Document:

Exhibit 10.64

 

FORM OF

SECURITIES PURCHASE AGREEMENT

 

This
SECURITIES PURCHASE AGREEMENT (this “Agreement”) is made as of the last date set forth on the signature
page hereof by and among CORONADO BIOSCIENCES, INC., a Delaware corporation having its principal place of business at 24
New England Executive Park, Burlington, MA 01803 (“Coronado”), [ _____
], a [ _____ ] having its principal place of business at [ _____ ] (the “Company”), and the undersigned (the
“Subscriber”).

 

WITNESSETH:

 

WHEREAS, the Subscriber and Coronado
are party to that certain Note Purchase Agreement, dated [ _____ ] (the “NPA”), pursuant to which Coronado issued
the Subscriber a promissory note in the aggregate principal amount of $[ _____ ] (the “Original Note”);

 

WHEREAS, the Company is a subsidiary
of Coronado and was the beneficiary of the proceeds of the Original Note, and, pursuant to Section 5.1 of the NPA and Section 3
of the Original Note, the Company desires to issue the Subscriber [a promissory note, in substantially the form attached hereto
as Exhibit A (the “Replacement Note” or the “Securities”), in exchange for, and as
a replacement of, the Original Note]/[a Warrant, in substantially the form attached hereto as Exhibit A to purchase shares
of the Company’s common stock, par value $[ _____ ] per share (the “Warrant” or the “Securities”)];
and

 

WHEREAS, the undersigned parties
desire to [exchange the Original Note for the Replacement Note]/[purchase the Securities], on the terms and conditions set forth
herein.

 

NOW, THEREFORE, in consideration
of the promises and the mutual representations and covenants hereinafter set forth, the parties hereto do hereby agree as follows:

 

I.           [EXCHANGE]/[SUBSCRIPTION].

 

1.1           [Exchange
of the Original Note]/[Purchase of the Securities]. Effective as of the date hereof (the “Closing”), [the
Subscriber hereby agrees to exchange and convert all outstanding principal and all accrued but unpaid interest under the Original
Note for and into a Replacement Note in the principal amount set forth on the signature page hereto]/[the Subscriber hereby agrees
to purchase, and the Company hereby agrees to issue and sell, a Warrant to purchase shares of the Company’s common stock,
for an aggregate purchase price of $1.00]. [Coronado, the Company and the Subscriber agree that, as of the date hereof, the Original
Note shall cease to be outstanding and shall represent the right to receive, upon surrender of the Original Note to Coronado at
its principal office, a Replacement Note, as set forth above. Upon surrender of the Original Note to Coronado, Coronado will direct
the Company to, and the Company will, issue the Replacement Note into which the Original Note was converted. The parties hereto
agree that the Replacement Note shall be deemed to be an extension or renewal of the Original Note for purposes of the NPA.]/[Upon
receipt of the purchase price for the Securities, the Company will issue the Subscriber the Warrant.]

 

1.2           [Release
of Obligations under the Original Note. The Subscriber hereby agrees and acknowledges that the issuance of the Replacement
Note by the Company as set forth herein shall and does fully satisfy and extinguish any and all obligations or liabilities of Coronado
under, or arising in connection with, the Original Note.]

 

    	 

    	 

    

 

		2	REPRESENTATIONS AND WARRANTIES OF THE SUBSCRIBER.

 

2.1           The
Subscriber recognizes that the purchase of the Securities involves a high degree of risk including, but not limited to, the following:
(a) the Company remains a development stage business and requires substantial additional funds; (b) an investment in the Company
is highly speculative, and only investors who can afford the loss of their entire investment should consider investing in the Company
and the Securities; (c) the Subscriber may not be able to liquidate its investment; (d) transferability of the Securities is extremely
limited; and (e) in the event of a disposition of the Securities, the Subscriber could sustain the loss of its entire investment.

 

2.2           The
Subscriber represents that the Subscriber is an “accredited investor” as such term is defined in Rule 501 of Regulation
D (“Regulation D”) promulgated under the Securities Act of 1933, as amended (the “Securities Act”),
as indicated by the Subscriber’s responses to the questions contained in [Article VII] hereof, and that the Subscriber is
able to bear the economic risk of an investment in the Securities. If the Subscriber is a natural person, the Subscriber has reached
the age of majority in the state or other jurisdiction in which the Subscriber resides, has adequate means of providing for the
Subscriber’s current financial needs and contingencies, is able to bear the substantial economic risks of an investment in
the Securities for an indefinite period of time, has no need for liquidity in such investment and, at the present time, could afford
a complete loss of such investment.

 

2.3           The
Subscriber hereby acknowledges and represents that (a) the Subscriber has sufficient knowledge and experience in business and financial
matters, prior investment experience, including investment in securities that are non-listed, unregistered and/or not traded on
a national securities exchange, or the Subscriber has employed the services of a “purchaser representative” (as defined
in Rule 501 of Regulation D), attorney and/or accountant to read all of the documents furnished or made available by the Company
both to the Subscriber and to all other prospective investors in the Securities in order to evaluate the merits and risks of such
an investment on the Subscriber’s behalf; (b) the Subscriber recognizes the highly speculative nature of this investment;
and (c) the Subscriber is able to bear the economic risk that the Subscriber hereby assumes.

 

2.4           The
Subscriber hereby acknowledges receipt and careful review of this Agreement and the Replacement Note, and hereby represents that
the Subscriber has been furnished by the Company with all information regarding the Company, the terms and conditions of the proposed
transaction and any additional information that the Subscriber, its purchaser representative, attorney and/or accountant has requested
or desired to know, and has been afforded the opportunity to ask questions of and receive answers from duly authorized officers
or other representatives of the Company concerning the Company and the terms and conditions of the proposed transaction.

 

2.5           (a)          To
the extent necessary, the Subscriber has retained, at its own expense, and relied upon appropriate professional advice regarding
the investment, tax and legal merits and consequences of this Agreement and the purchase of the Securities hereunder. The Subscriber
disclaims reliance on any statements made or information provided by any person or entity in the course of Subscriber’s consideration
of an investment in the Securities.

 

(b)          The
Subscriber represents that (i) the Subscriber was contacted regarding the sale of the Securities by the Company (or an authorized
agent or representative of the Company) with whom the Subscriber had a prior substantial pre-existing relationship and (ii) no
Securities were offered or sold to it by means of any form of general solicitation or general advertising, and in connection therewith,
the Subscriber did not (A) receive or review any advertisement, article, notice or other communication published in a newspaper
or magazine or similar media or broadcast over television or radio, whether closed circuit, or generally available; or (B) attend
any seminar meeting or industry investor conference whose attendees were invited by any general solicitation or general advertising.

 

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2.6           The
Subscriber hereby represents that the Subscriber, either by reason of the Subscriber’s business or financial experience or
the business or financial experience of the Subscriber’s professional advisors (who are unaffiliated with and not compensated
by the Company, Coronado or any affiliate or selling agent of the Company or Coronado, directly or indirectly), has the capacity
to protect the Subscriber’s own interests in connection with the transaction contemplated hereby.

 

2.7           The
Subscriber hereby acknowledges that the transactions proposed herein have not been reviewed by the United States Securities and
Exchange Commission (the “SEC”) nor any state regulatory authority since such transactions are intended to be
exempt from the registration requirements of Section 5 of the Securities Act pursuant to Regulation D promulgated thereunder. The
Subscriber understands that the Securities have not been registered under the Securities Act or under any state securities or “blue
sky” laws and agrees not to sell, pledge, assign or otherwise transfer or dispose of the Securities unless they are registered
under the Securities Act and under any applicable state securities or “blue sky” laws or unless an exemption from such
registration is available.

 

2.8           The
Subscriber understands that the Securities have not been registered under the Securities Act or any state securities laws by reason
of a claimed exemption under the provisions of the Securities Act and such state securities laws that depends, in part, upon the
Subscriber’s investment intention.

 

2.9           The
Subscriber understands that there is no public market for the Securities and that no market may develop for any of such Securities.
The Subscriber understands that even if a public market develops for such Securities, Rule 144 (“Rule 144”)
promulgated under the Securities Act requires for non-affiliates, among other conditions, a one-year holding period prior to the
resale (in limited amounts) of securities acquired in a non-public offering without having to satisfy the registration requirements
under the Securities Act. The Subscriber understands and hereby acknowledges that[, except as set forth in Article V below,] the
Company is under no obligation to register any of the Securities under the Securities Act or any state securities or “blue
sky” laws.

 

2.10         The
Subscriber consents to the placement of a legend on any certificate or other document evidencing the Securities that such Securities
have not been registered under the Securities Act or any state securities or “blue sky” laws and setting forth or referring
to the restrictions on transferability and sale thereof contained in this Agreement. The Subscriber is aware that the Company will
make a notation in its appropriate records with respect to the restrictions on the transferability of such Securities. The legend
to be placed on each certificate shall be in form substantially similar to the following:

 

“THE SECURITIES REPRESENTED HEREBY HAVE NOT BEEN
REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) OR ANY STATE SECURITIES OR “BLUE
SKY LAWS”, AND MAY NOT BE OFFERED, SOLD, TRANSFERRED, ASSIGNED, PLEDGED OR HYPOTHECATED ABSENT AN EFFECTIVE REGISTRATION
THEREOF UNDER SUCH ACT, OR UNLESS THE COMPANY HAS RECEIVED AN OPINION OF COUNSEL, REASONABLY SATISFACTORY TO THE COMPANY AND ITS
COUNSEL, THAT SUCH REGISTRATION IS NOT REQUIRED.”

 

2.11         The
Subscriber hereby represents that the address of the Subscriber furnished by Subscriber on the signature page hereof is the Subscriber’s
principal residence if Subscriber is an individual or its principal business address if it is a corporation or other entity.

 

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2.12         The
Subscriber represents that the Subscriber has full power and authority (corporate, statutory and otherwise) to execute and deliver
this Agreement and to purchase the Securities. This Agreement constitutes the legal, valid and binding obligation of the Subscriber,
enforceable against the Subscriber in accordance with its terms.

 

2.13         If
the Subscriber is a corporation, partnership, limited liability company, trust, employee benefit plan, individual retirement account,
Keogh Plan, or other tax-exempt entity, (a) it is authorized and qualified to invest in the Company and the person signing this
Agreement on behalf of such entity has been duly authorized by such entity to do so and (b) it is duly organized, validly existing
and in good standing under the laws of the jurisdiction of its organization.

 

2.14         The
Subscriber acknowledges that if he or she is a Registered Representative of a Financial Industry Regulatory Authority (“FINRA”)
member firm, he or she must give such firm the notice required by NASD Rule 3050, receipt of which must be acknowledged by such
firm in [Section 7.3] below.

 

2.15         (a)          The
Subscriber agrees not to issue any public statement with respect to the Subscriber’s investment or proposed investment in
the Company or the terms of any agreement or covenant between them and the Company without the Company’s prior written consent,
except such disclosures as may be required under applicable law or under any applicable order, rule or regulation.

 

(b)          The
Company agrees not to disclose the names, addresses or any other information about the Subscriber, except as required by law.

