Document:

Exhibit 10.35

 

THIS WARRANT AND THE SHARES ISSUABLE
UPON THE EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. EXCEPT AS OTHERWISE SET
FORTH HEREIN NEITHER THIS WARRANT NOR ANY OF SUCH SHARES MAY BE SOLD, TRANSFERRED OR ASSIGNED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION
STATEMENT FOR SUCH SECURITIES UNDER SAID ACT OR, OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO,
THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL
OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.

 

XG SCIENCES,
INC.

 

COMMON STOCK
PURCHASE WARRANT

 

	Certificate No: ___	______________ Warrants

_________________ ___, 201_

 

This Common Stock Purchase Warrant (this
“Warrant”) certifies that, for value received, ______________________________________________ (the “Holder”)
is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on
or after the date hereof (the “Initial Exercise Date”) and on or prior to 5:00 PM Eastern Time on ______________
__, 202__, that is, the fifth (5th) anniversary from the date hereof (the “Expiration Date”) but not thereafter,
to subscribe for and purchase from XG Sciences, Inc., a Michigan corporation with offices at 3101 Grand Oak Dr., Lansing, MI 48911
(the “Company”), up to _________________ shares (the “Shares” and each, a “Share”)
of the Company’s common stock, no par value per share (the “Common Stock”) at a price of $8.00 per Share,
as adjusted in accordance with Section 2 below (the “Purchase Price”), subject to a 30% warrant coverage for
purchases of the Warrant made by December 31, 2015, and 20% warrant coverage thereafter. This Warrant is being delivered in connection
with the Company’s offering of (i) promissory notes and (ii) warrants to purchase shares of Common Stock, pursuant to the
terms of a Subscription Agreement, dated _______________ __, 201_ by and between the Company and the Holder (“Subscription
Agreement”).

 

Section 1.          Exercise
of Warrants.

 

(a)          Upon
presentation and surrender at the principal executive office of the Company of this Warrant prior to the Expiration Date, along
with the Election to Purchase form attached here to as Exhibit A duly executed, together with a check to the Company in
the amount of the Purchase Price multiplied by the number of shares of Common Stock being purchased, the Company will deliver to
the holder hereof, certificates of Common Stock which in the aggregate represent the number of shares of Common Stock being purchased.
This Warrant may be partially exercised and, in the case of such partial exercise, the Company, upon surrender hereof, will deliver
to the Holder a new Warrant representing the number of shares which have not been exercised.

 

(b)          In
lieu of exercising this Warrant, the Holder may elect to receive Shares equal to the value of this Warrant (or the portion thereof
being canceled) by surrender of this Warrant at the principal office of the Company together with notice of such election, in which
event the Company shall issue to the Holder a number of Shares computed using the following formula:

 

     

     

    

 

Y (A-B)

X = ———————

A

 

“X” equals
the number of Shares to be issued to the Holder.

 

“Y” equals the number of Shares
purchasable under this Warrant.

 

“A” equals the fair market value
of one Share on the date of determination.

 

“B” equals the per share Purchase
Price (as adjusted to the date of such calculation).

 

(c)          Fair
Market Value. For purposes of this Section 1, the per share fair market value of the Shares means:

 

(i) If
the Common Stock is publicly traded, the per share fair market value of the Shares shall be (a) the daily volume weighted average
price of the Common Stock for such date (or the nearest preceding date) on the trading market (including, without limitation, the
OTCQX and OTCQB markets maintained by the OTC Markets Group, Inc. and any successor-entities) which the Common Stock is then listed
or quoted as reported by Bloomberg L.P. (based on a trading day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City
time)), (b) if the OTC Bulletin Board is not a trading market, the volume weighted average price of the Common Stock for such date
(or the nearest preceding date) on the OTC Bulletin Board, (c) if the Common Stock is not then listed or quoted for trading on
the OTC Bulletin Board and if prices for the Common Stock are then reported in the “Pink Sheets” published by Pink
OTC Markets, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the most recent bid price
per share of the Common Stock so reported; or

 

(ii) If
the Common Stock is not so publicly traded, the per share fair market value of the Shares shall be such fair market value as is
determined in good faith by the Board of Directors of the Company after taking into consideration factors it deems appropriate,
including, without limitation, recent sale and offer prices of the capital stock of the Company in private transactions negotiated
at arm’s length.

 

(d)          If
this Warrant shall be deemed “in the money” on the Expiration Date and the Holder has not exercise his, her or its
rights hereunder, the Company shall automatically effect a cashless exercise of this Warrant on behalf of the Holder in accordance
with the formula hereinabove.

 

(e)          The
rights represented by this Warrant may be exercised by the Holder, in whole or in part (with respect to shares of Common Stock),
subject to the conditions contained herein and at any time prior to the Expiration Date by: (i) surrender of this Warrant for calculation
(with the Election to Purchase form at the end hereof properly executed) at the principal executive office of the Company (or at
such other office or agency of the Company as it may designate by notice in writing to the Holder at the address of the Holder
appearing on the books of the Company); (ii) payment to the Company of the Purchase Price for the number of shares of Common Stock
specified in the Election to Purchase form, together with the amount of applicable stock transfer taxes, if any; and/or (iii) delivery
to the Company of a duly executed agreement signed by the person(s) designated in the Election to Purchase form to the effect that
such person(s) agree(s) to be bound by all of the terms and conditions of this Warrant. This Warrant shall be deemed to have been
exercised, in whole or in part to the extent specified, immediately prior to the close of business on the date on which all of
the applicable provisions of this Section 1(c) are reasonably satisfied, and the person(s) designated in the Election to Purchase
form shall become the holder(s) of record of the shares of Common Stock issuable upon such exercise at that time and date.

 

    	 	-2-	 

     

    

 

(f)          As
soon as possible after any full or partial exercise of this Warrant, but in any event no more than ten (10) business days, the
Company, at its expense, will cause to be issued in the name of and delivered to the Holder of this Warrant, a certificate or certificates
for the number of fully paid and non-assessable shares of Common Stock to which that Holder shall be entitled on such exercise.
No fractional shares will be issued on exercise of this Warrant. If, on any exercise of this Warrant, a fractional share results,
the Company will pay the cash value of that fractional share, calculated on the basis of the Purchase Price. All such certificates
shall bear a restrictive legend to the effect that the shares of Common Stock represented by such certificate have not been registered
under the Securities Act, and the shares of Common Stock may not be sold or transferred in the absence of such registration or
an exemption therefrom, such legend to be substantially in the form of the bold face language appearing in Section 2 of this Warrant.

 

Section 2. Legends.
Until the date on which a registration statement filed by the Company under the Securities Act of 1933, as amended (the “Securities
Act”) covering the issuance and sale or the resale of the Shares is declared effective by the U.S. Securities and Exchange
Commission (the “SEC”), any certificates evidencing the Shares shall bear a legend substantially in the following
form:

 

“THE SECURITIES REPRESENTED
BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR THE SECURITIES LAWS OF ANY STATE,
AND MAY NOT BE SOLD, TRANSFERRED, ASSIGNED, PLEDGED OR HYPOTHECATED UNLESS AND UNTIL REGISTERED UNDER SUCH ACT AND/OR APPLICABLE
STATE SECURITIES LAWS, OR UNLESS THE COMPANY HAS RECEIVED AN OPINION OF COUNSEL OR OTHER EVIDENCE, REASONABLY SATISFACTORY TO THE
COMPANY AND ITS COUNSEL, THAT SUCH REGISTRATION IS NOT REQUIRED.”

