Document:

ex10-2.htm

THIS PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT RELATES TO AN OFFERING OF SECURITIES IN AN OFFSHORE TRANSACTION TO PERSONS WHO ARE NOT U.S. PERSONS (AS DEFINED HEREIN) PURSUANT TO REGULATION S UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE "1933 ACT").

 

THE SECURITIES TO WHICH THIS PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT (THE “SUBSCRIPTION AGREEMENT”) RELATES HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE, AND WILL BE ISSUED IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE 1933 ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE 1933 ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS.

 

ANAVEX LIFE SCIENCES CORP.

 

PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT

UNITS

 

NON-UNITED STATES RESIDENT SUBSCRIBERS

INSTRUCTIONS TO PURCHASER

 

	
1.

	
The purchaser is to complete all the information in the boxes on page 1 and sign where indicated with an “X”.

 

	
2.

	
IF THE PURCHASER IS A CANADIAN RESIDENT AND IS AN ACCREDITED INVESTOR, then complete the “Accredited Investor Questionnaire” that starts on page 5.

 

	
3.

	
IF THE PURCHASER IS A CANADIAN RESIDENT AND IS NOT AN ACCREDITED INVESTOR, and not purchasing a minimum of $150,000 in value of securities, complete the “Friends and Family” Questionnaire that starts on page 8.

 

	
4.

	
RESIDENTS OF COUNTRIES OUTSIDE THE UNITED STATES AND CANADA AND CANADIAN RESIDENTS PURCHASING A MINIMUM OF $150,000 IN VALUE OF SECURITIES may subscribe without filling in an Accredited Investor or Friends and Family Questionnaire.

 

	
5.

	
All other information must be filled in where appropriate.

 

	
6.

	
CONFIRM WITH THE COMPANY THAT FUNDS ARE IN TRANSIT – PLEASE SEND VIA FACSIMILE TRANSMISSION, A COPY OF YOUR WIRE TRANSFER INSTRUCTIONS TO YOUR BANKING INSTITUTION IMMEDIATELY UPON THOSE INSTRUCTIONS BEING ISSUED BY YOU.   FACSIMILE NUMBER 250-764-9701 ATTENTION:  HARVEY LALACH, PRESIDENT (Tel: 250-864-2740) email – harvey@anavex.com

 

	
  

	
Wire Instructions:

 

  

  

  

This is Page 2 of 15 pages of a subscription agreement and related appendices, schedules and forms. Collectively, these pages together are referred to as the “Subscription Agreement”.

PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT

 

	
TO:

	
ANAVEX LIFE SCIENCES CORP. (the “Issuer”), of 50 Harrison Street, #315A, Hoboken, New Jersey.

 

Subject and pursuant to the terms set out in the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices attached which are hereby incorporated by reference, the Purchaser hereby irrevocably subscribes for, and on Closing will purchase from the Issuer, the following securities at the following price:

 

	
_______ UNITS

	
US$2.75 per Unit for a total purchase price of US$                                                                                                                               

	
The Purchaser owns, directly or indirectly, the following securities of the Issuer:

	  
	
[Check if applicable]  The Purchaser is  oan insider of the Issuer or  oa member of the professional group

 

The Purchaser directs the Issuer to issue, register and deliver the certificates representing the Purchased Securities as follows:

 

	
REGISTRATION INSTRUCTIONS

	  	
DELIVERY INSTRUCTIONS

	  	  	  
	
Name to appear on certificate

	  	
Name and account reference, if applicable

	  	  	  
	
Account reference if applicable

	  	
Contact name

	  	  	  
	
Address

	  	
Address

	  	  	  
	  	  	
Telephone Number

 

EXECUTED by the Purchaser this _______ day of _____________, 2010.  By executing this Subscription Agreement, the Purchaser certifies that the Purchaser and any beneficial purchaser for whom the Purchaser is acting is resident in the jurisdiction shown as the “Address of Purchaser”.

 

	
WITNESS:

	  	
EXECUTION BY PURCHASER:

	  	  	
X

	
Signature of Witness

	  	
Signature of individual (if Purchaser is an individual)

	  	  	
X

	
Name of Witness

	  	
Authorized signatory (if Purchaser is not an individual)

	  	  	  
	
Address of Witness

	  	
Name of Purchaser (please print)

	  	  	  
	  	  	
Name of authorized signatory (please print)

	
Accepted this _____ day of ____________, 2010

	  	  
	
ANAVEX LIFE SCIENCES CORP.

	  	
Address of Purchaser (residence)

	
Per:

	  	  
	  	  	
Telephone Number

	
Authorized Signatory

	  	  
	  	  	
E-mail address

	  	  	  
	  	  	
Social Security/Insurance No.:

By signing this acceptance, the Issuer agrees to be bound by the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices incorporated by reference. If funds are delivered to the Company’s lawyers, they are authorized to release the funds to the Issuer.

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 3 of 15

TERMS

 

	
Reference date of this Subscription Agreement

	
October 20, 2010  (the “Agreement Date”)

 

The Offering

 

	
The Issuer

	
Anavex Life Sciences Corp. (the “Issuer”)

 

	
Offering

	
The offering consists of units (“Units”) each comprising one common share (“Shares”) of the Issuer and one half  (.5) common share purchase warrant (“Warrants”).

 

	
Warrants

	
Each whole warrant is exercisable for 18 months from Closing at $3.75 per share.

 

	
Purchased Securities

	
The “Purchased Securities” under this Subscription Agreement are Shares and Warrants.

 

	
Total Amount

	
No minimum and no maximum amount of Offering

 

	
Issue Price

	
US$2.75 per Unit .

 

	
Selling Jurisdictions

	
The Units may be sold in Canada or in other jurisdictions other than the United States where they may be lawfully sold (the “Selling Jurisdictions”).