 

2.16         The
Subscriber represents and warrants that it has not engaged, consented to or authorized any broker, finder or intermediary to act
on its behalf, directly or indirectly, as a broker, finder or intermediary in connection with the transactions contemplated by
this Agreement. The Subscriber hereby agrees to indemnify and hold harmless the Company from and against all fees, commissions
or other payments owing to any such person or firm acting on behalf of such Subscriber hereunder.

 

2.17         The
Subscriber agrees to hold the Company and its directors, officers, employees, affiliates, controlling persons and agents and their
respective heirs, representatives, successors and assigns harmless and to indemnify them against all liabilities, costs and expenses
incurred by them as a result of (a) any sale or distribution of the Securities by
the Subscriber in violation of the Securities Act or any applicable state or foreign securities or “blue sky” laws;
or (b) any false representation or warranty or any breach or failure by the Subscriber to comply with any covenant made by the
Subscriber in this Agreement (including the Confidential Investor Questionnaire contained in [Article VII] herein) or any other
document furnished by the Subscriber to any of the foregoing in connection with this transaction; provided, however, that in no
event shall any indemnity under this Section 2.17 exceed the aggregate principal amount of the [Replacement Note subscribed for
by the Subscriber pursuant to this Agreement]/[purchase price for the Securities hereunder], except in the case of willful fraud
by the Subscriber.

 

2.18         The
Subscriber acknowledges that the information made available to the Subscriber is confidential and non-public and agrees that all
such information shall be kept in confidence by the Subscriber and neither used by the Subscriber for the Subscriber’s personal
benefit (other than in connection with this subscription) nor disclosed to any third party for any reason; provided, however,
that (a) the Subscriber may disclose such information to its attorneys and advisors who may have a need for such information in
connection with providing advice to the Subscriber with respect to its investment in the Company, so long as such affiliates and
advisors have an obligation of confidentiality, and (b) this obligation shall not apply to any such information that (i) is part
of the public knowledge or literature and readily accessible at the date hereof, (ii) becomes part of the public knowledge or
literature and readily accessible by publication (except as a result of a breach of this provision), or (iii) is received from
third parties without an obligation of confidentiality (except third parties who disclose such information in violation of any
confidentiality agreements or obligations, including, without limitation, any subscription or other similar agreement entered
into with the Company).

 

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2.19         The
Subscriber represents that no authorization, approval, consent or license of any person is required to be obtained for the purchase
of the Securities by the Subscriber, other than as have been obtained and are in full force and effect.

 

2.20         The
Subscriber represents that the representations, warranties and agreements of the Subscriber contained herein and in any other writing
delivered in connection with the transactions contemplated hereby shall be true and correct in all respects on the date hereof
as if made on and as of such date and shall survive the execution and delivery of this Agreement and the purchase of the Securities.
The Subscriber agrees that the Company and Coronado shall be entitled to rely on the representations, warranties and agreements
of the Subscriber contained herein.

 

2.21        The Subscriber understands,
acknowledges and agrees with the Company that, except as otherwise set forth herein, the subscription hereunder is irrevocable
by the Subscriber, that, except as required by law, the Subscriber is not entitled to cancel, terminate or revoke this Agreement
or any agreements of the Subscriber hereunder and that this Agreement and such other agreements shall survive the death or disability
of the Subscriber and shall be binding upon and inure to the benefit of the parties and their heirs, executors, administrators,
successors, legal representatives and permitted assigns. If the Subscriber is more than one person, the obligations of the Subscriber
hereunder shall be joint and several and the agreements, representations, warranties and acknowledgments herein contained shall
be deemed to be made by and be binding upon each such person and his/her heirs, executors, administrators, successors, legal representatives
and permitted assigns.

 

2.22         The
Subscriber understands, acknowledges and agrees with the Company that the transactions proposed hereby are intended to be exempt
from registration under the Securities Act by virtue of the provisions of Regulation D thereunder, which is in part dependent upon
the truth, completeness and accuracy of the representations and covenants made by the Subscriber in this Agreement.

 

2.23        (a)          Any
Subscriber subject to jurisdiction in the European Economic Area (“EEA”) either (i) is a qualified investor
for the purposes of Directive 2003/71/EC of the European Parliament and the Council (a “Qualified Investor”);
that is, a person falling within Article 2.1(e)(i), (ii) or (iii) of such directive or a person authorized by any such jurisdiction
to be considered as a qualified investor for the purposes of such directive, or (ii) it has notified the Company in writing that
it is not a Qualified Investor;

 

(b)          Any
EEA Subscriber entering into this Agreement and acquiring Securities is either (i) acting on its own account and not for the account
of or otherwise on behalf any other person or persons or (ii) if a Qualified Investor in the United Kingdom, it is acting as an
agent in the circumstances contemplated in section 86(2) of the United Kingdom Financial Services and Markets Act 2000;

 

(c)          Any
Subscriber, if in the United Kingdom, is (a) a person falling within Article 19(5) of the United Kingdom Financial Services and
Markets Act 2000 (Financial Promotion) Order 2005 (“FPO”) or (b) a person falling within Article 49(2)(a) to
(d) of the FPO;

 

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(d)          Each
Subscriber acknowledges that neither the Placement Agent (as defined in the NPA) nor any person acting on its behalf is making
any recommendations to it or advising it regarding the suitability or merits of purchasing the Securities or any transaction it
may enter into in connection with the offering of the Securities, and acknowledges that its participation in the offering of Securities
is on the basis that it is not and will not be a client or customer of the Placement Agent and that neither the Placement Agent
nor any person acting on its behalf has any duties or responsibilities to it for providing the protections afforded to their clients
or customers or for providing advice in relation to the offering of the Securities.

 

III.         REPRESENTATIONS
BY AND COVENANTS OF THE COMPANY

 

The Company hereby represents and warrants
to the Subscriber that:

 

3.1           Organization,
Good Standing and Qualification. The Company is a corporation duly organized, validly existing and in good standing under the
laws of the State of [ ____ ] and has full corporate power and authority to conduct its business as currently conducted. The Company
is duly qualified as a foreign corporation to do business and is in good standing in every jurisdiction in which the property owned
or leased by it or the nature of the business conducted by it makes such qualification necessary, except to the extent that the
failure to be so qualified or in good standing would not reasonably be expected to have, individually or in the aggregate, a material
adverse effect on the business, operations, conditions (financial or otherwise), properties, assets or results of operations of
the Company (a “Material Adverse Effect”).

 

3.2           Capitalization
and Voting Rights. The authorized, issued and outstanding shares of the capital stock of the Company are as set forth in Schedule
[ ___ ] hereto, and all issued and outstanding shares of the Company are validly issued, fully paid and nonassessable. Except as
set forth on Schedule [ __ ] hereto, there are no outstanding options, warrants, agreements, convertible securities, preemptive
rights or other rights to subscribe for or to purchase any shares of capital stock of the Company. Except as set forth on Schedule
[ ____ ] hereto and as otherwise required by law, there are no restrictions upon the voting or transfer of any of the shares of
capital stock of the Company pursuant to the Company’s [ _____ ] (the “Certificate of Incorporation”),
By-Laws or other governing documents or any agreement or other instruments to which the Company is a party or by which the Company
is bound.

 

3.3           Authorization;
Enforceability. The Company has all corporate right, power and authority to enter into this Agreement and to consummate the
transactions contemplated hereby. All corporate action on the part of the Company, its directors and stockholders necessary for
the (i) authorization, execution, delivery and performance of this Agreement by the Company; and (ii) authorization, sale, issuance
and delivery of the Securities contemplated hereby and the performance of the Company’s obligations hereunder has been taken.
This Agreement has been duly executed and delivered by the Company and constitutes a legal, valid and binding obligation of the
Company, enforceable against the Company in accordance with its terms, subject to laws of general application relating to bankruptcy,
insolvency and the relief of debtors and rules of law governing specific performance, injunctive relief or other equitable remedies,
and to limitations of public policy. The Securities, when issued and fully paid for in accordance with the terms of this Agreement,
will be validly issued. The issuance and sale of the Securities contemplated hereby will not give rise to any preemptive rights
or rights of first refusal on behalf of any person which have not been waived in connection with the transactions contemplated
hereby.

 

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3.4           No
Conflict; Governmental Consents.

 

(a)          Except
as would not reasonably be expected to have a Material Adverse Effect or have been waived, the execution and delivery by the Company
of this Agreement and the consummation of the transactions contemplated hereby will not result in the violation of any law, statute,
rule, regulation, order, writ, injunction, judgment or decree of any court or governmental authority to or by which the Company
is bound, or of any provision of the Certificate of Incorporation or By-Laws of the Company, and will not conflict with, or result
in a breach or violation of, any of the terms or provisions of, or constitute (with due notice or lapse of time or both) a default
under, any lease, loan agreement, mortgage, security agreement, trust indenture or other agreement or instrument to which the Company
is a party or by which it is bound or to which any of its properties or assets is subject, nor result in the creation or imposition
of any lien upon any of the properties or assets of the Company.

 

(b)          No
consent, approval, authorization or other order of any governmental authority or other third party is required to be obtained by
the Company in connection with the authorization, execution and delivery of this Agreement or with the authorization, issue and
sale of the Securities, except as have been obtained or such filings as may be required to be made with the SEC and with any state
or foreign blue sky or securities regulatory authority relating to an exemption from registration thereunder.

 

3.5           Licenses.
Except as would not reasonably be expected to have a Material Adverse Effect, the Company has sufficient licenses, permits and
other governmental authorizations currently required for the conduct of its business or ownership of properties and is in all material
respects complying therewith.

 

3.6           Litigation.
The Company knows of no pending or threatened legal or governmental proceedings against the Company which (i) adversely questions
the validity of this Agreement or any agreements related to the transactions contemplated hereby or the right of the Company to
enter into any of such agreements, or to consummate the transactions contemplated hereby or thereby or (ii) could, if there were
an unfavorable decision, have a Material Adverse Effect. There is no action, suit, proceeding or investigation by the Company currently
pending in any court or before any arbitrator or that the Company intends to initiate.

 

3.7           Investment
Company. The Company is not an “investment company” within the meaning of such term under the Investment Company
Act of 1940, as amended, and the rules and regulations of the SEC thereunder.

 

3.8           Financial
Statements. The financial statements of the Company provided to the Subscriber (the “Financial Statements”)
fairly present in all material respects the financial condition and results of operations of the Company at the dates and for the
periods indicated and have been prepared in conformity with generally accepted accounting principles in the United States (“GAAP”)
consistently applied throughout the periods covered thereby, except as may be otherwise specified in such Financial Statements
or the notes thereto, and except that unaudited financial statements do not contain all footnotes and do not contain the cash flow
statement required by GAAP, and fairly present in all material respects the financial condition of the Company as of the dates
thereof and the results of operations and cash flows for the periods then ended, subject, in the case of unaudited statements,
to normal year-end audit adjustments. Since the date of the most recent balance sheet included as part of the Financial Statements,
there has not been to the Company’s knowledge: (i) any change in the assets, liabilities, financial condition or operations
of the Company from that reflected in the Financial Statements, other than changes in the ordinary course of business, none of
which individually or in the aggregate would reasonably be expected to have a Material Adverse Effect; or (ii) any other event
or condition of any character that, either individually or cumulatively, would reasonably be expected to have a Material Adverse
Effect, except for the expenses incurred in connection with the transactions contemplated by this Agreement.

