Holder is aware that the
Company will make a notation in its appropriate records with respect to the restrictions on the transferability of the Exchange
Securities.

 

2.10         The
Holder represents and warrants that the address set forth on the signature page is the Holder’s true and correct address.

 

2.11         The
Holder represents and warrants that it is unaware of, is in no way relying on, and did not become aware of, the Exchange Offer
through, or as a result of, any form of general solicitation or advertising, including, without limitation, articles, notices,
advertisements or other communications published in any newspaper, magazine or other similar media or broadcast over television
or radio or any seminar or meeting where the attendees have been invited by any such means of general solicitation or advertising.

 

2.12         The
Holder represents and warrants as follows:

 

(i)          if
a natural person, the Holder represents and warrants that he has reached the age of 21 and has full power and authority to execute
and deliver this Agreement and all other related agreements or certificates and to carry out the provisions hereof and thereof;

 

(ii)         if
a corporation, partnership, limited liability company or partnership, association, joint stock company, trust, unincorporated organization
or other entity, the Holder represents and warrants that it was not formed for the specific purpose of acquiring the Exchange Securities,
it is duly organized, validly existing and in good standing under the laws of the state of its organization, the consummation of
the transactions contemplated hereby is authorized by, and will not result in a violation of, its charter or other organizational
documents, it has full power and authority to execute and deliver this Agreement and all other related agreements or certificates
and to carry out the provisions hereof and thereof and to acquire and hold the Exchange Securities, the execution and delivery
of this Agreement has been duly authorized by all necessary action, this Agreement has been duly executed and delivered on behalf
of the Holder and this Agreement a legal, valid and binding obligation of the Holder; and

 

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(iii)        if
executing this Agreement in a representative or fiduciary capacity, the Holder represents and warrants that it has full power and
authority to execute and deliver this Agreement in such capacity and on behalf of the individual, ward, partnership, trust, estate,
corporation, limited liability company or partnership, or other entity for whom the Holder is executing this Agreement, and such
individual, ward, partnership, trust, estate, corporation, limited liability company or partnership, or other entity has full right
and power to perform pursuant to this Agreement and acquire the Exchange Securities, and that this Agreement constitutes a legal,
valid and binding obligation of such entity.

 

2.13         The
Holder represents and warrants that the execution and delivery of this Agreement will not violate or be in conflict with any order,
judgment, injunction, agreement or other document to which the Holder is a party or by which it is bound.

 

2.14         NEITHER
THE SHARES, NOR THE WARRANT NOR THE WARRANT SHARES OFFERED HEREBY HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED,
OR THE SECURITIES LAWS OF ANY STATE AND ARE BEING OFFERED AND SOLD IN RELIANCE ON EXEMPTIONS FROM THE REGISTRATION REQUIREMENTS
OF SAID ACT AND SUCH LAWS.  THE SHARES, THE WARRANT AND THE WARRANT SHARES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY
AND RESALE AND MAY NOT BE TRANSFERRED OR RESOLD EXCEPT AS PERMITTED UNDER SAID ACT AND SUCH LAWS PURSUANT TO REGISTRATION OR EXEMPTION
THEREFROM. NEITHER THE SHARES, NOR THE WARRANT NOR THE WARRANT SHARES HAVE BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE
COMMISSION, ANY STATE SECURITIES COMMISSION OR ANY OTHER REGULATORY AUTHORITY, NOR HAVE ANY OF THE FOREGOING AUTHORITIES PASSED
UPON OR ENDORSED THE MERITS OF THIS OFFERING OR THE ACCURACY OR ADEQUACY OF THE SEC REPORTS.  ANY REPRESENTATION TO THE
CONTRARY IS UNLAWFUL.

 

2.15         The
Holder represents and warrants that no commission or other remuneration has been or will be given, directly or indirectly, by the
Holder or, to its knowledge, the Company in connection with the Exchange Offer.

 

2.16         The
Holders agrees that the certificates representing the Exchange Securities are not to be delivered within the United States.  The
Holder is neither a "U.S. person" (as such term is defined in Regulation S) nor is acquiring any of the Exchange Securities
for the account or benefit of a "U.S. person".  The Holder acknowledges that Rule 902(o) of Regulation S defines
a "U.S. person" generally as (a) a natural person resident in the United States; (b) a partnership or corporation organized
or incorporated under the laws of the United States; (c) an estate of which any executor or administrator is a U.S. person; (d)
a trust of which any trustee is a U.S. person; (e) an agency or branch of a foreign entity located in the United States; (f) a
non-discretionary account or similar account (other than an estate or trust) held by a dealer or other fiduciary for the benefit
or account of a U.S. person; (g) a discretionary account or similar account (other than an estate or trust) held by a dealer or
other fiduciary organized, incorporated or (if an individual) resident in the United States; and (h) a partnership or corporation
if (I) organized or incorporated under the laws of any foreign jurisdiction; and (II) formed by a U.S. person principally for the
purpose of investing in securities not registered under the Act, unless it is organized or incorporated, and owned, by accredited
investors (as defined in Rule 501(a) of Regulation D under the Act) who are not natural persons, estates or trusts.  The
Holder agrees that none of the Exchange Securities may be offered or sold in the United States or to "U.S. persons" unless
registered under the Act or an exemption therefrom is available and that hedging transactions involving the Company’s securities
may not be conducted unless in compliance with the Act.