 

	
Exemptions

	
The offering will be made in accordance with the following exemptions from the prospectus requirements:

         (a)the “accredited investor” exemption in Canada (section 2.3 of National Instrument 45-106);

         (b)the “$150,000 purchaser” exemption in Canada (section 2.10 of National Instrument 45-106);

(c)      the “Friends and Family” exemption in Canada except Ontario (section 2.5 of National Instrument 45-106)

(d)     such other exemptions as may be available the securities laws of the Selling Jurisdictions.

 

	
No Registration of Securities

	
The Units will not be registered with the SEC and will be tradable in compliance with Rule 144 restricted periods. Subscribers are advised to seek their own legal counsel as to any resale restrictions under Canadian law.

 

	
Resale restrictions and legends

	
The Purchaser acknowledges that the certificates representing the Purchased Securities will bear the following legends:

“THESE SECURITIES HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE AND HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT 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.”

Purchasers are advised to consult with their own legal counsel or advisors to determine the resale restrictions that may be applicable to them.

Purchaser has requested the Issuer not to include legend under Canadian Securities laws

	  	  
	
Additional definitions

	
In the Subscription Agreement, the following words have the following meanings unless otherwise indicated:

           (a)“Purchased Securities” means the Shares and Warrants purchased under this Subscription Agreement; and

           (b)“Securities” means the Shares, the Warrants and the common shares issued upon exercise of the Warrants.

 

	  	  
	  	  

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 4 of 15

 

The Issuer    

                                                                                                                                                                                                     .

	
Jurisdiction of organization

	
The Issuer is incorporated under the laws of the State of Nevada.

 

	
Stock exchange listings

	
Certain market makers make market in the Issuer’s stock on the US over the counter bulletin board

 

	
“Securities Legislation Applicable to the Issuer”

	
The “Securities Legislation Applicable to the Issuer” is the US Securities Exchange Act of 1934, and the Securities Commission having jurisdiction over the Issuer is the United States Securities and Exchange Commission (the “Commission”).

 

End of Terms

 

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 5 of 15

NATIONAL INSTRUMENT 45-106

 

ACCREDITED INVESTOR QUESTIONNAIRE

 

 

The purpose of this Questionnaire is to assure Anavex Life Sciences Corp. (the “Company”) that the undersigned (the “Subscriber”) will meet certain requirements for the registration and prospectus exemptions provided for under National Instrument 45-106 (“NI 45-106”), as adopted by the Securities Commissions in Canada, in respect of a proposed private placement of securities by the Company (the “Transaction”).  The Company will rely on the information contained in this Questionnaire for the purposes of such determination.

 

The undersigned Subscriber covenants, represents and warrants to the Company that:

 

	
  

	
1.

	
the Subscriber has such knowledge and experience in financial and business matters as to be capable of evaluating the merits and risks of the Transaction and the Subscriber is able to bear the economic risk of loss arising from such Transaction;

 

	
  

	
2.

	
the Subscriber satisfies one or more of the categories of “accredited investor” (as that term is defined in NI 45-106) indicated below (please check the appropriate box):

 

	
  

	 o	
(a) a Canadian financial institution as defined in National Instrument 14-101, or an authorized foreign bank listed in Schedule III of the Bank Act (Canada);

 

	
  

	 o	
(b) the Business Development Bank of Canada incorporated under the Business Development Bank Act (Canada);

 

	
  

	 o	
(c) a subsidiary of any person referred to in any of the foregoing categories, if the person owns all of the voting securities of the subsidiary, except the voting securities required by law to be owned by directors of that subsidiary;

 

	
  

	 o	
(d) an individual registered or formerly registered under securities legislation in a jurisdiction of Canada, as a representative of a person or company registered under securities legislation in a jurisdiction of Canada, as an adviser or dealer, other than a limited market dealer registered under the Securities Act (Ontario) or the Securities Act (Newfoundland);

 

	
  

	 o	
(e) an individual registered or formerly registered under the securities legislation of a jurisdiction of Canada as a representative of a person referred to in paragraph (d);

 

	
  

	 o	
(f) the government of Canada or a province, or any crown corporation or agency of the government of Canada or a province;

 

	
  

	 o	
(g) a municipality, public board or commission in Canada and a metropolitan community, school board, the Comite de gestion de la taxe scholaire de l’ile de Montreal or an intermunicipal management board in Québec;

 

	
  

	 o	
(h) a national, federal, state, provincial, territorial or municipal government of or in any foreign jurisdiction, or any agency thereof;

 

	
  

	 o	
(i) a pension fund that is regulated by either the Office of the Superintendent of Financial Institutions (Canada) or a pension commission or similar regulatory authority of a jurisdiction of Canada;

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 6 of 15

 

	
  

	 o	
(j) an individual who either alone or with a spouse beneficially owns, directly or indirectly, financial assets (as defined in NI 45-106) having an aggregate realizable value that, before taxes but net of any related liabilities, exceeds CDNUS$1,000,000;

 

	
  

	 o	
(k) an individual whose net income before taxes exceeded CDNUS$200,000 in each of the two more recent calendar years or whose net income before taxes combined with that of a spouse exceeded US$300,000 in each of those years and who, in either case, reasonably expects to exceed that net income level in the current calendar year;

 

	
  

	 o	
(l) an individual who, either alone or with a spouse, has net assets of at least CDN US$5,000,000;

 

	
  

	 o	
(m) a person, other than an individual or investment fund, that had net assets of at least CDNUS$5,000,000 as reflected on its most recently prepared financial statements;

 

	
  

	 o	
(n) an investment fund that distributes it securities only to persons that are accredited investors at the time of distribution, a person that acquires or acquired a minimum of CDN$150,000 of value in securities, or a person that acquires or acquired securities under Sections 2.18 or 2.19 of NI 45-106;

 

	
  

	 o	
(o) an investment fund that distributes or has distributed securities under a prospectus in a jurisdiction of Canada for which the regulator or, in Québec, the securities regulatory authority, has issued a receipt;

 

	
  

	 o	
(p) a trust company or trust corporation registered or authorized to carry on business under the Trust and Loan Companies Act (Canada) or under comparable legislation in a jurisdiction of Canada or a foreign jurisdiction, acting on behalf of a fully managed account managed by the trust company or trust corporation, as the case may be;