 

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3.9           Title
to Properties and Assets; Liens, Etc. The Company has good and marketable title to its properties and assets, including the
properties and assets reflected in the most recent balance sheet included in the Financial Statements, and good title to its leasehold
estates, in each case subject to no mortgage, pledge, lien, lease, encumbrance or charge, other than (a) those resulting from taxes
which have not yet become delinquent; (b) liens and encumbrances which do not materially detract from the value of the property
subject thereto or materially impair the operations of the Company; (c) those that have otherwise arisen in the ordinary course
of business; and (d) those that would not reasonably be expected to have a Material Adverse Effect. The Company is in compliance
with all material terms of each lease to which it is a party or is otherwise bound.

 

3.10         Patents
and Trademarks. Except as would not reasonably be expected to have a Material Adverse Effect or as disclosed in Schedule [
___ ] hereto, to the Company’s knowledge, (i) the Company owns or possesses adequate licenses or other rights to use all
patents, patent applications, trademarks, trademark applications, service marks, service mark applications, trade names, copyrights,
manufacturing processes, formulae, trade secrets, licenses, customer lists and know how (collectively, “Intellectual Property”),
(ii) the Company has not received any communications alleging that the Company has violated or, by conducting its business as conducted,
would violate any of the patents, trademarks, service marks, trade names, copyrights or trade secrets or other proprietary rights
or processes of any other person or entity, nor is the Company aware of any basis therefor and (iii) no claim is pending or, to
the Company’s knowledge after due inquiry, threatened to the effect that any Intellectual Property owned or licensed by the
Company, or which the Company otherwise has the right to use, is invalid or unenforceable by the Company.

 

3.11         Obligations
to Related Parties. Except as disclosed in Schedule [ ___ ] hereto or as would not reasonably be expected to have a Material
Adverse Effect, there are no obligations of the Company to officers, directors, stockholders, or employees of the Company other
than (a) for payment of salary or other compensation for services rendered, (b) reimbursement for reasonable expenses incurred
on behalf of the Company, (c) standard indemnification provisions in the Certificate of Incorporation and By-laws, and (d) for
other standard employee benefits made generally available to all employees (including stock option agreements outstanding under
any stock option plan approved by the Board of Directors of the Company). Except as may be disclosed in the Financial Statements,
the Company is not a guarantor or indemnitor of any indebtedness of any other person, firm or corporation other than its wholly
owned subsidiaries, if any.

 

3.12         Employee
Relations; Employee Benefit Plans. The Company is not a party to any collective bargaining agreement or a union contract. The
Company believes that its relations with its employees are good. No executive officer (as defined in Rule 501(f) of the Securities
Act) of the Company has notified the Company that such officer intends to leave the Company or otherwise terminate such officer’s
employment with the Company. The Company is in compliance with all federal, state, local and foreign laws and regulations respecting
employment and employment practices, terms and conditions of employment and wages and hours, except where failure to be in compliance
would not, either individually or in the aggregate, reasonably be expected to result in a Material Adverse Effect. Except as disclosed
in Schedule [ ___ ] hereto, the Company does not maintain any compensation or benefit plan, agreement, arrangement or commitment
(including, but not limited to, “employee benefit plans”, as defined in Section 3(3) of the Employee Retirement Income
Security Act of 1974, as amended (“ERISA”)) for any present or former employees, officers or directors of the
Company or with respect to which the Company has liability or makes or has an obligation to make contributions, other than any
such plans, agreements, arrangements or commitments made generally available to the Company’s employees.

 

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3.13         Environmental
Laws. To its knowledge, the Company (i) is in compliance with any and all Environmental Laws (as hereinafter defined), (ii)
has received all permits, licenses or other approvals required of it under applicable Environmental Laws to conduct its business
and (iii) is in compliance with all terms and conditions of any such permit, license or approval where, in each of the foregoing
clauses (i), (ii) and (iii), the failure to so comply would reasonably be expected to have, individually or in the aggregate, a
Material Adverse Effect. The term “Environmental Laws” means all federal, state, local or foreign laws relating
to pollution or protection of human health or the environment (including, without limitation, ambient air, surface water, groundwater,
land surface or subsurface strata), including, without limitation, laws relating to emissions, discharges, releases or threatened
releases of chemicals, pollutants, contaminants, or toxic or hazardous substances or wastes (collectively, “Hazardous
Materials”) into the environment, or otherwise relating to the manufacture, processing, distribution, use, treatment,
storage, disposal, transport or handling of Hazardous Materials, as well as all authorizations, codes, decrees, demands or demand
letters, injunctions, judgments, licenses, notices or notice letters, orders, permits, plans or regulations issued, entered, promulgated
or approved thereunder.

 

3.14         Tax
Status. To the best of the Company’s knowledge, the Company (i) has made or filed all federal and state income and all
other tax returns, reports and declarations required by any jurisdiction to which it is subject, (ii) has paid all taxes and other
governmental assessments and charges that are material in amount, shown or determined to be due on such returns, reports and declarations,
except those being contested in good faith and (iii) has set aside on its books provision reasonably adequate for the payment of
all taxes for periods subsequent to the periods to which such returns, reports or declarations apply. There are no unpaid taxes
in any material amount claimed to be due by the taxing authority of any jurisdiction, and the Company knows of no basis for any
such claim.

 

3.15         Absence
of Certain Changes. Since [ _____ ], there has been no change in the business, operations, conditions (financial or otherwise),
prospects, assets or results of operations of the Company or any of its subsidiaries that could reasonably be expected to have
a Material Adverse Effect.

 

3.16         Disclosure.
The information set forth herein as of the date hereof contains no untrue statement of a material fact nor omits to state a material
fact necessary in order to make the statements contained therein, in light of the circumstances under which they were made, not
misleading.

 

3.17         Indemnification.
The Company agrees to hold the Subscriber and its directors, officers, employees, affiliates, controlling persons and agents and
their respective heirs, representatives, successors and assigns harmless and to indemnify them against all liabilities, costs and
expenses incurred by them as a result of (a) any sale or distribution of the Securities by the Company in violation of the Securities
Act or any applicable state or foreign securities or “blue sky” laws; or (b) any false representation or warranty or
any breach or failure by the Company to comply with any covenant made by the Company in this Agreement or any other document furnished
by the Company to any of the foregoing in connection with this transaction; provided, however, that in no event shall any indemnity
under this Subsection 3.18 exceed the aggregate principal amount of the Replacement Note, except in the case of willful fraud by
the Subscriber.

 

3.18         Fund
Investors. In the event Subscriber is a Fund, the Fund investors shall be permitted to rely on the representations and warranties
of the Company set forth in this Section 3 in connection with such investors’ investment in the Fund. “Fund”
means an entity whose sole business is the purchase of the Securities.

 

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3.19         Solvency.
Based on the financial condition of the Subscriber as of the Closing Date, after giving effect to the receipt by the Subscriber
of the proceeds from the sale of the Securities hereunder: (i) the fair saleable value of the Subscriber’s assets exceeds
the amount that will be required to be paid on or in respect of the Subscriber’s existing debts and other liabilities (including
known contingent liabilities) as they mature, (ii) the Subscriber’s assets do not constitute unreasonably small capital to
carry on its business as now conducted and as proposed to be conducted including its capital needs taking into account the particular
capital requirements of the business conducted by the Subscriber, and projected capital requirements and capital availability thereof,
and (iii) the current cash flow of the Subscriber, together with the proceeds the Subscriber would receive, were it to liquidate
all of its assets, after taking into account all anticipated uses of the cash, would be sufficient to pay all amounts on or in
respect of its liabilities when such amounts are required to be paid. The Subscriber does not intend to incur debts beyond its
ability to pay such debts as they mature (taking into account the timing and amounts of cash to be payable on or in respect of
its debt). The Subscriber has no knowledge of any facts or circumstances which lead it to believe that it will file for reorganization
or liquidation under the bankruptcy or reorganization laws of any jurisdiction within one year from the Closing Date. For the purposes
of this Agreement, “Indebtedness” means (x) any liabilities for borrowed money or amounts owed in excess of
$50,000 (other than trade accounts payable incurred in the ordinary course of business), (y) all guaranties, endorsements and other
contingent obligations in respect of indebtedness of others, whether or not the same are or should be reflected in the Subscriber’s
balance sheet (or the notes thereto), except guaranties by endorsement of negotiable instruments for deposit or collection or similar
transactions in the ordinary course of business; and (z) the present value of any lease payments in excess of $50,000 due under
leases required to be capitalized in accordance with GAAP. The Subscriber is not in default with respect to any Indebtedness.

 

3.20         Compliance
with Laws. The Subscriber has complied and remains in compliance with all applicable statutes, laws, rules, regulations and
orders of all governmental authorities relating to drug development and commercialization, with respect to the conduct of the Subscriber’s
biopharmaceutical business, including those enforced by the United States Food and Drug Administration and comparable state regulatory
authorities and regulatory authorities outside the United States, except where the failure to so comply would not have a Material
Adverse Effect.

 

IV.          CONDITIONS
TO OBLIGATIONS OF THE PARTIES

 

4.1         The Company’s obligation to issue the Securities
at the Closing to the Subscriber is subject to the fulfillment on or prior to the Closing of the following conditions, which conditions
may be waived at the option of the Company to the extent permitted by law:

 

(a)          The
representations and warranties made by the Subscriber in [Article II] hereof shall be true and correct in all material respects.

 

(b)          All
covenants, agreements and conditions contained in this Agreement to be performed by such Subscriber on or prior to the date of
the Closing shall have been performed or complied with in all material respects.

 

(c)          There
shall not then be in effect any legal or other order enjoining or restraining the transactions contemplated by this Agreement.

 

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(d)          There
shall not be in effect any law, rule or regulation prohibiting or restricting such sale or requiring any consent or approval of
any person, which shall not have been obtained, to issue the Securities (except as otherwise provided in this Agreement).

 

4.2           The
Subscriber’s obligation to purchase the Securities at the Closing is subject to the fulfillment on or prior to the Closing
of the following conditions, which conditions may be waived at the option of the Subscriber to the extent permitted by law:

 

(a)          The
representations and warranties made by the Company in [Article III] hereof shall be true and correct in all material respects.

 

(b)          All
covenants, agreements and conditions contained in this Agreement to be performed by the Company on or prior to the date of the
Closing shall have been performed or complied with in all material respects.

 

(c)          There
shall not then be in effect any legal or other order enjoining or restraining the transactions contemplated by this Agreement.

 

(d)          There
shall not be in effect any law, rule or regulation prohibiting or restricting such sale or requiring any consent or approval of
any person, which shall not have been obtained, to issue the Securities (except as otherwise provided in this Agreement).

 

(e)          The
Placement Agent shall have received an Officer’s Certificate addressed to the Subscriber, signed by the authorized officer
of the Company and dated as of the Closing. The certificate shall state, among other things, that the representations and warranties
contained herein are true and accurate in all material respects as of the date hereof and the Placement Agent shall be entitled
to rely on such representations of the Company as if they were made directly to the Placement Agent.

