Document:

Exhibit 10.1

 

THIS WARRANT
AND THE UNDERLYING SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”),
OR UNDER THE SECURITIES LAWS OF ANY STATE. THESE SECURITIES MAY NOT BE OFFERED, SOLD OR OTHERWISE TRANSFERRED, PLEDGED OR HYPOTHECATED
EXCEPT AS PERMITTED UNDER THE ACT AND APPLICABLE STATE SECURITIES LAWS IN ACCORDANCE WITH APPLICABLE REGISTRATION REQUIREMENTS
OR AN EXEMPTION THEREFROM. THE ISSUER OF THESE SECURITIES MAY REQUIRE AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE ISSUER
THAT SUCH OFFER, SALE, TRANSFER, PLEDGE OR HYPOTHECATION OTHERWISE COMPLIES WITH THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS.
This warrant must be surrendered to the coMPANY or its transfer agent as a condition precedent
to the sale, transfer, pledge or hypothecation of any interest in any of the securities represented hereby.

 

WARRANT TO PURCHASE SHARES OF SERIES [A][A-1][A-2]
PREFERRED STOCK

of

SEMLER SCIENTIFIC, INC.

Dated as of [________]

Void after the date specified in Section 8

 

	No. 2013-__	___________ Shares of Series [A][A-1][A-2]

Preferred Stock

 

THIS CERTIFIES THAT, for value
received, ______________, or its registered assigns (the “Holder”), is entitled, subject to the provisions
and upon the terms and conditions set forth herein, to purchase from Semler Scientific, Inc., an Oregon corporation (the “Company”),
upon the exercise hereof and the terms herein, up to __________ shares of the Company’s Series [A][A-1][A-2] Preferred Stock
(the “Shares”) at such times and at the price per share set forth in Section 1. The term “Warrant”
as used herein shall include this Warrant and any warrants delivered in substitution or exchange therefor as provided herein. After
consideration of all relevant factors, the Company and the original Holder agree that the value of the Warrant is equal to $0.10
times the maximum number of shares purchasable upon exercise hereof; and Holder agrees to pay to the Company the aggregate purchase
price of $___________ upon the issuance of this Warrant to Holder.

 

The following is a statement of
the rights of the Holder and the conditions to which this Warrant is subject, and to which Holder, by acceptance of this Warrant,
agrees:

 

1.     
    Exercise Price and Exercise Period.

 

(a)          Exercise
Price. The exercise price per Share shall be [4.50]1 for Series [A] Warrant.

 

 

 

1 If Series
A, exercise price is $4.50; if Series A-1, exercise price is $4.00; if Series A-2, exercise price is $2.00.

 

    	 

    	 

    

  

(b)          Exercise
Period. This Warrant shall be exercisable, in whole or in part, at any time after the issuance hereof and prior to the
expiration of this Warrant as set forth in Section 8.

 

2.        
 Exercise of the Warrant.

 

(a)          Exercise.
The purchase rights represented by this Warrant may be exercised at the election of the Holder, in whole or in part, in accordance
with Section 1, by:

 

(i)          the
tender to the Company at its principal office (or such other office or agency as the Company may designate) of a notice of exercise
in the form of Exhibit A (the “Notice of Exercise”), duly completed and executed by or on behalf
of the Holder, together with the surrender of this Warrant; and

 

(ii)         the
payment to the Company of an amount equal to (x) the Exercise Price multiplied by (y) the number of Shares being purchased,
by wire transfer or certified, cashier’s or other check acceptable to the Company and payable to the order of the Company.

 

(b)          Net
Issue Exercise. In lieu of exercising this Warrant pursuant to Section 2(a)(ii), if the fair market value of one Share
is greater than the Exercise Price (at the date of calculation as set forth below), the Holder may elect to receive a number of
Shares equal to the value of this Warrant (or of any portion of this Warrant being canceled) by surrender of this Warrant at the
principal office of the Company (or such other office or agency as the Company may designate) together with a properly completed
and executed Notice of Exercise reflecting such election, in which event the Company shall issue to the Holder that number of Shares
computed using the following formula:

  

	X	=	Y (A – B)
	A

 

Where:

 

	X	=	The number of Shares to be issued to the Holder
	 	 	 
	Y	=	The number of Shares purchasable under this Warrant or, if only a portion of the Warrant is being exercised, the portion of the Warrant being canceled (at the date of such calculation)
	 	 	 
	A	=	The fair market value of one Share (at the date of such calculation)
	 	 	 
	B	=	The Exercise Price (as adjusted to the date of such calculation)

 

For purposes of the calculation
above, the fair market value of one Share shall be determined by the Board of Directors of the Company, acting in good faith; provided,
however, that:

 

(i)          where
a public market exists for the Company’s common stock at the time of such exercise, the fair market value per Share shall
be the average of the closing bid prices of the common stock or the closing price quoted on the national securities exchange on
which the common stock is listed as published in the Wall Street Journal, as applicable, for the ten (10) trading day period
ending five (5) trading days prior to the date of determination of fair market value; and

 

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(ii)         if
the Warrant is exercised in connection with the Company’s initial public offering of common stock, the fair market value
per Share shall be the product of the per share offering price to the public of the Company’s initial public offering.

 

(c)          Stock
Certificates. The rights under this Warrant shall be deemed to have been exercised and the Shares issuable upon such exercise
shall be deemed to have been issued immediately prior to the close of business on the date this Warrant is exercised in accordance
with its terms, and the person entitled to receive the Shares issuable upon such exercise shall be treated for all purposes as
the holder of record of such Shares as of the close of business on such date. As promptly as reasonably practicable on or after
such date, the Company shall issue and deliver to the person or persons entitled to receive the same a certificate or certificates
for that number of shares issuable upon such exercise. In the event that the rights under this Warrant are exercised in part and
have not expired, the Company shall execute and deliver a new Warrant reflecting the number of Shares that remain subject to this
Warrant.

 

(d)          No
Fractional Shares or Scrip. No fractional shares or scrip representing fractional shares shall be issued upon the exercise
of the rights under this Warrant. In lieu of such fractional share to which the Holder would otherwise be entitled, the Company
shall make a cash payment equal to the Exercise Price multiplied by such fraction.

 

(e)          Automatic
Exercise. If the Holder of this Warrant has not elected to exercise this Warrant prior to expiration of this Warrant pursuant
to Section 8, then this Warrant shall automatically (without any act on the part of the Holder) be exercised pursuant to Section 2(b)
effective immediately prior to the expiration of the Warrant to the extent such net issue exercise would result in the issuance
of Shares, unless Holder shall earlier provide written notice to the Company that the Holder desires that this Warrant expire unexercised.
If this Warrant is automatically exercised, the Company shall notify the Holder of the automatic exercise as soon as reasonably
practicable, and the Holder shall surrender the Warrant to the Company in accordance with the terms hereof.

 

(f)      
   Reservation of Stock. The Company agrees during the term the rights under this Warrant
are exercisable to take all reasonable action to reserve and keep available from its authorized and unissued shares of common
stock for the purpose of effecting the exercise of this Warrant such number of shares as shall from time to time be
sufficient to effect the exercise of the rights under this Warrant; and if at any time the number of authorized but unissued
shares of common stock shall not be sufficient for purposes of the exercise of this Warrant in accordance with its terms,
without limitation of such other remedies as may be available to the Holder, the Company will use all reasonable efforts to
take such corporate action as may, in the opinion of counsel, be necessary to increase its authorized and unissued shares of
its common stock to a number of shares as shall be sufficient for such purposes.

 

3.          Replacement
of the Warrant. Subject to the receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or
mutilation of this Warrant and, in the case of loss, theft or destruction, on delivery of an indemnity agreement reasonably satisfactory
in form and substance to the Company or, in the case of mutilation, on surrender and cancellation of this Warrant, the Company
at the expense of the Holder shall execute and deliver, in lieu of this Warrant, a new warrant of like tenor and amount.

 

4.          Transfer
of the Warrant.

 

(a)          Warrant
Register. The Company shall maintain a register (the “Warrant Register”) containing the name
and address of the Holder or Holders. Until this Warrant is transferred on the Warrant Register in accordance herewith, the Company
may treat the Holder as shown on the Warrant Register as the

 

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absolute owner of this Warrant for
all purposes, notwithstanding any notice to the contrary. Any Holder of this Warrant (or of any portion of this Warrant) may change
its address as shown on the Warrant Register by written notice to the Company requesting a change.

 

(b)          Warrant
Agent. The Company may appoint an agent for the purpose of maintaining the Warrant Register referred to in Section 4(a),
issuing the Shares or other securities then issuable upon the exercise of the rights under this Warrant, exchanging this Warrant,
replacing this Warrant or conducting related activities.

 

(c)          Transferability
of the Warrant. Subject to the provisions of this Warrant with respect to compliance with the Securities Act of 1933, as
amended (the “Securities Act”) and limitations on assignments and transfers, including without limitation
compliance with the restrictions on transfer set forth in Section 5, title to this Warrant may be transferred by endorsement
(by the transferor and the transferee executing the assignment form attached as Exhibit B (the “Assignment
Form”)) and delivery in the same manner as a negotiable instrument transferable by endorsement and delivery.

 

(d)          Exchange
of the Warrant upon a Transfer. On surrender of this Warrant (and a properly endorsed Assignment Form) for exchange, subject
to the provisions of this Warrant with respect to compliance with the Securities Act and limitations on assignments and transfers,
the Company shall issue to or on the order of the Holder a new warrant or warrants of like tenor, in the name of the Holder or
as the Holder (on payment by the Holder of any applicable transfer taxes) may direct, for the number of shares issuable upon exercise
hereof, and the Company shall register any such transfer upon the Warrant Register. This Warrant (and the securities issuable upon
exercise of the rights under this Warrant) must be surrendered to the Company or its warrant or transfer agent, as applicable,
as a condition precedent to the sale, pledge, hypothecation or other transfer of any interest in any of the securities represented
hereby.

 

(e)          Minimum
Transfer. This Warrant may not be transferred in part.

 

(f)          Taxes.
In no event shall the Company be required to pay any tax which may be payable in respect of any transfer involved in the issue
and delivery of any certificate in a name other than that of the Holder, and the Company shall not be required to issue or deliver
any such certificate unless and until the person or persons requesting the issue thereof shall have paid to the Company the amount
of such tax or shall have established to the satisfaction of the Company that such tax has been paid or is not payable.

