Document:

Exhibit
10.1

 

THIS
CONVERTIBLE PROMISSORY NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. NO SALE OR DISPOSITION MAY BE EFFECTED
EXCEPT IN COMPLIANCE WITH RULE 144 UNDER SAID ACT OR AN EFFECTIVE REGISTRATION STATEMENT RELATED THERETO OR AN OPINION OF COUNSEL FOR
THE HOLDER SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED UNDER THE ACT OR RECEIPT OF A NO-ACTION LETTER FROM THE
SECURITIES AND EXCHANGE COMMISSION.

 

CONVERTIBLE
PROMISSORY NOTE

 

	$_________________	__________
__, 2021

 

For
value received, QSAM Biosciences, Inc., a Delaware corporation (the “Company”),
promises to pay to __________________ or its assigns (“Holder”) the principal sum of $________________
together with accrued and unpaid interest thereon, each due and payable on the date and in the manner set forth below.

 

This
convertible promissory note (the “Note”) is issued as part of a series of similar convertible promissory notes
(collectively, the “Notes”) pursuant to the terms of that certain Convertible Promissory Note Purchase Agreement
(as amended, the “Agreement”) dated as of ________ __, 2021. Capitalized terms used herein without definition
shall have the meanings given to such terms in the Agreement.

 

1.
Repayment. All payments of interest and principal shall be in lawful money of the United States of America and shall be made pro
rata among all Holders. All payments shall be applied first to accrued interest, and thereafter to principal. The outstanding principal
amount of the Loan shall be due and payable on December 31, 2023 (the “Maturity Date”).

 

2.
Interest Rate. The Company promises to pay simple interest on the outstanding principal amount hereof from the date hereof until
payment in full, which interest shall be payable at the rate of six percent (6%) per annum or the maximum rate permissible by law, whichever
is less. Interest shall be due and payable on the Maturity Date and shall be calculated on the basis of a 365-day year for the actual
number of days elapsed.

 

3.
Conversion into Common Stock. 

 

(a)
Automatic Conversion. In the event that the Company issues and sells shares of its equity securities to investors (the “Investors”)
on or before the date of the repayment in full of this Note in an equity financing resulting in gross proceeds to the Company of at least
$5,000,000 (a “Qualified Financing”) or lists its equity securities on NASDAQ or the NYSE (an
“Uplisting”), then the outstanding principal balance of this Note plus all accrued and unpaid interest shall
automatically convert in whole without any further action by the Holder into Common Stock of the Company at a conversion price equal
to $0.20 per share (the “Conversion Price”), adjusted for stock splits, stock dividends and other recapitalizations.

 

    	1

     

    

 

(b)
Voluntary Conversion. At anytime prior to the Maturity Date, at the election of the Holder, the outstanding principal balance and
any unpaid accrued interest under this Note may be converted into shares of Common Stock of the Company at the Conversion Price.

 

(c)
Fractional Shares. If, after aggregation, the conversion of this Note would result in the issuance of a fractional share, the Company
shall, in lieu of issuance of any fractional share, round such number up to the closest whole share of Common Stock

 

(d)
Stock Dividend; Reclassifications; Recapitalizations; Etc. While this Note is outstanding, in the event the Company: (i) pays
a dividend in Common Stock or makes a distribution in Common Stock, (ii) subdivides its outstanding Common Stock into a greater number
of shares, (iii) combines its outstanding Common Stock into a smaller number of shares or (iv) increases or decreases the number of shares
of Common Stock outstanding by reclassification of its Common Stock, then the Conversion Price on the record date of such division or
distribution or the effective date of such action shall be proportionally adjusted

 

(e)
Combination; Liquidation. While this Note is outstanding, in the event of a Combination (as defined below), each Holder shall
have the right to receive upon conversion of the Note the kind and amount of shares of capital stock or other securities or property
which such Holder would have been entitled to receive upon or as a result of such Combination had such Note been converted immediately
prior to such event (subject to further adjustment in accordance with the terms hereof). The Company shall provide that the surviving
or acquiring Person (the “Successor Company”) in such Combination will assume by written instrument the obligations
under this Section 3 and the obligations to deliver to the Holder such shares of stock, securities or assets as, in accordance with the
foregoing provisions, the Holder may be entitled to acquire. “Combination” means an event in which the Company consolidates
with, mergers with or into, or sells all or substantially all of its assets to another Person, where “Person” means any individual,
corporation, partnership, joint venture, limited liability company, association, joint-stock company, trust, unincorporated organization,
government or any agency or political subdivision thereof or any other entity. In the event of (x) a Combination where consideration
to the holders of Common Stock in exchange for their shares is payable solely in cash or (y) the dissolution, liquidation or winding-up
of the Company, the Holders shall be entitled to receive, at their election upon surrender of their Note, distributions on an equal basis
with the holders of Common Stock or other securities issuable upon conversion of the Note, as if the Note had been converted immediately
prior to such event.