 

V.           [REGISTRATION RIGHTS1

 

5.1           Definitions.
As used in this Agreement, the following terms shall have the following meanings:

 

(a)          
The term “Holder” shall mean any holder of Registrable Securities.

 

(b)          
The terms “register”,
“registered” and “registration” refer to a registration effected by preparing and filing
a registration statement or similar document in compliance with the Securities Act, and the declaration or order of effectiveness
of such registration statement or document.

 

(c)          
The term “Registrable Securities”
shall mean (i) the common stock underlying the Warrant (the “Shares”); and (ii) any shares of equity securities
issuable (or issuable upon the conversion or exercise of any warrant, right or other security that is issued) pursuant to a dividend
or other distribution with respect to or in replacement of any Shares; provided, however, that securities shall only be treated
as Registrable Securities if and only for so long as they (A) have not been disposed of pursuant to a registration statement
declared effective by the SEC; (B) have not been sold in a transaction exempt from the registration and prospectus delivery
requirements of the Securities Act so that all transfer restrictions and restrictive legends with respect thereto are removed upon
the consummation of such sale; (C) are held by a Holder or a permitted transferee of a Holder pursuant to Section 5.11;
or (D) may not be disposed of under Rule 144 under the Securities Act without restriction.

 

 

1
Registration rights available only in the event this Agreement is for the sale of a warrant to purchase shares of the Company’s
equity securities.

 

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(d)          
 The term “Trading Event”
means the first date on which the Company’s Common Stock trades on a national securities exchange or the Over-the-Counter
Bulletin Board.         

 

5.2         Piggyback
Registration.

 

(a)          The
Company agrees that if, at any time, and from time to time, after the earlier to occur of (i) an initial public offering of
the Company’s equity securities pursuant to a registration statement declared effective by the SEC (“IPO”)
and (ii) a Trading Event, the Board of Directors of the Company (the “Board”) authorizes the filing of
a registration statement under the Securities Act (other than the filing of a registration statement pursuant to the IPO or a registration
statement on Form S-8, Form S-4 or any other form that does not include substantially the same information as would be required
in a form for the general registration of securities) in connection with the proposed offer of any of its securities by it or any
of its stockholders, the Company shall: (A) promptly notify each Holder that such registration statement will be filed and
that the Registrable Securities then held by such Holder will be included in such registration statement at such Holder’s
request; (B) subject to Section 5.7, cause such registration statement to cover all of such Registrable Securities issued
to such Holder for which such Holder requests inclusion; (C) use reasonable best efforts to cause such registration statement
to become effective as soon as practicable; and (D) take all other reasonable action necessary under any Federal or state
law or regulation of any governmental authority to permit all such Registrable Securities that have been issued to such Holder
to be sold or otherwise disposed of, and will maintain such compliance with each such Federal and state law and regulation of any
governmental authority for the period necessary for such Holder to promptly effect the proposed sale or other disposition.

 

(b)          Notwithstanding any other provision
of this Section 5.2, the Company may at any time, abandon or delay any registration commenced by the Company. In the event
of such an abandonment by the Company, the Company shall not be required to continue registration of shares requested by the Holder
for inclusion and the Holder shall retain the right to request inclusion of shares as set forth above.

 

5.3           Demand
Registration.

 

(a)          Registration
on Request.

 

(i)          The
Company agrees that, at any time, and from time to time, but at least 30 days after the earlier to occur of (A) an IPO and
(B) a Trading Event, Holders of a majority of the Registrable Securities may make a written request that the Company effect
the registration under the Securities Act of outstanding Registrable Securities; provided that such requested registration
would cover at least 51% of the Registrable Securities owned by all the Holders at such time; and provided,  further,
that the Holders shall be entitled to no more than one such demand registration; and provided, further, that the Company
agrees to register the Registrable Securities within 60 days of the request, and that the registration is declared effective by
the SEC within 120 after the request.

 

(ii)         The
Company further agrees that if, at any time, and from time to time, after the Company has qualified for the use of Form S-3 or
any successor form, one or more of the Holders desire to effect the registration under the Securities Act on Form S-3 or any successor
form (“Short-Form Registration”) of outstanding Registrable Securities, such Holder(s) may make a written request
that the Company effect a Short-Form Registration; provided, that the Company shall not be required to effect more than
one Short Form Registration in any 12-month period.

 

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(iii)        Each
request made by one or more of the Holders pursuant to subsection (i) or (ii) above (the “Initiating Holders”)
will specify the number of shares of Registrable Securities proposed to be sold and will also specify the intended method of disposition
thereof. Following receipt of any such request, the Company shall promptly notify all Holders other than the Initiating Holders
of receipt of such request and the Company shall use its best efforts to file, within 60 days of such request, a registration statement
under the Securities Act with respect to the Registrable Securities that the Company has been so requested to register in the request
by the Initiating Holders (and in all notices received by the Company from such other Holders within 30 days after the giving of
such notice by the Company), to the extent necessary to permit the disposition (in accordance with the intended methods thereof
as aforesaid) of the Registrable Securities to be registered. If such method of disposition shall be an underwritten public offering,
the Holders of a majority of the shares of Registrable Securities to be sold in such offering may designate the managing underwriter
of such offering, subject to the approval of the Company, which approval shall not be unreasonably withheld or delayed. The Holders
will be permitted to withdraw Registrable Securities from a registration at any time prior to the effective date of such registration;
provided the remaining number of shares of Registrable Securities subject to a requested registration is not less than the
minimum amount required pursuant to this Section 5.3.

 

(b)          Limitations
on Demand Registration. Notwithstanding Section 5.3(a), the Company shall not be obligated to file a registration statement
relating to a registration request pursuant to this Section 5.3 at any time during the 180-day period immediately following
the effective date of any registration statement filed by the Company (other than on Form S-8 or S-4 or any other form that does
not include substantially the same information as would be required in a form for the general registration of securities); and
if the Board determines, in its good faith judgment, that the Company (i) should not file any registration statement otherwise
required to be filed pursuant to Section 5.3 or (ii) should withdraw any such previously filed registration statement
because the Board determines, in its good faith judgment, that the Company is in the possession of material nonpublic information
required to be disclosed in such registration statement or an amendment or supplement thereto, the disclosure of which in such
registration statement would be materially disadvantageous to the Company (a “Disadvantageous Condition”), the
Company shall be entitled to postpone for the shortest reasonable period of time (but not exceeding 90 days from the date of the
determination), the filing of such registration statement or, if such registration statement has already been filed, may suspend
or withdraw such registration statement and shall promptly give the Holders written notice of such determination and an approximation
of the anticipated delay. Upon the receipt of any such notice, such Holders shall forthwith discontinue use of the prospectus contained
in such registration statement and, if so directed by the Company, shall deliver to the Company all copies of the prospectus then
covering such Registrable Securities current at the time of receipt of such notice (or, if no registration statement has yet been
filed, all drafts of the prospectus covering such Registrable Securities). If any Disadvantageous Condition shall cease to exist,
the Company shall promptly notify the Holders to such effect. If any registration statement shall have been withdrawn, the Company
shall, at such time as it is possible or, if earlier, at the end of the 90-day period following such withdrawal, file a new registration
statement covering the Registrable Securities that were covered by such withdrawn registration statement. The Company’s right
to delay a request for registration or to withdraw a registration statement pursuant to this Section 5.3 may not be exercised
more than once in any one-year period.

 

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(c)          Effect
of Failure to File and Obtain and Maintain Effectiveness of any Registration Statement. If (i) a registration statement covering
the resale of all of the Registrable Securities required to be covered thereby and required to be filed by the Company pursuant
to Section 5.3(a)(i) of this Agreement (a “Demand Registration Statement”) is (A) not filed with the SEC on
or before the deadline set forth in Section 5.3(a)(i) for such Demand Registration Statement (a “Filing Failure”)
or (B) not declared effective by the SEC on or before the deadline set forth in Section 5.3(a)(i) (an “Effectiveness Failure”),
(ii) on any day after the effective date of a Demand Registration Statement sales of all of the Registrable Securities required
to be included on such Demand Registration Statement cannot be made pursuant to such Demand Registration Statement (including,
without limitation, because of a failure to keep such Demand Registration Statement effective, a failure to disclose such information
as is necessary for sales to be made pursuant to such Demand Registration Statement, a suspension or delisting of (or a failure
to timely list) the shares of common stock on the stock’s public market, or a failure to register a sufficient number of
shares of common stock or by reason of a stop order) or the prospectus contained therein is not available for use for any reason
(a “Maintenance Failure”), or (iii) if a Demand Registration Statement is not effective for any reason or the
prospectus contained therein is not available for use for any reason, the Company fails to file with the SEC any required reports
under Section 13 or 15(d) of the Exchange Act such that it is not in compliance with Rule 144(c)(1) (a “Current Public
Information Failure”) as a result of which any of the Holders are unable to sell Registrable Securities without restriction
under Rule 144 (including, without limitation, volume restrictions), then, as partial relief for the damages to any Holder by reason
of any such delay in, or reduction of, its ability to sell the underlying shares of common stock (which remedy shall not be exclusive
of any other remedies available at law or in equity), the Company shall pay to each holder of Registrable Securities relating to
such Demand Registration Statement an amount in cash equal to one percent (1%) of such Holder’s original purchase price pursuant
to the Warrant (1) on the date of such Filing Failure, Effectiveness Failure, Maintenance Failure or Current Public Information
Failure, as applicable, and (2) on every thirty (30) day anniversary of (I) a Filing Failure until such Filing Failure is cured;
(II) an Effectiveness Failure until such Effectiveness Failure is cured; (III) a Maintenance Failure until such Maintenance Failure
is cured; and (IV) a Current Public Information Failure until the earlier of (i) the date such Current Public Information Failure
is cured and (ii) such time that such public information is no longer required pursuant to Rule 144 (in each case, pro rated for
periods totaling less than thirty (30) days). The payments to which a holder of Registrable Securities shall be entitled pursuant
to this Section 5.3(c) are referred to herein as “Registration Delay Payments.” Following the initial Registration
Delay Payment for any particular event or failure (which shall be paid on the date of such event or failure, as set forth above),
without limiting the foregoing, if an event or failure giving rise to the Registration Delay Payments is cured prior to any thirty
(30) day anniversary of such event or failure, then such Registration Delay Payment shall be made on the third (3rd) business day
after such cure. In the event the Company fails to make Registration Delay Payments in a timely manner in accordance with the foregoing,
such Registration Delay Payments shall bear interest at the rate of one percent (1%) per month (prorated for partial months) until
paid in full. Notwithstanding the foregoing, no Registration Delay Payments shall be owed to a Holder (other than with respect
to a Maintenance Failure resulting from a suspension or delisting of (or a failure to timely list) the shares of common on the
stock’s public market) with respect to any period during which all of such Holder’s Registrable Securities may be sold
by such Holder without restriction under Rule 144 (including, without limitation, volume restrictions) and without the need for
current public information required by Rule 144(c)(1). Notwithstanding the foregoing, the maximum aggregate Registration Delay
Payment payable pursuant to this Section 5.3(c) shall not exceed six percent (6%) of such Holder’s original purchase price
pursuant to the Warrant.

