Document:

Form of Convertible Promissory Note, dated Jan. 9, 2004

 Execution Version 
  
 EXHIBIT 10-j 
  
 EXHIBIT B 
  
 THIS CONVERTIBLE PROMISSORY NOTE AND ANY SECURITIES INTO WHICH THIS CONVERTIBLE PROMISSORY NOTE IS CONVERTIBLE HAVE BEEN ACQUIRED FOR INVESTMENT AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED, OR QUALIFIED UNDER ANY STATE SECURITIES LAWS. SUCH SECURITIES MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR QUALIFICATION OR AN EXEMPTION THEREFROM UNDER SAID ACT AND ANY APPLICABLE STATE SECURITIES LAWS.

  
 THIS CONVERTIBLE PROMISSORY NOTE AND ANY SECURITIES INTO WHICH
THIS CONVERTIBLE PROMISSORY NOTE IS CONVERTIBLE ARE SUBJECT TO RESTRICTIONS ON TRANSFER CONTAINED IN THAT CERTAIN NOTE AND WARRANT PURCHASE AGREEMENT, DATED JANUARY 14, 2004, WHICH RESTRICTIONS ON TRANSFER ARE INCORPORATED HEREIN BY REFERENCE.

  
 CONVERTIBLE PROMISSORY NOTE 
  

			
	 US$                    
	  	                    
    , 2004
	 	  	Portland, Oregon

  
 FOR VALUE
RECEIVED, OXIS International, Inc., a Delaware corporation (the “Company”), promises to pay to the order of
                                       
     , or its permitted assigns (“Holder”), the principal sum of
                                 United States dollars
(US$                    ) with interest on the outstanding principal amount at the rate of seven percent (7%) per annum (computed on the basis
of actual calendar days elapsed and a year of 365 days) or, if less, at the highest rate of interest then permitted under applicable law. Interest shall commence with the date hereof and shall continue on the outstanding principal until paid or
converted in accordance with the provisions hereof. In the event that any interest is paid on this Convertible Promissory Note (this “Note”) which is deemed to be in excess of the then legal maximum rate, then that portion of the interest
payment representing an amount in excess of the then legal maximum rate shall be deemed a payment of principal and applied against the principal of this Note. 
  

1. Definitions. For purposes of this Note, the following terms shall have the following meanings: 

 “Conversion Price” shall mean (i) US$0.40 per share of the Common Stock of the Company,
or (ii) after an Event of Default has occurred, US$0.15 per share of the Common Stock of the Company (each as adjusted for any stock splits, stock dividends, combinations, recapitalizations or the like). 
  
 “Control” shall mean the possession, directly or indirectly,
of the power to direct or cause the direction of the management or policies of a person, whether through the ownership of voting securities, by contract or otherwise, and the terms “Controlling” and “Controlled” (and the
lower-case versions of the same) shall have meanings correlative thereto. 
  
 “Qualified Financing” shall mean the closing of a private offering by the Company of shares of its equity stock to investors in one or more transactions for aggregate cash proceeds to the Company of
not less than two million dollars (US$2,000,000). 
  
 2. Note
and Warrant Purchase Agreement. This Note is issued pursuant to the terms of that certain Note and Warrant Purchase Agreement (the “Agreement”) dated as of January 14, 2004, by and among the Company and the investors set forth in the
Schedule of Investors attached thereto as Exhibit A. This Note is one of a series of notes (the “Notes”) having like tenor and effect (except for variations necessary to express the name of the holder, the principal amount of each
of the Notes and the date on which each Note is issued) issued or to be issued by the Company in accordance with the terms of the Agreement. The Notes shall rank equally without preference or priority of any kind over one another, and all payments
on account of principal and interest with respect to any of the Notes shall be applied ratably and proportionately on the outstanding Notes on the basis of the principal amount of the outstanding indebtedness represented thereby. 
  
 3. Maturity. Unless sooner paid or converted in accordance with the
terms hereof, the entire unpaid principal amount and all unpaid accrued interest shall become fully due and payable on the earlier of (i) the one (1) year anniversary of the date hereof, (ii) the acceleration of the maturity of this Note by the
Holder upon the occurrence of an Event of Default or (iii) in the event that the Company, at any time after the date of issuance of this Note, shall effect a Qualified Financing, then, upon twenty (20) calendar days’ written notice from Holder
to the Company (such earlier date, the “Maturity Date”). 
  
