Document:

Exhibit 4.10

 

Orchestra BioMed, Inc.

150 Union Square Drive

New Hope, PA 18938

 

[___________], 2022

 

SLD Capital Corp.

1220 Mirabeau Lane

Gladwyne, PA 19035

 

Re: Amendment to SLD Warrants

 

Reference is hereby made to
(i) that certain Common Stock Warrant No. OBI-SLD-01 of Orchestra BioMed, Inc. (the “Company”) issued to the undersigned
holder on or around August 13, 2018 and (ii) that certain Common Stock Warrant No. OBI-SLD-02 of the Company issued to the undersigned
holder on or around August 13, 2018 (collectively, the “Warrants”). All capitalized terms used but not defined in this
Amendment to SLD Warrants (this “Amendment”) shall have the meaning described in the Warrants.

 

In accordance with Section
11 of the Warrants, each Warrant may be amended with the written consent of the Company and holders of Warrants holding fifty percent
(50%) of the aggregate number of shares for which all such warrants are exercisable (the “Requisite Holders”).

 

By execution of this Amendment,
the parties hereto agree to the amendment of the Warrants, effective upon such time as the Requisite Holders sign corresponding amendments
in the form of this Amendment and in accordance with Section 11 of the Warrants, as follows:

 

		1.	Section 2(b). Section 2(b) of the Warrants is hereby amended and restated in its entirety as follows:

 

“Reserved.”

 

		2.	Section 2(c). Section 2(c) of the Warrants is hereby amended and restated in its entirety as follows:

 

“Reserved.”

 

		3.	Addition of Section 17. A new Section 17 shall be added immediately after Section 16 of the Warrants,
to read as follows:

 

“17.       Business
Combination – Automatic Adjustments to Underlying Warrant Shares and Exercise Price. Notwithstanding anything herein to
the contrary, in the event of the consummation of (a) a business combination transaction involving the Company and/or any direct or indirect
parent company thereof and a publicly traded U.S. domestic special purpose acquisition company or other similar U.S. domestic corporation
that is a “blank check” company under applicable U.S. securities laws and formed for the purpose of effecting such a transaction
or (b) the consummation of a business combination transaction involving the Company and/or any direct or indirect parent company thereof
with any public company listed on a U.S. securities exchange, then (i) in the event this Warrant has not been previously exercised, this
Warrant shall automatically become exercisable for a number of shares of common stock of such parent company party to such business combination
(the “Parent Common Stock”) equal to the product of (A) the number of Shares set forth in Section 1 (minus any
Shares previously issued upon partial exercise of this Warrant) multiplied by (B) 0.465, and (ii) the Exercise Price shall automatically
be adjusted to the quotient obtained by dividing (x) the Exercise Price by (y) 0.465 (the adjustments pursuant to clauses (i) and (ii),
the “Business Combination Adjustments”). From and after the effectiveness of the Business Combination Adjustments,
all other terms of this Warrant shall continue to apply to this Warrant and references to “Shares” and “Company Common
Stock” shall thereafter refer to shares of Parent Common Stock in accordance with the terms hereof.”

 

4.     
Miscellaneous. This Amendment shall be governed by and construed in accordance with the laws of the State of Delaware, without
regard to the conflicts of law provisions of the State of Delaware or any other state. The section headings of this Amendment are inserted
for convenience of reference only and shall not constitute a part of this Amendment in construing or interpreting any provision hereof.
Section 12 of the Warrants (“Notices”) shall apply to this Amendment mutatis mutandis. Except as specifically amended
in this Amendment, the Warrants shall remain unmodified and continue in full force and effect in accordance with their terms. This Amendment
may be executed in any number of counterparts, each of which shall be deemed to be an original and all of which together shall be deemed
to be one and the same instrument, and may be executed by facsimile signatures.

 

     

     

    

 

Please confirm that the foregoing
is our mutual understanding by signing in the appropriate space below and returning this letter to us.

 

	 	Sincerely,
	 	 	 
	 	ORCHESTRA BIOMED, INC.
	 	 	 