 

5.4           Registration
Procedures. Whenever required under this Article V to include Registrable Securities in a Company registration statement, the
Company shall, as expeditiously as reasonably possible:

 

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(a)           Use reasonable best efforts to (i) cause
such registration statement to become effective, and (ii) cause such registration statement to remain effective in accordance
with Section 5.12 hereof. The Company will also use its reasonable best efforts to, during the period that such registration
statement is required to be maintained hereunder, file such post-effective amendments and supplements thereto as may be required
by the Securities Act and the rules and regulations thereunder or otherwise to ensure that the registration statement does not
contain any untrue statement of material fact or omit to state a fact required to be stated therein or necessary to make the statements
contained therein, in light of the circumstances under which they are made, not misleading; provided, however, that if applicable
rules under the Securities Act governing the obligation to file a post-effective amendment permits, in lieu of filing a post-effective
amendment that (i) includes any prospectus required by Section 10(a)(3) of the Securities Act or (ii) reflects facts
or events representing a material or fundamental change in the information set forth in the registration statement, the Company
may incorporate by reference information required to be included in (i) or (ii) in the preceding sentence to the extent
such information is contained in periodic reports filed pursuant to Section 13 or 15(d) of the Exchange Act in the registration
statement. In the event that the Company becomes qualified for the use of Form S-3 or any successor form at a time when any registration
statement on any other Form which includes Registrable Securities is required to be maintained hereunder, the Company shall, upon
the request of any selling Holder, subject to Section 5.5, (i) as expeditiously as reasonably possible, use reasonable
best efforts to cause a Short-Form Registration covering such Registrable Securities to become effective and (ii) comply with
each of the other requirements of this Section 5.4 which may be applicable thereto. Upon the effectiveness of such Short-Form
Registration, the Company shall be relieved of its obligations hereunder to keep in effect the registration statement which initially
covered the Registrable Securities included in such Short-Form Registration.

 

(b)          
Prepare and file with the SEC such amendments and supplements to such registration statement, and the prospectus used in connection
with such registration statement, as may be necessary to comply with the provisions of the Securities Act with respect to the disposition
of all securities covered by such registration statement.

 

(c)          
 Furnish to the selling Holders such
numbers of copies of a prospectus, including a preliminary prospectus as amended or supplemented from time to time, in conformity
with the requirements of the Securities Act, and such other documents as they may reasonably request in order to facilitate the
disposition of Registrable Securities owned by them.

 

(d)          
Use reasonable best efforts to register
and qualify the securities covered by such registration statement under the state securities laws of such jurisdictions as shall
be reasonably requested by the selling Holders; provided, however, that the Company shall not be required in connection therewith
or as a condition thereto to qualify to do business or to file a general consent to service of process in any such states, unless
the Company is already subject to service in such jurisdiction and except as may be required by the Securities Act.

 

(e)          
In the event of any underwritten
public offering, enter into and perform its obligations under an underwriting agreement, in usual and customary form, with the
managing underwriter of such offering. Each selling Holder participating in such underwriting shall also enter into and perform
its obligations under such an agreement.

 

(f)          
Notify each Holder of Registrable Securities covered by such registration statement, at any time when a prospectus relating thereto
is required to be delivered under the Securities Act, (i) when the registration statement or any post-effective amendment
and supplement thereto has become effective; (ii) of the issuance by the SEC of any stop order or the initiation of proceedings
for that purpose (in which event the Company shall make every effort to obtain the withdrawal of any order suspending effectiveness
of the registration statement at the earliest possible time or prevent the entry thereof); (iii) of the receipt by the Company
of any notification with respect to the suspension of the qualification of the Registrable Securities for sale in any jurisdiction
or the initiation of any proceeding for such purpose; and (iv) of the happening of any event as a result of which the prospectus
included in such registration statement, as then in effect, includes an untrue statement of a material fact or omits to state a
material fact required to be stated therein or necessary to make the statements therein not misleading in the light of the circumstances
then existing (and each Holder agrees to suspend any trading under the registration statement until such condition is abated).

 

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(g)          
Cause all such Registrable Securities registered hereunder to be listed on each securities exchange or quotation service on which
similar securities issued by the Company are then listed or quoted or, if no such similar securities are listed or quoted on a
securities exchange or quotation service, apply for qualification and use reasonable best efforts to qualify such Registrable Securities
for inclusion on a national securities exchange or the Over-the-Counter Bulletin Board.

 

(h)          
Provide a transfer agent and registrar for all Registrable Securities registered hereunder and a CUSIP number for all such Registrable
Securities, in each case not later than the effective date of such registration.

 

(i)          
Cooperate with the selling Holders
and the managing underwriters, if any, to facilitate the timely preparation and delivery of certificates representing the Registrable
Securities to be sold, which certificates will not bear any restrictive legends; and enable such Registrable Securities to be in
such denominations and registered in such names as the managing underwriters, if any, shall request at least two business days
prior to any sale of the Registrable Securities to the underwriters.

 

5.5           Furnish
Information. It shall be a condition precedent to the obligation of the Company to take any action pursuant to this Article
V with respect to the Registrable Securities of any Holder that such Holder shall furnish to the Company such information regarding
the Holder, the Registrable Securities held by the Holder, and the intended method of disposition of such securities as shall be
reasonably required by the Company to effect the registration of such Holder’s Registrable Securities.

 

5.6           Registration
Expenses. The Company shall bear and pay all expenses incurred in connection with any registration, filing or qualification
of Registrable Securities with respect to registrations pursuant to Sections 5.2 or 5.3 for each Holder, including (without limitation)
all registration, filing, and qualification fees, printers and accounting fees relating or apportionable thereto (“Registration
Expenses”), but excluding underwriting discounts and commissions relating to Registrable Securities and excluding any
professional fees or costs of accounting, financial or legal advisors to any of the Holders, except that the Company shall pay
the legal fees for the Holders, such fees not to exceed $10,000 in the aggregate.

 

5.7           Underwriting
Requirements. In connection with any offering involving an underwriting of shares of the Company’s capital stock, the
Company shall not be required under Section 5.2 to include any of the Holders’ Registrable Securities in such underwriting
unless they accept the terms of the underwriting as agreed upon between the Company and the underwriters selected by it (or by
other persons entitled to select the underwriters), and then only in such quantity as the underwriters determine in their sole
discretion will not jeopardize the success of the offering by the Company. If the total amount of securities, including Registrable
Securities, requested by stockholders to be included in such offering exceeds the amount of securities sold other than by the Company
that the underwriters determine in their sole discretion is compatible with the success of the offering, then the Company shall
be required to include in the offering only that number of such securities, including Registrable Securities, which the underwriters
determine in their sole discretion will not jeopardize the success of the offering (the securities so included to be apportioned
pro rata among the selling Holders according to the total amount of securities entitled to be included therein owned by each selling
Holder or in such other proportions as shall mutually be agreed to by such selling Holders). For purposes of the preceding parenthetical
concerning apportionment, for any selling Holder who is a holder of Registrable Securities and is a partnership or corporation,
the partners, retired partners and stockholders of such Holder, or the estates and family members of any such partners and retired
partners and any trusts for the benefit of any of the foregoing persons shall be deemed to be a single “selling Holder”,
and any pro-rata reduction with respect to such “selling Holder” shall be based upon the aggregate amount of shares
carrying registration rights owned by all entities and individuals included in such “selling Holder”, as defined in
this sentence.

 

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5.8           Delay
of Registration. No Holder shall have any right to obtain or seek an injunction restraining or otherwise delaying any such
registration as the result of any controversy that might arise with respect to the interpretation or implementation of this Article
V.

 

5.9           Indemnification.
In the event that any Registrable Securities are included in a registration statement under this Article V:

 

(a)          To
the extent permitted by law, the Company will indemnify and hold harmless each Holder, any underwriter (as defined in the Securities
Act) for such Holder and each person, if any, who controls such Holder or underwriter within the meaning of the Securities Act
or the Exchange Act, against any losses, claims, damages, or liabilities (joint or several) to which they may become subject under
the Securities Act, or the Exchange Act, insofar as such losses, claims, damages, or liabilities (or actions in respect thereof)
arise out of or are based upon any of the following statements, omissions or violations (collectively a “Violation”):
(i) any untrue statement or alleged untrue statement of a material fact contained in such registration statement, including
any preliminary prospectus or final prospectus contained therein or any amendments or supplements thereto, (ii) the omission
or alleged omission to state therein a material fact required to be stated therein, or necessary to make the statements therein
not misleading, or (iii) any violation or alleged violation by the Company of the Securities Act, the Exchange Act, or any
rule or regulation promulgated under the Securities Act, or the Exchange Act, and the Company will pay to each such Holder, underwriter
or controlling person, as incurred, any legal or other expenses reasonably incurred by them in connection with investigating or
defending any such loss, claim, damage, liability, or action; provided, however, that the indemnity agreement contained in this
Section 5.9(a) shall not apply to amounts paid in settlement of any such loss, claim, damage, liability, or action if such
settlement is effected without the consent of the Company (which consent shall not be unreasonably withheld), nor shall the Company
be liable in any such case for any such loss, claim, damage, liability, or action to the extent that it arises out of or is based
upon a Violation which occurs in reliance upon and in conformity with written information furnished expressly for use in connection
with such registration by any such Holder, underwriter or controlling person or a violation of any provision of this Agreement
by a Holder.

 

(b)          To the extent permitted by law,
each selling Holder will indemnify and hold harmless the Company, each of its directors, each of its officers, each person, if
any, who controls the Company within the meaning of the Securities Act, any underwriter, any other Holder selling securities in
such registration statement and any controlling person of any such underwriter or other Holder, against any losses, claims, damages,
or liabilities (joint or several) to which any of the foregoing persons may become subject, under the Securities Act, or the Exchange
Act, insofar as such losses, claims, damages, or liabilities (or actions in respect thereto) arise out of or are based upon any
Violation, in each case to the extent (and only to the extent) that such Violation occurs in reliance upon and in conformity with
written information furnished by such Holder expressly for use in connection with such registration or a violation of any provision
of this Agreement by a Holder; and each such Holder will pay, as incurred, any legal or other expenses reasonably incurred by any
person intended to be indemnified pursuant to this Section 5.9(b), in connection with investigating or defending any such
loss, claim, damage, liability, or action; provided, however, that the indemnity agreement contained in this Section 5.9(b)
shall not apply to amounts paid in settlement of any such loss, claim, damage, liability or action if such settlement is effected
without the consent of the Holder, which consent shall not be unreasonably withheld; provided, further, that, in
no event shall any indemnity under this Section 5.9(b) exceed the greater of the cash value of the (i) gross proceeds
from the offering received by such Holder or (ii) such Holder’s investment pursuant to this Agreement as set forth on
the signature page attached hereto.