 

	
  

	 o	
(q) a person acting on behalf of a fully managed account managed by that person, if that person (i) is registered or authorized to carry on business as an adviser or the equivalent under the securities legislation of a jurisdiction of Canada or a foreign jurisdiction, and (ii) in Ontario, is purchasing a security that is not a security of an investment fund;

 

	
  

	 o	
(r) a registered charity under the Income Tax Act (Canada) that, in regard to the trade, has obtained advice from an eligibility advisor or an advisor registered under the securities legislation of the jurisdiction of the registered charity to give advice on the securities being traded;

 

	
  

	 o	
(s) an entity organized in a foreign jurisdiction that is analogous to any of the entities referred to in paragraphs (a) to (d) or paragraph (i) in form and function;

 

	
  

	 o	
(t) a person in respect of which all of the owners of interests, direct, indirect or beneficial, except the voting securities required by law are persons or companies that are accredited investors.

 

	
  

	 o	
(u) an investment funds that is advised by a person registered as an advisor or a person that is exempt from registration as an advisor; or

 

	
  

	 o	
(v) a person that is recognized or designated by the securities regulatory authority or, except in Ontario and Québec, the regulator as (i) an accredited investor, or (ii) an exempt purchaser in Alberta or Nevada;

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 7 of 15

 

	
  

	
The Subscriber acknowledges and agrees that the Subscriber may be required by the Company to provide such additional documentation as may be reasonably required by the Company and its legal counsel in determining the Subscriber’s eligibility to acquire the Units under relevant Legislation.

 

IN WITNESS WHEREOF, the undersigned has executed this Questionnaire as of the ________ day of __________________, 2010.

 

	
If a Corporation, Partnership or Other Entity:

	  	
If an Individual:

	  	  	
X

	
Print or Type Name of Entity

	  	
Signature

	
X

	  	  
	
Signature of Authorized Signatory

	  	
Print or Type Name

	  	  	  
	
Type of Entity

	  	  

 

 

 

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 8 of 15

 

Family, Friends and Business Associates Questionnaire

 

	
  

	
If the Subscriber is resident in a Canadian province or territory other than Ontario IS NOT PURCHASING MORE THAN $150,000 IN VALUE OF SECURITIES and is not an Accredited Investor, he or she is to check one or more of the following boxes, as appropriate:

 

	
(A)

	
a director, officer, employee or control person of the Issuer

	  
	
(B)

	
a spouse, parent, grandparent, brother, sister or child of a director, senior officer or control person of the Issuer

	  
	
(C)

	
a close personal friend of a director, senior officer or control person of the Issuer

	  
	
(D)

	
a close business associate of a director, senior officer or control person of the Issuer

	  

 

	
  

	
if the Subscriber is resident in Ontario, the Subscriber is (tick one or more of the following boxes only if the Subscriber is resident in Ontario):

 

	
(A)

	
a founder of the Issuer

	  
	
(B)

	
an affiliate of a founder of the Issuer

	  
	
(C)

	
a spouse, parent, brother, sister, grandparent or child of a director, executive officer or founder of the Issuer

	  
	
(D)

	
a person that is a control person of the Issuer

	  
	
(E)

	
an accredited investor

	  
	
(F)

	
purchasing as principal Securities with an aggregate acquisition cost of not less than CDN$150,000

	  

 

If the Subscriber ticked boxes A-D above, name of director, officer or employee of the Issuer with whom the Subscriber has a relationship:

 

_____________________________________________________________________________________

 

	
___________________________________________

Signature

	  
	
Print or Type Name of Entity or Individual

 

Date: _______________________, 2010

 

 

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 9 of 15

GENERAL PROVISIONS

 

 

	
1.  

	
DEFINITIONS

 

1.1           In the Subscription Agreement (including the first (cover) page, the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices incorporated by reference), the following words have the following meanings unless otherwise indicated:

 

	
(a)  

	
“1933 Act” means the United States Securities Act of 1933, as amended;

 

	
(b)  

	
“Applicable Legislation” means the Securities Legislation Applicable to the Issuer (as defined on page 8) and all legislation incorporated in the definition of this term in other parts of the Subscription Agreement, together with the regulations and rules made and promulgated under that legislation and all administrative policy statements, blanket orders and rulings, notices and other administrative directions issued by the Commissions;

 

	
(c)  

	
“Closing” means the completion of the sale and purchase of the Purchased Securities;

 

	
(d)  

	
“Closing Date” has the meaning assigned in the Terms;

 

	
(e)  

	
“Closing Year” means the calendar year in which the Closing takes place;

 

	
(f)  

	
“Commissions” means the Commission (as defined on page 4) and the securities commissions incorporated in the definition of this term in other parts of the Subscription Agreement;

 

	
(g)  

	
“Final Closing” means the last closing under the Private Placement;

 

	
(h)  

	
“General Provisions” means those portions of the Subscription Agreement headed “General Provisions” and contained on pages 9 to 15;

 

	
(i)  

	
“Private Placement” means the offering of the Units on the terms and conditions of this Subscription Agreement;

 

	
(j)  

	
“Purchased Securities” has the meaning assigned in the Terms;

 

	
(k)  

	
“Regulatory Authorities” means the Commissions;

 

	
(l)  

	
“Securities” has the meaning assigned in the Terms;

 

	
(m)  

	
“Subscription Agreement” means the first (cover) page, the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices incorporated by reference; and

 

	
(n)  

	
“Terms” means those portions of the Subscription Agreement headed “Terms” and contained on pages 3 to 4.

 

1.2           In the Subscription Agreement, the following terms have the meanings defined in Regulation S: “Directed Selling Efforts”, “Foreign Issuer”, “Substantial U.S. Market Interest”, “U.S. Person” and “United States”.

 

1.3           In the Subscription Agreement, unless otherwise specified, currencies are indicated in US dollars.

 

1.4           In the Subscription Agreement, other words and phrases that are capitalized have the meanings assigned to them in the body hereof.