 

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2.17         The
Holder represents and warrants that any information which the Holder has heretofore furnished or furnishes herewith to the Company
is complete and accurate and may be relied upon by the Company.

 

2.18         The
Holder represents and warrants that the director(s), shareholder(s), manager(s) or member(s), as the case may be, of the Holder
have not adopted any resolutions relative to the distribution of any of the Exchange Securities to the shareholder(s) or the member(s),
as the case may be, and have no present intention to do so.

 

3.          Miscellaneous.

 

3.1           Any
notice or other communication given hereunder shall be deemed sufficient if in writing and hand delivered or sent by certified
mail (return receipt requested, postage prepaid), or overnight mail or courier, addressed as follows:

 

To the Company:

 

40 Marcus Drive, Suite One

Melville, New York 11747

Attn: Chief
Executive Officer

 

With a copy
to:

 

Certilman
Balin Adler & Hyman, LLP

90 Merrick
Avenue

East Meadow,
New York 11554

Attn: Fred
Skolnik, Esq.

 

To the Holder:
at its address indicated on the signature page of this Agreement

 

or to such other address
as to which either party shall notify the other in accordance with the provisions hereof.  Notices shall be deemed to
have been given on the date of mailing, except notices of change of address, which shall be deemed to have been given when received.

 

3.2           This
Agreement shall not be changed, modified or amended except by a writing signed by the party to be charged, and this Agreement may
not be discharged except by performance in accordance with its terms or by a writing signed by the party to be charged.

 

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3.3           This
Agreement shall be binding upon and inure to the benefit of the parties hereto and to their respective successors, assigns and
legal representatives.  This Agreement sets forth the entire agreement and understanding between the parties as to the
subject matter thereof and merges and supersedes all prior discussions, agreements and understandings of any and every nature between
them.

 

3.4           This
Agreement and its validity, construction and performance shall be governed in all respects by the laws of the State of New York,
applicable to agreements to be performed wholly within the State of New York.  The Company and the Holder hereby irrevocably
consent and submit to the exclusive jurisdiction of any federal or state court located within Nassau or Suffolk County, New York
over any dispute arising out of or relating to this Agreement and each party hereby irrevocably agrees that all claims in respect
of such dispute or any legal action related thereto may be heard and determined in such courts.  Each of the Company
and the Holder hereby irrevocably waives, to the fullest extent permitted by applicable law, any objection that it may now or hereafter
have to the laying of venue of any such dispute brought in such court or any defense of inconvenient forum for the maintenance
of such dispute.

 

3.5           The
headings in this Agreement are inserted only as a matter of convenience, and in no way define, limit, extend or interpret the scope
of this Agreement or of any particular section.

 

3.6           All
references to the neuter gender herein shall likewise apply to the masculine or feminine gender as and where applicable, and vice-versa.

 

3.7           This
Agreement may be executed in counterparts, each of which shall be deemed to be an original and all of which together shall constitute
one instrument. Signatures transmitted herein via facsimile or other electronic image shall be deemed original signatures. Upon
the execution and delivery of this Agreement by the Holder, this Agreement shall become the binding obligation of the Holder with
respect to the acquisition of the Exchange Securities as herein provided.

 

3.8           Only
upon written approval and acceptance of this Agreement by the Company shall the Company be obligated hereunder.

 

3.9           The
Holder acknowledges that it has been represented by counsel, or afforded the opportunity to be represented by counsel, in connection
with this Agreement.  Accordingly, any rule of law or any legal decision that would require the interpretation of any
claimed ambiguities in this Agreement against the party that drafted it has no application and is expressly waived by the Holder.  The
provisions of this Agreement shall be interpreted in a reasonable manner to give effect to the intent of the parties hereto.

 

[Remainder of page intentionally left
blank.  Signature page follows.]

 

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BIORESTORATIVE THERAPIES, INC.