 4. Payments. 
  
 (a) Form of Payment. All
payments of interest and principal (other than payment by way of conversion) shall be in lawful money of the United States of America to Holder, at the address specified in the Agreement, or at such other address as may be specified from time to
time by Holder in a written notice delivered to the Company. All payments shall be applied first to accrued interest, and thereafter to principal. 
  
 (b) Prepayment. The Company may prepay any amounts owing under this Note in whole or in part, without the consent of the Holder, provided that (i)
any such prepayment must be preceded by at least twenty (20) calendar days’ prior written notice from the Company to Holder, (ii) the fair market value of a share of the Common Stock equals or exceeds 
  

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 two hundred percent (200%) of the Conversion Price as determined on the date of the written notice and (iii) any such
prepayment must be accompanied by the accrued and unpaid interest on the principal being prepaid through the date of prepayment. For purposes of the above calculation, the fair market value of one (1) share of the Common Stock shall mean (a) if the
Common Stock is then traded on a securities exchange, the average of the closing prices of such Common Stock on such exchange over the ten (10) trading day period (or portion thereof) ending the day prior to the date of the prepayment notice or (b)
if the Common Stock is then regularly traded over-the-counter, the average of the closing bid price of such Common Stock over the ten (10) trading day period (or portion thereof) ending the day prior to the date of the prepayment notice. Holder may
elect at any time prior to the expiration of the twenty (20) day prepayment notice period to exercise its conversion rights under Section 7(a)(ii) or 7(b)(ii) in respect of this Note. 
  
 5. Conversion or Repayment Upon Maturity. In the event that any indebtedness under this Note remains outstanding on
the Maturity Date, then all outstanding principal and unpaid accrued interest under this Note shall either (a) become immediately due and payable on such date, or (b) at the option of Holder, convert on such date into shares of Common Stock at the
Conversion Price. 
  
 6. Conversion or Repayment Upon
Acquisition. In the event that the Company sells, conveys or otherwise disposes of all or substantially all of its assets or is acquired by way of a merger, consolidation, reorganization or other transaction or series of transactions pursuant to
which stockholders of the Company prior to such transaction own less than fifty percent (50%) of the voting interests in the surviving or resulting entity (an “Acquisition”), then all outstanding principal and unpaid accrued interest under
this Note shall either (a) become immediately due and payable upon the closing of the Acquisition, or (b) at the option of Holder, immediately prior to the closing of the Acquisition, convert into shares of Common Stock of the Company at the
Conversion Price. 
  
 7. Conversion Upon Notice.

  
 (a) Individual Holder Conversion. 
  
 (i) Holder shall have the right to convert all or any portion of the
outstanding principal and unpaid accrued interest owing under this Note into shares of Common Stock at the Conversion Price upon surrender to the Company of this Note at the principal office of the Company accompanied by a written conversion request
notice at least twenty (20) days prior to the date of requested conversion. 
  
 (ii) During the twenty (20) day prepayment notice period described in Section 4, Holder shall have the right to convert all or any portion of the indebtedness owing under this Note into shares of Common Stock at the
Conversion Price upon surrender to the Company of this Note at the principal office of the Company accompanied by a written conversion request notice. 
  

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 (b) Effectiveness of Conversion. Any conversion pursuant to this Section 7 shall be deemed to have
been effected as of the close of business on the date on which this Note is surrendered at the principal office of the Company pursuant to Section 7(a)(ii), together with a written conversion request notice. At such time as such conversion has been
effected, the rights of Holder under this Note, to the extent of the conversion, shall cease, and Holder shall thereafter be deemed to have become the holder of record of the shares of capital stock issuable upon such conversion. 
  
 (c) Issuance of Certificates. As soon as is reasonably practicable
after a conversion has been effected, the Company shall deliver to Holder a certificate or certificates representing the number of shares of capital stock (excluding any fractional share) issuable by reason of such conversion in such name or names
and such denomination or denominations as Holder has specified. 
  
 (d) No Fractional Shares. If any fractional share of capital stock would, except for the provisions hereof, be deliverable upon conversion of this Note, the Company, in lieu of delivering such fractional share, shall pay an amount
equal to the value of such fractional share, as determined by the per share conversion price used to effect such conversion. 
  