 

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 10 of 15

Acknowledgements, REPRESENTATIONS AND WARRANTIES OF PURCHASER

 

2.1           Acknowledgements concerning offering

 

The Purchaser acknowledges that:

 

	
(a)  

	
none of the Securities have been registered under the 1933 Act, or under any state securities or "blue sky" laws of any state of the United States, and, unless so registered, may not be offered or sold in the United States or, directly or indirectly, to U.S. Persons, as that term is defined in Regulation S under the 1933 Act ("Regulation S"), except in accordance with the provisions of Regulation S, pursuant to an effective registration statement under the 1933 Act, or pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the 1933 Act and in each case in accordance with applicable state and provincial securities laws;

 

	
(b)  

	
the Purchaser acknowledges that the Company has not undertaken, and will have no obligation, to register any of the Securities under the 1933 Act;

 

	
(c)  

	
the decision to execute this Agreement and acquire the Units hereunder has not been based upon any oral or written representation as to fact or otherwise made by or on behalf of the Company, and such decision is based entirely upon a review of information (the receipt of which is hereby acknowledged) which has been filed by the Company with the Securities and Exchange Commission (the "SEC");

 

	
(d)  

	
neither the SEC nor any other securities commission or similar regulatory authority has reviewed or passed on the merits of the Shares;

 

	
(e)  

	
there is no government or other insurance covering any of the Shares;

 

	
(f)  

	
there are risks associated with an investment in the Shares;

 

	
(g)  

	
the Purchaser has not acquired the Units as a result of, and will not itself engage in, any "directed selling efforts" (as defined in Regulation S under the 1933 Act) in the United States in respect of the Units which would include any activities undertaken for the purpose of, or that could reasonably be expected to have the effect of, conditioning the market in the United States for the resale of any of the Shares; provided, however, that the Purchaser may sell or otherwise dispose of the Units pursuant to registration thereof under the 1933 Act and any applicable state and provincial securities laws or under an exemption from such registration requirements;

 

	
(h)  

	
the Purchaser and the Purchaser's advisor(s) have had a reasonable opportunity to ask questions of and receive answers from the Company in connection with the distribution of the Units hereunder, and to obtain additional information, to the extent possessed or obtainable without unreasonable effort or expense, necessary to verify the accuracy of the information about the Company;

 

	
(i)  

	
the books and records of the Company were available upon reasonable notice for inspection, subject to certain confidentiality restrictions, by the Purchaser during reasonable business hours at its principal place of business, and all documents, records and books in connection with the distribution of the Units hereunder have been made available for inspection by the Purchaser, the Purchaser's lawyer and/or advisor(s);

 

	
(j)  

	
the Purchaser will indemnify and hold harmless the Company and, where applicable, its directors, officers, employees, agents, advisors and shareholders, from and against any and all loss, liability, claim, damage and expense whatsoever (including, but not limited to, any and all fees, costs and expenses whatsoever reasonably incurred in investigating, preparing or defending against any claim, lawsuit, administrative proceeding or investigation whether commenced or threatened) arising out of or based upon any representation or warranty of the Purchaser contained herein or in

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 11 of 15

 

	
(k)  

	
any document furnished by the Purchaser to the Company in connection herewith being untrue in any material respect or any breach or failure by the Purchaser to comply with any covenant or agreement made by the Purchaser to the Company in connection therewith;

 

	
(l)  

	
the Shares are not listed on any stock exchange or automated dealer quotation system and no representation has been made to the Purchaser that any of the Shares will become listed on any stock exchange or automated dealer quotation system, except that currently market makers make a market for the Company's common shares on the NASD's OTC Bulletin Board;

 

	
(m)  

	
the Company will refuse to register any transfer of the Shares not made in accordance with the provisions of Regulation S, pursuant to an effective registration statement under the 1933 Act or pursuant to an available exemption from the registration requirements of the 1933 Act and in accordance with applicable state and provincial securities laws;

 

	
(n)  

	
the statutory and regulatory basis for the exemption claimed for the offer of the Shares, although in technical compliance with Regulation S, would not be available if the offering is part of a plan or scheme to evade the registration provisions of the 1933 Act or any applicable state and provincial securities laws;

 

	
(o)  

	
the Purchaser has been advised to consult the Purchaser's own legal, tax and other advisors with respect to the merits and risks of an investment in the Units and with respect to applicable resale restrictions, and it is solely responsible (and the Company is not in any way responsible) for compliance with:

 

	
  

	
(i)

	
any applicable laws of the jurisdiction in which the Purchaser is resident in connection with the distribution of the Units hereunder, and

 

	
  

	
(ii)

	
applicable resale restrictions;

 

	
(p)  

	
this Agreement is not enforceable by the Purchaser unless it has been accepted by the Company, and the Purchaser acknowledges and agrees that the Company reserves the right to reject any subscription for any reason; and

 

	
(q)  

	
By executing and delivering this Agreement, each Subscriber will have directed the Company not to include a Canadian Legend on any certificates representing the Units to be issued to such Subscriber. As a consequence, the Subscriber will not be able to rely on the resale provisions of Multilateral Instrument 45-102, and any subsequent trade in the Securities during or after the Canadian hold period described therein will be a distribution subject to the prospectus and registration requirements of Canadian securities legislation, to the extent that the trade is at that time subject to any such Canadian securities legislation.