 

EXCHANGE AGREEMENT

 

Accredited Investor Certification

(Initial the appropriate box(es))

 

The Holder represents
and warrants that it, he or she is an “accredited investor” based upon the satisfaction of one or more of the following
criteria:

 

		_____	(1) he or she is a natural person who has a net worth or joint net worth with his or her spouse
in excess of $1,000,000 at the date hereof1; or

 

		_____	(2) he or she is a natural person who had an individual income in excess of $200,000 in each of
the two most recent years or a joint income with his or her spouse in excess of $300,000 in each of those years and has a reasonable
expectation of reaching the same income level in the current year; or

 

		_____	(3) he or she is a director or executive officer of the Company; or

 

		_____	(4) it is either (a) a bank as defined in Section 3(a)(2) of the Securities Act of 1933, as amended
(the “Securities Act”), or a savings and loan association or other institution as defined in Section 3(a)(5)(A) of
the Securities Act, whether acting in its individual or fiduciary capacity, (b) a broker or dealer registered pursuant to Section
15 of the Securities Exchange Act of 1934, (c) an insurance company as defined in Section 2(13) of the Securities Act, (d) an investment
company registered under the Investment Company Act of 1940 or a business development company as defined in Section 2(a)(48) of
such act, (e) a small business investment company licensed by the United States Small Business Administration under Section 301(c)
or (d) of the Small Business Investment Act of 1958, (f) a plan established and maintained by a state or its political subdivisions,
or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, if such plan has total
assets in excess of $5,000,000 or (g) an employee benefit plan within the meaning of Title I of the Employee Retirement Income
Security Act of 1974, if the determination to accept the Exchange Offer is made by a plan fiduciary, as defined in Section 3(21)
of such act, which plan fiduciary is a bank, savings and loan association, an insurance company or a registered investment advisor,
or if the employee benefit plan has total assets in excess of $5,000,000 or, if a self-directed plan, with the determination to
accept the Exchange Offer made solely by persons who otherwise meet these suitability standards; or

 

 

1 For purposes of calculating net worth:

(i) The Holder’s primary residence
shall not be included as an asset;

(ii) Indebtedness that is secured by the
Holder’s primary residence, up to the estimated fair market value of the primary residence at the date hereof, shall not
be included as a liability (except that if the amount of such indebtedness outstanding at the date hereof exceeds the amount outstanding
60 days before the date hereof, other than as a result of the acquisition of the primary residence, the amount of such excess shall
be included as a liability); and

(iii) Indebtedness that is secured by the
Holder’s primary residence in excess of the estimated fair market value of the primary residence at the date hereof shall
be included as a liability.

 

    	 

    	 

    

  

		_____	(5) it is a private business development company as defined in Section 202(a)(22) of the Investment
Advisers Act of 1940; or

 

		_____	(6) it is an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986,
as amended, a corporation, a Massachusetts or similar business trust or a partnership not formed for the specific purpose of acquiring
the Exchange Securities offered hereby, with total assets in excess of $5,000,000; or

 

		_____	(7) it is a trust, with total assets in excess of $5,000,000, not formed for the specific purpose
of acquiring the Exchange Securities, whose determination to accept the Exchange Offer is directed by a sophisticated person who
has such knowledge and experience in financial and business matters that he or she is capable of evaluating the merits and risks
of the acquisition of the Exchange Securities; or

 

		_____	(8) it is a corporation, partnership or other entity, and each and every equity owner of such entity
initials a separate Accredited Investor Certification pursuant to which it, he or she certifies that it, he or she meets the qualifications
set forth in either (1), (2), (3), (4), (5), (6) or (7) above.

 

	If the Holder is an INDIVIDUAL, or if the Exchange Securities are being acquired as JOINT TENANTS, as TENANTS IN COMMON, or as COMMUNITY PROPERTY:	 	If the Holder is a PARTNERSHIP,

CORPORATION, LIMITED LIABILITY

 COMPANY or TRUST:
	 	 	 
	 	 	Westbury (Bermuda) Ltd.
	Name(s) of Holder	 	Name of Holder
	 	 	 
	 	 	By:	/s/ James Watt
	Signature of Holder	 	 	Signature of Authorized Representative
	 	 	 	 
	 	 	James Watt, President
	Signature, if jointly held	 	Name and Title of Authorized Representative
	 	 	 
	 	 	May 27, 2015
	Date	 	Date

 

    	 

    	 

    

  

IN WITNESS WHEREOF,
the parties have executed this Exchange Agreement as of the day first above written.

 

	 	 	BIORESTORATIVE THERAPIES, INC.
	 	 	 