 (e) Issuance Costs. The issuance of certificates for shares of capital stock issuable upon conversion of this Note shall be made without charge to
Holder for any issuance tax in respect thereof or other cost incurred by the Company in connection with such conversion and the related issuance of such shares of capital stock. Upon conversion of this Note, the Company shall take all such actions
as are necessary in order to ensure that the capital stock issuable with respect to such conversion shall be validly issued, fully paid and nonassessable. 
  
 (f) Compliance with Laws and Regulations. The Company shall take all such actions as may be necessary to assure that all shares of capital stock
issued upon conversion may be so issued without violation of any applicable law or governmental regulation or any requirement of any domestic securities exchange upon which such shares of capital stock may be listed (except for official notice of
issuance which shall be immediately delivered by the Company upon such issuance). 
  
 8. Events of Default. 
  
 (a) Definition. For purposes of this Note, an Event of Default shall be deemed to have occurred if: 
  
 (i) any indebtedness under this Note is not paid when and as the same shall become due and payable, whether at maturity, by acceleration, or otherwise,
and any such amount shall remain unpaid for a period of ten (10) days after Holder has provided notice to the Company of such failure to make timely payment; 
  
 (ii) default shall occur in the observance or performance of any other covenant, obligation or agreement of the Company under this Note or the Agreement,
which shall remain uncured for a period of twenty (20) days after Holder has provided notice to the Company of such default; or 
  

 4 

 (iii) the Company shall (A) apply for or consent to the appointment of a receiver, trustee, custodian or
liquidator of itself or any part of its property, (B) become subject to the appointment of a receiver, trustee, custodian or liquidator for itself or any part of its property if such appointment is not terminated or dismissed within thirty (30)
days, (C) make an assignment for the benefit of creditors, (D) be adjudicated as bankrupt or insolvent, (E) institute any proceedings under the United States Bankruptcy Code or any other federal or state bankruptcy, reorganization, receivership,
insolvency or other similar law affecting the rights of creditors generally, or file a petition or answer seeking reorganization or an arrangement with creditors to take advantage of any insolvency law, or file an answer admitting the material
allegations of a bankruptcy, reorganization or insolvency petition filed against it, or (F) become subject to any proceedings under the United States Bankruptcy Code or any other federal or state bankruptcy, reorganization, receivership, insolvency
or other similar law affecting the rights of creditors generally, which proceeding is not dismissed within thirty (30) days of filing, or have an order for relief entered against it in any proceeding under the United States Bankruptcy Code.

  
 (b) Consequences of Events of Default. 
  
 (i) If an Event of Default occurs, all indebtedness under this Note shall
become immediately due and payable without any action on the part of Holder. The Company agrees to pay Holder all reasonable out-of-pocket costs and expenses incurred by Holder in any effort to collect indebtedness under this Note, including
reasonable attorney fees, and to pay interest at the highest rate permitted by applicable law on such costs and expenses to the extent not paid when demanded. 
  

(ii) Holder shall also have any other rights which Holder may have been afforded under any contract or agreement at any time and any other rights
which Holder may have pursuant to applicable law. 
  
 11. Lost,
Stolen, Destroyed or Mutilated Notes. In case any Note shall be mutilated, lost, stolen or destroyed, the Company shall issue a new Note of like date, tenor and denomination and deliver the same in exchange and substitution for and upon
surrender and cancellation of any mutilated Note, or in lieu of any Note lost, stolen or destroyed, upon receipt of evidence satisfactory to the Company of the loss, theft or destruction of such Note. 
  
 12. Governing Law. This Note is to be construed in accordance with and
governed by the internal laws of the State of Delaware without giving effect to any choice of law rule that would cause the application of the laws of any jurisdiction other than the internal laws of the State of Delaware to the rights and duties of
the Company and the Holder. All disputes and controversies arising out of or in connection with this Note shall be resolved exclusively by the state and federal courts located in the State of Oregon, and each of the Company and the Holder hereto
agrees to submit to the jurisdiction of said courts and agrees that venue shall lie exclusively with such courts. 
  

 5 

 13. Amendment. Any term of this Note may be amended and the observance of any term of this Note
may be waived (either generally or in a particular instance and either retroactively or prospectively), only with the written consent of the Company and the holder of this Note. Any amendment or waiver effected in accordance with this paragraph
shall be binding upon the Company and the Holder of this Note. 
  
 14. Notices. Except as may be otherwise provided herein, all notices, requests, waivers and other communications made pursuant to this Note shall be made in accordance with Section 8.6 of the Agreement. 
  