 

(f)
Notice of Adjustment. While this Note is outstanding, should the Company propose to take any action set forth in Section 3
(d) or (e), the Company shall send to each Holder a notice of such proposed action or offer. Such notice shall be mailed to the Holders
at their addresses as they appear in the Note Register, and shall specify the record date for the proposed event, shall briefly indicate
the effect of the proposed event on the securities or property issuable upon the conversion of the Note, and shall indicate the effect
of the proposed event, if any, on the Conversion Price (after giving effect to any adjustment pursuant to this Section 3.

 

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4.
Maturity. Unless this Note has been previously converted in accordance with the terms of Sections 3(a) through (c) above the entire
outstanding principal balance and all unpaid accrued interest shall become fully due and payable on the Maturity Date.

 

5.
Expenses. In the event of any default hereunder, the Company shall pay all reasonable attorneys’ fees and court costs incurred
by Holder in enforcing and collecting this Note.

 

6.
Prepayment. The Company may not prepay this Note prior to the Maturity Date without the consent of the Holder.

 

7.
Default. If there shall be any Event of Default hereunder, at the option and upon the declaration of the Holder and upon written
notice to the Company (which election and notice shall not be required in the case of an Event of Default under Section 7(c) or 7(d)),
this Note shall accelerate and all principal and unpaid accrued interest shall become due and payable. The occurrence of any one or more
of the following shall constitute an Event of Default:

 

(a)
The Company fails to pay timely any of the principal amount due under this Note on the date the same becomes due and payable or any
accrued interest or other amounts due under this Note on the date the same becomes due and payable;

 

(b)
The Company shall default in its performance of any covenant under the Agreement or any Note;

 

(c)
The Company files any petition or action for relief under any bankruptcy, reorganization, insolvency or moratorium law or any other
law for the relief of, or relating to, debtors, now or hereafter in effect, or makes any assignment for the benefit of creditors or takes
any corporate action in furtherance of any of the foregoing; or

 

(d)
An involuntary petition is filed against the Company (unless such petition is dismissed or discharged within 60 days under any bankruptcy
statute now or hereafter in effect, or a custodian, receiver, trustee, assignee for the benefit of creditors (or other similar official)
is appointed to take possession, custody or control of any property of the Company.

 

8.
Waiver. The Company hereby waives demand, notice, presentment, protest and notice of dishonor.

 

9.
Governing Law. This Note shall be governed by and construed under the laws of the State of Florida, without giving effect to conflicts
of laws principles.

 

10.
Parity with Other Notes. The Company’s repayment obligation to the Holder under this Note shall be on parity with the Company’s
obligation to repay all Notes issued pursuant to the Agreement. In the event that the Company is obligated to repay the Notes and does
not have sufficient funds to repay all the Notes in full, payment shall be made to the Holders of the Notes on a pro rata basis.
The preceding sentence shall not, however, relieve the Company of its obligations to the Holder hereunder.

 

11.
Modification; Waiver. Any term of this Note may be amended or waived with the written consent of the Company and the Holder.

 

12.
Assignment. This Note may be transferred only upon its surrender to the Company for registration of transfer, duly endorsed, or accompanied
by a duly executed written instrument of transfer in form satisfactory to the Company. Thereupon, this Note shall be reissued to, and
registered in the name of, the transferee, or a new Note for like principal amount and interest shall be issued to, and registered in
the name of, the transferee. Interest and principal shall be paid solely to the registered holder of this Note. Such payment shall constitute
full discharge of the Company’s obligation to pay such interest and principal.

 

[signature
page follows]

 

    	3

     

    

 

 

	 	 	QSAM Biosciences, Inc.
	 	 	 