 

2.2           Representations by the purchaser

 

The Purchaser represents and warrants to the Issuer that, as at the Agreement Date and at the Closing:

 

	
(a)  

	
the Purchaser has the legal capacity and competence to enter into and execute this Agreement and to take all actions required pursuant hereto and, if the Purchaser is a corporation, it is duly incorporated and validly subsisting under the laws of its jurisdiction of incorporation and all necessary approvals by its directors, shareholders and others have been obtained to authorize execution and performance of this Agreement on behalf of the Purchaser;

 

	
(b)  

	
the entering into of this Agreement and the transactions contemplated hereby do not result in the violation of any of the terms and provisions of any law applicable to the Purchaser or of any

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 12 of 15

 

	
(c)  

	
agreement, written or oral, to which the Purchaser may be a party or by which the Purchaser is or may be bound;

 

	
(d)  

	
the Purchaser has duly executed and delivered this Agreement and it constitutes a valid and binding agreement of the Purchaser enforceable against the Purchaser in accordance with its terms;

 

	
(e)  

	
the Purchaser is not acquiring the Units for the account or benefit of, directly or indirectly, any U.S. Person;

 

	
(f)  

	
the Purchaser is not a U.S. Person;

 

	
(g)  

	
the Purchaser is resident in the jurisdiction set out under the heading "Name and Address of Purchaser" on the signature page of this Agreement;

 

	
(h)  

	
the sale of the Units to the Purchaser as contemplated in this Agreement complies with or is exempt from the applicable securities legislation of the jurisdiction of residence of the Purchaser;

 

	
(i)  

	
the Purchaser is acquiring the Units for investment only and not with a view to resale or distribution and, in particular, it has no intention to distribute either directly or indirectly any of the Units in the United States or to U.S. Persons;

 

	
(j)  

	
the Purchaser is outside the United States when receiving and executing this Agreement and is acquiring the Units as principal for the Purchaser's own account, for investment purposes only, and not with a view to, or for, resale, distribution or fractionalisation thereof, in whole or in part, and no other person has a direct or indirect beneficial interest in such Shares;

 

	
(k)  

	
the Purchaser is not an underwriter of, or dealer in, the common shares of the Company, nor is the Purchaser participating, pursuant to a contractual agreement or otherwise, in the distribution of the Shares;

 

	
(l)  

	
the Purchaser (i) is able to fend for him/her/itself in the Subscription; (ii) has such knowledge and experience in business matters as to be capable of evaluating the merits and risks of its prospective investment in the Shares; and (iii) has the ability to bear the economic risks of its prospective investment and can afford the complete loss of such investment;

 

	
(m)  

	
the Purchaser acknowledges that the Purchaser has not acquired the Units as a result of, and will not itself engage in, any "directed selling efforts" (as defined in Regulation S under the 1933 Act) in the United States in respect of the Shares which would include any activities undertaken for the purpose of, or that could reasonably be expected to have the effect of, conditioning the market in the United States for the resale of the Shares; provided, however, that the Purchaser may sell or otherwise dispose of the Shares pursuant to registration of the Shares pursuant to the 1933 Act and any applicable state and provincial securities laws or under an exemption from such registration requirements and as otherwise provided herein;

 

	
(n)  

	
the Purchaser understands and agrees that none of the Shares have been registered under the 1933 Act, or under any state securities or "blue sky" laws of any state of the United States, and, unless so registered, may not be offered or sold in the United States or, directly or indirectly, to U.S. Persons except in accordance with the provisions of Regulation S, pursuant to an effective registration statement under the 1933 Act, or pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the 1933 Act;

 

	
(o)  

	
the Purchaser understands and agrees that offers and sales of any of the Shares prior to the expiration of a period of one year after the date of original issuance of the Units (the one year

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 13 of 15

 

	
(p)  

	
period hereinafter referred to as the "Distribution Compliance Period") shall only be made in compliance with the safe harbor provisions set forth in Regulation S, pursuant to the registration provisions of the 1933 Act or an exemption therefrom, and that all offers and sales after the Distribution Compliance Period shall be made only in compliance with the registration provisions of the 1933 Act or an exemption therefrom and in each case only in accordance with applicable state and provincial securities laws;

 

	
(q)  

	
the Purchaser understands and agrees not to engage in any hedging transactions involving any of the Shares unless such transactions are in compliance with the provisions of the 1933 Act and in each case only in accordance with applicable state and provincial securities laws;

 

	
(r)  

	
the Purchaser understands and agrees that the Company will refuse to register any transfer of the Shares not made in accordance with the provisions of Regulation S, pursuant to an effective registration statement under the 1933 Act or pursuant to an available exemption from the registration requirements of the 1933 Act;

 

	
(s)  

	
the Purchaser is not aware of any advertisement of any of the Units and is not acquiring the Units as a result of any form of general solicitation or general advertising including advertisements, articles, notices or other communications published in any newspaper, magazine or similar media or broadcast over radio or television, or any seminar or meeting whose attendees have been invited by general solicitation or general advertising; and

 

	
(t)  

	
no person has made to the Purchaser any written or oral representations:

 

	
  

	
(i)

	
that any person will resell or repurchase any of the Shares;

 

	
  

	
(ii)

	
that any person will refund the purchase price of any of the Shares;

 

	
  

	
(iii)

	
as to the future price or value of any of the Shares; or

 

	
  

	
(iv)

	
that any of the Shares will be listed and posted for trading on any stock exchange or automated dealer quotation system or that application has been made to list and post any of the Shares of the Company on any stock exchange or automated dealer quotation system.

 

2.3           Reliance, indemnity and notification of changes

 

The representations and warranties in the Subscription Agreement (including the first (cover) page, the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices incorporated by reference) are made by the Purchaser with the intent that they be relied upon by the Issuer in determining its suitability as a purchaser of Purchased Securities, and the Purchaser hereby agrees to indemnify the Issuer against all losses, claims, costs, expenses and damages or liabilities which any of them may suffer or incur as a result of reliance thereon. The Purchaser undertakes to notify the Issuer immediately of any change in any representation, warranty or other information relating to the Purchaser set forth in the Subscription Agreement (including the first (cover) page, the Terms on pages 3 to 4, the General Provisions on pages 9 to 14 and the other schedules and appendices incorporated by reference) which takes place prior to the Closing.

2.4           Survival of representations and warranties

 

The representations and warranties contained in this Section will survive the Closing.

 

2. ISSUER’S ACCEPTANCE

 

The Subscription Agreement, when executed by the Purchaser, and delivered to the Issuer, will constitute a subscription for Units which will not be binding on the Issuer until accepted by the Issuer by executing the

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 14 of 15

Subscription Agreement in the space provided on the face page(s) of the Agreement and, notwithstanding the Agreement Date, if the Issuer accepts the subscription by the Purchaser, the Subscription Agreement will be entered into on the date of such execution by the Issuer.