 

Section 3.          Charges,
Taxes and Expenses. Issuance of certificates for Shares shall be made without charge to the Holder for any issue or transfer
tax or other incidental expense in respect of the issuance of such certificate, all of which taxes and expenses shall be paid by
the Company, and such certificates shall be issued in the name of the Holder or in such name or names as may be directed by the
Holder; provided, however, that in the event certificates for Shares are to be issued in a name other than the name
of the Holder, this Warrant when surrendered for exercise shall be accompanied by the Assignment Form attached hereto duly executed
by the Holder and the Company may require, as a condition thereto, the payment of a sum sufficient to reimburse it for any transfer
tax incidental thereto.

 

Section 4.          Certain
Adjustments.

 

(a)          Stock
Dividends and Stock Splits. If the Company, at any time after the date hereof: (A) shall pay a stock dividend or otherwise
make a distribution or distributions on shares of its Common Stock in shares of Common Stock, (B) subdivide outstanding shares
of Common Stock into a larger number of shares, or (C) combine (including by way of reverse stock split) outstanding shares
of Common Stock into a smaller number of shares, then the Purchase Price shall be multiplied by a fraction of which the numerator
shall be the number of shares of Common Stock outstanding before such event and of which the denominator shall be the number of
shares of Common Stock outstanding after such event. Any adjustment made pursuant to this Section shall become effective immediately
after the record date for the determination of stockholders entitled to receive such dividend or distribution and shall become
effective immediately after the effective date in the case of a subdivision, combination or reclassification, and the number of
shares issuable upon exercise of this Warrant, shall be proportionately adjusted such that the aggregate Purchase Price of this
Warrant shall remain unchanged.

 

    	 	-3-	 

     

    

 

(b)          
Fundamental Transaction. If, at any time while this Warrant is outstanding, (A) the Company effects any merger or consolidation
of the Company with or into another Person, (B) the Company effects any sale of all or substantially all of its assets in
one or a series of related transactions, (C) any tender offer or exchange offer (whether by the Company or another Person)
is completed pursuant to which holders of Common Stock are permitted to tender or exchange their shares for other securities, cash
or property, or (D) the Company effects any reclassification of the Common Stock or any compulsory share exchange pursuant
to which the Common Stock is effectively converted into or exchanged for other securities, cash or property (in any such case,
a “Fundamental Transaction”), then upon any subsequent exercise of this Warrant, the Holder shall have the right
to receive, for each share of Common Stock that would have been issuable upon such conversion absent such Fundamental Transaction,
the same kind and amount of securities, cash or property as it would have been entitled to receive upon the occurrence of such
Fundamental Transaction if it had been, immediately prior to such Fundamental Transaction, the holder of one share of Common Stock
(the “Alternate Consideration”). For purposes of any such conversion, the determination of the Purchase Price
shall be appropriately adjusted to apply to such Alternate Consideration based on the amount of Alternate Consideration issuable
in respect of one share of Common Stock in such Fundamental Transaction, and the Company shall apportion the Purchase Price among
the Alternate Consideration in a reasonable manner reflecting the relative value of any different components of the Alternate Consideration,
If holders of Common Stock are given any choice as to the securities, cash or property to be received in a Fundamental Transaction,
then the Holder shall be given the same choice as to the Alternate Consideration it receives upon any exercise of this Warrant
following such Fundamental Transaction. To the extent necessary to effectuate the foregoing provisions, any successor to the Company
or surviving entity in such Fundamental Transaction shall issue to the Holder a new warrant consistent with the foregoing provisions
and evidencing the Holder’s right to exercise such warrant for the Alternate Consideration. The terms of any agreement pursuant
to which a Fundamental Transaction is effected shall include terms requiring any such successor or surviving entity to comply with
the provisions of this paragraph (b) and insuring that this Warrant (or any such replacement security) will be similarly adjusted
upon any subsequent transaction analogous to a Fundamental Transaction.

 

Section 5.          Transfer
of Warrant. This Warrant and all rights hereunder are transferable, in whole or in part, upon surrender of this Warrant at
the principal office of the Company or its designated agent, together with a written assignment of this Warrant substantially in
the form attached hereto as Exhibit B, duly executed by the Holder or its agent or attorney and funds sufficient to pay
any transfer taxes payable upon the making of such transfer. Upon such surrender and, if required, such payment, the Company shall
execute and deliver a new Warrant or Warrants in the name of the assignee or assignees, as applicable, and in the denomination
or denominations specified in such instrument of assignment, and shall issue to the assignor a new Warrant evidencing the portion
of this Warrant not so assigned, and this Warrant shall promptly be cancelled. The Warrant, if properly assigned in accordance
herewith, may be exercised by a new holder for the purchase of Warrant Shares without having a new Warrant issued.

 

Section 6.          Miscellaneous.

 

(a)          No
Rights as Stockholder Until Exercise. This Warrant does not entitle the Holder to any voting rights, dividends or other rights
as a stockholder of the Company prior to the exercise hereof.

 

    	 	-4-	 

     

    

 

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

 

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

 

(d)          Authorized
Shares. The Company covenants that, during the period the Warrant is outstanding, it will reserve from its authorized and unissued
Common Stock a sufficient number of shares of Common Stock to provide for the issuance of the Shares upon the exercise of any purchase
rights under this Warrant. The Company further covenants that its issuance of this Warrant shall constitute full authority to its
officers who are charged with the duty of executing stock certificates to execute and issue the necessary certificates for the
Shares upon the exercise of the purchase rights under this Warrant. The Company will take all such reasonable action as may be
necessary to assure that such Shares may be issued as provided herein without violation of any applicable law or regulation, or
of any requirements of any trading market upon which the Common Stock may be listed. The Company covenants that all Shares which
may be issued upon the exercise of the purchase rights represented by this Warrant will, upon exercise of the purchase rights represented
by this Warrant and payment for such Shares in accordance herewith, be duly authorized, validly issued, fully paid and nonassessable
and free from all taxes, liens and charges created by the Company in respect of the issue thereof (other than taxes in respect
of any transfer occurring contemporaneously with such issue).

 

(e)          Jurisdiction.
All questions concerning the construction, validity, enforcement and interpretation of this Warrant shall be determined in accordance
with the laws of the State of Michigan.

 

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

 

(g)          Nonwaiver.
No course of dealing or any delay or failure to exercise any right hereunder on the part of Holder shall operate as a waiver of
such right or otherwise prejudice the Holder’s rights, powers or remedies.

 

(h)          Notices.
Any notice, request or other document required or permitted to be given or delivered to the Holder by the Company shall be delivered
to the Holder at the address provided herein by Holder in Exhibit C, attached hereto. If the Holder has not provided contact
information in Exhibit C, the Company shall be entitled to use the contact information provided by such Holder in the Subscription
Agreement.

 

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

 

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

 

    	 	-5-	 

     

    

 

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

 

(l)          Amendment.
This Warrant may only be modified or amended or the provisions hereof waived with the written consent of the Company and the Holder.

 

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

 

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

 

(Signature Page Follows)

 

    	 	-6-	 

     

    

 

IN WITNESS WHEREOF,
the Company has caused this Warrant to be signed by its duly authorized officer and this Warrant to be dated as of the date first
above written.

 

	 	XG SCIENCES, INC.
	 	 	 
	 	By: 	 
	 	 	Philip Rose, Chief Executive Officer

 

    	 	-7-	 

     

    

 

EXHIBIT
A

 

NOTICE OF
EXERCISE

 

TO: XG SCIENCES, INC.