	 	By:	/s/ Mark Weinreb
	 	 	Mark Weinreb
	 	 	President and Chief Executive Officer

 

If the Holder is an INDIVIDUAL, or if
the Exchange Securities are being acquired as JOINT TENANTS, as TENANTS IN COMMON, or as COMMUNITY PROPERTY:

 

	 	 	 
	Print Name(s)	 	Social Security Number(s)
	 	 	 
	Signature of Holder	 	Signature of Holder, if more than one
	 	 	 
	Principal Amount of Note/Interest	 	Date of Note
	 	 	 
	Number of Exchange Shares	 	Address(es)
	 	 	 
	Number of Warrant Shares	 	Date

 

 

 

If the Holder is a PARTNERSHIP, CORPORATION,
LIMITED LIABILITY COMPANY or TRUST:

 

	Westbury (Bermuda) Ltd.	 	Corporation
	Name of Partnership, Corporation	 	Type of Entity
	Limited Liability Company or Trust	 	 
	 	 	-
	By:	/s/ James Watt	 	Federal Taxpayer Identification Number
	 	Name:	James Watt	 	 
	 	Title:	President	 	February 10, 2011, November 4, 2011,
	 	 	March 30, 2012, March 27, 2013
	$4,410,937.50 / $69,436.00	 	and May 7, 2014
	Aggregate Outstanding Principal Amount	 	Dates of Notes
	of Notes/Aggregate Amount of Interest	 	 
	 	 	Victoria Hall
	14,934,578	 	11 Victoria Street, PO Box HM 1065  
	Number of Exchange Shares	 	Hamilton HM EX, Bermuda
	 	 	Address
	3,733,645	 	 
	Number of Warrant Shares	 	Bermuda
	 	 	State of Organization
	 	 	 
	 	 	May 27, 2015
	 	 	Date

 

    	 

    	 

    

  

Exhibit
A 

 

VOID AFTER 5:00 P.M., EASTERN TIME, ON
MAY 27, 2020

 

NEITHER THIS WARRANT NOR THE WARRANT
STOCK (AS HEREINAFTER DEFINED) HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE
SECURITIES LAWS OF ANY STATE.  THIS WARRANT AND THE WARRANT STOCK MAY BE TRANSFERRED ONLY IN COMPLIANCE WITH THE ACT
AND SUCH LAWS.  THIS LEGEND SHALL BE ENDORSED UPON ANY WARRANT ISSUED IN EXCHANGE FOR THIS WARRANT.

 

 

 

BIORESTORATIVE THERAPIES, INC.

 

(Incorporated under the laws of the State
of Delaware)

 

Warrant

 

	3,733,645 Shares	May 27, 2015

 

FOR VALUE RECEIVED,
BIORESTORATIVE THERAPIES, INC., a Delaware corporation (the “Company”), hereby certifies that WESTBURY
(BERMUDA) LTD., a Bermuda corporation (the “Holder”), is entitled, subject to the provisions of this Warrant, to
purchase from the Company up to THREE MILLION SEVEN HUNDRED THIRTY-THREE THOUSAND SIX HUNDRED FORTY-FIVE (3,733,645) SHARES
OF COMMON STOCK, $.001 par value per share, of the Company (“Common Shares”) at a price of SEVENTY-FIVE
CENTS ($0.75) per share (the “Exercise Price”) during the period commencing on the date hereof and terminating
at 5:00 P.M. on the fifth anniversary of the date hereof.

 

The number of Common
Shares to be received upon the exercise of this Warrant may be adjusted from time to time as hereinafter set forth.  The
Common Shares deliverable upon such exercise, and as adjusted from time to time, are hereinafter sometimes referred to as “Warrant
Stock.”

 

The Holder agrees with
the Company that this Warrant is issued, and all the rights hereunder shall be held subject to, all of the conditions, limitations
and provisions set forth herein.

 

1.          Exercise
of Warrant.  This Warrant may be exercised by its presentation and surrender to the Company at 40 Marcus Drive,
Suite One, Melville, New York 11747 (or such office or agency of the Company as it may designate in writing to the Holder hereof)
with the Warrant Exercise Form attached hereto duly executed and accompanied by payment (either in cash or by official bank check,
payable to the order of the Company) of the Exercise Price for the number of shares specified in such Form.  The Company
agrees that the Holder hereof shall be deemed the record owner of such Common Shares as of the close of business on the date on
which this Warrant shall have been presented and payment made for such Common Shares as aforesaid whether or not the Company or
its transfer agent is open for business.  Certificates for the Common Shares so purchased shall be delivered to the Holder
hereof within a reasonable time after the rights represented by this Warrant shall have been so exercised.  If this Warrant
is exercised in part only, the Company shall, upon surrender of this Warrant for cancellation, execute and deliver a new Warrant
evidencing the rights of the Holder hereof to purchase the balance of the shares purchasable hereunder.