 

5.          Restrictions
on Transfer of the Warrant and Shares; Compliance with Securities Laws. By acceptance of this Warrant, the Holder agrees to
comply with the following:

 

(a)          Restrictions
on Transfers. Subject to Section 5(b), this Warrant may not be transferred or assigned in whole or in part without
the Company’s prior written consent (which shall not be unreasonably withheld), and any attempt by Holder to transfer or
assign any rights, duties or obligations that arise under this Warrant without such permission shall be void. Any transfer of this
Warrant or the Shares (the “Securities”) must be in compliance with all applicable federal and state
securities laws. The Holder agrees not to make any sale, assignment, transfer, pledge or other disposition of all or any portion
of the Securities, or any beneficial interest therein, unless and until the transferee thereof has agreed in writing for the benefit
of the Company to take and hold such Securities subject to, and to be bound by, the terms and conditions set forth in this Warrant
to the same extent as if the transferee were the original Holder hereunder, and

 

(i)          there
is then in effect a registration statement under the Securities Act covering such proposed disposition and such disposition is
made in accordance with such registration statement, or

 

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(ii)         (A) such
Holder shall have given prior written notice to the Company of such Holder’s intention to make such disposition and shall
have furnished the Company with a detailed description of the manner and circumstances of the proposed disposition, (B) the
transferee shall have confirmed to the satisfaction of the Company in writing, substantially in the form of Exhibit A-1, that
the Securities are being acquired (i) solely for the transferee’s own account and not as a nominee for any other party,
(ii) for investment and (iii) not with a view toward distribution or resale, and shall have confirmed such other matters
related thereto as may be reasonably requested by the Company, and (C) such Holder shall have furnished the Company, at the
Holder’s expense, with (i)  an opinion of counsel, reasonably satisfactory to the Company, to the effect that such disposition
will not require registration of such Securities under the Securities Act or (ii) a “no action” letter from the
Securities and Exchange Commission to the effect that the transfer of such Securities without registration will not result in a
recommendation by the staff of the Securities and Exchange Commission that action be taken with respect thereto, whereupon such
Holder shall be entitled to transfer such Securities in accordance with the terms of the notice delivered by the Holder to the
Company. It is agreed that the Company will not require opinions of counsel for transactions made pursuant to Rule 144 except
in unusual circumstances.

 

(b)          Permitted
Transfers. Permitted transfers include (i) a transfer not involving a change in beneficial ownership, or (ii) transactions
involving the distribution without consideration of Securities by any Holder to (x) a parent, subsidiary or other affiliate
of a Holder that is a corporation, (y) any of the Holder’s partners, members or other equity owners, or retired partners
or members, or to the estate of any of its partners, members or other equity owners or retired partners or members, or (z) a
venture capital fund that is controlled by or under common control with one or more general partners or managing members of, or
shares the same management company with, the Holder; provided, in each case, that the Holder shall give written notice to
the Company of the Holder’s intention to effect such disposition and shall have furnished the Company with a detailed description
of the manner and circumstances of the proposed disposition.

 

(c)          Investment
Representation Statement. Unless the rights under this Warrant are exercised pursuant to an effective registration statement
under the Securities Act that includes the Shares with respect to which the Warrant was exercised, it shall be a condition to any
exercise of the rights under this Warrant that the Holder shall have confirmed to the satisfaction of the Company in writing, substantially
in the form of Exhibit A-1, that the Shares so purchased are being acquired solely for the Holder’s own account and
not as a nominee for any other party, for investment and not with a view toward distribution or resale and that the Holder shall
have confirmed such other matters related thereto as may be reasonably requested by the Company.

 

(d)          Securities
Law Legend. The Securities shall (unless otherwise permitted by the provisions of this Warrant) be stamped or imprinted
with a legend substantially similar to the following (in addition to any legend required by state securities laws):

 

THE SECURITIES REPRESENTED HEREBY HAVE NOT
BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR UNDER THE SECURITIES LAWS OF CERTAIN STATES.
THESE SECURITIES MAY NOT BE OFFERED, SOLD OR OTHERWISE TRANSFERRED, PLEDGED OR HYPOTHECATED EXCEPT AS PERMITTED UNDER THE ACT AND
APPLICABLE STATE SECURITIES LAWS IN ACCORDANCE WITH APPLICABLE REGISTRATION REQUIREMENTS OR AN EXEMPTION THEREFROM. THE ISSUER
OF THESE SECURITIES MAY REQUIRE AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE ISSUER THAT SUCH OFFER, SALE OR TRANSFER,
PLEDGE OR HYPOTHECATION OTHERWISE COMPLIES WITH THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS. This
certificate must be surrendered to the coMPANY or its transfer agent as a condition precedent to the sale,

 

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TRANSFER,
pledge OR hypothecation of any interest in any of the securities represented hereby.

 

(e)          Market
Stand-off Legend. The Shares shall also be stamped or imprinted with a legend in substantially the following form:

 

THE SHARES REPRESENTED BY THIS CERTIFICATE
ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY AND RESALE, INCLUDING A LOCK-UP PERIOD IN THE EVENT OF A PUBLIC OFFERING, AS SET
FORTH IN THE WARRANT PURSUANT TO WHICH THESE SHARES WERE ISSUED, A COPY OF WHICH MAY BE OBTAINED AT THE PRINCIPAL OFFICE OF THE
COMPANY.

 

(f)      
    Instructions Regarding Transfer Restrictions. The Holder consents to the Company making
a notation on its records and giving instructions to any transfer agent in order to implement the restrictions on transfer
established in this Section 5.

 

(g)          Removal
of Legend. The legend referring to federal and state securities laws identified in Section 5(d)
stamped on a certificate evidencing the Shares and the stock transfer instructions and record notations with respect to such securities
shall be removed and the Company shall issue a certificate without such legend to the holder of such securities if (i) such
securities are registered under the Securities Act, or (ii) such holder provides the Company with an opinion of counsel reasonably
acceptable to the Company to the effect that a sale or transfer of such securities may be made without registration or qualification.

 

6.          Adjustments.
Subject to the expiration of this Warrant pursuant to Section 8, the number and kind
of shares purchasable hereunder and the Exercise Price therefor are subject to adjustment from time to time, as follows:

 

(a)          Merger
or Reorganization. If at any time there shall be any reorganization, recapitalization, merger or consolidation (a “Reorganization”)
involving the Company (other than as otherwise provided for herein or as would cause the expiration of this Warrant under Section 8)
in which shares of the Company’s stock are converted into or exchanged for securities, cash or other property, then, as a
part of such Reorganization, lawful provision shall be made so that the Holder shall thereafter be entitled to receive upon exercise
of this Warrant, the kind and amount of securities, cash or other property of the successor corporation resulting from such Reorganization,
equivalent in value to that which a holder of the Shares deliverable upon exercise of this Warrant would have been entitled in
such Reorganization if the right to purchase the Shares hereunder had been exercised immediately prior to such Reorganization.
In any such case, appropriate adjustment (as determined in good faith by the Board of Directors of the successor corporation) shall
be made in the application of the provisions of this Warrant with respect to the rights and interests of the Holder after such
Reorganization to the end that the provisions of this Warrant shall be applicable after the event, as near as reasonably may be,
in relation to any shares or other securities deliverable after that event upon the exercise of this Warrant.

 

(b)          Reclassification
of Shares. If the securities issuable upon exercise of this Warrant are changed into the same or a different number of
securities of any other class or classes by reclassification, capital reorganization, conversion of all outstanding shares of the
relevant class or series (other than as would cause the expiration of this Warrant pursuant to Section 8) or otherwise (other
than as otherwise provided for herein) (a “Reclassification”), then, in any such event, in lieu of the
number of Shares which the Holder would otherwise have been entitled to receive, the Holder shall have the right thereafter to
exercise this Warrant for a number of shares of such other class or classes of stock that a holder of the number of securities

 

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deliverable upon exercise of this
Warrant immediately before that change would have been entitled to receive in such Reclassification, all subject to further adjustment
as provided herein with respect to such other shares.

 

(c)          Subdivisions
and Combinations. In the event that the outstanding shares of the securities issuable upon exercise of this Warrant are
subdivided (by stock split, by payment of a stock dividend or otherwise) into a greater number of shares of such securities, the
number of Shares issuable upon exercise of the rights under this Warrant immediately prior to such subdivision shall, concurrently
with the effectiveness of such subdivision, be proportionately increased, and the Exercise Price shall be proportionately decreased,
and in the event that the outstanding shares of the securities issuable upon exercise of this Warrant are combined (by reclassification
or otherwise) into a lesser number of shares of such securities, the number of Shares issuable upon exercise of the rights under
this Warrant immediately prior to such combination shall, concurrently with the effectiveness of such combination, be proportionately
decreased, and the Exercise Price shall be proportionately increased.

 

(d)          Notice
of Adjustments. Upon any adjustment in accordance with this Section 6, the Company shall give notice thereof to the
Holder, which notice shall state the event giving rise to the adjustment, the Exercise Price as adjusted and the number of securities
or other property purchasable upon the exercise of the rights under this Warrant, setting forth in reasonable detail the method
of calculation of each. The Company shall, upon the written request of any Holder, furnish or cause to be furnished to such Holder
a certificate setting forth (i) such adjustments, (ii) the Exercise Price at the time in effect and (iii) the number
of securities and the amount, if any, of other property that at the time would be received upon exercise of this Warrant.

 

7.          Notification
of Certain Events. Prior to the expiration of this Warrant pursuant to Section 8, in the event that the Company shall
authorize:

 

(a)          the
issuance of any dividend or other distribution on the capital stock of the Company (other than (i) dividends or distributions
otherwise provided for in Section 6, (ii) repurchases of common stock issued to or held by employees, officers, directors
or consultants of the Company or its subsidiaries upon termination of their employment or services pursuant to agreements providing
for the right of said repurchase; (iii) repurchases of common stock issued to or held by employees, officers, directors or
consultants of the Company or its subsidiaries pursuant to rights of first refusal or first offer contained in agreements providing
for such rights; or (iv) repurchases of capital stock of the Company in connection with the settlement of disputes with any
stockholder), whether in cash, property, stock or other securities;

 

(b)          the
voluntary liquidation, dissolution or winding up of the Company; or

 

(c)          any
transaction resulting in the expiration of this Warrant pursuant to Section 8(b);

 

the Company shall send to the Holder
of this Warrant at least ten (10) days prior written notice of the date on which a record shall be taken for any such dividend
or distribution specified in clause (a) or the expected effective date of any such other event specified in clause (b)
or (c), as applicable. The notice provisions set forth in this section may be shortened or waived prospectively or retrospectively
by the consent of the holders of a majority of the Shares issuable upon exercise of the rights under the Warrants.