 15. Severability. If one or more provisions of this Note are held to
be unenforceable under applicable law, such provision shall be excluded from this Note and the balance of the Note shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms. 
  

 6 

 IN WITNESS WHEREOF, the Company has caused this Note to be duly executed by its officers, thereunto duly
authorized as of the date first above written. 
  

			
	OXIS INTERNATIONAL, INC.
		
	 By:
	 	  

	 	 	 Ray R. Rogers, Chairman and Chief
 Executive Officer

  

 7Form of Warrant to Purchase Common Stock, dated Jan. 9, 2004

 EXHIBIT 10-k 
  
 EXHIBIT C 
  
 THIS WARRANT AND THE SHARES PURCHASABLE HEREUNDER HAVE BEEN ACQUIRED FOR INVESTMENT AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR
QUALIFIED UNDER ANY STATE SECURITIES LAWS. SUCH SECURITIES MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR QUALIFICATION OR AN EXEMPTION THEREFROM UNDER SAID ACT AND ANY APPLICABLE STATE SECURITIES LAWS. 
  
 THIS WARRANT AND THE SHARES PURCHASABLE HEREUNDER ARE SUBJECT TO RESTRICTIONS ON
TRANSFER CONTAINED IN THAT CERTAIN NOTE AND WARRANT PURCHASE AGREEMENT, DATED JANUARY 14, 2004, WHICH RESTRICTIONS ON TRANSFER ARE INCORPORATED HEREIN BY REFERENCE. 
  
 Dated:                 
    , 2004 
  
 WARRANT TO PURCHASE

 COMMON STOCK OF 
 OXIS INTERNATIONAL, INC. 
  
 This certifies that
                    , or assigns (collectively, the “Holder”), for value received, is entitled to purchase, at the Stock Purchase
Price (as defined below), from OXIS International, Inc., a Delaware corporation (the “Company”), up to [                    ] fully
paid and nonassessable shares (each a “Warrant Share,” and collectively the “Warrant Shares”) of the Common Stock of the Company, par value $0.001 per share (“Common Stock”). 
  
 This Warrant is issued pursuant to the terms of that certain Note and Warrant
Purchase Agreement (the “Agreement”) dated as of January 14, 2004, by and among the Company and the investors set forth in the Schedule of Investors attached thereto as Exhibit A. 
  
 Unless sooner terminated earlier as provided herein, this Warrant shall be
exercisable at any time up to and including 5:00 p.m. (Pacific Time) on the five (5) year anniversary of the date hereof (the “Expiration Date”), upon surrender to the Company at its principal office (or at such other location as the
Company may advise the Holder in writing) of this Warrant properly endorsed with (i) the Form of Subscription attached hereto duly completed and executed, (ii) payment pursuant to Section 2 of the aggregate Stock Purchase Price for the number of
shares for which this Warrant is being exercised determined in accordance with the provisions hereof, and (iii) any documents reasonably requested by the Company to be executed by the Holder, including without limitation a stock purchase agreement.
The Stock Purchase Price and the number of shares purchasable hereunder are subject to adjustment as provided in Section 4 of this Warrant. 

 For purposes of this Warrant, the term “Stock Purchase Price” shall mean US$0.50 per Warrant
Share. 
  
 1. Exercise; Issuance of Certificates;
Acknowledgement. This Warrant is exercisable at the option of the holder of record hereof, at any time or from time to time from or after issuance up to the Expiration Date for all or any part of the Warrant Shares (but not for a fraction of a
share) which may be purchased hereunder. The Company agrees that the shares of Common Stock purchased under this Warrant shall be and are deemed to be issued to the Holder hereof as the record owner of such shares as of the close of business on the
date on which this Warrant shall have been surrendered, properly endorsed, the completed, executed Form of Subscription delivered and payment made for such shares. Certificates for the shares of the Common Stock so purchased, together with any other
securities or property to which the Holder hereof is entitled upon such exercise, shall be delivered to the Holder hereof by the Company at the Company’s expense within a reasonable time after the rights represented by this Warrant have been so
exercised. Each certificate so delivered shall be in such denominations of the Warrant Shares as may be requested by the Holder hereof and shall be registered in the name of such Holder. In case of a purchase of less than all the Warrant Shares, the
Company shall execute and deliver to Holder within a reasonable time an Acknowledgement in the form attached hereto indicating the number of Warrant Shares which remain subject to this Warrant, if any. 
  