 

    	 

    	 

    

  

2.          Registered
Owner.  The Company may consider and treat the person in whose name this Warrant shall be registered as the absolute
owner thereof for all purposes whatsoever and the Company shall not be affected by any notice to the contrary.  Subject
to the provisions hereof, the registered owner of this Warrant shall have the right to transfer it by assignment and the transferee
thereof, upon his registration as owner of this Warrant, shall become vested with all the powers and rights of the transferor.  Registration
of any new owner shall take place upon presentation of this Warrant to the Company at its offices together with the Warrant Assignment
Form attached hereto duly executed.  In case of transfers by operation of law, the transferee shall notify the Company
of such transfer and of his address, and shall submit appropriate evidence regarding the transfer so that this Warrant may be registered
in the name of the transferee.  This Warrant is transferable only on the books of the Company by the Holder on the surrender
hereof, duly endorsed. Communications sent to any registered owner shall be effective as against all holders or transferees of
this Warrant not registered at the time of sending the communication.  

 

3.          Reservation
of Shares.  During the period within which the rights represented by this Warrant may be exercised, the Company
shall, at all times, reserve and keep available out of its authorized capital stock, solely for the purposes of issuance upon exercise
of this Warrant, such number of its Common Shares as shall be issuable upon the exercise of this Warrant; and if at any time the
number of authorized Common Shares shall not be sufficient to effect the exercise of this Warrant, the Company will take such corporate
action as may be necessary to increase its authorized but unissued Common Shares to such number of shares as shall be sufficient
for such purpose; the Company shall have analogous obligations with respect to any other securities or property issuable upon exercise
of this Warrant.

 

4.          Fractional
Shares.  The Company shall not be required to issue certificates representing fractions of Common Shares, nor
shall it be required to issue scrip or pay cash in lieu of fractional interests, it being the intent of the Company and the Holder
that all fractional interests shall be eliminated.

 

5.          Rights
of the Holder.  The Holder shall not, by virtue hereof, be entitled to any voting or other rights of a stockholder
of the Company, either at law or in equity, and the rights of the Holder are limited to those expressed in this Warrant.

 

6.          Anti-Dilution
Provisions.

 

6.1           Adjustments
for Stock Dividends; Combinations, Etc.  (a) In case the Company shall do any of the following (an “Event”):

 

(i)          declare
a dividend or other distribution on its Common Shares payable in Common Shares of the Company,

 

(ii)         subdivide
the outstanding Common Shares pursuant to a stock split or otherwise,

 

    	2

    	 

    

  

(iii)        combine
the outstanding Common Shares into a smaller number of shares pursuant to a reverse split or otherwise, or

 

(iv)        reclassify
its Common Shares,

 

then the Exercise Price in effect at the
time of the record date for such dividend or other distribution or of the effective date of such subdivision, combination or reclassification
shall be changed to a price determined by dividing (a) the product of the number of Common Shares outstanding immediately prior
to such Event, multiplied by the Exercise Price in effect immediately prior to such Event by (b) the number of Common Shares outstanding
immediately after such Event.  Each such adjustment of the Exercise Price shall be calculated to the nearest one-hundredth
of a cent.  Such adjustment shall be made successively whenever any Event listed above shall occur.

 

(b)          Whenever
the Exercise Price is adjusted as set forth in Section 6.1 (whether or not the Company then or thereafter elects to issue additional
Warrants in substitution for an adjustment in the number of shares of Warrant Stock), the number of shares of Warrant Stock specified
in each Warrant which the Holder may purchase shall be adjusted, to the nearest full share, by multiplying such number of shares
of Warrant Stock immediately prior to such adjustment by a fraction, of which the numerator shall be the Exercise Price immediately
prior to such adjustment and the denominator shall be the Exercise Price immediately thereafter.

 

6.2           Adjustment
for Reorganization, Consolidation or Merger.  In case of any reorganization of the Company (or any other entity,
the securities of which are at the time receivable on the exercise of this Warrant) after the date hereof or in case after such
date the Company (or any such other entity) shall consolidate with or merge with or into another entity, then, and in each such
case, the Holder of this Warrant upon the exercise thereof as provided in Section l at any time after the consummation of such
reorganization, consolidation or merger, shall be entitled to receive, in lieu of the securities and property receivable upon the
exercise of this Warrant prior to such consummation, the securities or property to which such Holder would have been entitled upon
such consummation if such Holder had exercised this Warrant immediately prior thereto, all subject to further adjustment as provided
in Section 6.l; in each such case, the terms of this Warrant shall be applicable to the securities or property receivable upon
the exercise of this Warrant after such consummation.

 

7.          Investment
Intent.  Unless, prior to the exercise of this Warrant, the issuance of the Warrant Stock has been registered
with the Securities and Exchange Commission pursuant to the Act, the Warrant Exercise Form shall be accompanied by the Investment
Representation Letter attached hereto, duly executed by the Holder.