 

3. CLOSING

 

4.1           On or before the end of the fifth business day before the Closing Date, the Purchaser will deliver to the Issuer the Subscription Agreement and all applicable schedules and required forms, duly executed, and payment in full for the total price of the Purchased Securities to be purchased by the Purchaser.

 

4.2           At Closing, the Issuer will deliver to the Purchaser the certificates representing the Purchased Securities purchased by the Purchaser registered in the name of the Purchaser or its nominee, or as directed by the Purchaser.

 

 

4. MISCELLANEOUS

 

5.1           The Purchaser agrees to sell, assign or transfer the Securities only in accordance with the requirements of applicable securities laws and any legends placed on the Securities as contemplated by the Subscription Agreement.

 

5.2           The Purchaser hereby authorizes the Issuer to correct any minor errors in, or complete any minor information missing from any part of the Subscription Agreement and any other schedules, forms, certificates or documents executed by the Purchaser and delivered to the Issuer in connection with the Private Placement.

 

5.3           The Issuer may rely on delivery by fax machine of an executed copy of this subscription, and acceptance by the Issuer of such faxed copy will be equally effective to create a valid and binding agreement between the Purchaser and the Issuer in accordance with the terms of the Subscription Agreement.

 

5.4           Without limitation, this subscription and the transactions contemplated by this Subscription Agreement are conditional upon and subject to the Issuer’s having obtained such regulatory approval of this subscription and the transactions contemplated by this Subscription Agreement as the Issuer considers necessary.

 

5.5           This Subscription Agreement is not assignable or transferable by the parties hereto without the express written consent of the other party to this Subscription Agreement.

 

5.6           Time is of the essence of this Subscription Agreement.

 

5.7           Except as expressly provided in this Subscription Agreement and in the agreements, instruments and other documents contemplated or provided for in this Subscription Agreement, this Subscription Agreement contains the entire agreement between the parties with respect to the Securities and there are no other terms, conditions, representations or warranties whether expressed, implied, oral or written, by statute, by common law, by the Issuer, or by anyone else.

 

5.8           The parties to this Subscription Agreement may amend this Subscription Agreement only in writing.

 

5.9           This Subscription Agreement enures to the benefit of and is binding upon the parties to this Subscription Agreement and their successors and permitted assigns.

 

5.10           A party to this Subscription Agreement will give all notices to or other written communications with the other party to this Subscription Agreement concerning this Subscription Agreement by hand or by registered mail addressed to the address given on page 1.

 

5.11           This Subscription Agreement is to be read with all changes in gender or number as required by the context.

 

5.12           This Subscription Agreement will be governed by and construed in accordance with the internal laws of Nevada (without reference to its rules governing the choice or conflict of laws), and the parties hereto irrevocably

 

  

  

  

Subscription Agreement (with related appendices, schedules and forms)Page 15 of 15

attorn and submit to the exclusive jurisdiction of the courts of Nevada with respect to any dispute related to this Subscription Agreement.

 

End of General Provisions

 

End of Subscription Agreementex10-3.htm

  

1

  

 

EXHIBIT A

 

FORM OF WARRANT

 

THESE SECURITIES HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE AND HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE 1933 ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE 1993 ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS.

THESE WARRANTS WILL EXPIRE AND BECOME NULL AND VOID

AT 12:01 A.M. ON _________.

 

SHARE PURCHASE WARRANTS TO PURCHASE SHARE OF COMMON STOCK OF

 

ANAVEX LIFE SCIENCES CORP.

 

THIS IS TO CERTIFY THAT ________ (the "Holder") of _______ common shares of Anavex Life Sciences Corp.  has the right to purchase, upon and subject to the terms and conditions hereinafter referred to, up to _______ fully paid and non-assessable shares of common stock (the "Shares") in the capital of Anavex Life Sciences Corp. (hereinafter called the "Company") on or before 11:59p.m. on _______ (the "Expiry Date") at a price per Share of US$_______(the "Exercise Price") on the terms and conditions attached hereto as Appendix A (the "Terms and Conditions").

 

	
  

	
1.

	
ONE (1) WARRANT AND THE EXERCISE PRICE ARE REQUIRED TO PURCHASE ONE SHARE.  THIS CERTIFICATE REPRESENTS _________WARRANTS.

 

	
  

	
2.

	
These Warrants are issued subject to the Terms and Conditions, and the Warrant Holder may exercise the right to purchase Shares only in accordance with those Terms and Conditions.

 

	
  

	
3.

	
Nothing contained herein or in the Terms and Conditions will confer any right upon the Holder hereof or any other person to subscribe for or purchase any Shares at any time subsequent to the Expiry Date, and from and after such time, this Warrant and all rights hereunder will be void and of no value.

 

IN WITNESS WHEREOF the Company has executed this Warrant Certificate this ___ day of_______.

 

ANAVEX LIFE SCIENCES CORP.

 

 

 

Per:           _________________________________

Authorized Signatory

  

2

  

APPENDIX A

TERMS AND CONDITIONS dated _________, attached to the Warrants issued by Anavex Life Sciences Corp.

 

	
1.  

	
INTERPRETATION

 

1.1 Definitions

 

In these Terms and Conditions, unless there is something in the subject matter or context inconsistent therewith:

 

	
(a)  

	
"Company" means Anavex Life Sciences Corp. until a successor corporation will have become such as a result of consolidation, amalgamation or merger with or into any other corporation or corporations, or as a result of the conveyance or transfer of all or substantially all of the properties and estates of the Company as an entirety to any other corporation and thereafter "Company" will mean such successor corporation;

 

	
(b)  

	
"Company's Auditors" means an independent firm of accountants duly appointed as auditors of the Company;

 

	
(c)  

	
"Director" means a director of the Company for the time being, and reference, without more, to action by the directors means action by the directors of the Company as a Board, or whenever duly empowered, action by an executive committee of the Board;

 

	
(d)  

	
"herein", "hereby" and similar expressions refer to these Terms and Conditions as the same may be amended or modified from time to time; and the expression "Article" and "Section," followed by a number refer to the specified Article or Section of these Terms and Conditions;

 

	
(e)  

	
"person" means an individual, corporation, partnership, trustee or any unincorporated organization and words importing persons have a similar meaning;

 

	
(f)  

	
"shares" means the shares of common stock in the capital of the Company as constituted at the date hereof and any shares resulting from any subdivision or consolidation of the shares;

 

	
(g)  

	
"Warrant Holders" or "Holders" means the holders of the Warrants; and

 

	
(h)  

	
"Warrants" means the warrants of the Company issued and presently authorized and for the time being outstanding.