	 	By:	 
	 	 	David Hochman
	 	 	Chief Executive Officer

 

Accepted and Agreed as of the date first set forth above

 

	SLD Capital Corp.	 
	 	 
	By:	 	 
	Name: 	Steven Rosner
	 
	Title:	PresidentExhibit 4.12

SUBSCRIPTION AGREEMENT

 

Orchestra BioMed, Inc.

150 Union Square Drive

New Hope, PA 18938

 

Ladies and Gentlemen:

 

1.   Subscription.
The undersigned (the “Purchaser”), intending to be legally bound, hereby irrevocably agrees to purchase from Orchestra BioMed,
Inc., a Delaware corporation (the “Company”), the number of units (the “Units”) set forth on the signature page
hereof at a purchase price of $150,000 per Unit (“Unit Price”). Each Unit consists of 10,000 shares of Series B-1 Preferred
Stock, par value $0.0001 (“Series B-1 Preferred” or “Shares”), at a price of $15.00 per Share, with a minimum
investment amount of $150,000, provided a lower subscription amount may be accepted at the discretion of the Company. The Units are being
sold in the Offering (as defined below), as more fully described in the Memorandum (as defined below). This Subscription Agreement (this
“Subscription Agreement”) is one in a series of similar subscription agreements (collectively, the “Subscription Agreements”)
entered into pursuant to the Offering.

 

2.   The
Offering. This subscription is submitted to you in accordance with and subject to the terms and conditions described in this Subscription
Agreement and the Confidential Private Placement Memorandum of the Company dated March 19, 2019, as amended or supplemented from time
to time, including all attachments, schedules and exhibits thereto (the “Memorandum”), relating to the offering (the “Offering”)
by the Company of a minimum of 30 Units ($4,500,000) (the “Minimum Offering Amount”), and up to a maximum of 100 Units ($15,000,000)
(the “Maximum Offering Amount”), with an over-allotment amount of up to 100 Units ($15,000,000) (the “Over-Allotment
Amount”). SternAegis Ventures, through Aegis Capital Corp., (“SternAegis”), has been engaged as exclusive placement
agent in connection with the Offering (sometimes referred to as the “Placement Agent”). The terms of the Offering are more
completely described in the Memorandum and such terms are incorporated herein in their entirety.

 

3.   Deliveries
and Payment; Escrow of Funds. Simultaneously with the execution hereof, the Purchaser shall: (a) deliver to SternAegis in accordance
with the Subscription Instructions attached hereto, (i) one (1) completed and executed Omnibus Signature Page to this Subscription Agreement
and the Voting Agreement, dated as of May 31, 2018, by and among the Company and the investors signatory thereto (as may be further amended,
the “Voting Agreement”) (page 16), (ii) a completed Accredited Investor Certification (pages 17-18), (iii) a completed Investor
Profile (page 19) and (iv) one (1) completed and executed Tax Certification for U.S. Persons or Non-U.S. Persons, as applicable (beginning
on page 21); and (b) make a wire transfer payment to, “Signature Bank, Escrow Agent for Orchestra BioMed, Inc.” in an amount
equal to the product of (i) the number of Units being subscribed for by the Purchaser in the Offering as set forth on the signature page
hereof, multiplied by (ii) the Unit Price. Wire transfer instructions are set forth on page 12 hereof under the heading “To subscribe
for Units in the private offering of Orchestra BioMed, Inc.” Such funds will be held for the Purchaser's benefit in a non-interest-bearing
escrow account (the “Escrow Account”) until the earliest to occur of (a) a closing of the sale of the Minimum Offering Amount
or more (the “First Closing”), (b) the rejection of such subscription, or (c) the termination of the Offering by the Company
or the Placement Agent. The Company and the Placement Agent may continue to offer and sell the Units and conduct additional closings for
the sale of additional Units after the First Closing and until the termination of the Offering.