 

8.          Restrictions
on Transfer.

 

8.1           Transfer
to Comply with the Securities Act of 1933.  Neither this Warrant nor any Warrant Stock may be sold, assigned,
transferred or otherwise disposed of except as follows: (1) to a person who, in the opinion of counsel satisfactory to the Company,
is a person to whom this Warrant or the Warrant Stock may legally be transferred without registration and without the delivery
of a current prospectus under the Act with respect thereto and then only against receipt of an agreement of such person to comply
with the provisions of this Section 8 with respect to any resale, assignment, transfer or other disposition of such securities;
or (2) to any person upon delivery of a prospectus then meeting the requirements of the Act relating to such securities and the
offering thereof for such sale, assignment, transfer or disposition.

 

    	3

    	 

    

  

8.2           Legend.  Subject
to the terms hereof, upon exercise of this Warrant and the issuance of the Warrant Stock, all certificates representing such Warrant
Stock shall bear on the face or reverse thereof substantially the following legend:

 

“The securities which are
represented by this certificate have not been registered under the Securities Act of 1933, and may not be sold, transferred, hypothecated
or otherwise disposed of until a registration statement with respect thereto is declared effective under such act, or the Company
receives an opinion of counsel for the Company that an exemption from the registration requirements of such act is available.”

 

9.          Lost,
Stolen or Destroyed Warrant.  In the event that the Holder notifies the Company that this Warrant has been lost,
stolen or destroyed and provides (a) a letter, in form satisfactory to the Company, to the effect that it will indemnify the Company
from any loss incurred by it in connection therewith, and/or (b) an indemnity bond in such amount as is reasonably required by
the Company, the Company having the option of electing either (a) or (b) or both, the Company may, in its sole discretion, accept
such letter and/or indemnity bond in lieu of the surrender of this Warrant as required by Section 1 hereof.

 

10.         Notices.  All
notices required hereunder shall be given by first-class mail, postage prepaid, or overnight mail or courier and, if given by the
Holder addressed to the Company at 40 Marcus Drive, Suite One, Melville, New York 11747, Attention: Chief Executive Officer, or
such other address as the Company may designate in writing to the Holder; and if given by the Company, addressed to the Holder
at the address of the Holder shown on the books of the Company.

 

11.         Applicable
Law; Jurisdiction.  This Warrant is issued under, and shall for all purposes be governed by and construed in
accordance with, the laws of the State of Delaware, excluding choice of law principles thereof. The Company and, by its acceptance
of this Warrant, the Holder hereby irrevocably consent and submit to the exclusive jurisdiction of any federal or state court located
within Nassau or Suffolk County, New York over any dispute arising out of or relating to this Warrant and each party hereby irrevocably
agrees that all claims in respect of such dispute or any legal action related thereto may be heard and determined in such courts.  Each
of the Company and the Holder hereby irrevocably waives, to the fullest extent permitted by applicable law, any objection that
it or he may now or hereafter have to the laying of venue of any such dispute brought in such court or any defense of inconvenient
forum for the maintenance of such dispute.

 

[Remainder of page intentionally left blank.  Signature
page follows.]

 

    	4

    	 

    

  

IN WITNESS WHEREOF, the Company has
caused this Warrant to be signed on its behalf, in its corporate name, by its duly authorized officer, all as of the day and year
first above written.

 

	 	BIORESTORATIVE THERAPIES, INC.
	 	 	 
	 	By:	 
	 	 	Mark Weinreb
	 	 	Chief Executive Officer

 

    	 

    	 

    

  

BIORESTORATIVE THERAPIES, INC.

 

WARRANT EXERCISE FORM

 

The undersigned
hereby irrevocably elects to exercise the within Warrant dated as of May 27, 2015 to the extent of purchasing ______________
shares of Common Stock of BIORESTORATIVE THERAPIES, INC.  The undersigned hereby makes a payment of
$__________ in payment therefor.

 

	TO BE COMPLETED BY INDIVIDUAL	 	TO BE COMPLETED BY CORPORATE,
	HOLDER, JOINT TENANTS, TENANTS	 	PARTNERSHIP, LIMITED LIABILITY
	IN COMMON OR AS HOLDERS OF 	 	COMPANY OR TRUST HOLDER
	COMMUNITY PROPERTY	 	 
	 	 	 
	 	 	 
	Name(s) of Holder(s) [Please Print]	 	Name of Holder [Please Print]
	 	 	 	 
	 	 	By:	 
	Signature of Holder	 	 	Authorized Signatory
	 	 	 	 
	 	 	 
	Signature of Holder, if jointly held	 	Name and Title of Authorized Signatory
	 	 	[Please Print]
	 	 	 
	 	 	 
	Address(es) of Holder(s)	 	Address of Holder
	 	 	 
	 	 	 
	Social Security Number(s) of Holder(s)	 	Tax Identification Number of Holder
	 	 	 
	 	 	 
	Date	 	Date

 

    	 

    	 

    

  

BIORESTORATIVE THERAPIES, INC.