 

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8.          Expiration
of the Warrant. This Warrant shall expire and shall no longer be exercisable as of the earlier of:

 

(a)   5:00
p.m., Pacific time, on [July 31, 2016]2;

 

(b)          (i)
the acquisition of the Company by another entity by means of any transaction or series of related transactions to which the Company
is a party (including, without limitation, any stock acquisition, reorganization, merger or consolidation, but excluding any sale
of stock for capital raising purposes and any transaction effected primarily for purposes of changing the Company’s jurisdiction
of incorporation) other than a transaction or series of related transactions in which the holders of the voting securities of the
Company outstanding immediately prior to such transaction or series of related transactions retain, immediately after such transaction
or series of transactions, as a result of shares in the Company held by such holders prior to such transaction or series of transactions,
at least a majority of the total voting power represented by the outstanding voting securities of the Company or such other surviving
or resulting entity (or if the Company or such other surviving or resulting entity is a wholly-owned subsidiary immediately following
such acquisition, its parent), or (ii) a sale, lease or other disposition of all or substantially all of the assets of the
Company and its subsidiaries taken as a whole by means of any transaction or series of related transactions, except where such
sale, lease or other disposition is to a wholly-owned subsidiary of the Company; or

 

9.          No
Rights as a Stockholder. Nothing contained herein shall entitle the Holder to any rights as a stockholder of the Company or
to be deemed the holder of any securities that may at any time be issuable on the exercise of the rights hereunder for any purpose
nor shall anything contained herein be construed to confer upon the Holder, as such, any right to vote for the election of directors
or upon any matter submitted to stockholders at any meeting thereof, or to give or withhold consent to any corporate action (whether
upon any recapitalization, issuance of stock, reclassification of stock, change of par value or change of stock to no par value,
consolidation, merger, conveyance or otherwise) or to receive notice of meetings, or to receive dividends or subscription rights
or any other rights of a stockholder of the Company until the rights under the Warrant shall have been exercised and the Shares
purchasable upon exercise of the rights hereunder shall have become deliverable as provided herein.

 

10.        Market
Stand-off. The Holder of this Warrant hereby agrees that such Holder shall not sell or otherwise transfer, make any short sale
of, grant any option for the purchase of, or enter into any hedging or similar transaction with the same economic effect as a sale,
of any common stock (or other securities) of the Company held by the Holder (other than those included in the registration) during
the one hundred eighty (180) day period following the effective date of a registration statement of the Company filed under the
Securities Act (or such other period as may be requested by the Company or an underwriter to accommodate
regulatory restrictions on (i) the publication or other distribution of research reports and (ii) analyst recommendations
and opinions, including, but not limited to, the restrictions contained in NASD Rule 2711(f)(4) or NYSE Rule 472(f)(4),
or any successor provisions or amendments thereto), provided that all officers and directors of the Company and holders
of at least one percent (1%) of the Company’s voting securities are bound by and have entered into similar agreements. The
obligations described in this section shall not apply to a registration relating solely to employee benefit plans on Form S-l or
Form S-8 or similar forms that may be promulgated in the future, or a registration relating solely to a transaction on Form S-4
or similar forms that may be promulgated in the future. The Company may impose stop-transfer instructions and

 

 

2 If Series A, expiration date is July 31,
2016; if Series A-1, expiration date is June 30, 2023; if Series A-2, expiration date is June 30, 2022.

 

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may stamp each certificate with a
legend as substantially set forth in Section 5(e) with respect to the shares of common stock (or other securities) subject
to the foregoing restriction until the end of such one hundred eighty (180) day (or other) period. The Holder agrees to execute
a market stand-off agreement with the underwriters in the offering in customary form consistent with the provisions of this section.

 

11.        Representations
and Warranties of the Holder. By acceptance of this Warrant, the Holder represents and warrants to the Company as follows:

 

(a)          No
Registration. The Holder understands that the Securities have not been, and will not be, registered under the Securities
Act by reason of a specific exemption from the registration provisions of the Securities Act, the availability of which depends
upon, among other things, the bona fide nature of the investment intent and the accuracy of the Holder’s representations
as expressed herein or otherwise made pursuant hereto.

 

(b)          Investment
Intent. The Holder is acquiring the Securities for investment for its own account, not as a nominee or agent, and not with
a view to, or for resale in connection with, any distribution thereof. The Holder has no present intention of selling, granting
any participation in, or otherwise distributing the Securities, nor does it have any contract, undertaking, agreement or arrangement
for the same.

 

(c)          Investment
Experience. The Holder has substantial experience in evaluating and investing in private placement transactions of securities
in companies similar to the Company, and has such knowledge and experience in financial or business matters so that it is capable
of evaluating the merits and risks of its investment in the Company and protecting its own interests.

 

(d)          Speculative
Nature of Investment. The Holder understands and acknowledges that the Company has a limited financial and operating history
and that its investment in the Company is highly speculative and involves substantial risks. The Holder can bear the economic risk
of its investment and is able, without impairing its financial condition, to hold the Securities for an indefinite period of time
and to suffer a complete loss of its investment.

 

(e)          Access
to Data. The Holder has had an opportunity to ask questions of officers of the Company, which questions were answered to
its satisfaction. The Holder believes that it has received all the information that it considers necessary or appropriate for deciding
whether to acquire the Securities. The Holder understands that any such discussions, as well as any information issued by the Company,
were intended to describe certain aspects of the Company’s business and prospects, but were not necessarily a thorough or
exhaustive description. The Holder acknowledges that any business plans prepared by the Company have been, and continue to be,
subject to change and that any projections included in such business plans or otherwise are necessarily speculative in nature,
and it can be expected that some or all of the assumptions underlying the projections will not materialize or will vary significantly
from actual results.

 

(f)          Accredited
Investor. The Holder is an “accredited investor” within the meaning of Regulation D, Rule 501(a),
promulgated by the Securities and Exchange Commission and agrees to submit to the Company such further assurances of such status
as may be reasonably requested by the Company.

 

(g)          Residency.
The residency of the Holder (or, in the case of a partnership or corporation, such entity’s principal place of business)
is correctly set forth on the signature page hereto.

 

(h)          Restrictions
on Resales. The Holder acknowledges that the Securities must be held indefinitely unless subsequently registered under
the Securities Act or an exemption from such registration is available. The Holder is aware of the provisions of Rule 144
promulgated under the Securities Act, which

 

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permit resale of shares purchased
in a private placement subject to the satisfaction of certain conditions, which may include, among other things, the availability
of certain current public information about the Company; the resale occurring not less than a specified period after a party has
purchased and paid for the security to be sold; the number of shares being sold during any three-month period not exceeding specified
limitations; the sale being effected through a “broker’s transaction,” a transaction directly with a “market
maker” or a “riskless principal transaction” (as those terms are defined in the Securities Act or the Securities
Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder); and the filing of a Form 144 notice, if
applicable. The Holder acknowledges and understands that the Company may not be satisfying the current public information requirement
of Rule 144 at the time the Holder wishes to sell the Securities and that, in such event, the Holder may be precluded from
selling the Securities under Rule 144 even if the other applicable requirements of Rule 144 have been satisfied. The
Holder acknowledges that, in the event the applicable requirements of Rule 144 are not met, registration under the Securities
Act or an exemption from registration will be required for any disposition of the Securities. The Holder understands that, although
Rule 144 is not exclusive, the Securities and Exchange Commission has expressed its opinion that persons proposing to sell
restricted securities received in a private offering other than in a registered offering or pursuant to Rule 144 will have
a substantial burden of proof in establishing that an exemption from registration is available for such offers or sales and that
such persons and the brokers who participate in the transactions do so at their own risk.

 

(i)    
      No Public Market. The Holder understands and acknowledges that no public
market now exists for any of the securities issued by the Company and that the Company has made no assurances that a public
market will ever exist for the Company’s securities.

 

(j)        
  Brokers and Finders. The Holder has not engaged any brokers, finders or agents in connection with
the Securities, and the Company has not incurred nor will incur, directly or indirectly, as a result of any action taken by
the Holder, any liability for brokerage or finders’ fees or agents’ commissions or any similar charges in
connection with the Securities.

 

(k)          Legal
Counsel. The Holder has had the opportunity to review this Warrant, the exhibits and schedules attached hereto and the
transactions contemplated by this Warrant with its own legal counsel. The Holder is not relying on any statements or representations
of the Company or its agents for legal advice with respect to this investment or the transactions contemplated by this Warrant.

 

(l)    
      Tax Advisors. The Holder has reviewed with its own tax advisors the U.S.
federal, state and local and non-U.S. tax consequences of this investment and the transactions contemplated by this Warrant.
With respect to such matters, the Holder relies solely on any such advisors and not on any statements or representations of
the Company or any of its agents, written or oral. The Holder understands that it (and not the Company) shall be responsible
for its own tax liability that may arise as a result of this investment and the transactions contemplated by this
Warrant.

 

12.        Miscellaneous.

 

(a)          Amendments.
Except as expressly provided herein, neither this Warrant nor any term hereof may be amended, waived, discharged or terminated
other than by a written instrument referencing this Warrant and signed by the Company and the holders of Warrants representing
not less than a majority of the Shares issuable upon exercise of any and all outstanding Warrants, which majority does not need
to include the consent of the Holder. Any amendment, waiver, discharge or termination effected in accordance with this Section 12(a)
shall be binding upon each holder of the Warrants, each future holder of such Warrants and the Company.

 

    	- 10 -

    	 

    

  

(b)          Waivers.
No waiver of any single breach or default shall be deemed a waiver of any other breach or default theretofore or thereafter occurring.

 

(c)          Notices.
All notices and other communications required or permitted hereunder shall be in writing and shall be mailed by registered or certified
mail, postage prepaid, sent by facsimile or electronic mail (if to the Holder) or otherwise delivered by hand, messenger or courier
service addressed:

 

(i)          if
to the Holder, to the Holder at the Holder’s address, facsimile number or electronic mail address as shown in the Company’s
records, as may be updated in accordance with the provisions hereof, or until any such Holder so furnishes an address, facsimile
number or electronic mail address to the Company, then to and at the address, facsimile number or electronic mail address of the
last holder of this Warrant for which the Company has contact information in its records; or

 

(ii)         if
to the Company, to the attention of the President or Chief Financial Officer of the Company at the Company’s address as shown
on the signature page hereto, or at such other address as the Company shall have furnished to the Holder, with a copy to J. Casey
McGlynn, Wilson Sonsini Goodrich & Rosati, P.C., 650 Page Mill Road, Palo Alto, California 94304.

 

Each such notice or other communication
shall for all purposes of this Warrant be treated as effective or having been given (i) if delivered by hand, messenger or
courier service, when delivered, or (ii) if sent by mail, at the earlier of its receipt or 72 hours after the same has
been deposited in a regularly maintained receptacle for the deposit of the United States mail, addressed and mailed as aforesaid,
or (iii) if sent by facsimile, upon confirmation of facsimile transfer or, if sent by electronic mail, upon confirmation of
delivery when directed to the relevant electronic mail address. In the event of any conflict between the Company’s books
and records and this Warrant or any notice delivered hereunder, the Company’s books and records will control absent fraud
or error.

 

(d)          Governing
Law. This Warrant and all actions arising out of or in connection with this Warrant shall be governed by and construed
in accordance with the laws of the State of California, without regard to the conflicts of law provisions of the State of California,
or of any other state.