 

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

 

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

 

 ̈
wire transfer in lawful money of the United States;

 ̈ cashier’s
check drawn on a U.S. bank; or

 ̈ in accordance with the formula set forth in Section 1(b), to exercise this Warrant
with respect to the number of shares of Common Stock purchasable pursuant to the cashless exercise procedure set forth in Section
1(b).

 

The undersigned requests that the certificates
for the shares of such Common Stock be issued in the name(s) of, and delivered to, the person(s) whose name(s) and address(es)
are set forth below:

 

 

(Please type or print name and address)

 

 

(Social Security or tax identification
number)

 

	and delivered to:   	 
	(Please type or print name and address)

 

and, if such number of shares of Common
Stock shall not be all the Common Stock evidenced by this Warrant, that a new Warrant of like tenor for the balance of the shares
of Common Stock subject to the Warrant be registered in the name of, and delivered to, the Holder at the address stated below.

 

[SIGNATURE OF HOLDER]

 

	Name of Investing Entity: 	 

 

	Signature of Authorized Signatory of Investing Entity: 	 

 

	Name of Authorized Signatory: 	 

 

	Title of Authorized Signatory: 	 

 

	Date: 	 

 

    	 	-8-	 

     

    

 

EXHIBIT B

 

WARRANT ASSIGNMENT

 

FOR VALUE RECEIVED, the undersigned does hereby assign and transfer
to ________________, Federal Identification No. __________, a warrant to purchase ____________ shares of the capital stock of XG
Sciences, Inc. represented by warrant certificate no. _____, standing in the name of the undersigned on the books of said corporation.
The undersigned does hereby irrevocably constitute and appoint ______________, attorney to transfer the warrants of said corporation,
with full power of substitution in the premises.

  

	Dated:  _________________	[Holder]
	 	 
	 	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 

 

     

     

    

 

EXHIBIT C

 

WARRANT HOLDER’S CONTACT INFORMATION

 

 

	Name:	 	 
	 	 	 
	Address:	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	Telephone Number:  	 	 
	 	 	 
	Email:Exhibit 10.36

 

XG SCIENCES, INC.

 

SUBSCRIPTION AGREEMENT

 

FOR ACCREDITED INVESTORS UNDER REGULATION
D

 

THE SECURITIES HAVE NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933 OR THE SECURITIES LAWS OF ANY U.S. STATE OR ANY OTHER JURISDICTION. THERE ARE FURTHER RESTRICTIONS
ON THE TRANSFERABILITY OF THE SECURITIES DESCRIBED HEREIN.

 

THE PURCHASE OF THE SECURITIES INVOLVES
A HIGH DEGREE OF RISK AND SHOULD BE CONSIDERED ONLY BY ACCREDITED INVESTORS WHO CAN BEAR THE RISK OF THE LOSS OF THEIR ENTIRE INVESTMENT.

 

Ladies/Gentlemen:

 

XG Sciences, Inc.,
a Michigan corporation (the "Company") is selling in this offering (this “Offering”) (i) promissory
notes (each a “Note”), in the form attached hereto as Exhibit A, and (ii) warrants to purchase shares
of the common stock of the Company, no par value per share (“Common Stock”) in the form attached hereto as Exhibit
B (“Warrants” and together with the Notes and any shares of Common Stock issuable upon exercise of the Warrants,
the “Securities”) to persons who are “accredited investors” as such term is defined in Regulation
D promulgated under the Securities Act of 1933, as amended (the “Securities Act”). The Company reserves the
right to increase or decrease the amount of the Offering at its sole discretion. The Company may conduct
multiple closings of this Offering upon its acceptance of subscriptions from investors (each, a “Closing”).

   

		1.	Subscription.

 

1.1           The
undersigned hereby subscribes for the number of Securities set forth on the signature page below at the purchase price set forth
therein. The undersigned acknowledges and agrees that the Company will only issue Warrants to purchase Common Stock at a strike
price of $8 per share (with a 30% warrant coverage for investors who in invest in the Offering prior to December 31, 2015, and
a 20% warrant coverage for investors who invest thereafter), to those investors who meet the criteria below.

 

Such Warrants will
have a five (5) year term and will contain a provision that allows for a net exercise of the Warrants by the holder and that to
the extent any of such warrants are “in the money” at expiration, the Company will automatically effect a “net
exercise” of such Warrants on behalf of the holder. The Company reserves the right to alter this Warrant coverage at any
time in its discretion prior to execution of this Agreement by the undersigned. 

 

1.2           If
the undersigned is paying with a check or money order, enclosed is a check or money order payable to the order of XG Sciences,
Inc., in the amount set forth on the signature page below as payment in full of the total purchase price of the Securities
subscribed for.

 

1.3           If
the undersigned in paying by wire transfer, the understand shall effect a wire transfer in the amount set forth on the signature
page below as payment in full of the total purchase price of the Securities subscribed for to the bank account set forth in and
in accordance with the wire instructions detailed in Exhibit C.

 

1.4           The
subscription amount tendered by the undersigned will be deposited by the Company into a non-interest bearing account when received.

 

    	 	Page 1	 

     

    

 

1.5           The
Company expects to utilize the subscription funds received from this Offering to expand capacity and invest in capital equipment.
The remaining funds will be used to fund general Company operations and may be spent for salaries and wages, sales and marketing,
research and development, or general corporate purposes as determined by management.

 

		2.	Representations and Warranties of the Company.

 

The Company hereby
represents and warrants as follows:

 

2.1           The
Company is a corporation duly organized, validly existing and in good standing under the laws of the jurisdiction of its incorporation
and has all requisite corporate power and authority to carry on its business as now conducted.

 

2.2           The
Company has full power and authority and, has taken all requisite action on the part of the Company, its officers, directors and
stockholders necessary for (i) the authorization, execution and delivery of the this Subscription Agreement, the Note and Warrant
(collectively, the “Transaction Documents”), (ii) the authorization of the performance of all obligations of
the Company hereunder or thereunder, and (iii) the authorization, issuance (or reservation for issuance) and delivery of the Securities.
The Transaction Documents constitute the legal, valid and binding obligations of the Company, enforceable against the Company in
accordance with their terms, subject to bankruptcy, insolvency, fraudulent transfer, reorganization, moratorium and similar laws
of general applicability, relating to or affecting creditors’ rights generally.

 

2.3           The
issuance of the Securities has been duly and validly authorized and, when issued and paid for pursuant to this Subscription Agreement,
shall be free and clear of all encumbrances and restrictions (other than those created by the undersigned investor (the “Investor”)),
except for restrictions on transfer set forth in the Transaction Documents or imposed by applicable securities laws. Upon the due
exercise of the Warrants, the Common Stock issuable will be validly issued, fully paid and non-assessable free and clear of all
encumbrances and restrictions, except for restrictions on transfer set forth in the Transaction Documents or imposed by applicable
securities laws and except for those created by the Investor. The Company has reserved a sufficient number of shares of Common
Stock for issuance upon exercise of the Warrants.