 

    1

     

    

 

4.   Acceptance
of Subscription. The Purchaser understands and agrees that the Company, in its sole discretion, reserves the right to accept or reject
this or any other subscription for Units, in whole or in part, notwithstanding prior receipt by the Purchaser of notice of acceptance
of this subscription. In furtherance of the foregoing, the Company shall have the right to require potential subscribers to supply additional
information and execute additional documents in a satisfactory manner, which determination shall be at the sole discretion of the Company,
prior to the acceptance of this Subscription Agreement. The Company shall have no obligation hereunder until the Company shall execute
and deliver to the Purchaser an executed copy of this Subscription Agreement. If this subscription is rejected in whole, the Offering
of Units is terminated or the Minimum Offering Amount is not raised, all funds received from the Purchaser will be returned without interest
or offset, and this Subscription Agreement shall thereafter be of no further force or effect. If this subscription is rejected in part,
the funds for the rejected portion of this subscription will be returned without interest or offset, and this Subscription Agreement will
continue in full force and effect to the extent this subscription was accepted.

 

5.   Representations
and Warranties.

 

The Purchaser hereby acknowledges,
represents, warrants, and agrees as follows:

 

(a)   None
of the Shares or the shares of common stock of the Company issuable upon conversion of the Shares (the “Conversion Securities”)
offered pursuant to the Memorandum are registered under the Securities Act of 1933, as amended (the “Securities Act”), or
any state securities laws. The Purchaser understands that the offering and sale of the Units is intended to be exempt from registration
under the Securities Act, by virtue of Section 4(a)(2) thereof and the provisions of Regulation D (“Regulation D”) as promulgated
by the United States Securities and Exchange Commission (the “SEC”) thereunder, based, in part, upon the representations,
warranties and agreements of the Purchaser contained in this Subscription Agreement.

 

(b)   Prior
to the execution of this Subscription Agreement, the Purchaser and the Purchaser’s attorney, accountant, purchaser representative
and/or tax adviser, if any (collectively, the “Advisers”), have received the Memorandum and all other documents requested
by the Purchaser, have carefully reviewed them and understand the information contained therein.

 

(c)   Neither
the SEC nor any state securities commission or other regulatory authority has approved the Units or the Conversion Securities or passed
upon or endorsed the merits of the Offering or confirmed the accuracy or determined the adequacy of the Memorandum. The Memorandum has
not been reviewed by any federal, state or other regulatory authority.

 

    2

     

    

 

(d)   All
documents, records, and books pertaining to the investment in the Units (including, without limitation, the Memorandum) have been made
available for inspection by such Purchaser and its Advisers, if any.

 

(e)   The
Purchaser and its Advisers, if any, have had a reasonable opportunity to ask questions of and receive answers from a person or persons
acting on behalf of the Company concerning the offering of the Units and the business, financial condition and results of operations of
the Company and Caliber Therapeutics, Inc., BackBeat Medical, Inc. and FreeHold Surgical, Inc. (the “Subsidiaries”) and all
such questions have been answered to the full satisfaction of the Purchaser and its Advisers, if any.

 

(f)   In
evaluating the suitability of an investment in the Company and the Units, the Purchaser has not relied upon any representation or information
(oral or written) other than as stated in the Memorandum.

 

(g)   The
Purchaser is unaware of, is in no way relying on, and did not become aware of the Offering through or as a result of, any form of general
solicitation or general advertising including, without limitation, any article, notice, advertisement or other communication published
in any newspaper, magazine or similar media or broadcast over television, radio or the Internet (including, without limitation, internet
“blogs,” bulletin boards, discussion groups and social networking sites) in connection with the Offering and is not subscribing
for the Units and did not become aware of the Offering through or as a result of any seminar or meeting to which the Purchaser was invited
by, or any solicitation of a subscription by, a person not previously known to the Purchaser in connection with investments in securities
generally.

 

(h)   The
Purchaser has taken no action that would give rise to any claim by any person for brokerage commissions, finders’ fees or the like
relating to this Subscription Agreement or the transactions contemplated hereby (other than commissions to be paid by the Company to the
Placement Agent or as otherwise described in the Memorandum).