 

1.2 Gender

 

Words importing the singular number include the plural and vice versa and words importing the masculine gender include the feminine and neuter genders.

 

1.3 Interpretation not affected by Headings

 

The division of these Terms and Conditions into Articles and Sections, and the insertion of headings are for convenience of reference only and will not affect the construction or interpretation thereof.

 

1.4 Applicable Law

 

The Warrant and the terms hereof are governed by the laws of the State of Nevada and the federal laws applicable therein.  The Holder, in the Holder’s personal or corporate capacity and, if applicable, on behalf of each beneficial purchaser for whom the Holder is acting, irrevocably attorns to the jurisdiction of the courts of the State of Nevada.

  

3

  

 

ISSUE OF WARRANTS

 

1.5 Additional Warrants

 

The Company may at any time and from time to time issue additional warrants or grant options or similar rights to purchase shares of its capital stock.

 

1.6 Warrants to Rank Pari Passu

 

All Warrants and additional warrants, options or similar rights to purchase shares from time to time issued or granted by the Company, will rank pari passu whatever may be the actual dates of issue or grant thereof, or of the dates of the certificates by which they are evidenced.

 

1.7 Issue in substitution for Lost Warrants

 

	
(a)  

	
In case a Warrant becomes mutilated, lost, destroyed or stolen, the Company, at its discretion, may issue and deliver a new Warrant of like date and tenor as the one mutilated, lost, destroyed or stolen, in exchange for and in place of and upon cancellation of such mutilated Warrant, or in lieu of, and in substitution for such lost, destroyed or stolen Warrant and the substituted Warrant will be entitled to the benefit hereof and rank equally in accordance with its terms with all other Warrants issued or to be issued by the Company.

 

	
(b)  

	
The applicant for the issue of a new Warrant pursuant hereto will bear the cost of the issue thereof and in case of loss, destruction or theft furnish to the Company such evidence of ownership and of loss, destruction, or theft of the Warrant so lost, destroyed or stolen as will be satisfactory to the Company in its discretion and such applicant may also be required to furnish indemnity in amount and form satisfactory to the Company in its discretion, and will pay the reasonable charges of the Company in connection therewith.

 

1.8 Warrant Holder Not a Shareholder

 

The holding of a Warrant will not constitute the Holder thereof as a shareholder of the Company, nor entitle him to any right or interest in respect thereof except as in the Warrant expressly provided.

 

	
2.  

	
NOTICE

 

2.1 Notice to Warrant Holder

 

Any notice required or permitted to be given to the Holder will be in writing and may be given by prepaid registered post, electronic facsimile transmission or other means of electronic communication capable of producing a printed copy to the address of the Holder appearing on the Holder's Warrant or to such other address as any Holder may specify by notice in writing to the Company, and any such notice will be deemed to have been given and received by the Holder to whom it was addressed if mailed, on the third day following the mailing thereof, if by facsimile or other electronic communication, on successful transmission, or, if delivered, on delivery; but if at the time or mailing or between the time of mailing and the third business day thereafter there is a strike, lockout, or other labor disturbance affecting postal service, then the notice will not be effectively given until actually delivered.

 

2.2 Notice to the Company

 

Any notice required or permitted to be given to the Company will be in writing and may be given by prepaid registered post, electronic facsimile transmission or other means of electronic communication capable of producing a printed copy to the address of the Company set forth below or such other address as the Company may specify by notice in writing to the Holder, and any such notice will be deemed to have been given and received by the Company to whom it was addressed if mailed, on the third day following the mailing thereof, if by facsimile or other electronic communication, on successful transmission, or, if delivered, on delivery; but if at the time or mailing or between the time of mailing and the third business day thereafter there is a strike, lockout, or other labour disturbance affecting postal service, then the notice will not be effectively given until actually delivered:

  

4

  

 

                                Anavex Life Sciences Corp.

27 Marathonos Ave., Pallini, 17455 Athens, Greece

 

Attention: President

 

Fax No. +1 250 764 9701

 

	
3.  

	
EXERCISE OF WARRANTS

 

3.1 Method of Exercise of Warrants

 

The right to purchase shares conferred by the Warrants may be exercised by the Holder surrendering the Warrant Certificate representing same, with a duly completed and executed subscription in the form attached hereto and a bank draft or certified check payable to the Company for the purchase price applicable at the time of surrender in respect of the shares subscribed for in lawful money of the United States of America, to the Company at the address set forth in, or from time to time specified by the Company pursuant to, Section 3.2.

 

3.2 Effect of Exercise of Warrants

 

	
(a)  

	
Upon surrender and payment as aforesaid the shares so subscribed for will be deemed to have been issued and such person or persons will be deemed to have become the Holder or Holders of record of such shares on the date of such surrender and payment, and such shares will be issued at the subscription price in effect on the date of such surrender and payment.

 

	
(b)  

	
Within ten business days after surrender and payment as aforesaid, the Company will forthwith cause to be delivered to the person or persons in whose name or names the shares so subscribed for are to be issued as specified in such subscription or mailed to him, her or them at his, her or their respective addresses specified in such subscription, a certificate or certificates for the appropriate number of shares not exceeding those which the Warrant Holder is entitled to purchase pursuant to the Warrant surrendered.