 

2.4           The
execution, delivery and performance by the Company of the Transaction Documents, and the offer, issuance and sale of the Securities
require no consent of, action by or in respect of, or filing with, any governmental body, agency, or official other than filings
that have been made pursuant to applicable state securities laws, and post-sale filings pursuant to applicable state and federal
securities laws which the Company undertakes to file within the applicable time periods. Subject to the accuracy of the representations
and warranties of the Investor set forth in Section 5 hereof, the Company has taken all action necessary to exempt (i) the issuance
and sale of the Securities, (ii) the issuance of the Common Stock upon exercise of the Warrants, and (iii) the other transactions
contemplated by the Transaction Documents from the provisions of any shareholder rights plan or other “poison pill”
arrangement, any anti-takeover, business combination or control share law or statute binding on the Company or to which the Company
or any of its assets and properties may be subject and any provision of the Company Organizational Documents (as defined in Section
4.6) that is or could reasonably be expected to become applicable to the Investor as a result of the transactions contemplated
hereby, including without limitation, the issuance of the Securities and the ownership, disposition or voting of the Securities
by the Investor or the exercise of any right granted to the Investor pursuant to this Subscription Agreement or the other Transaction
Documents.

 

2.5           The
net proceeds of the Offering hereunder shall be used by the Company for working capital and general corporate purposes.

 

2.6           The
execution, delivery and performance of the Transaction Documents by the Company and the issuance and sale of the Securities will
not conflict with or result in a breach or violation of any of the terms and provisions of, or constitute a default under (i) the
Company Organizational Documents (as defined in Section 4.6) in effect on the date hereof, or (ii)(a) any statute, rule, regulation
or order of any governmental agency or body or any court, domestic or foreign, having jurisdiction over the Company, or (b) any
agreement or instrument to which the Company is a party or by which the Company is bound or to which any of their respective assets
or properties is subject.

 

    	 	Page 2	 

     

    

 

2.7           No
person will have, as a result of the transactions contemplated by the Transaction Documents, any valid right, interest or claim
against or upon the Company for any commission, fee or other compensation pursuant to any agreement, arrangement or understanding
entered into by or on behalf of the Company.

 

2.8           Neither
the Company nor any person acting on its behalf has conducted any general solicitation or general advertising (as those terms are
used in Regulation D) in connection with the offer or sale of any of the Securities.

 

2.9           Neither
the Company nor any of its affiliates, nor any person acting on its or their behalf has, directly or indirectly, made any offers
or sales of any Company security or solicited any offers to buy any security, under circumstances that would adversely affect reliance
by the Company on Section 4(a)(2) for the exemption from registration for the transactions contemplated hereby or would require
registration of the Securities under the Securities Act .

 

2.10         There
is no action, suit, proceeding, inquiry or investigation before or by any court, public board, government agency, self-regulatory
organization or body pending or, to the knowledge of the Company, threatened against or affecting the Company or any of the Company’s
officers or directors in their capacities as such, which could reasonably be expected to have a material adverse effect.

 

2.11         The
Company has made or filed all federal and state income and all other material tax returns, reports and declarations required by
any jurisdiction to which it is subject (unless and only to the extent that the Company has set aside on its books provisions reasonably
adequate for the payment of all unpaid and unreported taxes) and has paid all taxes and other governmental assessments and charges
that are material in amount, shown or determined to be due on such returns, reports and declarations, except those being contested
in good faith and has set aside on its books provision reasonably adequate for the payment of all taxes for periods subsequent
to the periods to which such returns, reports or declarations apply. There are no unpaid taxes in any material amount claimed to
be due by the taxing authority of any jurisdiction, and the officers of the Company know of no basis for any such claim.

 

2.12         The
Company shall keep adequate records and books of account, in which complete entries will be made in accordance with GAAP consistently
applied, reflecting all financial transactions of the Company, and in which, for each fiscal year, all proper reserves for depreciation,
depletion, obsolescence, amortization, taxes, bad debts and other purposes in connection with its business shall be made.

2.13         
The Company is not in default under any material agreement or instrument, and to the knowledge of the Company, no such default
by the Company is imminent.

 

2.14         Michael
Knox has withdrawn his Default and Foreclosure Notice sent to the Company on December 7, 2015 and no other officer, director, or
investor in the Company has provided the Company any notice of default under any material agreement or instrument.

 

3.           Defaults.
To the actual knowledge of the Company, all of the representations of the Company herein are true at the time of executing this
Subscription Agreement. If any of the representations of the Company made herein are false, it shall be an Event of Default (as
defined in the Note) under the Note and subject to the remedies described therein.

 

4.           Subscriber’s
Acknowledgments and Agreements.

 

The undersigned understands,
acknowledges and agrees that:

 

    	 	Page 3	 

     

    

 

4.1           This
subscription may be accepted or rejected in whole or in part by the Company, in its sole discretion. The Company may also terminate
the Offering at any time, and may increase or decrease the size of the Offering at its sole discretion.

 

4.2           Except
as provided under applicable securities laws, this subscription is and shall be irrevocable except that (a) the undersigned’s
execution and delivery of this Subscription Agreement will not constitute an agreement between the Company and the undersigned
until this Subscription Agreement is accepted on behalf of the Company and, if not so accepted, the undersigned’s subscription
and obligations hereunder will terminate and (b) the undersigned can, at any time prior to acceptance of this Subscription Agreement,
request in writing that the undersigned be released from the obligations hereunder (and the Company may, but need not, in its discretion,
elect to release the undersigned from the subscription and from such obligations).

 

4.3           No
U.S. federal or state agency has made any finding or determination as to the fairness of the terms of this Offering. These Securities
have not been recommended or endorsed by any U.S. federal or state securities commission or regulatory agency.

 

4.4           (a)
The Securities have not been registered under the Securities Act, or applicable U.S. state securities laws, (b) the Securities
are deemed to be “restricted securities” under the Securities Act and applicable U.S. state securities laws, and (c)
the purchase of the Securities is taking place in a transaction not involving a public offering or persons that are not accredited
investors. Furthermore, the undersigned is aware that any resale inconsistent with the Securities Act may create liability on the
undersigned’s part and/or the part of the Company, and agrees not to assign, sell, pledge, transfer or otherwise dispose
of or transfer any such Securities unless registered under the Securities Act and applicable U.S. state securities laws, or an
opinion is given by counsel satisfactory to the Company that such registration is not required.

 

4.5           The
undersigned acknowledges and agrees that there can be no assurance that there will be any market for the Securities in the foreseeable
future, and that, as a result, the undersigned must be prepared to bear the economic risk of his investment for an indefinite period
of time.

 

4.6           The
Company has made available to the undersigned (a) the Company’s Articles of Incorporation and Bylaws, each as amended to
date (collectively, the “Company Organizational Documents”), (b) the Shareholder Agreement dated March 18, 2013
(the “Shareholder Agreement”), (c) the Voting Agreement dated January 15, 2014 (the “Voting Agreement”),
(d) the Certificate of Designations, (e) the Warrant and (f) the Note. The undersigned also acknowledges that the undersigned has
had a reasonable opportunity to examine the Company Organizational Documents, the Shareholder Agreement, the Voting Agreement,
the Certificate of Designations, the Warrant and the Note. The undersigned further acknowledges and agrees that the undersigned
will continue to be bound by the Company Organizational Documents, the Shareholder Agreement, the Voting Agreement, the Certificate
of Designations, the terms of the Warrant (if one is issued) and the Note. 

 

		5.	Subscriber’s Representations and Warranties.

 

The undersigned hereby
represents and warrants as follows:

 

5.1           The
undersigned is acquiring the Securities for the undersigned’s own account for investment, not for the interest of any other
person, not for resale to any other person and not with a view to or in connection with a sale or distribution.

 

5.2           All
information furnished in the Investor Questionnaire, in the form of Exhibit D attached hereto, completed by the undersigned
is true and correct in all respects.