 

WARRANT ASSIGNMENT FORM

 

FOR VALUE RECEIVED,
_________________________ hereby sells, assigns and transfers unto _____________________________ (please type or print name of
assignee) with an address at ______________________________________________________________ the right to purchase shares of Common
Stock of BIORESTORATIVE THERAPIES, INC. (the “Company”) represented by this Warrant dated as of May 27, 2015
to the extent of ___________ shares and does hereby irrevocably constitute and appoint ___________________ attorney to transfer
the same on the books of the Company with full power of substitution in the premises.

 

	TO BE COMPLETED BY INDIVIDUAL	 	TO BE COMPLETED BY CORPORATE,
	HOLDER, JOINT TENANTS, TENANTS	 	PARTNERSHIP, LIMITED LIABILITY
	IN COMMON OR AS HOLDERS OF 	 	COMPANY OR TRUST HOLDER
	COMMUNITY PROPERTY	 	 
	 	 	 
	 	 	 
	Name(s) of Holder(s) [Please Print]	 	Name of Holder [Please Print]
	 	 	 	 
	 	 	By:	 
	Signature of Holder	 	 	Authorized Signatory
	 	 	 	 
	 	 	 
	Signature of Holder, if jointly held	 	Name and Title of Authorized Signatory
		 	[Please Print]
	 	 	 
	 	 	 
	Date	 	Date

 

Signature(s) Guaranteed:

 

    	 

    	 

    

  

BIORESTORATIVE THERAPIES, INC.

 

FORM OF INVESTMENT REPRESENTATION
LETTER

 

BioRestorative Therapies,
Inc.

40 Marcus Drive

Suite One

Melville, New York 11747

 

Gentlemen:

 

In connection with
the acquisition of _______________ shares of Common Stock (the “Shares”) of BIORESTORATIVE THERAPIES, INC.,
a Delaware corporation (the “Company”), by the undersigned from the Company pursuant to the exercise of a Warrant,
dated as of May 27, 2015, the undersigned does hereby represent and warrant to the Company as follows:

 

(a)          The
undersigned represents and warrants that the Shares acquired by it are being acquired for its own account, for investment purposes
and not with a view to any distribution within the meaning of the Securities Act of 1933, as amended (the “Securities Act”).  The
undersigned will not sell, assign, mortgage, pledge, hypothecate, transfer or otherwise dispose of any of the Shares unless (i)
a registration statement under the Securities Act with respect thereto is in effect and the prospectus included therein meets the
requirements of Section 10 of the Securities Act, or (ii) the Company has received a written opinion of its counsel that, after
an investigation of the relevant facts, such counsel is of the opinion that such proposed sale, assignment, mortgage, pledge, hypothecation,
transfer or disposition does not require registration under the Securities Act or any state securities law.

 

(b)          The
undersigned understands that the resale of the Shares is not, and is not being, registered under the Securities Act and the Shares
must be held indefinitely unless they are subsequently registered thereunder or an exemption from such registration is available.  

 

(c)          The
undersigned recognizes that the acquisition of the Shares involves a high degree of risk and is suitable only for persons of adequate
financial means who have no need for liquidity with respect to the Shares in that (a) it may not be able to liquidate the Shares
in the event of emergency; (b) transferability is extremely limited; and (c) it could sustain a complete loss of its investment.

 

(d)          The
undersigned represents and warrants that it (a) is competent to understand and does understand the nature of its investment; and
(b) is able to bear the economic risk of an acquisition of the Shares.

 

    	 

    	 

    

  

(e)          The
undersigned represents and warrants that it is an “accredited investor,” as such term is defined in Rule 501 of Regulation
D promulgated under the Securities Act.  The undersigned meets the requirements of at least one of the suitability standards
for an “accredited investor” as set forth on the Accredited Investor Certification attached hereto.  

 

(f)          The
undersigned has reviewed the Company’s filings with the Securities and Exchange Commission, including the risk factors set
forth therein, and has been afforded the opportunity to obtain such information regarding the Company as it has reasonably requested
to evaluate the merits and risks of the undersigned’s investment in the Shares. No oral or written representations have been
made or oral information furnished to the undersigned or its advisers in connection with the investment in the Shares.

 

(g)          The
undersigned confirms that the representations and warranties set forth in the Subscription Agreement pursuant to which the Warrant
was issued are true and correct as of the date hereof as if made on and as of the date hereof with respect to the purchase of the
Shares.

 

(h)          The
undersigned acknowledges that counsel to the Company will be relying, and may rely, upon the foregoing in connection with any opinion
of counsel it may give with regard to the issuance of the Shares by the Company to the undersigned, and any subsequent transfer
of the Shares by the undersigned, and agrees to advise the Company and its counsel in writing in the event of any change in any
of the foregoing.