	 	 	By:____________________________________________
	 	 	Name:__________________________________________
	 	 	Title:___________________________________________
	 	 	 
	Holder:
________________________________________    	 	 
	 	 	 
	Principal
    Amount of Note: __________________________	 	 
	 	 	 
	Date
    of Note: ____________________________________Exhibit
10.3

 

THIS
WARRANT AND THE UNDERLYING SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”),
OR ANY OTHER SECURITIES LAWS, HAVE BEEN TAKEN FOR INVESTMENT, AND MAY NOT BE SOLD OR TRANSFERRED OR OFFERED FOR SALE OR TRANSFER UNLESS
A REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND OTHER APPLICABLE SECURITIES LAWS WITH RESPECT TO SUCH SECURITIES IS THEN IN EFFECT,
OR IN THE OPINION OF COUNSEL (WHICH OPINION IS REASONABLY SATISFACTORY TO THE ISSUER OF THESE SECURITIES), SUCH REGISTRATION UNDER THE
SECURITIES ACT AND OTHER APPLICABLE SECURITIES LAWS IS NOT REQUIRED.

 

	Date:
    _________	 	Warrant
    to Purchase

     

    ***________***

     

    Shares

 

QSAM
BIOSCIECNES, INC. 

WARRANT FOR THE PURCHASE OF SHARES OF

COMMON
STOCK

 

Warrant
Price: $0.60 per share,
subject to adjustment as provided below.

 

THIS
IS TO CERTIFY that, for value received, ____________________, who has invested in the Company’s Convertible Note offering (the
“Holder”), is entitled to purchase, subject to the terms and conditions hereinafter set forth, up to _______ shares [equal
to 100% of dollar amount invested in the Convertible Note – shares X Warrant Price] of the common stock (“Common Stock”),
of QSAM Biosciences, Inc. (the “Company”), and to receive certificate(s) for the Common Stock so purchased.

 

1.
Exercise Period and Vesting. The exercise period is the period beginning on the date of this Warrant (the “Issuance Date”)
and ending at 5:00 p.m., New York time, on October 31, 2022 (the “Exercise Period”). This Warrant is vested in full
as of the Issuance Date and is immediately exercisable by Holder. This Warrant will terminate automatically and immediately upon the
expiration of the Exercise Period.

 

2.
Exercise of Warrant. This Warrant may be exercised, in whole or in part, at any time and from time to time during the Exercise
Period. Such exercise shall be accomplished by tender to the Company of the purchase price set forth above as the warrant price (the
“Warrant Price”), in cash by wire transfer or by certified check or bank cashier’s check, payable to the order of the
Company, together with presentation and surrender to the Company of this Warrant with an executed subscription in substantially the form
attached hereto as Exhibit A (the “Subscription”). Upon receipt of the foregoing, the Company will deliver to the
Holder, as promptly as possible, a certificate or certificates representing the shares of Common Stock so purchased, registered in the
name of the Holder or its transferee (as permitted under Section 3 below). With respect to any exercise of this Warrant, the Holder will
for all purposes be deemed to have become the holder of record of the number of shares of Common Stock purchased hereunder on the date
this Warrant, a properly executed Subscription and payment of the Warrant Price is received by the Company (the “Exercise Date”),
irrespective of the date of delivery of the certificate evidencing such shares, except that, if the date of such receipt is a date on
which the stock transfer books of the Company are closed, such person will be deemed to have become the holder of such shares at the
close of business on the next succeeding date on which the stock transfer books are open. Fractional shares of Common Stock will not
be issued upon the exercise of this Warrant. In lieu of any fractional shares that would have been issued but for the immediately preceding
sentence, the Holder will be entitled to receive cash equal to the current market price of such fraction of a share of Common Stock on
the trading day immediately preceding the Exercise Date. In the event this Warrant is exercised in part, the Company shall issue a new
Warrant to the Holder covering the aggregate number of shares of Common Stock as to which this Warrant remains exercisable for.

 

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3.
Transferability and Exchange.

 

(a)
This Warrant, and the Common Stock issuable upon the exercise hereof, may not be sold, transferred, pledged or hypothecated unless the
Company shall have been provided with an opinion of counsel, or other evidence reasonably satisfactory to it, that such transfer is not
in violation of the Securities Act, and any applicable state securities laws. Subject to the satisfaction of the aforesaid condition,
this Warrant and the underlying shares of Common Stock shall be transferable from time to time by the Holder upon written notice to the
Company. If this Warrant is transferred, in whole or in part, the Company shall, upon surrender of this Warrant to the Company, deliver
to each transferee a Warrant evidencing the rights of such transferee to purchase the number of shares of Common Stock that such transferee
is entitled to purchase pursuant to such transfer. The Company may place a legend similar to the legend at the top of this Warrant on
any replacement Warrant and on each certificate representing shares issuable upon exercise of this Warrant or any replacement Warrants.
Only a registered Holder may enforce the provisions of this Warrant against the Company. A transferee of the original registered Holder
becomes a registered Holder only upon delivery to the Company of the original Warrant and an original Assignment, substantially in the
form set forth in Exhibit B attached hereto.