 2. Payment for Shares. The aggregate purchase price for Warrant Shares
being purchased hereunder shall be paid by cash or wire transfer of immediately available United States funds. 
  
 3. Shares to be Fully Paid; Reservation of Shares. The Company covenants and agrees that all shares of Common Stock which may be issued upon the
exercise of the rights represented by this Warrant will, upon issuance, be duly authorized, validly issued, fully paid and nonassessable and free from all preemptive rights of any stockholder and free of all taxes, liens and charges with respect to
the issue thereof. The Company further covenants and agrees that during the period within which the rights represented by this Warrant may be exercised, the Company will at all times have authorized and reserved, for the purpose of issue or transfer
upon exercise of the subscription rights evidenced by this Warrant, a sufficient number of shares of authorized but unissued shares of Common Stock, or other securities and property, when and as required to provide for the exercise of the rights
represented by this Warrant. 
  
 4. Adjustment of Stock
Purchase Price and Number of Shares. The number of shares of Common Stock purchasable upon exercise of this Warrant and the Stock Purchase Price shall be subject to adjustment from time to time as follows: 
  
 4.1 Subdivisions, Combinations and Other Issuances. If the Company
shall at any time prior to the expiration of this Warrant subdivide the Common Stock by split-up or otherwise, or combine or issue additional shares thereof, or issue Common Stock as a dividend 
  

 2 

 with respect to any shares thereof, the number of shares of Common Stock issuable on the exercise of this Warrant shall
forthwith be proportionately increased in the case of a subdivision or stock dividend, or proportionately decreased in the case of a combination. Appropriate adjustments shall also be made to the Stock Purchase Price payable per share, but the
aggregate purchase price payable for the total number of shares of Common Stock purchasable under this Warrant (as adjusted) shall remain the same. Any adjustment under this Section 4.1 shall become effective at the close of business on the date the
subdivision or combination becomes effective, or as of record date of such dividend, or in the event that no record date is fixed, upon the making of such dividend. 
  
 4.2 Reclassification, Reorganization and Consolidation. In case of any reclassification, capital reorganization, or
change in the Common Stock (other than as a result of a subdivision, combination or stock dividend provided for in Section 4.1 above), then, as a condition of such reclassification, reorganization or change, lawful provision shall be made, and duly
executed documents evidencing the same from the Company or its successor shall be delivered to the holder of this Warrant, so that the holder of this Warrant shall have the right at any time prior to the expiration of this Warrant to purchase, at a
total price equal to that payable upon the exercise of this Warrant, the kind and amount of shares of stock and other securities and property receivable in connection with such reclassification, reorganization or change by a holder of the same
number of shares of Common Stock as were purchasable by the holder of this Warrant immediately prior to such reclassification, reorganization or change. 
  
 4.3 Notice of Adjustment. When any adjustment is required to be made in the number or kind of shares purchasable upon exercise of the Warrant, the
Company shall promptly notify the holder of such event and of the number of shares of Common Stock or other securities or property thereafter purchasable upon exercise of the Warrant. 
  
 4.4 Other Notices. If at any time: 
  
 (1) the Company shall declare any cash dividend upon its Common Stock; 
  
 (2) there shall be any capital reorganization or reclassification of the
capital stock of the Company; or consolidation or merger of the Company with, or sale of all or substantially all of its assets to, another corporation or other business entity; or 
  
 (3) there shall be a voluntary or involuntary dissolution, liquidation or winding-up of the Company. 
  
 then, in any one or more of said cases, the Company shall give, by first class mail, postage
prepaid, addressed to the Holder of this Warrant at the address of such Holder as shown on the books of the Company, (a) at least twenty (20) days prior written notice of the date on which the books of the Company shall close or a record shall be
taken for such dividend or for determining rights to vote in respect of any such reorganization, reclassification, consolidation, merger, sale, dissolution, liquidation or winding-up, and (b) in the case of any such reorganization, reclassification,
consolidation, merger, sale, dissolution, liquidation or winding-up, at least 
  

 3 

 twenty (20) days prior written notice of the date when the same shall take place; provided, however, that the Holder
shall make a best efforts attempt to respond to such notice as early as possible after the receipt thereof. Any notice given in accordance with the foregoing clause (a) shall also specify, in the case of any such dividend, the date on which the
holders of Common Stock shall be entitled thereto. Any notice given in accordance with the foregoing clause (b) shall also specify the date on which the holders of Common Stock shall be entitled to exchange their Common Stock for securities or other
property deliverable upon such Corporate Transaction. 
  