 

(e)          Jurisdiction
and Venue. Each of the Holder and the Company irrevocably consents to the exclusive jurisdiction and venue of any
court within Santa Clara County, State of California, in connection with any matter based upon or arising out of this Warrant or
the matters contemplated herein, and agrees that process may be served upon them in any manner authorized by the laws of the State
of California for such persons.

 

(f)          Titles
and Subtitles. The titles and subtitles used in this Warrant are used for convenience only and are not to be considered
in construing or interpreting this Warrant. All references in this Warrant to sections, paragraphs and exhibits shall, unless otherwise
provided, refer to sections and paragraphs hereof and exhibits attached hereto.

 

(g)          Severability.
If any provision of this Warrant becomes or is declared by a court of competent jurisdiction to be illegal, unenforceable or void,
portions of such provision, or such provision in its entirety, to the extent necessary, shall be severed from this Warrant, and
such illegal, unenforceable or void provision shall be replaced with a valid and enforceable provision that will achieve, to the
extent possible, the same economic, business and other purposes of the illegal, unenforceable or void provision. The balance of
this Warrant shall be enforceable in accordance with its terms.

 

    	- 11 -

    	 

    

  

(h)          Waiver
of Jury Trial. Each of the Holder and
the Company waives, to the fullest extent permitted by law, any and all right to trial by jury in any legal proceeding (whether
based on contract, tort or otherwise) arising out of or related to this Warrant. If the waiver of jury trial set forth
in this paragraph is not enforceable, then any claim or cause of action arising out of or relating to this Warrant shall be settled
by judicial reference pursuant to California Code of Civil Procedure Section 638 et seq. before a referee sitting without
a jury, such referee to be mutually acceptable to the parties or, if no agreement is reached, by a referee appointed by the Presiding
Judge of the California Superior Court for Santa Clara County. This paragraph shall not restrict the Holder or the Company from
exercising remedies under the Uniform Commercial Code or from exercising pre-judgment remedies under applicable law.

 

(i)     
     California Corporate Securities Law. THE SALE OF THE SECURITIES THAT ARE THE
SUBJECT OF THIS WARRANT HAS NOT BEEN QUALIFIED WITH THE COMMISSIONER OF CORPORATIONS OF THE STATE OF CALIFORNIA AND THE
ISSUANCE OF SUCH SECURITIES OR THE PAYMENT OR RECEIPT OF ANY PART OF THE CONSIDERATION THEREFOR PRIOR TO SUCH QUALIFICATION
IS UNLAWFUL, UNLESS THE SALE OF SECURITIES IS EXEMPT FROM QUALIFICATION BY SECTION 25100, 25102, OR 25105 OF THE
CALIFORNIA CORPORATIONS CODE. THE RIGHTS OF ALL PARTIES TO THIS WARRANT ARE EXPRESSLY CONDITIONED UPON THE QUALIFICATION
BEING OBTAINED, UNLESS THE SALE IS SO EXEMPT.

 

(j)       
   Saturdays, Sundays and Holidays. If the last or appointed day for the taking of any action or
the expiration of any right required or granted herein shall be a Saturday, Sunday or U.S. federal holiday, then such action
may be taken or such right may be exercised on the next succeeding day that is not a Saturday, Sunday or U.S. federal
holiday.

 

(k)          Rights
and Obligations Survive Exercise of the Warrant. Except as otherwise provided herein, the rights and obligations of the
Company and the Holder under this Warrant shall survive exercise of this Warrant.

 

(l)          Entire
Agreement. Except as expressly set forth herein, this Warrant (including the exhibits attached hereto) constitutes the
entire agreement and understanding of the Company and the Holder with respect to the subject matter hereof and supersede all prior
agreements and understandings relating to the subject matter hereof.

 

(signature page follows)

 

    	- 12 -

    	 

    

 

The Company and the Holder sign
this Warrant No. 2013-__ as of the date stated on the first page.

 

	 	SEMLER SCIENTIFIC, INC.
	 	 
	 	By:	 
	 	 
	 	Name: 	Daniel E. Conger
	 	 
	 	Title:	VP, Finance
	 	 
	 	Address:
	 	2330 N.W. Everett St
	 	Portland, OR 97210

 

	AGREED AND ACKNOWLEDGED,	 
	 	 
	 	 

 

 

	By:	 	 
	 	 
	Name:	 	 
	 	 
	Title:	 	 

 

	Address:	 
	 	 
	 	 

	Fascimile number:	 	 
	Email address:	 	 

 

(Signature Page to Warrant
to Purchase Shares of Preferred Stock of Semler Scientific, Inc.)

 

    	 

    	 

    

 

EXHIBIT A

 

NOTICE OF EXERCISE

 

	TO:	SEMLER SCIENTIFIC, INC. (the “Company”)

 

	Attention:	President

 

		(1)	Exercise. The undersigned elects to purchase the following
pursuant to the terms of the attached warrant:

 

	Number of shares:	 
	 	 
	Type of security:	 

 

		(2)	Method of Exercise. The undersigned elects to exercise the attached warrant pursuant to:

 

	0	A cash payment, and tenders herewith payment of the purchase price for such shares in full, together with all applicable transfer taxes, if any.
	 	 
	0	The net issue exercise provisions of Section 2(b) of the attached warrant.

 

		(3)	Stock Certificate. Please issue a certificate or certificates representing the shares in
the name of:

 

	0	The undersigned	 	 
	 	 	 	 
	0	Other—Name:	 	 
	 	 	 	 
	 	 Address:	 	 
	 	 	 	 
	 	 	 	 

 

		(4)	Unexercised Portion of the Warrant. Please issue a new warrant for the unexercised portion
of the attached warrant in the name of:

 

	0	The undersigned	 	 
	 	 	 	 
	0	Other—Name:	 	 
	 	 	 	 
	 	 Address:	 	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	0	Not applicable	 	 

 

		(5)	Investment Intent. The undersigned represents and warrants that the aforesaid
shares are being acquired for investment for its own account, not as a nominee or agent, and not with a view to, or for resale
in connection with, the distribution thereof, and that the undersigned has no present intention of selling, granting any participation
in, or otherwise distributing the shares, nor does it have any contract, undertaking, agreement or arrangement for the same,
and all representations and warranties of the undersigned set forth in Section 11 of the attached warrant are true and correct
as of the date hereof.

 

    	A-1

    	 

    

  

		(6)	Investment Representation Statement and Market Stand-Off Agreement. The undersigned has
executed, and delivers herewith, an Investment Representation Statement and Market Stand-Off Agreement in a form substantially
similar to the form attached to the warrant as Exhibit A-1.

 

		(7)	Consent to Receipt of Electronic Notice. Subject to the limitations set forth in Delaware
General Corporation Law §232(e), the undersigned consents to the delivery of any notice to stockholders given by the Company
under the Delaware General Corporation Law or the Company’s certificate of incorporation or bylaws by (i) facsimile
telecommunication to the facsimile number provided below (or to any other facsimile number for the undersigned in the Company’s
records), (ii) electronic mail to the electronic mail address provided below (or to any other electronic mail address for
the undersigned in the Company’s records), (iii) posting on an electronic network together with separate notice to the
undersigned of such specific posting or (iv) any other form of electronic transmission (as defined in the Delaware General
Corporation Law) directed to the undersigned. This consent may be revoked by the undersigned by written notice to the Company and
may be deemed revoked in the circumstances specified in Delaware General Corporation Law §232.

 

	 	 
	 	(Print name of the warrant holder)
	 	 
	 	 
	 	(Signature)
	 	 
	 	 
	 	(Name and title of signatory, if applicable)
	 	 
	 	 
	 	(Date)
	 	 
	 	 
	 	(Fax number)
	 	 
	 	 
	 	(Email address)

 

(Signature
page to the Notice of Exercise)

 

    	A-2

    	 

    

 

EXHIBIT A-l

 

INVESTMENT REPRESENTATION STATEMENT 

AND 

MARKET STAND-OFF AGREEMENT

 

	INVESTOR:	 	 
	 	 
	COMPANY:	SEMLER SCIENTIFIC, INC.
	 	 
	SECURITIES:	THE WARRANT, NO. 2013-__, ISSUED ON [______], 2013 (THE “WARRANT”) AND THE SECURITIES ISSUED OR ISSUABLE UPON EXERCISE THEREOF
	 	 
	DATE:	 	 	 

 

In connection with the purchase
or acquisition of the above-listed Securities, the undersigned Investor represents and warrants to, and agrees with, the Company
as follows:

 

1.          No
Registration. The Investor understands that the Securities have not been, and will not be, registered under the Securities
Act of 1933, as amended (the “Securities Act”), by reason of a specific exemption from the registration
provisions of the Securities Act, the availability of which depends upon, among other things, the bona fide nature of the
investment intent and the accuracy of the Investor’s representations as expressed herein or otherwise made pursuant hereto.

 

2.          Investment
Intent. The Investor is acquiring the Securities for investment for its own account, not as a nominee or agent, and not with
a view to, or for resale in connection with, any distribution thereof. The Investor has no present intention of selling, granting
any participation in, or otherwise distributing the Securities, nor does it have any contract, undertaking, agreement or arrangement
for the same.

 

3.          Investment
Experience. The Investor has substantial experience in evaluating and investing in private placement transactions of securities
in companies similar to the Company, and has such knowledge and experience in financial or business matters so that it is capable
of evaluating the merits and risks of its investment in the Company and protecting its own interests.

 

4.          Speculative
Nature of Investment. The Investor understands and acknowledges that the Company has a limited financial and operating history
and that its investment in the Company is highly speculative and involves substantial risks. The Investor can bear the economic
risk of its investment and is able, without impairing its financial condition, to hold the Securities for an indefinite period
of time and to suffer a complete loss of its investment.

 

5.          Access
to Data. The Investor has had an opportunity to ask questions of officers of the Company, which questions were answered to
its satisfaction. The Investor believes that it has received all the information that it considers necessary or appropriate for
deciding whether to acquire the Securities. The Investor understands that any such discussions, as well as any information issued
by the Company, were intended to describe certain aspects of the Company’s business and prospects, but were not necessarily
a thorough or exhaustive description. The Investor acknowledges that any business plans prepared by the Company have been, and
continue to be, subject to change and that any projections included in such business 

 

    	A-1-1

    	 

    

 

plans or otherwise are
necessarily speculative in nature, and it can be expected that some or all of the assumptions underlying the projections will
not materialize or will vary significantly from actual results.

 

6.          Accredited
Investor. The Investor is an “accredited investor” within the meaning of Regulation D, Rule 501(a), promulgated
by the Securities and Exchange Commission and agrees to submit to the Company such further assurances of such status as may be
reasonably requested by the Company.

 

7.          Residency.
The residency of the Investor (or, in the case of a partnership or corporation, such entity’s principal place of business)
is correctly set forth on the signature page hereto.