 

(b)
This Warrant is exchangeable upon its surrender by the Holder to the Company for new Warrants of like tenor and date representing in
the aggregate the right to purchase the number of shares purchasable hereunder, each of such new Warrants to represent the right to purchase
such number of shares as may be designated by the Holder at the time of such surrender.

 

4.
Adjustments to Warrant Price and Number of Shares Subject to Warrant. The Warrant Price and the number of shares of Common Stock
purchasable upon the exercise of this Warrant are subject to adjustment from time to time upon the occurrence of any of the events specified
in this Section 4. For the purpose of this Section 4, “Common Stock” means shares now or hereafter authorized of any class
of common stock of the Company and any other stock of the Company, however designated, that has the right to participate in any distribution
of the assets or earnings of the Company without limit as to per share amount (excluding, and subject to any prior rights of, any class
or series of preferred stock).

 

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(a)
In case the Company shall (i) pay a dividend or make a distribution in shares of Common Stock or other securities, (ii) subdivide
its outstanding shares of Common Stock into a greater number of shares, (iii) combine its outstanding shares of Common Stock into a
smaller number of shares, or (iv) issue by reclassification of its shares of Common Stock other securities of the Company, then the
Warrant Price in effect at the time of the record date for such dividend or on the effective date of such subdivision, combination
or reclassification, and/or the number and kind of securities issuable on such date, shall be proportionately adjusted so that the
Holder of any Warrant thereafter exercised shall be entitled to receive the aggregate number and kind of shares of Common Stock (or
such other securities other than Common Stock) of the Company, at the same aggregate Warrant Price, that, if such Warrant had been
exercised immediately prior to such date, the Holder would have owned upon such exercise and been entitled to receive by virtue of
such dividend, distribution, subdivision, combination or reclassification. Such adjustment shall be made successively whenever any
event listed above shall occur.

 

(b)
In case the Company shall fix a record date for the making of a distribution to all holders of Common Stock (including any such distribution
made in connection with a consolidation or merger in which the Company is the surviving corporation) of cash, evidences of indebtedness
or assets, or subscription rights or warrants, the Warrant Price to be in effect after such record date shall be determined by multiplying
the Warrant Price in effect immediately prior to such record date by a fraction, the numerator of which shall be the current market price
per share of Common Stock on such record date, less the amount of cash so to be distributed (or the fair market value (as determined
in good faith by, and reflected in a formal resolution of, the Board of Directors of the Company) of the portion of the assets or evidences
of indebtedness so to be distributed, or of such subscription rights or warrants, applicable to one share of Common Stock, and the denominator
of which shall be such current market price per share of Common Stock. Such adjustment shall be made successively whenever such a record
date is fixed; and in the event that such distribution is not so made, the Warrant Price shall again be adjusted to be the Warrant Price
which would then be in effect if such record date had not been fixed.

 

(c)
For the purpose of any computation under any subsection of this Section 4, the “current market price” per share of Common
Stock on any date shall be the per share price of the Common Stock on the trading day immediately prior to the event requiring an adjustment
hereunder and shall be: (i) if the principal trading market for such securities is a national or regional securities exchange, the closing
price on such exchange on such day; or (ii) if sales prices for shares of Common Stock are reported by the Nasdaq National Market System
or Small Cap Market System (or a similar system then in use), the last reported sales price so reported on such day; or (iii) if neither
(i) nor (ii) above are applicable, and if bid and ask prices for shares of Common Stock are reported in the over-the-counter market by
Nasdaq (or, if not so reported, by the National Quotation Bureau), the average of the high bid and low ask prices so reported on such
day. Notwithstanding the foregoing, if there is no reported closing price, last reported sales price, or bid and ask prices, as the case
may be, for the day in question, then the current market price shall be determined as of the latest date prior to such day for which
such closing price, last reported sales price, or bid and ask prices, as the case may be, are available, unless such securities have
not been traded on an exchange or in the over-the-counter market for 30 or more days immediately prior to the day in question, in which
case the current market price shall be determined in good faith by, and reflected in a formal resolution of, the Board of Directors of
the Company.