 

5.3           The
undersigned’s overall commitment to investments that are not readily marketable is not disproportionate to the undersigned’s
net worth and the undersigned’s investment in the Company will not cause such overall commitment to become excessive. The
undersigned has adequate net worth and means of providing for current needs and personal contingencies to sustain a complete loss
of the undersigned’s investment in the Company, and the undersigned has no need for liquidity in this investment.

 

    	 	Page 4	 

     

    

 

5.4           The
undersigned has sufficient knowledge and experience in financial and business matters so that he/she is capable of evaluating the
merits and risks of an investment in the Securities and of protecting his or her interests in connection with such investment,
or he/she has obtained the advice of an attorney, a certified public accountant, or an investment advisor registered under the
Investment Advisors Act of 1940 or under the Michigan Uniform Securities Act of 2002, with respect to the merits and risks of an
investment in the Securities and the protection of his interests.

 

5.5           The
undersigned has had an opportunity to ask questions of and receive answers from representatives of the Company with respect to
this Offering. The Company has provided the undersigned with all documents requested and has provided answers to all of the undersigned’s
questions relating to an investment in the Company. In addition, the undersigned has had an opportunity to discuss this investment
with representatives of the Company and to ask questions of them.

 

5.6           The
undersigned is acquiring the Securities and has been furnished with the Company Organizational Documents (as amended to date),
the Shareholder Agreement, the Voting Agreement, the Certificate of Designations, the Warrant and the Note. The undersigned has
not been furnished with any prospectus or other offering literature.

 

5.7           The
undersigned understands that an investment in the Company is speculative and involves a high degree of risk, and the undersigned
has carefully reviewed and is aware of all of the risk factors related to the purchase of the Securities.

 

5.8           The
undersigned understands that there is no market for the Securities, and it is not anticipated that such a market will develop.

 

5.9           If
this Subscription Agreement is executed and delivered on behalf of a partnership, trust, corporation or other entity: the undersigned
has been duly authorized to execute and deliver this Subscription Agreement, the Investor Questionnaire, and all other documents
and instruments (if any) executed and delivered on behalf of such entity in connection with its purchase of Securities subscribed
for.

 

5.10         The
Company and the other purchasers are relying on the truth and accuracy of the declarations, representations and warranties herein
made by the undersigned. Accordingly, the foregoing representations and warranties and undertakings are made by the undersigned
with the intent that they may be relied upon in determining his/her suitability as a purchaser. The undersigned agrees that such
representations and warranties shall survive the acceptance of the undersigned as a purchaser, and the undersigned indemnifies
and agrees to hold harmless, the Company and each other purchaser from and against all damages, claims, expenses, losses or actions
resulting from the untruth of any of the warranties and representations contained in this Subscription Agreement.

 

5.11         The
foregoing representations and warranties are true as of the date of this Subscription Agreement and shall be true as of the date
the Company issues and sells Securities to the undersigned. If such representations and warranties shall not be true in any respect
prior to such date, the undersigned will give prompt written notice of such fact to the Company.

 

6           Certificates.
The undersigned agrees that each certificate representing the Securities shall be stamped or otherwise imprinted with a legend
substantially in the following form (in addition to any legend required by applicable state securities or "blue sky"
laws):

 

“THESE
SECURITIES REPRESENTED BY THIS CERTIFICATE (THE “SECURITIES”) HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF
1933, AS AMENDED (THE “SECURITIES ACT”) OR ANY STATE SECURITIES LAWS AND MAY NOT BE SOLD, TRANSFERRED OR OTHERWISE
DISPOSED OF UNLESS REGISTERED UNDER THE SECURITIES ACT AND UNDER APPLICABLE STATE SECURITIES LAWS OR THE ISSUER SHALL HAVE RECEIVED
AN OPINION OF COUNSEL THAT REGISTRATION OF SUCH SECURITIES UNDER THE SECURITIES ACT AND UNDER THE PROVISIONS OF APPLICABLE STATE
SECURITIES LAWS IS NOT REQUIRED.”

 

    	 	Page 5	 

     

    

 

		7	Registration Rights; Exchange Right.

 

7.1           The
Company will use its best efforts to (a) publicly file a registration statement on Form S-1 with the Securities and Exchange Commission
(“SEC”) to register shares of its Common Stock (a “Registration Statement”) by January 31,
2016 (the “Registration Timeframe”), provided, however, such Registration Timeframe may be extended as the Company
determines in its sole discretion.

 

7.2           Commencing
six (6) months following the listing of the Common Stock on a Qualified National Exchange, the Company shall be obligated to notify
the holder of Registrable Securities (as defined below) in writing at least ten (10) days prior to the filing of any registration
statement under the Securities Act for purposes of a public offering of securities of the Company (including, but not limited to,
registration statements relating to secondary offerings of securities of the Company, but excluding any registration statement
relating to any employee benefit plan or with respect to any corporate reorganization or other transaction under Rule 145 of the
Securities Act) and will afford each such holder an opportunity to include in such registration statement all or part of such Registrable
Securities held by such holder. Each holder of Registrable Securities desiring to include in any such registration statement, all
of part of the Registrable Securities held by it shall, within ten (10) days after the above-described notice from the Company,
so notify the Company in writing. Such notice shall state the intended method of disposition of the Registrable Securities held
by such holder. If a holder decides not to include all of its Registrable Securities in the registration statement thereafter filed
by the Company, such holder shall nevertheless continue to have the right to include any Registrable Securities in any subsequent
registration statement or registration statements as may be filed by the Company with respect to offerings of its securities, all
upon the terms and conditions set forth herein. “Registrable Securities” means the shares of Common Stock issuable
upon the exercise of the Warrants sold pursuant to this Offering.

 

7.3           For
the period of time commencing on the Closing of the Offering (hereinafter, the “Commencement Date”) and ending
on the earlier to occur of (i) December 31, 2017, and (ii) the date the Company consummates a sale of New Securities (as defined
below) that results in gross proceeds to the Company of at least $18,000,000 (the “Exchange Right Period”),
in the event that the Company consummates any financing transaction with any third-party consisting of any new designation of debt,
equity or equity-linked securities of the Company, such designation of securities having never been issued prior to the Commencement
Date (any such security or securities used in such new financing are hereinafter collectively referred to as a “New Security”),
then the Investor shall have the right (the “Exchange Right”), in his, her or its sole discretion, to exchange
all or any portion of the Common Stock issuable to such Investor in connection herewith, in his, her or its possession on a price
per share basis into such New Security on the relative price per share terms as such New Security was sold to the third-parties
(an “Exchange”). Upon an Exchange, the Company shall take all necessary action to ensure that the Investor is
assigned all rights and assumes all obligations set forth in the definitive agreements pursuant to which the New Security was sold.
For so long as any amounts remain outstanding under the Notes during the Exchange Right Period, the Company shall notify each holder
of such outstanding Notes in writing within ten (10) business days of the issuance of any New Security (the “New Security
Closing Date”) and such written notice shall contain: (a) the names and contact information for the investors in the
New Security, (b) the aggregate dollar amount or principal amount of such New Securities being issued to each new investor of such
securities, and (c) a copy of the definitive transaction documents affecting the issuance of the New Security (“Notice”).
Notwithstanding the foregoing, the Exchange Right attached to any particular New Security shall terminate at 5:00 PM, ET on the
later of the 30th day following (a) the Notice date, or (b) the New Security Closing Date. The holder shall make each election
under this Section 7 by delivering written notice of such election to the Company.