 

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(c)          Promptly
after receipt by an indemnified party under this Section 5.9 of notice of the commencement of any action (including any governmental
action), such indemnified party shall, if a claim in respect thereof is to be made against any indemnifying party under this Section 5.9,
deliver to the indemnifying party a written notice of the commencement thereof and the indemnifying party shall have the right
to participate in, and, to the extent the indemnifying party so desires, jointly with any other indemnifying party similarly notified,
to assume the defense thereof with counsel selected by the indemnifying party and approved by the indemnified party (whose approval
shall not be unreasonably withheld); provided, however, that an indemnified party (together with all other indemnified parties
which may be represented without conflict by one counsel) shall have the right to retain one separate counsel, with the fees and
expenses to be paid by the indemnifying party, if representation of such indemnified party by the counsel retained by the indemnifying
party would be inappropriate due to actual or potential differing interests between such indemnified party and any other party
represented by such counsel in such proceeding. The failure to deliver written notice to the indemnifying party within a reasonable
time of the commencement of any such action, if prejudicial to its ability to defend such action, shall relieve such indemnifying
party of any liability to the indemnified party under this Section 5.9, but the omission so to deliver written notice to
the indemnifying party will not relieve it of any liability that it may have to any indemnified party otherwise than under this
Section 5.9.

 

(d)          If the
indemnification provided for in this Section 5.9 is held by a court of competent jurisdiction to be unavailable to an indemnified
party with respect to any loss, liability, claim, damage, or expense referred to therein, then the indemnifying party, in lieu
of indemnifying such indemnified party hereunder, shall contribute to the amount paid or payable by such indemnified party as
a result of such loss, liability, claim, damage, or expense in such proportion as is appropriate to reflect the relative fault
of the indemnifying party on the one hand and of the indemnified party on the other in connection with the statements or omissions
that resulted in such loss, liability, claim, damage, or expense as well as any other relevant equitable considerations. The relative
fault of the indemnifying party and of the indemnified party shall be determined by reference to, among other things, whether
the untrue or alleged untrue statement of a material fact or the alleged omission to state a material fact relates to information
supplied by the indemnifying party or by the indemnified party and the parties’ relative intent, knowledge, access to information,
and opportunity to correct or prevent such statement or omission.

 

(e)          
Notwithstanding the foregoing, to the extent that the provisions on indemnification and contribution contained in the underwriting
agreement entered into in connection with the underwritten public offering are in conflict with the foregoing provisions, the
provisions in the underwriting agreement shall control.

 

(f)         
The
obligations of the Company and Holders under this Section 5.9 shall survive the completion of any offering of Registrable
Securities in a registration statement under this Article V, and otherwise.

 

5.10         Reports
under Securities Exchange Act of 1934. With a view to making available to the Holders the benefits of Rule 144 and any other
rule or regulation of the SEC that may at any time permit a Holder to sell securities of the Company to the public without registration
or pursuant to a registration on Form S-3, the Company agrees to:

 

    	18

    	 

    

 

(a)          
make
and keep public information available, as those terms are understood and defined in Rule 144, at all times after 90 days after
the effective date of the IPO or Trading Event by the Company;

 

(b)          
file with the SEC in a timely manner all reports and other documents required of the Company under the Securities Act and the
Exchange Act; and

 

(c)          
furnish
to any Holder, so long as the Holder owns any Registrable Securities, forthwith upon request (i) a copy of the most recent
annual or quarterly report of the Company and such other reports and documents so filed by the Company, and (ii) such other
information as may be reasonably requested in availing any Holder of any rule or regulation of the SEC which permits the selling
of any such securities without registration or pursuant to such form.

 

5.11         Permitted
Transferees. The rights to cause the Company to register Registrable Securities granted to the Holders by the Company under
this Article V may be assigned in full by a Holder in connection with a transfer by such Holder of its Registrable Securities
if: (a) such transferee agrees in writing to comply with the terms and provisions of this Agreement; (b) such transfer
is otherwise in compliance with this Agreement; (c) such transfer is otherwise effected in accordance with applicable securities
laws; and (d) such Holder transfers at least 51% of its shares of Registrable Securities to the transferee. Except as specifically
permitted by this Section 5.11, the rights of a Holder with respect to Registrable Securities as set out herein shall not
be transferable to any other Person, and any attempted transfer of such registration rights shall by void.

 

5.12         Termination
of Registration Rights. The right of any Holder to request or demand inclusion in any registration pursuant to Section 5.2
and Section 5.3 shall terminate if all Registrable Securities held by such Holder may immediately be sold under Rule 144
without restriction.]

 

VI.          MISCELLANEOUS

 

6.1           Any
notice or other communication given hereunder shall be deemed sufficient if in writing and sent by registered or certified mail,
return receipt requested, or delivered by hand against written receipt therefor, addressed as follows:

 

if
to the Company, to it at:

 

[ _____ ]

 

if to Coronado,
to it at:

 

Coronado Biosciences, Inc.

24 New England Executive
Park

Burlington, MA 01803

Attn: President

 

With a copy to:

 

Wyrick Robbins Yates &
Ponton LLP

4101 Lake Boone Trail, Suite
300

Raleigh, NC 27607-7506

Facsimile: (919) 781-4865

Attn: W. David Mannheim,
Esq.

 

    	19

    	 

    

 

if to the Subscriber, to
the Subscriber’s address indicated on the signature page of this Agreement.

 

Notices shall be deemed to have
been given or delivered on the date of mailing, except notices of change of address, which shall be deemed to have been given
or delivered when received.

 

6.2           Except
as otherwise expressly provided herein, any term of this Agreement may be amended and the observance of any term of this Agreement
may be waived (either generally or in a particular instance, either retroactively or prospectively and either for a specified
period of time or indefinitely) with the written consent of the Company and subscribers holding [Replacement Notes evidencing]
at least sixty six and two-thirds percent (66 2/3%) of the then outstanding [principal amount of the Replacement Notes]/[Warrants]
issued pursuant to this Agreement and substantially similar agreements. Any amendment or waiver effected in accordance with this
Section 6.2 shall be binding upon the Subscriber and the Company (even if the Subscriber does not consent to such amendment or
waiver), and upon the effectuation of each such amendment or waiver, the Company shall promptly give written notice thereof to
the Subscriber if the Subscriber has not previously consented thereto in writing.

 

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

 

6.4           Upon
the execution and delivery of this Agreement by the Subscriber, this Agreement shall become a binding obligation of the Subscriber
with respect to the purchase of Securities as herein provided, subject, however, to the right hereby reserved by the Company to
enter into the same agreements with other subscribers and to add and/or delete other persons as subscribers.

 

6.5           NOTWITHSTANDING
THE PLACE WHERE THIS AGREEMENT MAY BE EXECUTED BY ANY OF THE PARTIES HERETO, THE PARTIES EXPRESSLY AGREE THAT ALL THE TERMS AND
PROVISIONS HEREOF SHALL BE CONSTRUED IN ACCORDANCE WITH AND GOVERNED BY THE SUBSTANTIVE AND PROCEDURAL LAWS OF THE STATE OF NEW
YORK WITHOUT REGARD TO SUCH STATE’S PRINCIPLES OF CONFLICTS OF LAW. IN THE EVENT THAT A JUDICIAL PROCEEDING IS NECESSARY,
THE SOLE FORUM FOR RESOLVING DISPUTES ARISING OUT OF OR RELATING TO THIS AGREEMENT IS THE STATE AND FEDERAL COURTS sitting
in the Borough of Manhattan, County of New York. THE PARTIES HEREBY IRREVOCABLY CONSENT TO THE JURISDICTION OF SUCH COURTS
AND AGREE TO SAID VENUE.

 

6.6           The
holding of any provision of this Agreement to be invalid or unenforceable by a court of competent jurisdiction shall not affect
any other provision of this Agreement, which shall remain in full force and effect. If any provision of this Agreement shall be
declared by a court of competent jurisdiction to be invalid, illegal or incapable of being enforced in whole or in part, such
provision shall be interpreted so as to remain enforceable to the maximum extent permissible consistent with applicable law and
the remaining conditions and provisions or portions thereof shall nevertheless remain in full force and effect and enforceable
to the extent they are valid, legal and enforceable, and no provisions shall be deemed dependent upon any other covenant or provision
unless so expressed herein.

 

6.7           It
is agreed that a waiver by either party of a breach of any provision of this Agreement shall not operate, or be construed, as
a waiver of any subsequent breach by that same party.

 

    	20

    	 

    

 

6.8           The
parties agree to execute and deliver all such further documents, agreements and instruments and take such other and further action
as may be necessary or appropriate to carry out the purposes and intent of this Agreement.

 

6.9           This
Agreement may be executed in two or more counterparts each of which shall be deemed an original, but all of which shall together
constitute one and the same instrument.

 

6.10         Nothing
in this Agreement shall create or be deemed to create any rights in any person or entity not a party to this Agreement, except
that the Placement Agent may rely upon the representations and acknowledgements of the Subscriber in Articles II and [VII] hereof
and the representations and warranties of the Company in Article III hereof.

 

Remainder
of Page Intentionally Left Blank.

 

    	21

    	 

    

 

 

VII.         CONFIDENTIAL INVESTOR QUESTIONNAIRE

 

7.1           ALL
INVESTORS - The undersigned represents and warrants as indicated below by the undersigned’s mark:

 

	A.	 	Individual
    investors:  (Please mark one or more of the following statements)
	 	 	 
	1.	              	I certify that I am an accredited investor
    because I have had individual income (exclusive of any income earned by my spouse) of more than $200,000 in each of the most
    recent two years and I reasonably expect to have an individual income in excess of $200,000 for the current year.
	 	 	 
	2.	              	I certify that I am an accredited investor
    because I have had joint income with my spouse in excess of $300,000 in each of the most recent two years and reasonably expect
    to have joint income with my spouse in excess of $300,000 for the current year.
	 	 	 
	3.	              	I certify that I am an accredited investor
    because I have an individual net worth, or my spouse and I have a joint net worth, in excess of $1,000,000 (exclusive of my
    personal residence).
	 	 	 
	4.	              	I am a director or executive officer
    of the Company.

 

	B.		Partnerships,
                                         corporations, trusts or other entities: (Please mark one of the following seven statements).
                                         The undersigned hereby certifies that it is an accredited investor because it is:

 

	1.	              	an employee benefit plan
    whose total assets exceed $5,000,000;
	 	 	 
	2.	              	an employee benefit plan whose investments
    decisions are made by a plan fiduciary which is either a bank, savings and loan association or an insurance company (as defined
    in Section 3(a) of the Securities Act) or an investment adviser registered as such under the Investment Advisers Act of 1940;
	 	 	 
	3.	              	a self-directed employee benefit plan,
    including an Individual Retirement Account, with investment decisions made solely by persons that are accredited investors;
	 	 	 
	4.	              	an organization described in Section
    501(c)(3) of the Internal Revenue Code of 1986, as amended, not formed for the specific purpose of acquiring the Securities,
    with total assets in excess of $5,000,000;
	 	 	 
	5.	              	a corporation, partnership, limited
    liability company, limited liability partnership, other entity or similar business trust, not formed for the specific purpose
    of acquiring the Securities, with total assets excess of $5,000,000;
	 	 	 
	6.	              	a trust, not formed for the specific
    purpose of acquiring the Securities, with total assets exceed $5,000,000, whose purchase is directed by a person who has such
    knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of an investment
    in the Securities; or
	 	 	 
	7.	              	an entity (including a revocable grantor
    trust but other than a conventional trust) in which each of the equity owners qualifies as an accredited investor.