 

8.          Restrictions
on Resales. The Investor acknowledges that the Securities must be held indefinitely unless subsequently registered under the
Securities Act or an exemption from such registration is available. The Investor is aware of the provisions of Rule 144 promulgated
under the Securities Act, which permit resale of shares purchased in a private placement subject to the satisfaction of certain
conditions, which may include, among other things, the availability of certain current public information about the Company; the
resale occurring not less than a specified period after a party has purchased and paid for the security to be sold; the number
of shares being sold during any three-month period not exceeding specified limitations; the sale being effected through a “broker’s
transaction,” a transaction directly with a “market maker” or a “riskless principal transaction”
(as those terms are defined in the Securities Act or the Securities Exchange Act of 1934, as amended, and the rules and regulations
promulgated thereunder); and the filing of a Form 144 notice, if applicable. The Investor acknowledges and understands that the
Company may not be satisfying the current public information requirement of Rule 144 at the time the Investor wishes to sell
the Securities and that, in such event, the Investor may be precluded from selling the Securities under Rule 144 even if the
other applicable requirements of Rule 144 have been satisfied. The Investor understands and acknowledges that, in the event
the applicable requirements of Rule 144 are not met, registration under the Securities Act or an exemption from registration
will be required for any disposition of the Securities. The Investor understands that, although Rule 144 is not exclusive,
the Securities and Exchange Commission has expressed its opinion that persons proposing to sell restricted securities received
in a private offering other than in a registered offering or pursuant to Rule 144 will have a substantial burden of proof
in establishing that an exemption from registration is available for those offers or sales and that those persons and the brokers
who participate in the transactions do so at their own risk.

 

9.          No
Public Market. The Holder understands and acknowledges that no public market now exists for any of the securities issued by
the Company and that the Company has made no assurances that a public market will ever exist for the Company’s securities.

 

10.         Brokers
and Finders. The Investor has not engaged any brokers, finders or agents in connection with the Securities, and the Company
has not incurred nor will incur, directly or indirectly, as a result of any action taken by the Investor, any liability for brokerage
or finders’ fees or agents’ commissions or any similar charges in connection with the Securities.

 

11.         Legal
Counsel. The Investor has had the opportunity to review the Warrant, the exhibits and schedules attached thereto and the transactions
contemplated by the Warrant with its own legal counsel. The Investor is not relying on any statements or representations of the
Company or its agents for legal advice with respect to this investment or the transactions contemplated by the Warrant.

 

12.         Tax
Advisors. The Investor has reviewed with its own tax advisors the U.S. federal, state and local and non-U.S. tax consequences
of this investment and the transactions contemplated by the Warrant. With respect to such matters, the Investor relies solely on
such advisors and not on any statements or representations of the Company or any of its agents, written or oral. The Investor understands
that it (and not

 

    	A-1-2

    	 

    

 

the Company) shall be responsible
for its own tax liability that may arise as a result of this investment or the transactions contemplated by the Warrant.

 

13.         Market
Stand-off. The Investor agrees that the Investor shall not sell or otherwise transfer, make any short sale of, grant any option
for the purchase of, or enter into any hedging or similar transaction with the same economic effect as a sale, of any common stock
(or other securities) of the Company held by the Investor (other than those included in the registration) during the one hundred
eighty (180) day period following the effective date of a registration statement of the Company filed under the Securities Act
(or such other period as may be requested by the Company or an underwriter to accommodate regulatory
restrictions on (i) the publication or other distribution of research reports and (ii) analyst recommendations and opinions,
including, but not limited to, the restrictions contained in NASD Rule 2711(f)(4) or NYSE Rule 472(f)(4), or any successor
provisions or amendments thereto), provided that all officers and directors of the Company and holders of at least
one percent (1%) of the Company’s voting securities are bound by and have entered into similar agreements. The obligations
described in this section shall not apply to a registration relating solely to employee benefit plans on Form S-l or Form S-8 or
similar forms that may be promulgated in the future, or a registration relating solely to a transaction on Form S-4 or similar
forms that may be promulgated in the future. The Company may impose stop-transfer instructions and may stamp each certificate with
a legend with respect to the shares of common stock (or other securities) subject to the foregoing restriction until the end of
such one hundred eighty (180) day (or other) period. The Investor agrees to execute a market stand-off agreement with the relevant
underwriters in customary form consistent with the provisions of this section.

 

(signature page follows)

 

    	A-1-3

    	 

    

  

The Investor is signing this Investment
Representation Statement and Market Stand-Off Agreement on the date first written above.

 

	 	INVESTOR
	 	 
	 	 
	 	 
	 	(Print name of the investor)
	 	 
	 	 
	 	(Signature)
	 	 
	 	 
	 	(Name and title of signatory, if applicable)
	 	 
	 	 
	 	(Street address)
	 	 
	 	 
	 	(City, state and ZIP)

 

    	A-1-4

    	 

    

 

EXHIBIT B

 

ASSIGNMENT FORM

 

	ASSIGNOR:	 
	 	 
	COMPANY:	SEMLER SCIENTIFIC, INC.
	 	 
	WARRANT:	THE WARRANT NO. 2013-__ TO PURCHASE SHARES OF SERIES [A][A-1[A-2] PREFERRED STOCK ISSUED ON [_____], 2013 (THE “WARRANT”)
	 	 
	DATE:	 	 

 

		(1)	Assignment. The undersigned registered holder of the Warrant (“Assignor”)
assigns and transfers to the assignee named below (“Assignee”) all of the rights of Assignor under the
Warrant, with respect to the number of shares set forth below:

 

	 	Name of Assignee:	 
	 	 	 
	 	Address of Assignee:	 
	 	 	 
	 	 	 

 

	 	Number of Shares Assigned:	 

 

and does irrevocably constitute
and appoint ______________________ as attorney to make such transfer on the books of Semler Scientific, Inc., maintained for the
purpose, with full power of substitution in the premises.

 

		(2)	Obligations of Assignee. Assignee agrees to take and hold the Warrant and any shares of
stock to be issued upon exercise of the rights thereunder (the “Securities”) subject to, and to be bound
by, the terms and conditions set forth in the Warrant to the same extent as if Assignee were the original holder thereof.

 

		(3)	Investment Intent. Assignee represents and warrants that the Securities are being acquired
for investment for its own account, not as a nominee or agent, and not with a view to, or for resale in connection with, the distribution
thereof, and that Assignee has no present intention of selling, granting any participation in, or otherwise distributing the shares,
nor does it have any contract, undertaking, agreement or arrangement for the same, and all representations and warranties set forth
in Section 11 of the Warrant are true and correct as to Assignee as of the date hereof.

 

		(4)	Investment Representation Statement and Market Stand-Off Agreement. Assignee has executed,
and delivers herewith, an Investment Representation Statement and Market Stand-Off Agreement in a form substantially similar to
the form attached to the Warrant as Exhibit A-1.

 

    	B-1

    	 

    

  

Assignor and Assignee are signing
this Assignment Form on the date first set forth above.

 

	ASSIGNOR	 	ASSIGNEE
	 	 	 
	 	 	 
	 	 	 
	(Print name of Assignor)	 	(Print name of Assignee)
	 	 	 
	 	 	 
	(Signature of Assignor)	 	(Signature of Assignee)
	 	 	 
	 	 	 
	(Print name of signatory, if applicable)	 	(Print name of signatory, if applicable)
	 	 	 
	 	 	 
	(Print title of signatory, if applicable)	 	(Print title of signatory, if applicable)
	 	 	 
	Address:	 	Address:
	 	 	 
	 	 	 
	 	 	 
	 	 	 

 

    	B-2Exhibit 10.2

 

 

Form of Representative’s Warrant Agreement

 

THE REGISTERED HOLDER OF
THIS PURCHASE WARRANT BY ITS ACCEPTANCE HEREOF, AGREES THAT IT WILL NOT SELL, TRANSFER OR ASSIGN THIS PURCHASE WARRANT EXCEPT AS
HEREIN PROVIDED AND THE REGISTERED HOLDER OF THIS PURCHASE WARRANT AGREES THAT IT WILL NOT SELL, TRANSFER, ASSIGN, PLEDGE OR HYPOTHECATE
THIS PURCHASE WARRANT FOR A PERIOD OF 180 DAYS FOLLOWING THE EFFECTIVE DATE OF THE REGISTRATION STATEMENT (DEFINED BELOW) TO ANYONE
OTHER THAN (I) AEGIS CAPITAL CORP. OR AN UNDERWRITER OR A SELECTED DEALER IN CONNECTION WITH THE OFFERING, OR (II) A BONA FIDE
OFFICER OR PARTNER OF AEGIS CAPITAL CORP. OR OF ANY SUCH UNDERWRITER OR SELECTED DEALER.

 

THIS PURCHASE WARRANT IS
NOT EXERCISABLE PRIOR TO [·], 20[14]. VOID AFTER 5:00 P.M., EASTERN TIME, [·],
20[18].

 

 

COMMON STOCK PURCHASE WARRANT

 

For the Purchase of [·]
Shares of Common Stock

 

of

 

SEMLER SCIENTIFIC, INC.

 

 

1.            Purchase
Warrant. THIS CERTIFIES THAT, in consideration of funds duly paid by or on behalf of [·]
(“Holder”), as registered owner of this Purchase Warrant, to Semler Scientific, Inc., a Delaware corporation
(the “Company”), Holder is entitled, at any time or from time to time from [·],
20[14] (the “Commencement Date”), and at or before 5:00 p.m., Eastern time, [·],
20[18] (the “Expiration Date”), but not thereafter, to subscribe for, purchase and receive, in whole
or in part, up to [·] shares of common stock of the Company [equal to 5% of the
Shares sold in the Offering], par value $0.001 per share (the “Shares”), subject to adjustment as provided in
Section 6 hereof. If the Expiration Date is a day on which banking institutions are authorized by law to close, then this
Purchase Warrant may be exercised on the next succeeding day which is not such a day in accordance with the terms herein. During
the period ending on the Expiration Date, the Company agrees not to take any action that would terminate the Purchase Warrant.
This Purchase Warrant is initially exercisable at $[·] per Share (125% of the price
of the Shares sold in the Offering); provided, however, that upon the occurrence of any of the events specified in
Section 6 hereof, the rights granted by this Purchase Warrant, including the exercise price per Share and the number of
Shares to be received upon such exercise, shall be adjusted as therein specified. The term “Exercise Price”
shall mean the initial exercise price or the adjusted exercise price, depending on the context.

 

2.            Exercise.

 

2.1          Exercise Form.
In order to exercise this Purchase Warrant, the exercise form attached hereto must be duly executed and completed and delivered
to the Company, together with this Purchase Warrant and payment of the Exercise Price for the Shares being purchased payable in
cash by wire transfer of immediately available funds to an account designated by the Company or by certified check or official
bank check. If the subscription rights represented hereby shall not be exercised at or before 5:00 p.m., Eastern time, on the Expiration
Date, this Purchase Warrant shall become and be void without further force or effect, and all rights represented hereby shall cease
and expire.