 

    	 	Page 6	 

     

    

 

		8	Governing Law; Arbitration; Venue.

 

8.1           This
Subscription Agreement and all rights and obligations hereunder shall be deemed to be made under and governed by the laws of the
State of Michigan applicable to agreements made and to be performed entirely within such State, without reference to such State's
laws regarding the conflict of laws.

 

8.2           Any
dispute or difference with respect to any matter arising out of or in connection with this Subscription Agreement and the Offering
shall first be submitted for arbitration to the American Arbitration Association.

 

8.3           Any
litigation arising hereunder shall be instituted only in Ingham County or the state courts of the State of Michigan sitting in
Ingham County. All parties agree that venue shall be proper in Ingham County for all such legal or equitable proceedings.

 

8.4           Failure
of any party to exercise any right or remedy under this Subscription Agreement or otherwise, or delay by a party in exercising
such right or remedy, shall not operate as a waiver thereof.

 

8.5           All
pronouns and any variations thereof refer to the masculine, feminine or neuter, singular or plural, as the context may require.

 

8.6           The
headings of this Subscription Agreement are for convenience of reference and shall not form part of, or affect the interpretation
of, this Subscription Agreement.

 

8.7           If
any provision of this herein shall be invalid or unenforceable in any jurisdiction, such invalidity or unenforceability shall not
affect the validity or enforceability of the remainder of this Subscription Agreement or the validity or enforceability of this
Subscription Agreement in any other jurisdiction. 

 

[Remainder of page
intentionally left blank. Signatures to follow]

 

    	 	Page 7	 

     

    

 

IN WITNESS WHEREOF,
the parties have executed this Agreement or caused their duly authorized officers to execute this Subscription Agreement as of
the Date Accepted below.

 

	 	The Company:
	 	 
	 	XG SCIENCES, INC.
	 	 	 
	 	By:	 
	 	Name:
	 	Title:
	 	 
	 	The Investor:
	 	 	 
	 	By:	 
	 	Name:
	 	Title:

 

    	 	Page 8	 

     

    

 

	Date: 	 

 

	Name of Subscriber:    	 

 

Type of Subscriber (check one): Individual _____ Tenants in
Common _____ Existing Partnership _____ Joint Tenants _____ Corporation _____ Trust _____ Minor with Adult Custodian under
UGMA _____

 

	Principal Amount of Note Subscribed For: 	 

 

	Number of Warrants issuable (with a strike price of $8/share): 	 

 

	By:	 	 	 
	 	Signature of Subscriber	 	Taxpayer I.D. Number of Subscriber
	Name:	 	 	 
	Title:	 	 	 
	 	 	 
	Subscriber’s business address, including email, and 	 	Subscriber’s mailing address
	telephone number (please type or print)	 	(if different than business address)
	 	 	 
	 	 	 
	 	 	 
	Email:	 	 
	Phone:	 	 
	 	 	 	 
	By:	 	 	 
	 	Signature of Co-Subscriber	 	Taxpayer I.D. Number of Co-Subscriber
	Name:	 	 	 
	 	 	 
	Co-Subscriber’s business address including email and 	 	Co-Subscriber’s mailing address
	telephone number (please type or print)	 	(if different than business address)
	 	 	 
	 	 	 
	 	 	 
	Email:	 	 
	Phone:	 	 

 

Accepted: 

 

XG SCIENCES, INC.

 

	By:	 	 	Date Accepted: 	 
	Name:	 	 	 
	Title:	 	 	 

 

    	 	Page 9	 

     

    

 

EXHIBIT A

 

FORM OF NOTE

 

     

     

    

 

EXHIBIT B

 

FORM OF WARRANT

 

     

     

    

 

EXHIBIT C

WIRE INFORMATION

 

     

     

    

 

EXHIBIT D

 

CONFIDENTIAL ACCREDITED INVESTOR QUESTIONNAIRE

XG
SCIENCES, INC.

 

		To:	XG Sciences, Inc.

 

XG
Sciences, Inc., a Michigan corporation (the “Company”), is offering, pursuant to an accompanying Subscription
Agreement (the “Subscription Agreement”), promissory notes (“Notes”) and warrants
(“Warrants”) to purchase common stock, no par value per share (“Common Stock”).
The Warrant and the Notes are referred to herein as the “Securities”. 

 

I.           The
undersigned subscriber (the “Subscriber”) represents and warrants that he, she or it comes within one category
marked below, and that for any category marked, he, she or it has truthfully set forth, where applicable, the factual basis
or reason the Subscriber comes within that category. ALL INFORMATION IN RESPONSE TO THIS SECTION WILL BE KEPT STRICTLY CONFIDENTIAL
EXCEPT AS NECESSARY FOR THE COMPANY TO COMPLY WITH LAW AND/OR ANY RULES PROMULGATED BY ANY REGULATORY AGENCY. The undersigned shall
furnish any additional information which the Company deems necessary in order to verify the answers set forth below.

 

	Category
    A_____	The undersigned is an individual (not a partnership, corporation, etc.) whose individual net worth, or joint net worth with his or her spouse, presently exceeds $1,000,000.
	 	 
	 	Explanation. In calculating net worth you may include equity in personal property and real estate (other than the value, after deducting mortgage obligations, of Subscriber’s principal residence which may not be included in such net worth calculation), cash, short-term investments, stock and securities. Equity in personal property and real estate should be based on the fair market value of such property less debt secured by such property.
	 	 
	Category
    B_____	The undersigned is an individual (not a partnership, corporation, etc.) who had an individual income in excess of $200,000 in each of the two most recent years, or joint income with his or her spouse in excess of $300,000 in each of those years (in each case including foreign income, tax exempt income and full amount of capital gains and losses but excluding any income of other family members and any unrealized capital appreciation) and has a reasonable expectation of reaching the same income level in the current year.
	 	 
	Category
    C_____	The undersigned is a director or executive officer of the Company, which is issuing and selling the Securities.
	 	 
	Category
    D_____	The undersigned is a bank; a savings and loan association; insurance company; registered investment company; registered business development company; licensed small business investment company (“SBIC”); or employee benefit plan within the meaning of Title 1 of ERISA and (a) the investment decision is made by a plan fiduciary which is either a bank, savings and loan association, insurance company or registered investment advisor, or (b) the plan has total assets in excess of $5,000,000 or is a self directed plan with investment decisions  made solely by persons that are accredited investors.

 

    	 	1	 

     

    

 

	 	 
	 	 
	 	 
	 	(describe entity)

 

	Category E_____	The undersigned is a private business development company as defined in section 202(a)(22) of the Investment Advisors Act of 1940.

 

	 	 
	 	 
	 	 
	 	(describe entity)

 

	Category F_____	The undersigned is either a corporation, partnership, Massachusetts business trust, or non-profit organization within the meaning of Section 501(c)(3) of the Internal Revenue Code, in each case not formed for the specific purpose of acquiring the Securities and with total assets in excess of $5,000,000.

 

	 	 
	 	 
	 	 
	 	(describe entity)

 

	Category G	The undersigned is a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the Securities, where the purchase is directed by a “sophisticated person” as defined in Regulation 506(b)(2)(ii) under the Securities Act of 1933.

 

	 	 
	 	 
	 	 
	 	(describe entity)

 

	Category H_____	The undersigned is an entity (other than a trust) all the equity owners of which are “accredited investors” within one or more of the above categories. If relying upon this Category alone, each equity owner must complete a separate copy of this Questionnaire.

 

	 	 
	 	 
	 	 
	 	(describe entity)

 

	Category I_____	The undersigned is not within any of the categories above and is therefore not an accredited investor.