 

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(d)
Notwithstanding any provision herein to the contrary, no adjustment in the Warrant Price shall be required unless such adjustment would
require an increase or decrease of at least 1% in the Warrant Price; provided, however, that any adjustments which by reason of this
subsection (d) are not required to be made shall be carried forward and taken into account in any subsequent adjustment. All calculations
under this Section 4 shall be made to the nearest cent or the nearest one-hundredth of a share, as the case may be.

 

(e)
In the event that at any time, as a result of an adjustment made pursuant to subsection (a) above, the Holder of any Warrant thereafter
exercised shall become entitled to receive any shares of capital stock of the Company other than shares of Common Stock, thereafter the
number of such other shares so receivable upon exercise of any Warrant shall be subject to adjustment from time to time in a manner and
on terms as nearly equivalent as practicable to the provisions with respect to the shares of Common Stock contained in this Section 4,
and the other provisions of this Warrant shall apply on like terms to any such other shares.

 

(f)
If the Company merges or consolidates into or with another corporation or entity, or if another corporation or entity merges into or
with the Company (excluding such a merger in which the Company is the surviving or continuing corporation and which does not result in
any reclassification, conversion, exchange, or cancellation of the outstanding shares of Common Stock), or if all or substantially all
of the assets or business of the Company are sold or transferred to another corporation, entity, or person, then, as a condition to such
consolidation, merger, or sale (a “Transaction”), lawful and adequate provision shall be made whereby the Holder shall have
the right from and after the Transaction to receive, upon exercise of this Warrant and upon the terms and conditions specified herein
and in lieu of the shares of the Common Stock that would have been issuable if this Warrant had been exercised immediately before the
Transaction, such shares of stock, securities, or assets as the Holder would have owned immediately after the Transaction if the Holder
had exercised this Warrant immediately before the effective date of the Transaction.

 

5.
Reservation of Shares. The Company agrees at all times to reserve and hold available out of its authorized but unissued shares
of Common Stock the number of shares of Common Stock issuable upon the full exercise of this Warrant. The Company further covenants and
agrees that all shares of Common Stock that may be delivered upon the exercise of this Warrant will, upon delivery, be fully paid and
nonassessable and free from all taxes, liens and charges with respect to the purchase thereof hereunder.

 

6.
Notices to Holder. Upon any adjustment of the Warrant Price (or number of shares of Common Stock purchasable upon the exercise
of this Warrant) pursuant to Section 4, the Company shall promptly thereafter cause to be given to the Holder written notice of such
adjustment. Such notice shall include the Warrant Price (and/or the number of shares of Common Stock purchasable upon the exercise of
this Warrant) after such adjustment, and shall set forth in reasonable detail the Company’s method of calculation and the facts
upon which such calculations were based. Where appropriate, such notice shall be given in advance and included as a part of any notice
required to be given under the other provisions of this Section 7.

 

    	4

     

    

 

In
the event of (a) any fixing by the Company of a record date with respect to the holders of any class of securities of the Company for
the purpose of determining which of such holders are entitled to dividends or other distributions, or any rights to subscribe for, purchase
or otherwise acquire any shares of capital stock of any class or any other securities or property, or to receive any other right, (b)
any capital reorganization of the Company, or reclassification or recapitalization of the capital stock of the Company or any transfer
of all or substantially all of the assets or business of the Company to, or consolidation or merger of the Company with or into, any
other entity or person, or (c) any voluntary or involuntary dissolution or winding up of the Company, then and in each such event the
Company will give the Holder a written notice specifying, as the case may be (i) the record date for the purpose of such dividend, distribution,
or right, and stating the amount and character of such dividend, distribution, or right; or (ii) the date on which any such reorganization,
reclassification, recapitalization, transfer, consolidation, merger, conveyance, dissolution, liquidation, or winding up is to take place
and the time, if any is to be fixed, as of which the holders of record of Common Stock (or such capital stock or securities receivable
upon the exercise of this Warrant) shall be entitled to exchange their shares of Common Stock (or such other stock securities) for securities
or other property deliverable upon such event. Any such notice shall be given at least 10 days prior to the earliest date therein specified.

 

7.
No Rights as a Stockholder. This Warrant does not entitle the Holder to any voting rights or other rights as a stockholder of
the Company, nor to any other rights whatsoever except the rights herein set forth.

 

8.
Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the Company, the Holder and their respective
successors and permitted assigns.

 

9.
Notices. The Company agrees to maintain a ledger of the ownership of this Warrant (the “Ledger”). Any notice hereunder
shall be given by registered or certified mail if to the Company, at its principal executive office and, if to the Holder, to its address
shown in the Ledger of the Company; provided, however, that the Holder may at any time on three (3) days written notice to the Company
designate or substitute another address where notice is to be given. Notice shall be deemed given and received after a certified or registered
letter, properly addressed with postage prepaid, is deposited in the U.S. mail.