 

2.2          Cashless
Exercise.  If at any time after the Commencement Date there is no effective registration statement registering, or no
current prospectus available for, the resale of the Shares by the Holder, then in lieu of exercising this Purchase Warrant by payment
of cash or check payable to the order of the Company pursuant to Section 2.1 above, Holder may elect to receive the number
of Shares equal to the value of this Purchase Warrant (or the portion thereof being exercised), by surrender of this Purchase Warrant
to the Company, together with the

    	 

    	 

    

exercise form attached hereto, in which event
the Company shall issue to Holder, Shares in accordance with the following formula:

 

	X	=	Y(A-B)	
	A	
	Where,	X	=	The number of Shares to be issued to Holder;
		Y	=	The number of Shares for which the Purchase Warrant is being exercised;
		A	=	The fair market value of one Share; and
		B	=	The Exercise Price.

 

For
purposes of this Section 2.2, the fair market value of a Share is defined as follows:

 

(i)           
if the Company’s common stock is traded on a securities exchange, the value shall be deemed to be the closing price
on such exchange prior to the exercise form being submitted in connection with the exercise of the Purchase Warrant; or

 

(ii)         
if the Company’s common stock is actively traded over-the-counter, the value shall be deemed to be the closing bid
price prior to the exercise form being submitted in connection with the exercise of the Purchase Warrant; if there is no active
public market, the value shall be the fair market value thereof, as determined in good faith by the Company’s Board of Directors.

 

2.3          Legend.
Each certificate for the securities purchased under this Purchase Warrant shall bear a legend as follows unless such securities
have been registered under the Securities Act of 1933, as amended (the “Act”):

 

“The securities
represented by this certificate have not been registered under the Securities Act of 1933, as amended (the “Act”),
or applicable state law. Neither the securities nor any interest therein may be offered for sale, sold or otherwise transferred
except pursuant to an effective registration statement under the Act, or pursuant to an exemption from registration under the Act
and applicable state law which, in the opinion of counsel to the Company, is available.”

 

3.            Transfer.

 

3.1          General Restrictions.
The registered Holder of this Purchase Warrant agrees by his, her or its acceptance hereof, that such Holder will not: (a) sell,
transfer, assign, pledge or hypothecate this Purchase Warrant for a period of 180 days following the effective date of the registration
statement on form S-1 (Registration No. 333-[·]) of the Company (the “Registration
Statement”) to anyone other than: (i) Aegis Capital Corp. (“Aegis”) or an underwriter or a selected
dealer participating in the Offering, or (ii) a bona fide officer or partner of Aegis or of any such underwriter or selected dealer,
in each case in accordance with FINRA Conduct Rule 5110(g)(1), or (b) cause this Purchase Warrant or the securities issuable hereunder
to be the subject of any hedging, short sale, derivative, put or call transaction that would result in the effective economic disposition
of this Purchase Warrant or the securities hereunder, except as provided for in FINRA Rule 5110(g)(2). On and after that date that
is 180 days after the effective date of the Registration Statement, transfers to others may be made subject to compliance with
or exemptions from applicable securities laws. In order to make any permitted assignment, the Holder must deliver to the Company
the assignment form attached hereto duly executed and completed, together with the Purchase Warrant and payment of all transfer
taxes, if any, payable in connection therewith. The Company shall within five (5) Business Days transfer this Purchase Warrant
on the books of the Company and shall execute and deliver a new Purchase Warrant or Purchase Warrants of like tenor to the appropriate
assignee(s) expressly evidencing the right to purchase the aggregate number of Shares purchasable hereunder or such portion of
such number as shall be contemplated by any such assignment.

 

3.2         Restrictions
Imposed by the Act. The securities evidenced by this Purchase Warrant shall not be transferred unless and until: (i) the Company
has received the opinion of counsel for the Holder that the securities may be transferred pursuant to an exemption from registration
under the Act and applicable state securities laws, the availability of which is established to the reasonable satisfaction of
the Company, or (ii) a registration statement or a 

    	-2-

    	 

    

post-effective amendment to the Registration Statement relating to the offer
and sale of such securities has been filed by the Company and declared effective by the
U.S. Securities and Exchange Commission (the “Commission”) and compliance with applicable state securities
law has been established.

 

4.             Registration Rights.

 

4.1          Demand Registration.

 

4.1.1       Grant of Right.
The Company, upon written demand (a “Demand Notice”) of the Holder(s) of at least 51% of the Purchase Warrants
and/or the underlying Shares (“Majority Holders”), agrees to register, on one occasion, all or any portion of
the Shares underlying the Purchase Warrants (collectively, the “Registrable Securities”). On such occasion,
the Company will file a registration statement with the Commission covering the Registrable Securities within sixty (60) days after
receipt of a Demand Notice and use its reasonable best efforts to have the registration statement declared effective promptly thereafter,
subject to compliance with review by the Commission; provided, however, that the Company shall not be required to
comply with a Demand Notice if the Company has filed a registration statement with respect to which the Holder is entitled to piggyback
registration rights pursuant to Section 4.2 hereof and either: (i) the Holder has elected to participate in the offering
covered by such registration statement or (ii) if such registration statement relates to an underwritten primary offering of securities
of the Company, until the offering covered by such registration statement has been withdrawn or until thirty (30) days after such
offering is consummated. The demand for registration may be made at any time during a period of four (4) years beginning one year
after the effective date of the Registration Statement. The Company covenants and agrees to give written notice of its receipt
of any Demand Notice by any Holder(s) to all other registered Holders of the Purchase Warrants and/or the Registrable Securities
within ten (10) days after the date of the receipt of any such Demand Notice.

 

4.1.2      Terms. The
Company shall bear all fees and expenses attendant to the registration of the Registrable Securities pursuant to Section 4.1.1,
but the Holders shall pay any and all underwriting commissions and the expenses of any legal counsel selected by the Holders to
represent them in connection with the sale of the Registrable Securities. The Company agrees to use its reasonable best efforts
to cause the filing required herein to become effective promptly and to qualify or register the Registrable Securities in such
States as are reasonably requested by the Holder(s); provided, however, that in no event shall the Company be required
to register the Registrable Securities in a State in which such registration would cause: (i) the Company to be obligated to register
or license to do business in such State or submit to general service of process in such State, or (ii) the principal shareholders
of the Company to be obligated to escrow their shares of capital stock of the Company. The Company shall cause any registration
statement filed pursuant to the demand right granted under Section 4.1.1 to remain effective for a period of at least twelve
(12) consecutive months after the date that the Holders of the Registrable Securities covered by such registration statement are
first given the opportunity to sell all of such securities. The Holders shall only use the prospectuses provided by the Company
to sell the shares covered by such registration statement, and will immediately cease to use any prospectus furnished by the Company
if the Company advises the Holder that such prospectus may no longer be used due to a material misstatement or omission. Notwithstanding
the provisions of this Section 4.1.2, the Holder shall be entitled to a demand registration under this Section 4.1.2
on only one (1) occasion and such demand registration right shall terminate on the fifth anniversary of the effective date of the
Registration Statement in accordance with FINRA Rule 5110(f)(2)(H)(iv).

 

4.2          “Piggy-Back”
Registration.

 

4.2.1      Grant of Right.
In addition to the demand right of registration described in Section 4.1 hereof, the Holder shall have the right, for a
period of six (6) years commencing one year after the effective date of the Registration Statement, to include the Registrable
Securities as part of any other registration of securities filed by the Company (other than in connection with a transaction contemplated
by Rule 145 promulgated under the Act or pursuant to Form S-8 or any equivalent form); provided, however, that if,
solely in connection with any primary underwritten public offering for the account of the Company, the managing underwriter(s)
thereof shall, in its reasonable discretion, impose a limitation on the number of shares of Common Stock which may be included
in the Registration Statement because, in such underwriter(s)’ judgment, marketing or other factors dictate such limitation
is necessary to facilitate public distribution, then the Company shall be obligated to include in such Registration Statement only
such limited portion of the Registrable Securities with respect to which the Holder requested

    	-3-

    	 

    

inclusion hereunder as the underwriter
shall reasonably permit. Any exclusion of Registrable Securities shall be made pro rata among the Holders seeking to
include Registrable Securities in proportion to the number of Registrable Securities sought to be included by such Holders; provided,
however, that the Company shall not exclude any Registrable Securities unless the Company has first excluded all outstanding
securities, the holders of which are not entitled to inclusion of such securities in such Registration Statement or are not entitled
to pro rata inclusion with the Registrable Securities.

 

4.2.2      Terms. The
Company shall bear all fees and expenses attendant to registering the Registrable Securities pursuant to Section 4.2.1 hereof,
but the Holders shall pay any and all underwriting commissions and the expenses of any legal counsel selected by the Holders to
represent them in connection with the sale of the Registrable Securities. In the event of such a proposed registration, the Company
shall furnish the then Holders of outstanding Registrable Securities with not less than thirty (30) days written notice prior to
the proposed date of filing of such registration statement. Such notice to the Holders shall continue to be given for each registration
statement filed by the Company until such time as all of the Registrable Securities have been sold by the Holder. The holders of
the Registrable Securities shall exercise the “piggy-back” rights provided for herein by giving written notice, within
ten (10) days of the receipt of the Company’s notice of its intention to file a registration statement. Except as otherwise
provided in this Purchase Warrant, there shall be no limit on the number of times the Holder may request registration under this
Section 4.2.2; provided, however, that such registration rights shall terminate on the seventh anniversary of the effective
date of the Registration Statement.

 

4.3          General Terms.

 

4.3.1        Indemnification.
The Company shall indemnify the Holder(s) of the Registrable Securities to be sold pursuant to any registration statement hereunder
and each person, if any, who controls such Holders within the meaning of Section 15 of the Act or Section 20(a) of the Securities
Exchange Act of 1934, as amended (“Exchange Act”), against all loss, claim, damage, expense or liability (including
all reasonable attorneys’ fees and other expenses reasonably incurred in investigating, preparing or defending against any
claim whatsoever) to which any of them may become subject under the Act, the Exchange Act or otherwise, arising from such registration
statement but only to the same extent and with the same effect as the provisions pursuant to which the Company has agreed to indemnify
the Underwriters contained in Section 7(a) of the Underwriting Agreement between the Underwriters and the Company, dated as of
[·], 2013. The Holder(s) of the Registrable Securities to be sold pursuant to such
registration statement, and their successors and assigns, shall severally, and not jointly, indemnify the Company, against all
loss, claim, damage, expense or liability (including all reasonable attorneys’ fees and other expenses reasonably incurred
in investigating, preparing or defending against any claim whatsoever) to which they may become subject under the Act, the Exchange
Act or otherwise, arising from information furnished by or on behalf of such Holders, or their successors or assigns, in writing,
for specific inclusion in such registration statement to the same extent and with the same effect as the provisions contained in
Section [·] of the Underwriting Agreement pursuant to which the Underwriters have
agreed to indemnify the Company.