 

    	 	2	 

     

    

 

For purposes hereof, “individual
income” means adjusted gross income less any income attributable to a spouse or to property owned by a spouse, increased
by the following amounts (but not including any amounts attributable to a spouse or to property owned by a spouse): (i) the amount
of any interest income received which is tax-exempt under Section 103 of the Internal Revenue Code of 1986, as amended (the “Code”),
(ii) the amount of losses claimed as a limited partner in a limited partnership (as reported on Schedule E of Form 1040), (iii)
any deduction claimed for depletion under Section 611 et seq. of the Code, and (iv) any amount by which income from long-term
capital gains has been reduced in arriving at adjusted gross income pursuant to the provisions of Section 12.02 of the Code.

 

The undersigned agrees that the undersigned
will notify the Company at any time on or prior to the execution of the Subscription Agreement or this Questionnaire in the event
that the representations and warranties in the Subscription Agreement or in this Questionnaire shall cease to be true, accurate
and complete.

 

 

II.          SUITABILITY
(please answer each question)

 

(a)          For
an individual Subscriber, please describe your current employment, including the company by which you are employed and its principal
business:

 

 

 

 

 

 

(b)          For
an individual Subscriber, please describe any college or graduate degrees held by you:

 

 

 

 

(c)          For
all Subscribers, please list types of prior investments:

 

 

 

 

 

(d)          For
all Subscribers, please state whether you have you participated in other private placements before:

 

YES________    NO________

 

(e)          If
your answer to question (d) above was “YES”, please indicate frequency of such prior participation in private placements
of:

 

	 	 	Public	 	Private
	 	 	Companies	 	Companies
	 	 	 	 	 
	Frequently	 	 	 	 
	Occasionally	 	 	 	 
	Never	 	 	 	 

 

    	 	3	 

     

    

 

(f)          For
individual Subscribers, do you expect your current level of income to significantly decrease in the foreseeable future:

 

YES________    NO________

 

(g)          For
trust, corporate, partnership and other institutional Subscribers, do you expect your total assets to significantly decrease in
the foreseeable future:

 

YES________    NO________

 

(h)          For
all Subscribers, do you have any other investments or contingent liabilities which you reasonably anticipate could cause you to
need sudden cash requirements in excess of cash readily available to you:

 

YES________    NO________

 

(i)          For
all Subscribers, are you familiar with the risk aspects and the non-liquidity of investments such as the Securities for which you
seek to subscribe?

 

YES________    NO________

 

(j)          For
all Subscribers, do you understand that there is no guarantee of financial return on this investment and that you run the risk
of losing your entire investment?

 

YES________    NO________

 

III.         MANNER
IN WHICH TITLE IS TO BE HELD. (circle one)

 

		(a)	Individual Ownership

		(b)	Community Property

		(c)	Joint Tenant with Right of Survivorship (both parties must
sign)

		(d)	Partnership*

		(e)	Tenants in Common

		(f)	Corporation*

		(g)	Trust*

		(h)	Limited Liability Company*

		(i)	Other

 

*If Securities are being subscribed for
by an entity, the attached Certificate of Signatory must also be completed.

 

IV.          FINRA
AFFILIATION.

 

Are you affiliated or associated with a FINRA member firm (please
check one):

 

YES________    NO________

 

If Yes, please describe:

 

 

    	 	4	 

     

    

 

 

 

*If Subscriber is a Registered Representative
with an FINRA member firm, have the following acknowledgment signed by the appropriate party:

 

The undersigned FINRA member firm acknowledges
receipt of the notice required by Rule 3050 of the NASD Conduct Rules.

 

	 	 
	Name of FINRA Member Firm	 
	 	 	 
	By:	 	 
	Authorized Officer	 
	 	 	 
	Date:	 	 

 

		V.	Disqualification Events.

 

		1.	Certain Criminal Convictions.

Have you been convicted, within
the past ten (10) years (or five (5) years, in the case of the Company, its predecessors and affiliated issuers), of any felony
or misdemeanor involving:

 

		·	in connection with the purchase or sale of any security;

		·	involving the making of any false filing with the U.S. Securities and Exchange Commission (the
“SEC”); or

		·	arising out of the conduct of the business of an underwriter, broker, dealer, municipal securities
dealer, investment advisor or paid solicitor of purchasers of securities?

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈
No.

 

		2.	Certain Court Injunctions and Restraining Orders.

Are you subject to any order,
judgment or decree of any court of competent jurisdiction that was entered within the past five (5) years and currently restrains
or enjoins you from engaging in any conduct or practice:

 

		·	in connection with the purchase or sale of any security;

		·	involving the making of any false filing with the SEC; or

		·	arising out of the conduct of the business of an underwriter, broker, dealer, municipal securities
dealer, investment adviser or paid solicitor of purchasers of securities?

 

    	 	5	 

     

    

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈
No.

 

		3.	Final Orders of Certain State and Federal Regulators.

Are you
subject to a Final Order (as defined below) of state regulators of securities, insurance, banking, savings associations or credit
unions; federal banking agencies; the Commodity Futures Trading Commission; or the National Credit Union Administration that:

 

		·	bars you from:

		·	associating with an entity regulated by any of the aforementioned regulators;

		·	engaging in the business of securities, insurance or banking; or

		·	engaging in savings association or credit union activities; or

 

		·	constitutes a Final Order based on a violation of any law or regulation that prohibits fraudulent,
manipulative, or deceptive conduct entered within the past ten (10) years?

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈
No.

 

The term “Final Order”
means a written directive or declaratory statement issued by a federal or state agency described in Rule 506(d)(1)(iii) under the
Securities Act of 1933 under applicable statutory authority that provides for notice and an opportunity for a hearing, which constitutes
a final disposition or action by that federal or state agency.

 

		4.	SEC Disciplinary Orders.

Are you subject to any order
of the SEC that currently:

 

		·	suspends or revokes your registration as a broker, dealer, municipal securities dealer or investment
adviser;

		·	places limitations on the activities, functions or operations of, or imposes civil money penalties
on, such person; or

		·	bars you from being associated with any entity or from participating in the offering of any penny
stock?1

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 

1
A disqualification based on a suspension or limitation of activities expires when the suspension or limitation expires.

 

 ̈
No.

 

    	 	6	 

     

    

 

		5.	SEC Cease-and-Desist Orders.

Are you subject to any order
of the SEC that was entered within the past five (5) years and currently orders you to cease and desist from committing or causing
a future violation of:

 

		·	any scienter-based (intent-based) anti-fraud provision of the federal securities laws (including,
for example, but not limited to):

		·	Section 17(a)(1) of the Securities Act of 1933,

		·	Section 10(b) of the Exchange Act and Rule 10b-5, and

		·	Section 15 (c) (1) of the Securities Exchange Act); or

 

		·	Section 5 of the Securities Act of 1933, which generally requires that securities be registered
and prohibits the sale of unregistered securities.

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈No.

 

		6.	SRO Suspension/Expulsion.

Have you been suspended or expelled
from membership in, or suspended or barred from association with a member of, a securities self-regulatory organization (“SRO”,
such as a registered national securities exchange or a registered national or affiliated securities association, including FINRA)
for any act or omission to act constituting conduct inconsistent with just and equitable principles of trade?

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈No.

 

		7.	SEC Stop Orders.

Have you filed (as a registrant
or issuer), or were you named as an underwriter in any registration statement or Regulation A offering statement filed with the
SEC that, within the past five (5) years, was the subject of a refusal order, stop order, or order suspending the Regulation A
exemption, or is currently the subject of an investigation or proceeding to determine whether a stop order or suspension order
should be issued?