 

10.
Severability. Every provision of this Warrant is intended to be severable. If any term or provision hereof is illegal or invalid
for any reason whatsoever, such illegality or invalidity shall not affect the remainder of this Warrant.

 

11.
Governing Law. This Warrant shall be governed by and construed in accordance with the laws of the State of Florida without giving
effect to the principles of choice of laws thereof.

 

12.
Attorneys’ Fees. In any action or proceeding brought to enforce any provision of this Warrant, the prevailing party shall
be entitled to recover reasonable attorneys’ fees in addition to its costs and expenses and any other available remedy.

 

13.
Entire Agreement. This Warrant (including the Exhibits attached hereto) constitutes the entire understanding between the Company
and the Holder with respect to the subject matter hereof, and supersedes all prior negotiations, discussions, agreements and understandings
relating to such subject matter.

 

    	5

     

    

 

IN
WITNESS WHEREOF, the Company has caused this Warrant to be executed by its duly authorized officer as of the date first set forth above.

 

	 	QSAM
    BIOSCIENCES, INC.
	 	 	                         
	 	By:	 
	 	Title:	 

 

    	6

     

    

 

Exhibit
A

SUBSCRIPTION FORM

 

(To
be Executed by the Holder to Exercise the Rights To Purchase Common Stock Evidenced by the Within Warrant)

 

The
undersigned hereby irrevocably subscribes for _______ shares (the “Stock”) of the Common Stock of ___________________________(the
“Company”) pursuant to and in accordance with the terms and conditions of the attached Warrant (the “Warrant”),
and hereby makes payment of $_______ therefor by tendering cash, wire transferring or delivering a certified check or bank cashier’s
check, payable to the order of the Company. The undersigned requests that a certificate for the Stock be issued in the name of the undersigned
and be delivered to the undersigned at the address stated below. If the Stock is not all of the shares purchasable pursuant to the Warrant,
the undersigned requests that a new Warrant of like tenor for the balance of the remaining shares purchasable thereunder be delivered
to the undersigned at the address stated below.

 

In
connection with the issuance of the Stock, I hereby represent to the Company that I am acquiring the Stock for my own account for investment
and not with a view to, or for resale in connection with, a distribution of the shares within the meaning of the Securities Act of 1933,
as amended (the “Securities Act”).

 

I
understand that because the Stock has not been registered under the Securities Act, I must hold such Stock indefinitely unless the Stock
is subsequently registered and qualified under the Securities Act or is exempt from such registration and qualification. I shall make
no transfer or disposition of the Stock unless (a) such transfer or disposition can be made without registration under the Securities
Act by reason of a specific exemption from such registration and such qualification, or (b) a registration statement has been filed pursuant
to the Securities Act and has been declared effective with respect to such disposition. I agree that each certificate representing the
Stock delivered to me shall bear substantially the same as set forth on the front page of the Warrant.

 

I
agree that each certificate representing the Stock delivered to me shall bear substantially the same legend as set forth on the front
page of the Warrant.

 

I
further agree that the Company may place stop orders on the certificates evidencing the Stock with the transfer agent, if any, to the
same effect as the above legend. The legend and stop transfer notice referred to above shall be removed only upon my furnishing to the
Company of an opinion of counsel (reasonably satisfactory to the Company) to the effect that such legend may be removed.

 

	Date:__________________________	Signed:__________________________________________

    

	 	 
	 	Address:_________________________________________
	 	________________________________________________

 

    	Exhibit A

     

    

 

Exhibit
B

ASSIGNMENT

(To be Executed by the Holder to Effect Transfer of the Attached Warrant)

 

For
Value Received __________________________ hereby sells, assigns and transfers to _________________________ the Warrant attached hereto
and the rights represented thereby to purchase _________ shares of Common Stock in accordance with the terms and conditions hereof, and
does hereby irrevocably constitute and appoint _________________________ as attorney to transfer such Warrant on the books of the Company
with full power of substitution.

 

	Dated:________________________	Signed:_____________________________________

 

	Please
    print or typewrite

    name
    and address of assignee:

    ____________________________

    

    ____________________________

    

    ____________________________
	 	Please
    insert Social Security

    or other Tax Identification

    Number of Assignee:

    

    _________________________________________

 

    	Exhibit B

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