 5. No
Voting or Dividend Rights. Nothing contained in this Warrant shall be construed as conferring upon the Holder hereof the right to vote or to consent to receive notice as a stockholder of the Company or any other matters or any rights whatsoever
as a stockholder of the Company. No dividends or interest shall be payable or accrued in respect of this Warrant or the interest represented hereby or the shares purchasable hereunder until, and only to the extent that, this Warrant shall have been
exercised. 
  
 6. Warrants Transferable. Subject to
compliance with applicable federal and state securities laws and the transfer restrictions set forth in the Agreement, under which this Warrant was issued, this Warrant and all rights hereunder may be transferred, in whole or in part, without charge
to the holder hereof (except for transfer taxes), upon surrender of this Warrant properly endorsed and in compliance with the provisions of the Agreement. 
  
 7. Lost Warrants. Upon receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction, or mutilation of this Warrant
and, in the case of any such loss, theft or destruction, upon receipt of an indemnity reasonably satisfactory to the Company, or in the case of any such mutilation upon surrender and cancellation of such Warrant, the Company, at its expense, will
make and deliver a new Warrant, of like tenor, in lieu of the lost, stolen, destroyed or mutilated Warrant. 
  
 8. Modification and Waiver. Any term of this Warrant may be amended and the observance of any term of this Warrant may be waived (either generally
or in a particular instance and either retroactively or prospectively), only with the written consent of the Company and the holder of this Warrant. Any amendment or waiver effected in accordance with this paragraph shall be binding upon the Company
and the Holder of this Warrant. 
  
 9. Notices. Except as
may be otherwise provided herein, all notices, requests, waivers and other communications made pursuant to this Warrant shall be made in accordance with Section 8.6 of the Agreement. 
  
 10. Titles and Subtitles; Governing Law; Venue. 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. This Warrant is to be construed in accordance with and governed by the internal laws of the State of Delaware without giving effect to any choice of law rule
that would cause the application of the laws of any jurisdiction other than the internal laws of the State of Delaware to the rights and duties of the Company and the Holder. All disputes and controversies arising out of or in connection with this
Warrant shall be resolved exclusively by 
  

 4 

 the state and federal courts located in the State of Oregon, and each of the Company and the Holder hereto agrees to
submit to the jurisdiction of said courts and agrees that venue shall lie exclusively with such courts. 
  
 IN WITNESS WHEREOF, the Company has caused this Warrant to be duly executed by its officers, thereunto duly authorized as of the date first above written.

  

			
	OXIS INTERNATIONAL, INC.
		
	 By:
	 	  

	 	 	 Ray R. Rogers, Chairman and Chief
 Executive Officer

  
  

 5 

 FORM OF SUBSCRIPTION 
  
 (To be signed only upon exercise of Warrant) 
  
 To:                     

  
 The undersigned, the holder of a right to purchase shares of
Common Stock of OXIS International, Inc. (the “Company”) pursuant to that certain Warrant to Purchase Common Stock of the Company (the “Warrant”), dated as of
                    , 2004, hereby irrevocably elects to exercise the purchase right represented by such Warrant for, and to purchase
thereunder,                      (            ) shares of Common Stock of
the Company and herewith makes payment of                      Dollars
(US$            ) therefor by cash or wire transfer of immediately available United States funds. 
  
 The undersigned represents that it is acquiring such securities for its own account for investment and not with a view to or
for sale in connection with any distribution thereof and in order to induce the issuance of such securities makes to the Company, as of the date hereof, the representations and warranties set forth in Section 3 of the Note and Warrant Purchase
Agreement, dated as of                     , 2004, by and among the Company and the investors listed on Exhibit A thereto. 

 
 DATED:
                     
  

			
	 [Name of Holder]

		
	 By:
	 	  

	 Name:
	 	  

	 Its:
	 	  

 ACKNOWLEDGMENT 
  
 To: [Name of Holder] 
  
 The undersigned hereby acknowledges that as of the date hereof,
                     (            ) shares of Common Stock remain subject
to the right of purchase in favor of [Name of Holder] pursuant to that certain Warrant to Purchase Common Stock of OXIS International, Inc. dated as of
                    , 2004. 
  
 DATED:                      
  

			
	OXIS INTERNATIONAL, INC.
		
	 By:
	 	  

	 Name:
	 	  

	 Its:

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