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 

 ̈
No.

 

    	 	7	 

     

    

 

		8.	USPS False Representations Order.

Are you subject to a United States
Postal Service (“USPS”) false representation order entered within the past five (5) years, or are you currently
subject to a temporary restraining order or preliminary injunction with respect to conduct alleged by the USPS to constitute a
scheme or device for obtaining money or property through the mail by means of false representations?

 

 ̈
Yes. If yes, please explain: ____________________________________________________

 

 

 

 

 ̈
No.

 

VI.          The
undersigned is informed of the significance to the Company of the foregoing representations and answers contained in this Questionnaire
contained herein and such answers have been provided under the assumption that the Company will rely on them.

 

VII.         In
furnishing the above information, the undersigned acknowledges that the Company will be relying thereon in determining, among other
things, whether there are reasonable grounds to believe that the undersigned qualifies as a Purchaser under Section 4(2) and/or
Regulation D of the Securities Act of 1933 and applicable state securities laws for the purposes of the proposed investment.

 

VIII.         The
undersigned understands and agrees that the Company may request further information of the undersigned in verification or amplification
of the undersigned’s knowledge of business affairs, the undersigned’s assets and the undersigned’s ability to
bear the economic risk involved in an investment in the securities of the Company.

 

IX.          The
undersigned represents to you that (a) the information contained herein is complete and accurate on the date hereof and may be
relied upon by you, (b) the undersigned will notify you immediately of any change in any such information occurring prior to the
acceptance of the subscription and will promptly send you written confirmation of such change. The undersigned hereby certifies
that he, she or it has read and understands the Subscription Agreement related hereto and (c) the undersigned acknowledges that
you may be required to publicly disclose the information provided in this Questionnaire and that he, she or it consents to such
public disclosure.

 

X.           In
order for the Company to comply with applicable anti-money laundering/U.S. Treasury Department Office of Foreign Assets Control
(“OFAC”) rules and regulations, Subscriber is required to provide the following information:

 

    	 	8	 

     

    

 

		1.	Payment Information

 

(a)          Name
and address (including country) of the bank from which Subscriber’s payment to the Company is being wired (the “Wiring
Bank”):

 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 

 

(b)          Subscriber’s
wiring instructions at the Wiring Bank:

 

	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 

 

(c)          Is
the Wiring Bank located in the U.S. or another “FATF Country”*?

 

________ Yes           ________
No

 

(d)          Is
Subscriber a customer of the Wiring Bank?

 

________ Yes           ________
No

 

		2.	Additional Information

 

For Individual
Subscribers:

 

_____ A government issued
form of picture identification (e.g., passport or drivers license).

 

_____ Proof of the individual’s
current address (e.g., current utility bill), if not included in the form of picture identification.

 

 

*
As of the date hereof, countries that are members of the Financial Action Task Force on Money Laundering (“FATF Country”)
are: Argentina, Australia, Austria, Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland,
Italy, Japan, Luxembourg, Mexico, Kingdom of the Netherlands, New Zealand, Norway, Portugal, Russian Federation, Singapore, South
Africa, Spain, Sweden, Switzerland, Turkey, United Kingdom and the United States of America.

 

    	 	9	 

     

    

 

For Funds of Funds
or Entities that Invest on Behalf of Third Parties:

 

	_____	A certificate of due formation and organization and continued authorization to conduct business in the jurisdiction of its organization (e.g., certificate of good standing).
	 	 
	_____	An “incumbency certificate” attesting to the title of the individual executing these subscription materials on behalf of the prospective investor.
	 	 
	_____	A completed copy of a certification that the entity has adequate anti-money laundering policies and procedures (“AML Policies and Procedures”) in place that are consistent with the USA PATRIOT Act, OFAC and other relevant federal, state or non-U.S. anti-money laundering laws and regulations (with a copy of the entity’s current AML Policies and Procedures to which such certification relates).
	 	 
	_____	A letter of reference any entity not located in the U.S. or other FATF Country, from the entity’s local office of a reputable bank or brokerage firm that is incorporated, or has its principal place of business located, in the U.S. or other FATF Country certifying that the prospective investor maintains an account at such bank/brokerage firm for a length of time and containing a statement affirming the prospective investor’s integrity.

 

For all other Entity
Subscribers:

 

	_____	A certificate of due formation and organization and continued authorization to conduct business in the jurisdiction of its organization (e.g., certificate of good standing).
	 	 
	_____	An “incumbency certificate” attesting to the title of the individual executing these subscription materials on behalf of the prospective investor.
	 	 
	_____	A letter of reference from the entity’s local office of a reputable bank or brokerage firm that is incorporated, or has its principal place of business located, in the U.S. or other FATF Country certifying that the prospective investor maintains an account at such bank/brokerage firm for a length of time and containing a statement affirming the prospective investor’s integrity.
	 	 
	_____	If the prospective investor is a privately-held entity, a certified list of the names of every person or entity who is directly or indirectly the beneficial owner of 25% or more of any voting or non-voting class of equity interests of the Subscriber, including (i) country of citizenship (for individuals) or principal place of business (for entities) and, (ii) for individuals, such individual’s principal employer and position.
	 	 
	_____	If the prospective investor is a trust, a certified list of (i) the names of the current beneficiaries of the trust that have, directly or indirectly, 25% or more of any interest in the trust, (ii) the name of the settlor of the trust, (iii) the name(s) of the trustee(s) of the trust, and (iv) the country of citizenship (for individuals) or principal place of business (for entities).

 

    	 	10	 

     

    

 

XI.          ADDITIONAL
INFORMATION.

 

A TRUST MUST ATTACH
A COPY OF ITS DECLARATION OF TRUST OR OTHER GOVERNING INSTRUMENT, AS AMENDED, AS WELL AS ALL OTHER DOCUMENTS THAT AUTHORIZE THE
TRUST TO INVEST IN THE SECURITIES. ALL RESOLUTIONS AND DOCUMENTATION MUST BE COMPLETE AND CORRECT AS OF THE DATE HEREOF.

 

 

XII.         INFORMATION
VERIFICATION CONSENT.

 

BY SIGNING THIS QUESTIONNAIRE,
SUBSCRIBER HEREBY GRANTS THE COMPANY PERMISSION TO REVIEW ALL PUBLICLY AVAILABLE INFORMATION REGARDING SUBSCRIBER, INCLUDING, BUT
NOT LIMITED TO INFORMATION PROVIDED BY OFAC FOR THE PURPOSE OF VERIFYING INFORMATION PROVIDED BY SUBSCRIBER HEREIN.

 

[SIGNATURE PAGE FOLLOWS]

 

    	 	11	 

     

    

 

INVESTOR QUESTIONNAIRE EXECUTION PAGE

 

	 	 	 
	Subscriber’s Name	 	Co-Subscriber’s Name
	 	 	 
	 	 	 
	Signature	 	Signature (if purchasing jointly)
	 	 	 
	 	 	 
	Name Typed or Printed	 	Name Typed or Printed
	 	 	 
	 	 	 
	Title	 	Title
	 	 	 
	 	 	 
	Address	 	Address
	 	 	 
	 	 	 
	City, State and Zip Code	 	City, State and Zip Code
	 	 	 
	 	 	 
	Telephone Number	 	Telephone Number
	 	 	 
	 	 	 
	Email Address	 	Email Address

 

    	 	12

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