 

3.3 Subscription for Less Than Entitlement

 

The Holder of any Warrant may subscribe for and purchase a number of shares less than the number which the Holder is entitled to purchase pursuant to the surrendered Warrant. In the event of any purchase of a number of shares less than the number which can be purchased pursuant to a Warrant, the Holder thereof upon exercise thereof will in addition be entitled to receive a new Warrant in respect of the balance of the shares which the Holder is entitled to purchase pursuant to the surrendered Warrant and which are not then purchased.

 

3.4 Warrants for Fractions of Shares

 

To the extent that the Holder of any Warrant is entitled to receive on the exercise or partial exercise thereof a fraction of a share, such right may be exercised in respect of such fraction only in combination with another Warrant or other Warrants which in the aggregate entitle the Holder to receive a whole number of such shares.

 

3.5 Expiration of Warrants

 

After the expiration of the period within which a Warrant is exercisable, all rights thereunder will wholly cease and terminate and such Warrant will be void and of no effect.

 

3.6 Time of Essence

 

Time will be of the essence hereof.

 

  

5

  

 

Subscription Price

 

Each Warrant is exercisable at a price per share (the "Exercise Price") of US$_____.  One (1) Warrant and the Exercise Price are required to subscribe for each share during the term of the Warrants.

 

3.7 Adjustment of Exercise Price

 

	
(a)  

	
The Exercise Price and the number of shares deliverable upon the exercise of the Warrants will be subject to adjustment in the event and in the manner following:

 

	
(i)  

	
If and whenever the shares at any time outstanding are subdivided into a greater or consolidated into a lesser number of shares the Exercise Price will be decreased or increased proportionately as the case may be; upon any such subdivision or consolidation the number of shares deliverable upon the exercise of the Warrants will be increased or decreased proportionately as the case may be.

 

	
(ii)  

	
In case of any capital reorganization or of any reclassification of the capital of the Company or in the case of the consolidation, merger or amalgamation of the Company with or into any other Company (hereinafter collectively referred to as a "Reorganization"), each Warrant will after such Reorganization confer the right to purchase the number of shares or other securities of the Company (or of the Company's resulting from such Reorganization) which the Warrant Holder would have been entitled to upon Reorganization if the Warrant Holder had been a shareholder at the time of such Reorganization.

 

In any such case, if necessary, appropriate adjustments will be made in the application of the provisions of this Article Four relating to the rights and interest thereafter of the Holders of the Warrants so that the provisions of this Article Four will be made applicable as nearly as reasonably possible to any shares or other securities deliverable after the Reorganization on the exercise of the Warrants.

 

The subdivision or consolidation of shares at any time outstanding into a greater or lesser number of shares (whether with or without par value) will not be deemed to be a Reorganization for the purposes of this clause 4.8(a)(ii).

 

	
(b)  

	
The adjustments provided for in this Section 4.8 are cumulative and will become effective immediately after the record date or, if no record date is fixed, the effective date of the event which results in such adjustments.

 

3.8 Determination of Adjustments

 

If any questions will at any time arise with respect to the Exercise Price or any adjustment provided for in Section 4.8, such questions will be conclusively determined by the Company's Auditors, or, if they decline to so act any other firm of certified public accountants in the United States of America that the Company may designate and who will have access to all appropriate records and such determination will be binding upon the Company and the Holders of the Warrants.

 

	
4.  

	
WAIVER OF CERTAIN RIGHTS

 

4.1 Immunity of Shareholders, etc.

 

The Warrant Holder, as part of the consideration for the issue of the Warrants, waives and will not have any right, cause of action or remedy now or hereafter existing in any jurisdiction against any past, present or future incorporator, shareholder, director or officer (as such) of the Company for the issue of shares pursuant to any Warrant or on any covenant, agreement, representation or warranty by the Company herein contained or in the Warrant.

  

6

  

 

MODIFICATION OF TERMS, ETC.

 

4.2 Modification of Terms and Conditions for Certain Purposes

 

From time to time the Company may, subject to the provisions of these presents, modify the Terms and Conditions hereof, for the purpose of correction or rectification of any ambiguities, defective provisions, errors or omissions herein.

 

4.3 Warrants Not Transferable

 

The Warrant and all rights attached to it are not transferable.

 

DATED as of the date first above written in these Terms and Conditions.

 

ANAVEX LIFE SCIENCES CORP.

 

Per:           ___________________________________

Authorized Signatory

 

  

7

  

FORM OF SUBSCRIPTION

 

	
TO:

	
Anavex Life Sciences Corp.

	
  

	
27 Marathonos Ave.

	
  

	
Pallini, 17455

	
  

	
Athens, Greece

 

The undersigned Holder of the within Warrants hereby subscribes for ____________ shares of common stock (the "Shares") of Anavex Life Sciences Corp. (the "Company") pursuant to the within Warrants at US$2.25 per Share on the terms specified in the said Warrants.  This subscription is accompanied by a certified check or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares.

 

The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate.

 

The undersigned hereby directs that the Shares be registered as follows:

	
NAME(S) IN FULL

	  	
ADDRESS(ES)

	  	
NUMBER OF SHARES

	  	  	  	  	  
	  	  	  	  	  
	  	  	
TOTAL:

	  	  

 

(Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable).

 

DATED this ________  day of __________________ , ______.

 

In the presence of:

 

__________________________________________________________________________

Signature of Witness                                                                           Signature of Warrant Holder

 

Please print below your name and address in full.

 

Name (Mr./Mrs./Miss)      _____________________________________

 

Address                                _____________________________________

 

_____________________________________

 

INSTRUCTIONS FOR SUBSCRIPTION

 

The signature to the subscription must correspond in every particular with the name written upon the face of the Warrant without alteration or enlargement or any change whatever.  If there is more than one subscriber, all must sign.  In the case of persons signing by agent or attorney or by personal representative(s), the authority of such agent, attorney or representative(s) to sign must be proven to the satisfaction of the Company.  If the Warrant certificate and the form of subscription are being forwarded by mail, registered mail must be employed.

 

  

8

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