 

4.3.2       Exercise of
Purchase Warrants. Nothing contained in this Purchase Warrant shall be construed as requiring the Holder(s) to exercise their
Purchase Warrants prior to or after the initial filing of any registration statement or the effectiveness thereof.

 

4.3.3       Documents Delivered
to Holders. The Company shall furnish to each Holder participating in any of the foregoing offerings and to each underwriter
of any such offering, if any, a signed counterpart, addressed to such Holder or underwriter, of: (i) an opinion of counsel to the
Company, dated the effective date of such registration statement (and, if such registration includes an underwritten public offering,
an opinion dated the date of the closing under any underwriting agreement related thereto), and (ii) a “cold comfort”
letter dated the effective date of such registration statement (and, if such registration includes an underwritten public offering,
a letter dated the date of the closing under the underwriting agreement) signed by the independent registered public accounting
firm which has issued a report on the Company’s financial statements included in such registration statement, in each case
covering substantially the same matters with respect to such registration statement (and the prospectus included therein) and,
in the case of such accountants’ letter, with respect to events subsequent to the date of such financial statements, as are
customarily covered in opinions of issuer’s counsel and in accountants’ letters delivered to underwriters in underwritten
public offerings of securities. The Company shall also deliver promptly to each Holder participating in the offering requesting
the correspondence and memoranda

    	-4-

    	 

    

described below and to the managing underwriter, if any, copies of all correspondence between
the Commission and the Company, its counsel or auditors and all
memoranda relating to discussions with the Commission or its staff with respect to the registration statement and permit each Holder
and underwriter to do such investigation, upon reasonable advance notice, with respect to information contained in or omitted from
the registration statement as it deems reasonably necessary to comply with applicable securities laws or rules of FINRA. Such investigation
shall include access to books, records and properties and opportunities to discuss the business of the Company with its officers
and independent auditors, all to such reasonable extent and at such reasonable times as any such Holder shall reasonably request.

 

4.3.4      Underwriting
Agreement. The Company shall enter into an underwriting agreement with the managing underwriter(s), if any, selected by any
Holders whose Registrable Securities are being registered pursuant to this Section 4, which managing underwriter shall be
reasonably satisfactory to the Company. Such agreement shall be reasonably satisfactory in form and substance to the Company, each
Holder and such managing underwriters, and shall contain such representations, warranties and covenants by the Company and such
other terms as are customarily contained in agreements of that type used by the managing underwriter. The Holders shall be parties
to any underwriting agreement relating to an underwritten sale of their Registrable Securities and may, at their option, require
that any or all the representations, warranties and covenants of the Company to or for the benefit of such underwriters shall also
be made to and for the benefit of such Holders. Such Holders shall not be required to make any representations or warranties to
or agreements with the Company or the underwriters except as they may relate to such Holders, their Shares and their intended methods
of distribution.

 

4.3.5      Documents to
be Delivered by Holder(s). Each of the Holder(s) participating in any of the foregoing offerings shall furnish to the Company
a completed and executed questionnaire provided by the Company requesting information customarily sought of selling security holders.

 

4.3.6      Damages.
Should the registration or the effectiveness thereof required by Section 4.1 and Section 4.2 hereof be delayed by
the Company or the Company otherwise fails to comply with such provisions, the Holder(s) shall, in addition to any other legal
or other relief available to the Holder(s), be entitled to obtain specific performance or other equitable (including injunctive)
relief against the threatened breach of such provisions or the continuation of any such breach, without the necessity of proving
actual damages and without the necessity of posting bond or other security.

 

5.            New Purchase Warrants to be Issued.

 

5.1          Partial Exercise
or Transfer. Subject to the restrictions in Section 3 hereof, this Purchase Warrant may be exercised or assigned in
whole or in part. In the event of the exercise or assignment hereof in part only, upon surrender of this Purchase Warrant for cancellation,
together with the duly executed exercise or assignment form and funds sufficient to pay any Exercise Price and/or transfer tax
if exercised pursuant to Section 2.1 hereof, the Company shall cause to be delivered to the Holder without charge a new
Purchase Warrant of like tenor to this Purchase Warrant in the name of the Holder evidencing the right of the Holder to purchase
the number of Shares purchasable hereunder as to which this Purchase Warrant has not been exercised or assigned.

 

5.2          Lost Certificate.
Upon receipt by the Company of evidence satisfactory to it of the loss, theft, destruction or mutilation of this Purchase Warrant
and of reasonably satisfactory indemnification or the posting of a bond, the Company shall execute and deliver a new Purchase Warrant
of like tenor and date. Any such new Purchase Warrant executed and delivered as a result of such loss, theft, mutilation or destruction
shall constitute a substitute contractual obligation on the part of the Company.

 

6.            Adjustments.

 

6.1          Adjustments to
Exercise Price and Number of Securities. The Exercise Price and the number of Shares underlying the Purchase Warrant shall
be subject to adjustment from time to time as hereinafter set forth:

 

6.1.1       Share Dividends;
Split Ups. If, after the date hereof, and subject to the provisions of Section 6.3 below, the number of outstanding
Shares is increased by a stock dividend payable in Shares or by a split up of Shares or other similar event, then, on the effective
day thereof, the number of Shares purchasable hereunder

    	-5-

    	 

    

shall be increased in proportion to such increase in outstanding shares,
and the Exercise Price shall be proportionately decreased.

 

6.1.2      Aggregation
of Shares. If, after the date hereof, and subject to the provisions of Section 6.3 below, the number of outstanding
Shares is decreased by a consolidation, combination or reclassification of Shares or other similar event, then, on the effective
date thereof, the number of Shares purchasable hereunder shall be decreased in proportion to such decrease in outstanding shares,
and the Exercise Price shall be proportionately increased.

 

6.1.3      Replacement
of Securities upon Reorganization, etc. In case of any reclassification or reorganization of the outstanding Shares other than
a change covered by Section 6.1.1 or Section 6.1.2 hereof or that solely affects the par value of such Shares, or
in the case of any share reconstruction or amalgamation or consolidation of the Company with or into another corporation (other
than a consolidation or share reconstruction or amalgamation in which the Company is the continuing corporation and that does not
result in any reclassification or reorganization of the outstanding Shares), or in the case of any sale or conveyance to another
corporation or entity of the property of the Company as an entirety or substantially as an entirety in connection with which the
Company is dissolved, the Holder of this Purchase Warrant shall have the right thereafter (until the expiration of the right of
exercise of this Purchase Warrant) to receive upon the exercise hereof, for the same aggregate Exercise Price payable hereunder
immediately prior to such event, the kind and amount of shares of stock or other securities or property (including cash) receivable
upon such reclassification, reorganization, share reconstruction or amalgamation, or consolidation, or upon a dissolution following
any such sale or transfer, by a Holder of the number of Shares of the Company obtainable upon exercise of this Purchase Warrant
immediately prior to such event; and if any reclassification also results in a change in Shares covered by Section 6.1.1
or Section 6.1.2, then such adjustment shall be made pursuant to Section 6.1.1, Section 6.1.2 and this Section
6.1.3. The provisions of this Section 6.1.3 shall similarly apply to successive reclassifications, reorganizations,
share reconstructions or amalgamations, or consolidations, sales or other transfers.

 

6.1.4      Changes in Form
of Purchase Warrant. This form of Purchase Warrant need not be changed because of any change pursuant to this Section 6.1,
and Purchase Warrants issued after such change may state the same Exercise Price and the same number of Shares as are stated in
the Purchase Warrants initially issued pursuant to this Agreement. The acceptance by any Holder of the issuance of new Purchase
Warrants reflecting a required or permissive change shall not be deemed to waive any rights to an adjustment occurring after the
Commencement Date or the computation thereof.

 

6.2         Substitute Purchase
Warrant. In case of any consolidation of the Company with, or share reconstruction or amalgamation of the Company with or into,
another corporation (other than a consolidation or share reconstruction or amalgamation which does not result in any reclassification
or change of the outstanding Shares), the corporation formed by such consolidation or share reconstruction or amalgamation shall
execute and deliver to the Holder a supplemental Purchase Warrant providing that the holder of each Purchase Warrant then outstanding
or to be outstanding shall have the right thereafter (until the stated expiration of such Purchase Warrant) to receive, upon exercise
of such Purchase Warrant, the kind and amount of shares of stock and other securities and property receivable upon such consolidation
or share reconstruction or amalgamation, by a holder of the number of Shares of the Company for which such Purchase Warrant might
have been exercised immediately prior to such consolidation, share reconstruction or amalgamation, sale or transfer. Such supplemental
Purchase Warrant shall provide for adjustments which shall be identical to the adjustments provided for in this Section 6.
The above provision of this Section 6 shall similarly apply to successive consolidations or share reconstructions or amalgamations.

 

6.3          Elimination
of Fractional Interests. The Company shall not be required to issue certificates representing fractions of Shares upon the
exercise of the Purchase Warrant, nor shall it be required to issue scrip or pay cash in lieu of any fractional interests, it being
the intent of the parties that all fractional interests shall be eliminated by rounding any fraction up or down, as the case may
be, to the nearest whole number of Shares or other securities, properties or rights.

 

7.            Reservation and Listing. The
Company shall at all times reserve and keep available out of its authorized Shares, solely for the purpose of issuance upon exercise
of the Purchase Warrants, such number of Shares or other

    	-6-

    	 

    

securities, properties or rights as shall be issuable upon the exercise
thereof. The Company covenants and agrees that, upon exercise of the Purchase Warrants
and payment of the Exercise Price therefor, in accordance with the terms hereby, all Shares and other securities issuable upon
such exercise shall be duly and validly issued, fully paid and non-assessable and not subject to preemptive rights of any shareholder.
The Company further covenants and agrees that upon exercise of the Purchase Warrants and payment of the exercise price therefor,
all Shares and other securities issuable upon such exercise shall be duly and validly issued, fully paid and non-assessable and
not subject to preemptive rights of any shareholder. As long as the Purchase Warrants shall be outstanding, the Company shall use
its commercially reasonable efforts to cause all Shares issuable upon exercise of the Purchase Warrants to be listed (subject to
official notice of issuance) on all national securities exchanges (or, if applicable, on the OTC Bulletin Board or any successor
trading market) on which the Shares issued to the public in the Offering may then be listed and/or quoted.