 

    	22

    	 

    

 

7.2           EUROPEAN
ECONOMIC AREA (“EEA”) INVESTORS - The undersigned further represents and warrants as indicated below by the undersigned’s
mark:

 

		A.	Please mark one of the following statements:

 

either

 

1.              The
undersigned hereby certifies that it is a Qualified Investor for the purposes of Directive 2003/71/EC because it is a person falling
within Article 2.1(e)(i), (ii) or (iii) of such directive or a person authorized by a jurisdiction in the EEA to be considered
as a qualified investor for the purposes of such directive;

 

or

 

2.              The
undersigned hereby certifies that it is not a Qualified Investor for the purposes of Directive 2003/71/EC.

 

B.           Please
mark one of the following statements.

 

1.              The
undersigned hereby certifies that it is acting on its own account and not for the account of or otherwise on behalf of any person
or persons; or

 

2.              The
undersigned is in the United Kingdom and is a Qualified Investor for the purposes of Directive 2003/71/EC and is acting as an
agent in the circumstances contemplated in section 86(2) of the United Kingdom Financial Services and Markets Act 2000.

 

C.           Please
mark the following statement:

 

1.              The
undersigned hereby certifies that it has not received any recommendation from the Placement Agent nor any person acting on their
behalf in relation to the purchase of the Securities.

 

D.           Please
mark one of the following statements:

 

1.              The
undersigned hereby certifies that it is not in the United Kingdom.

 

2.              The
undersigned hereby certifies that it is a person falling within Article 19(5) of the Financial Services and Markets Act 2000 (Financial
Promotion) Order 2005 (“FPO”).

 

3.              The
undersigned hereby certifies that it is a person falling within Article 49(2)(a) to the (d) of the FPO.

 

7.3           ALL
INVESTORS - The undersigned further represents and warrants as indicated below by the undersigned’s mark:

 

FINRA AFFILIATION.

 

Are you affiliated or associated with an FINRA member firm:

 

Yes _________No __________

 

    	23

    	 

    

 

If Yes, please describe:

_________________________________________________________

_________________________________________________________

_________________________________________________________

 

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

 

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

 

	 	 
	Name of FINRA Member Firm	 
	 	 
	By:	 	 
	Authorized Officer	 
	 	 
	Date:	 	 

 

7.4           ALL
INVESTORS - Indicate manner in which title is to be held (circle one)

 

	 	(a)	Individual Ownership
	 	(b)	Community Property
	 	(c)	Joint Tenant with Right of 
	 	 	Survivorship (both parties
	 	 	must sign)
	 	(d)	Partnership
	 	(e)	Tenants in Common
	 	(f)	Corporation
	 	(g)	Limited Liability Company
	 	(h)	Trust
	 	(i)	Other

 

The undersigned is informed of the significance to the Company
of the foregoing representations and answers contained in the Confidential Investor Questionnaire contained in this [Article VII]
and such answers have been provided under the assumption that the Company will rely on them.

 

    	24

    	 

    

 

AGGREGATE PRINCIPAL AMOUNT OF THE ORIGINAL NOTE = $                  
(TOTAL INVESTMENT)

 

	 	 	 	 
	Signature	 	Signature (if purchasing jointly)	 
	 	 	 	 
	 	 	 	 
	Name Typed or Printed	 	Name Typed or Printed	 
	 	 	 	 
	 	 	 	 
	Entity Name	 	Entity Name	 
	 	 	 	 
	 	 	 	 
	Address	 	Address	 
	 	 	 	 
	 	 	 	 
	City, State and Zip Code	 	City, State and Zip Code	 
	 	 	 	 
	 	 	 	 
	Telephone-Business	 	Telephone-Business	 
	 	 	 	 
	 	 	 	 
	Telephone-Residence	 	Telephone-Residence	 
	 	 	 	 
	 	 	 	 
	Facsimile-Business	 	Facsimile-Business	 
	 	 	 	 
	 	 	 	 
	Facsimile-Residence	 	Facsimile-Residence	 
	 	 	 	 
	 	 	 	 
	Tax ID # or Social Security #	 	Tax ID # or Social Security # 	 
	 	 	 	 
	Name in which securities should be issued:	 	 	 

 

	Dated:                                  	 , 201_	 

 

    	 

    	 

    

 

This Securities Purchase Agreement is agreed
to and accepted as of ______________________________.

 

	 	CORONADO BIOSCIENCES, INC.
	 	 	 
	 	By:	 
	 	Name:	Lindsay A. Rosenwald, MD
	 	Title:	Chief Executive Officer

 

	 	COMPANY:
	 	 
	 	[ __________ ]
	 	 	 
	 	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 

 

    	 

    	 

    

 

Annex A

 

CERTIFICATE OF SIGNATORY

 

(To be completed if Securities are

being subscribed for by an entity)

 

I,____________________________, am the____________________________
of __________________________________________ (the “Entity”).

 

I certify that I am empowered and duly authorized by the Entity
to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Securities, and certify further
that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding
obligation of the Entity.

 

IN WITNESS WHEREOF, I have set my hand this ________ day of
_________________, 201_

 

	 	 	 
	 	 	(Signature)

 

    	 

    	 

    

 

EXHIBIT A

 

[Form of Replacement Note]

 

[Form of Warrant]Exhibit 10.65

 

THE SECURITIES REPRESENTED HEREBY HAVE
NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR ANY STATE SECURITIES LAWS, AND MAY
NOT BE SOLD, TRANSFERRED, ASSIGNED OR HYPOTHECATED UNLESS THERE IS AN EFFECTIVE REGISTRATION STATEMENT UNDER SUCH ACT AND ANY APPLICABLE
STATE SECURITIES LAWS COVERING SUCH SECURITIES OR THE SALE IS MADE IN ACCORDANCE WITH AN EXEMPTION UNDER THE ACT AND ANY APPLICABLE
STATE SECURITIES LAWS, AND THE COMPANY RECEIVES AN OPINION OF COUNSEL FOR THE HOLDER OF THESE SECURITIES REASONABLY SATISFACTORY
TO THE COMPANY STATING THAT SUCH SALE, TRANSFER, ASSIGNMENT OR HYPOTHECATION IS EXEMPT FROM THE REGISTRATION AND PROSPECTUS DELIVERY
REQUIREMENTS OF SUCH ACT AND ANY APPLICABLE STATE SECURITIES LAWS.

 

[SUBCO]

 

COMMON STOCK WARRANT

 

This Warrant is issued as of this __ day
of ____________ 201_ (the “Issue Date”) by [SubCo], a Delaware corporation (the “Company”),
to _______________, or permitted assigns (the “Holder”).

 

1.          Issuance
of Warrant; Number and Type of Securities Subject to Warrant. Previously, the Holder made a loan to Company’s parent
and a portion of the loan was used for the benefit of the Company (the “SubCo Loan”). In consideration
of the Holder’s agreement to fund the SubCo Loan, the receipt and sufficiency of which are hereby acknowledged, the Company
hereby grants to the Holder the right to purchase a number of shares of the Company’s Common Stock (the “Common
Stock”) equal to the twenty five percent (25%) of the SubCo Loan divided by the lowest price at which equity securities
are sold in the first third party financing of the Company (the “SubCo Financing”). In the event of a
Deemed Liquidation Event occurring prior to the SubCo Financing, the price used will be the price per share to be received by the
common shareholders as a result of such Deemed Liquidation Event. The exercise price of the warrant will be the par value of the
Common Stock. A “Deemed Liquidation Event” shall mean: (A) any sale of all or substantially all of the
assets of the Company; (B) any consolidation or merger of the Company with or into any other corporation or other entity or person,
or any other corporate reorganization, other than any such consolidation, merger or reorganization in which the holders of equity
securities of the Company immediately prior to such consolidation, merger or reorganization, continue to hold a majority of the
equity securities of the surviving entity in substantially the same proportions (or, if the surviving entity is a wholly owned
subsidiary, its parent) immediately after such consolidation, merger or reorganization; or (C) any transaction or series of related
transactions to which the Company is a party in which in excess of fifty percent (50%) of the Company’s equity securities
are transferred.

 

    	 

    	 

    

 

2.            Term;
Exercise Price. This Warrant shall only be exercisable in accordance with the terms of Section 6 hereof, and shall expire on
the date that is ten (10) years after the Issue Date. The per share exercise price (the “Warrant Price”)
for the purchase of shares of Common Stock issuable pursuant to this Warrant (the “Warrant Shares”) shall
be $____, the par value of the Common Stock.

 

3.             Adjustments
and Notices. This Warrant shall be subject to adjustment from time to time in accordance with the following provisions.

 

(a)          Stock
Splits, Subdivisions or Combinations. If at any time on or after the date hereof the Company shall split, subdivide or otherwise
change its outstanding shares of any securities receivable upon exercise of this Warrant into a greater number of securities, the
Warrant Price in effect immediately prior to such subdivision shall thereby be proportionately reduced and the number of Warrant
Shares shall thereby be proportionately increased; and, conversely, if at any time on or after the date hereof the outstanding
number of shares of any securities receivable upon exercise of this Warrant shall be combined into a smaller number of securities,
the Warrant Price in effect immediately prior to such combination shall thereby be proportionately increased and the number of
Warrant Shares shall thereby be proportionately decreased, all subject to further adjustment as provided in this Section 3.

 

(b)          Reclassification.
If the Company, by reclassification of securities, reorganization of the Company (or any other entity the securities of which are
at the time receivable upon the exercise of this Warrant) or otherwise (including by merger or consolidation), shall change any
of the securities as to which purchase rights under this Warrant exist into the same or a different number of securities of any
other class or classes, this Warrant shall thereafter represent the right to acquire such number and kind of securities as would
have been issuable as the result of such change with respect to the securities that were subject to the purchase rights under this
Warrant immediately prior to such reclassification or other change and the Warrant Price therefor shall be appropriately adjusted,
all subject to further adjustment as provided in this Section 3.

 

(c)          No
Impairment. The Company shall not, by amendment of its Certificate of Incorporation or Bylaws, each as amended to date, or
through a reorganization, transfer of assets, consolidation, merger, dissolution, issue, or sale of securities or any other voluntary
action, avoid or seek to avoid the observance or performance of any of the terms to be observed or performed under this Warrant
by the Company, but shall at all times in good faith assist in carrying out the provisions of this Warrant and in taking all such
action as may be necessary or appropriate to protect the Holder’s rights under this Warrant against impairment.

 

(d)          Fractional
Shares. No fractional Warrant Shares shall be issuable upon exercise or conversion of the Warrant and the number of Warrant
Shares to be issued shall be rounded to the nearest whole Warrant Share. If a fractional Warrant Share arises upon any exercise
or conversion of the Warrant, the Company shall eliminate such fractional Warrant Share by paying the Holder an amount computed
by multiplying the fractional interest by the fair market value of a full Warrant Share.

 

    	2

    	 

    

 

4.            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 on 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.