 

Very truly
yours,

 

	TO BE COMPLETED BY INDIVIDUAL	 	TO BE COMPLETED BY CORPORATE,
	HOLDER, JOINT TENANTS, TENANTS	 	PARTNERSHIP, LIMITED LIABILITY
	IN COMMON OR AS HOLDERS OF 	 	COMPANY OR TRUST HOLDER
	COMMUNITY PROPERTY	 	 
	 	 	 
	 	 	 
	Name(s) of Holder(s) [Please Print]	 	Name of Holder [Please Print]
	 	 	 	 
	 	 	By:	 
	Signature of Holder	 	 	Authorized Signatory
	 	 	 	 
	 	 	 
	Signature of Holder, if jointly held	 	Name and Title of Authorized Signatory
		 	[Please Print]
	 	 	 
	 	 	 
	Date	 	Date

 

    	 

    	 

    

  

BIORESTORATIVE THERAPIES, INC.

 

WARRANT EXERCISE

 

Accredited Investor Certification

(Initial the appropriate box(es))

 

The undersigned represents
and warrants that it, he or she is an “accredited investor” based upon the satisfaction of one or more of the following
criteria:

 

		_____	(1) he or she is a natural person who has a net worth or joint net worth with his or her spouse
in excess of $1,000,000 at the time of his or her purchase1; or

 

		_____	(2) he or she is a natural person who had an individual income in excess of $200,000 in each of
the two most recent years or a joint income with his or her spouse in excess of $300,000 in each of those years and has a reasonable
expectation of reaching the same income level in the current year; or

 

		_____	(3) he or she is a director or executive officer of the Company; or

 

		_____	(4) it is either (a) a bank as defined in Section 3(a)(2) of the Securities Act or a savings and
loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act, whether acting in its individual
or fiduciary capacity, (b) a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934, (c) an
insurance company as defined in Section 2(13) of the Securities Act, (d) an investment company registered under the Investment
Company Act of 1940 or a business development company as defined in Section 2(a)(48) of such act, (e) a small business investment
company licensed by the United States Small Business Administration under Section 301(c) or (d) of the Small Business Investment
Act of 1958, (f) a plan established and maintained by a state or its political subdivisions, or any agency or instrumentality of
a state or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000
or (g) an employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974, if the investment
decision is made by a plan fiduciary, as defined in Section 3(21) of such act, which plan fiduciary is a bank, savings and loan
association, an insurance company or a registered investment advisor, or if the employee benefit plan has total assets in excess
of $5,000,000 or, if a self-directed plan, with investment decisions made solely by persons who otherwise meet these suitability
standards; or

 

 

1For purposes of calculating
net worth:

(i) The undersigned’s primary residence
shall not be included as an asset;

(ii) Indebtedness that is secured by the
undersigned’s primary residence, up to the estimated fair market value of the primary residence at the date hereof, shall
not be included as a liability (except that if the amount of such indebtedness outstanding at the date hereof exceeds the amount
outstanding 60 days before the date hereof, other than as a result of the acquisition of the primary residence, the amount of such
excess shall be included as a liability); and

(iii) Indebtedness that is secured by the
undersigned’s primary residence in excess of the estimated fair market value of the primary residence at the date hereof
shall be included as a liability.

 

    	 

    	 

    

  

		_____	(5) it is a private business development company as defined in Section 202(a)(22) of the Investment
Advisers Act of 1940; or

 

		_____	(6) it is an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986,
as amended, a corporation, a Massachusetts or similar business trust or a partnership not formed for the specific purpose of acquiring
the Shares offered hereby, with total assets in excess of $5,000,000; or

 

		_____	(7) it is a trust, with total assets in excess of $5,000,000, not formed for the specific purpose
of acquiring the Shares, whose purchase is directed by a sophisticated person who has such knowledge and experience in financial
and business matters that he or she is capable of evaluating the merits and risks of the prospective investment; or

 

		_____	(8) it is a corporation, partnership or other entity, and each and every equity owner of such entity
initials a separate Accredited Investor Certification pursuant to which it, he or she certifies that it, he or she meets the qualifications
set forth in either (1), (2), (3), (4), (5), (6) or (7) above.

  

	If the Warrant Holder is an INDIVIDUAL,

 or if the Shares are being acquired as JOINT

 TENANTS, as TENANTS IN COMMON, or 

as COMMUNITY PROPERTY:	 	If the Warrant Holder is a PARTNERSHIP, 

CORPORATION, LIMITED LIABILITY

COMPANY or TRUST:
	 	 	 
	 	 	 
	Name(s) of Warrant Holder	 	Name of Warrant Holder
	 	 	 	 
	 	 	By:	 
	Signature of Warrant Holder	 	 	Signature of Authorized Representative
	 	 	 
	 	 	 
	Signature, if jointly held	 	Name and Title of Authorized Representative
	 	 	 
	 	 	 
	Date	 	Date

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