 

8.            Certain Notice Requirements.

 

8.1          Holder’s
Right to Receive Notice. Nothing herein shall be construed as conferring upon the Holders the right to vote or consent or to
receive notice as a shareholder for the election of directors or any other matter, or as having any rights whatsoever as a shareholder
of the Company. If, however, at any time prior to the expiration of the Purchase Warrants and their exercise, any of the events
described in Section 8.2 shall occur, then, in one or more of said events, the Company shall give written notice of such
event at least fifteen days prior to the date fixed as a record date or the date of closing the transfer books (the “Notice
Date”) for the determination of the shareholders entitled to such dividend, distribution, conversion or exchange of securities
or subscription rights, or entitled to vote on such proposed dissolution, liquidation, winding up or sale. Such notice shall specify
such record date or the date of the closing of the transfer books, as the case may be. Notwithstanding the foregoing, the Company
shall deliver to each Holder a copy of each notice given to the other shareholders of the Company at the same time and in the same
manner that such notice is given to the shareholders.

 

8.2          Events Requiring
Notice. The Company shall be required to give the notice described in this Section 8 upon one or more of the following
events: (i) if the Company shall take a record of the holders of its Shares for the purpose of entitling them to receive a dividend
or distribution payable otherwise than in cash, or a cash dividend or distribution payable otherwise than out of retained earnings,
as indicated by the accounting treatment of such dividend or distribution on the books of the Company, (ii) the Company shall offer
to all the holders of its Shares any additional shares of capital stock of the Company or securities convertible into or exchangeable
for shares of capital stock of the Company, or any option, right or warrant to subscribe therefor, or (iii) a dissolution, liquidation
or winding up of the Company (other than in connection with a consolidation or share reconstruction or amalgamation) or a sale
of all or substantially all of its property, assets and business shall be proposed.

 

8.3          Notice of Change
in Exercise Price. The Company shall, promptly after an event requiring a change in the Exercise Price pursuant to Section
6 hereof, send notice to the Holders of such event and change (“Price Notice”). The Price Notice shall describe
the event causing the change and the method of calculating same and shall be certified as being true and accurate by the Company’s
Chief Financial Officer.

 

8.4          Transmittal
of Notices. All notices, requests, consents and other communications under this Purchase Warrant shall be in writing and shall
be deemed to have been duly made (1) when hand delivered, (2) when mailed by express mail or private courier service or (3) when
the event requiring notice is disclosed in all material respects and filed in a current report on Form 8-K or in a definitive proxy
statement on Schedule 14A prior to the Notice Date: (i) if to the registered Holder of the Purchase Warrant, to the address of
such Holder as shown on the books of the Company, or (ii) if to the Company, to following address or to such other address as the
Company may designate by notice to the Holders:

 

    	-7-

    	 

    

If to the Holder:

 

Aegis Capital Corp.

810 Seventh Avenue, 11th Floor

New York, New York 10019

Attn: Mr. David Bocchi, Managing Director of

Investment Banking

Fax No.: (212) 813-1047

 

With a copy (which shall not constitute
notice) to:

 

Blank Rome LLP

405 Lexington Avenue

New York, NY 10174

Attn: Brad Shiffman, Esq.

Fax: (917) 332-3725

 

If to the Company:

 

Semler Scientific, Inc.

2330 NW Everett St.

Portland, OR 97210

Attention: Douglas Murphy-Chutorian,
M.D., Chief Executive Officer

Fax No: [·]

 

with a copy (which shall not constitute
notice) to:

 

Reed Smith LLP

599 Lexington Avenue

New York, New York 10174

Attention: Yvan Claude-Pierre, Esq.

Fax No: (212) 521-5450

 

9.            Miscellaneous.

 

9.1          Amendments.
The Company and Aegis may from time to time supplement or amend this Purchase Warrant without the approval of any of the Holders
in order to cure any ambiguity, to correct or supplement any provision contained herein that may be defective or inconsistent with
any other provisions herein, or to make any other provisions in regard to matters or questions arising hereunder that the Company
and Aegis may deem necessary or desirable and that the Company and Aegis deem shall not adversely affect the interest of the Holders.
All other modifications or amendments shall require the written consent of and be signed by the party against whom enforcement
of the modification or amendment is sought.

 

9.2          Headings.
The headings contained herein are for the sole purpose of convenience of reference, and shall not in any way limit or affect the
meaning or interpretation of any of the terms or provisions of this Purchase Warrant.

 

9.3.         Entire Agreement.
This Purchase Warrant (together with the other agreements and documents being delivered pursuant to or in connection with this
Purchase Warrant) constitutes the entire agreement of the parties hereto with respect to the subject matter hereof, and supersedes
all prior agreements and understandings of the parties, oral and written, with respect to the subject matter hereof.

 

9.4         Binding Effect.
This Purchase Warrant shall inure solely to the benefit of and shall be binding upon, the Holder and the Company and their permitted
assignees, respective successors, legal representative and assigns, and no other person shall have or be construed to have any
legal or equitable right, remedy or claim under or in respect of or by virtue of this Purchase Warrant or any provisions herein
contained.

    	-8-

    	 

    

 

9.5          Governing Law;
Submission to Jurisdiction. This Purchase Warrant shall be governed by and construed and enforced in accordance with the laws
of the State of Delaware, without giving effect to conflict of laws principles thereof. The Company hereby agrees that any action,
proceeding or claim against it arising out of, or relating in any way to this Purchase Warrant shall be brought and enforced in
the New York Supreme Court, County of New York, or in the United States District Court for the Southern District of New York, and
irrevocably submits to such jurisdiction, which jurisdiction shall be exclusive. The Company hereby waives any objection to such
exclusive jurisdiction and that such courts represent an inconvenient forum. Any process or summons to be served upon the Company
may be served by transmitting a copy thereof by registered or certified mail, return receipt requested, postage prepaid, addressed
to it at the address set forth in Section 8 hereof. Such mailing shall be deemed personal service and shall be legal and
binding upon the Company in any action, proceeding or claim. The Company and the Holder agree that the prevailing party(ies) in
any such action shall be entitled to recover from the other party(ies) all of its reasonable attorneys’ fees and expenses
relating to such action or proceeding and/or incurred in connection with the preparation therefor. The Company (on its behalf and,
to the extent permitted by applicable law, on behalf of its stockholders and affiliates) and the Holder hereby irrevocably waive,
to the fullest extent permitted by applicable law, any and all right to trial by jury in any legal proceeding arising out of or
relating to this agreement or the transactions contemplated hereby.

 

9.6          Waiver, etc.
The failure of the Company or the Holder to at any time enforce any of the provisions of this Purchase Warrant shall not be deemed
or construed to be a waiver of any such provision, nor to in any way affect the validity of this Purchase Warrant or any provision
hereof or the right of the Company or any Holder to thereafter enforce each and every provision of this Purchase Warrant. No waiver
of any breach, non-compliance or non-fulfillment of any of the provisions of this Purchase Warrant shall be effective unless set
forth in a written instrument executed by the party or parties against whom or which enforcement of such waiver is sought; and
no waiver of any such breach, non-compliance or non-fulfillment shall be construed or deemed to be a waiver of any other or subsequent
breach, non-compliance or non-fulfillment.

 

9.7          Execution in
Counterparts. This Purchase Warrant may be executed in one or more counterparts, and by the different parties hereto in separate
counterparts, each of which shall be deemed to be an original, but all of which taken together shall constitute one and the same
agreement, and shall become effective when one or more counterparts has been signed by each of the parties hereto and delivered
to each of the other parties hereto. Such counterparts may be delivered by facsimile transmission or other electronic transmission.

 

9.8          Exchange Agreement.
As a condition of the Holder’s receipt and acceptance of this Purchase Warrant, Holder agrees that, at any time prior to
the complete exercise of this Purchase Warrant by Holder, if the Company and Aegis enter into an agreement (“Exchange
Agreement”) pursuant to which they agree that all outstanding Purchase Warrants will be exchanged for securities or cash
or a combination of both, then Holder shall agree to such exchange and become a party to the Exchange Agreement.

 

 

[Remainder of page intentionally
left blank.]

 

 

 

 

 

 

 

    	-9-

    	 

    

IN WITNESS WHEREOF,
the Company has caused this Purchase Warrant to be signed by its duly authorized officer as of the ____ day of _______, 20[13].

 

 

SEMLER SCIENTIFIC, INC.

 

 

By:_________________________________

Name:

Title:

 

 

 

    	-10-

    	 

    

 

Form to be used to exercise
Purchase Warrant:

 

 

 

Date: __________, 20___

 

 

 

The undersigned hereby
elects irrevocably to exercise the Purchase Warrant for ______ Shares of Semler Scientific, Inc., a Delaware corporation (the “Company”)
and hereby makes payment of $____ (at the rate of $____ per Share) in payment of the Exercise Price pursuant thereto. Please issue
the Shares as to which this Purchase Warrant is exercised in accordance with the instructions given below and, if applicable, a
new Purchase Warrant representing the number of Shares for which this Purchase Warrant has not been exercised.

 

or

 

The undersigned hereby
elects irrevocably to convert its right to purchase ___ Shares under the Purchase Warrant for ______ Shares, as determined in accordance
with the following formula:

 

	X	=	Y(A-B)	
				A	
	Where,	X	=	The number of Shares to be issued to Holder;
		Y	=	The number of Shares for which the Purchase Warrant is being exercised;
		A	=	The fair market value of one Share which is equal to $_____; and
		B	=	The Exercise Price which is equal to $______ per share

 

The undersigned agrees
and acknowledges that the calculation set forth above is subject to confirmation by the Company and any disagreement with respect
to the calculation shall be resolved by the Company in its sole discretion.

 

Please issue the Shares
as to which this Purchase Warrant is exercised in accordance with the instructions given below and, if applicable, a new Purchase
Warrant representing the number of Shares for which this Purchase Warrant has not been converted.

 

Signature

 

 

 

Signature Guaranteed

    	-11-

    	 

    

INSTRUCTIONS FOR REGISTRATION
OF SECURITIES

 

Name:

(Print in Block Letters)

Address:

 

 

 

 

 

 

 

 

NOTICE: The signature to
this form must correspond with the name as written upon the face of the Purchase Warrant without alteration or enlargement or any
change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership
on a registered national securities exchange.

    	-12-

    	 

    

Form to be used to assign Purchase Warrant:

ASSIGNMENT

 

(To be executed by the registered Holder to
effect a transfer of the within Purchase Warrant):

 

 

 

FOR VALUE RECEIVED, __________________ does
hereby sell, assign and transfer unto the right to purchase shares of Semler Scientific, Inc., a Delaware corporation (the “Company”),
evidenced by the Purchase Warrant and does hereby authorize the Company to transfer such right on the books of the Company.

 

 

 

Dated: __________, 20__

 

 

 

 

Signature

 

 

 

 

Signature Guaranteed

 

 

 

 

NOTICE: The signature to
this form must correspond with the name as written upon the face of the within Purchase Warrant without alteration or enlargement
or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having
membership on a registered national securities exchange.

 

    	-13-

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