 

5.            Shares
to be Fully Paid; Reservation of Shares. The Company covenants and agrees that all Warrant Shares will, upon issuance and payment
of the applicable Warrant Price, be duly authorized, validly issued, fully paid and nonassessable, and free of all preemptive rights,
liens and encumbrances, except for restrictions on transfer provided for herein. The Company shall at all times reserve and keep
available out of its authorized and unissued Common Stock, solely for the purpose of providing for the exercise of the rights to
purchase all Warrant Shares granted pursuant to this Warrant, such number of shares of Common Stock as shall, from time to time,
be sufficient therefor.

 

6.            Exercise
of Warrant. Subject to Section 4, this Warrant may be exercised in whole or in part, at any time, by the surrender of this
Warrant, together with the Notice of Exercise and Investment Representation Statement in substantially the forms attached hereto
as Attachment 1 and Attachment 2, respectively (subject to appropriate revision if this Warrant is adjusted pursuant
to Section 3 hereof), duly completed and executed at the principal office of the Company, and accompanied by payment in full of
the applicable aggregate Warrant Price in cash or by check with respect to the Warrant Shares being purchased. Prior to exercise
of the Warrant, the Holder shall notify the Company of its desire to exercise the Warrant. This Warrant shall be deemed to have
been exercised immediately prior to the close of business on the date of its surrender for exercise as provided above, and the
person or entity entitled to receive the Warrant Shares issuable upon such exercise shall be treated for all purposes as holder
of such shares of record as of the close of business on such date.

 

7.            Notice
of Proposed Transfer. Prior to any proposed transfer of this Warrant or the Warrant Shares received on the exercise of this
Warrant (together, the “Securities”), unless there is in effect a registration statement under the Securities
Act of 1933, as amended (the “Act”) covering the proposed transfer, the Holder thereof shall give written
notice to the Company of such Holder’s intention to effect such transfer. Each such notice shall describe the manner and
circumstances of the proposed transfer in sufficient detail, and shall, if the Company so requests, be accompanied (except in transactions
in compliance with Rule 144) by either (i) an unqualified written opinion of legal counsel who shall be reasonably satisfactory
to the Company addressed to the Company and reasonably satisfactory in form and substance to the Company’s counsel, to the
effect that the proposed transfer of the Securities may be effected without registration under the Act, or (ii) a “no action”
letter from the Securities and Exchange Commission (the “Commission”) to the effect that the transfer
of such Securities without registration will not result in a recommendation by the staff of the Commission that action be taken
with respect thereto, whereupon the Holder of the Securities shall be entitled to transfer the Securities in accordance with the
terms of the notice delivered by the Holder to the Company; provided, however, no such registration statement or opinion
of counsel shall be necessary for a transfer by a Holder to any affiliate of such Holder. Each certificate evidencing the Securities
transferred as above provided shall bear the appropriate restrictive legend set forth above, except that such certificate shall
not bear such restrictive legend if in the opinion of counsel for the Company such legend is not required in order to establish
compliance with any provisions of the Act.

 

    	3

    	 

    

 

8.            Certificate
of Adjustment. Whenever the Warrant Price or number or type of Warrant Shares issuable upon exercise of this Warrant is adjusted,
as herein provided, the Company shall promptly deliver to the record holder of this Warrant a certificate of the Secretary of the
Company setting forth the nature of such adjustment and a brief statement of the facts requiring such adjustment.

 

9.            Replacement
of Warrants. Upon receipt by the Company of evidence reasonably satisfactory to the Company of the loss, theft, destruction
or mutilation of the Warrant, and in the case of any such loss, theft or destruction of the Warrant, on delivery of an indemnity
agreement or security reasonably satisfactory in form and amount to the Company, and reimbursement to the Company of all reasonable
expenses incidental thereto, and upon surrender and cancellation of the Warrant if mutilated, the Company will execute and deliver,
in lieu thereof, a new Warrant of like tenor.

 

10.           Amendment,
Waiver, etc. 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 signed by the party against whom enforcement of any such amendment, waiver, discharge
or termination is sought; provided, however, that any provisions hereof may be amended, waived, discharged or terminated
upon the written consent of the Company and a Requisite Majority. For purposes hereof, “Requisite Majority”
shall mean Holders of at least a majority of the Warrant Shares then issuable upon exercise of then outstanding warrants of like
tenor to this Warrant issued by the Company (the “Offering Warrants”); provided, however,
that no such amendment or waiver may disproportionately and adversely affect the Holder relative to the holders of all other Offering
Warrants without the Holder’s consent. Any amendment effected in accordance with this Section shall be binding upon all holders
of the Offering Warrants, each future holder of the Offering Warrants, and the Company. By acceptance hereof, the Holder acknowledges
that in the event the required consent is obtained, any term of this Warrant may be amended or waived with or without the consent
of the Holder.

 

11.           Successors
and Assigns. This Warrant and the rights evidenced hereby shall inure to the benefit of and be binding upon the successors
of the Company and the successors and assigns of the Holder. The provisions of this Warrant are intended to be for the benefit
of all Holders from time to time of this Warrant, and shall be enforceable by any such Holder.

 

12.           Severability.
In case any one or more of the provisions of this Warrant shall be invalid or unenforceable in any respect, the validity and enforceability
of the remaining terms and provisions of this Warrant shall not in any way be affected or impaired thereby and the parties will
attempt in good faith to agree upon a valid and enforceable provision which shall be a commercially reasonable substitute therefor,
and upon so agreeing, shall incorporate such substitute provision in this Warrant.

 

13.           Miscellaneous.
This Warrant shall be governed by the laws of the State of New York as such laws are applied to contracts to be entered into and
performed entirely in New York. The headings in this Warrant are for purposes of convenience and reference only, and shall not
be deemed to constitute a part hereof.

 

    	4

    	 

    

 

ISSUED this __ day of ____________ 2015.

 

	 	[SUBCO]
	 	 
	 	By:	 
	 	Name:
	 	Title: Chief Executive Officer

 

    	 

    	 

    

 

Attachment 1

 

NOTICE OF EXERCISE

 

TO:[SubCo]

 

1.          The
undersigned hereby elects to purchase _____________ shares of __________ of [SubCo] (the “Warrant Shares”) pursuant
to the terms of the attached Warrant, and tenders herewith payment of the purchase price in full, together with all applicable
transfer taxes, if any.

 

2.          Please
issue a certificate or certificates representing said number of Warrant Shares in the name of the undersigned or in such other
name as is specified below:

 

	________________________________________
	(Name)
	________________________________________
	(Address)

 

	 	 	 
	 	 	 	 
	(Date)	 	(Name of Warrant Holder)
	 	 	 
	 	 	By: 	 
	 	 	 
	 	 	Title: 	 
	 	 	 	 	 

    	 

    	 

    

 

Attachment 2

INVESTMENT REPRESENTATION STATEMENT

 

Shares of _________ of

[SubCo]

 

In connection with the purchase of the shares
of __________ of [SubCo], the undersigned hereby represents to [SubCo] (the “Company”) as follows:

 

(A)         The
undersigned is an accredited investor (as defined in Rule 501(a) of Regulation D promulgated under the Securities Act of 1933,
as amended (the “Act”)). The undersigned acknowledges that an investment in the Company is highly speculative and represents
that it is able to fend for itself in the transactions contemplated by this Statement, has such knowledge and experience in financial
and business matters as to be capable of evaluating the merits and risks of its investments, and has the ability to bear the economic
risks (including the risk of a total loss) of its investment. The undersigned represents that it has had the opportunity to ask
questions of the Company concerning the Company’s business and assets and to obtain any additional information which it considered
necessary to verify the accuracy of or to amplify the Company’s disclosures, and has had all questions which have been asked
by it satisfactorily answered by the Company.

 

(B)         The
undersigned understands that no liquid public market now exists for the securities being issued by the Company and that the Company
has made no assurances that a public market will ever exist for the Company’s securities being obtained hereby.

 

(C)         The
undersigned understands that the securities issued upon exercise of the Warrant (the “Securities”), and any securities
issued in respect thereof or exchange therefor, may bear the following legend:

 

“THE SECURITIES REPRESENTED BY THIS
CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) OR ANY STATE SECURITIES
LAWS, AND MAY NOT BE SOLD, TRANSFERRED, ASSIGNED OR HYPOTHECATED UNLESS THERE IS AN EFFECTIVE REGISTRATION STATEMENT UNDER SUCH
ACT AND ANY APPLICABLE STATE SECURITIES LAWS COVERING SUCH SECURITIES OR THE SALE IS MADE IN ACCORDANCE WITH AN EXEMPTION UNDER
THE ACT AND ANY APPLICABLE STATE SECURITIES LAWS, AND THE COMPANY RECEIVES AN OPINION OF COUNSEL FOR THE HOLDER OF THESE SECURITIES
REASONABLY SATISFACTORY TO THE COMPANY STATING THAT SUCH SALE, TRANSFER, ASSIGNMENT OR HYPOTHECATION IS EXEMPT FROM THE REGISTRATION
AND PROSPECTUS DELIVERY REQUIREMENTS OF SUCH ACT AND ANY APPLICABLE STATE SECURITIES LAWS.”

 

(D)         By
executing this Statement, the undersigned further represents that it does not have any contract, undertaking, agreement or arrangement
with any person to sell, transfer or grant participation to such person or to any third person, with respect to any Securities
issuable upon exercise of the Warrant.

 

    	 

    	 

    

 

(E)         The
undersigned understands that the Securities issuable upon exercise of the Warrant at the time of issuance and exercise may not
be registered under the Act, and applicable state securities laws, on the ground that the issuance of such securities is exempt
pursuant to Section 4(2) of the Act and state law exemptions relating to offers and sales not by means of a public offering, and
that the Company’s reliance on such exemptions is predicated on the undersigned’s representations set forth herein.

 

(F)         The
undersigned agrees that in no event will it make a disposition of any Securities acquired upon the exercise of the Warrant unless
and until (i) it shall have notified the Company of the proposed disposition and shall have furnished the Company with a statement
of the circumstances surrounding the proposed disposition, and (ii) if reasonably required by the Company it shall have furnished
the Company with an opinion of counsel reasonably satisfactory to the Company and Company’s counsel to the effect that (A)
appropriate action necessary for compliance with the Act and any applicable state securities laws has been taken or an exemption
from the registration requirements of the Act and such laws is available, and (B) the proposed transfer will not violate any of
said laws.

 

(G)      The undersigned acknowledges that the Securities
issuable upon exercise of the Warrant must be held indefinitely unless subsequently registered under the Act or an exemption from
such registration is available. The undersigned is aware of the provisions of Rule 144 promulgated under the Act which permit limited
resale of shares purchased in a private placement subject to the satisfaction of certain conditions, including, among other things,
the existence of a public market for the shares, the availability of certain current public information about the Company, the
resale occurring not less than one year after a party has purchased and paid for the security to be sold, the sale being through
a “broker’s transaction” or in transactions directly with a “market makers” (as provided by Rule
144(f)) and the number of shares being sold during any three-month period not exceeding specified limitations.

 

[Signature
on Next Page]

 

    	 

    	 

    

 

	Dated:	 	 
	 	 
	 	 	 
	(Print Name of Holder)	 
	 	 	 
	By:	 	 
	 	(signature)	 
	 	 	 
	Name:	 	 
	 	(print name of person signing)	 
	 	 	 
	Title:

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