 

(i)   The
Purchaser, together with its Advisers, if any, has such knowledge and experience in financial, tax, and business matters, and, in particular,
investments in securities, so as to enable it to utilize the information made available to it in connection with the Offering to evaluate
the merits and risks of an investment in the Units and the Company and to make an informed investment decision with respect thereto.

 

(j)   The
Purchaser is not relying on the Company, the Placement Agent or any of their respective employees or agents with respect to the legal,
tax, economic and related considerations of an investment in the Company and the Units, and the Purchaser has relied on the advice of,
or has consulted with, only its own Advisers.

 

(k)   The
Purchaser is acquiring the Units solely for such Purchaser’s own account for investment purposes only and not with a view to or
intent of resale or distribution thereof, in whole or in part. The Purchaser has no agreement or arrangement, formal or informal, with
any person to sell or transfer all or any part of the Shares constituting the Units or the Conversion Securities, and the Purchaser has
no plans to enter into any such agreement or arrangement.

 

    3

     

    

 

(l)   The
Purchaser must bear the substantial economic risks of the investment in the Units indefinitely because none of the Shares or Conversion
Securities may be sold, hypothecated or otherwise disposed of unless subsequently registered under the Securities Act and applicable state
securities laws or an exemption from such registration is available. Legends shall be placed on the securities included in the Units to
the effect that they have not been registered under the Securities Act or applicable state securities laws and appropriate notations thereof
will be made in the Company’s stock books. Stop transfer instructions will be placed with the transfer agent of the Units, if any.
The Company has agreed that purchasers of the Units will have, with respect to the Conversion Securities, the registration rights described
herein. Notwithstanding such registration rights, there can be no assurance that there will be any market for resale of the Units, the
Shares or the Conversion Securities, nor can there be any assurance that such securities will be freely transferable at any time in the
foreseeable future.

 

(m)   The
Purchaser has adequate means of providing for such Purchaser’s current financial needs and foreseeable contingencies and has no
need for liquidity from its investment in the Units for an indefinite period of time.

 

(n)   The
Purchaser is aware that an investment in the Units is high risk, involving a number of very significant risks and has carefully read and
considered the matters set forth under the caption “Risk Factors” in the Memorandum, and, in particular, acknowledges that
each of the Company and its Subsidiaries has a limited operating history, significant operating losses since inception, no revenues from
operations to date, extremely limited assets and are engaged in highly competitive businesses.

 

(o)   The
Purchaser meets the requirements of at least one of the suitability standards for an “accredited investor” as that term is
defined in Regulation D and as set forth on the Accredited Investor Certification contained herein.

 

(p)   The
Purchaser (i) if a natural person, represents that the Purchaser has reached the age of 21 and has full power and authority to execute
and deliver this Subscription Agreement and all other related agreements or certificates and to carry out the provisions hereof and thereof;
(ii) if a corporation, partnership, or limited liability company or partnership, or association, joint stock company, trust, unincorporated
organization or other entity, represents that such entity was not formed for the specific purpose of acquiring the Units, such entity
is duly organized, validly existing and in good standing under the laws of the state of its organization, the consummation of the transactions
contemplated hereby is authorized by, and will not result in a violation of state law or its charter or other organizational documents,
such entity has full power and authority to execute and deliver this Subscription Agreement and all other related agreements or certificates
and to carry out the provisions hereof and thereof and to purchase and hold the securities constituting the Units, the execution and delivery
of this Subscription Agreement has been duly authorized by all necessary action, this Subscription Agreement has been duly executed and
delivered on behalf of such entity and is a legal, valid and binding obligation of such entity; or (iii) if executing this Subscription
Agreement in a representative or fiduciary capacity, represents that it has full power and authority to execute and deliver this Subscription
Agreement in such capacity and on behalf of the subscribing individual, ward, partnership, trust, estate, corporation, or limited liability
company or partnership, or other entity for whom the Purchaser is executing this Subscription Agreement, and such individual, partnership,
ward, trust, estate, corporation, or limited liability company or partnership, or other entity has full right and power to perform pursuant
to this Subscription Agreement and make an investment in the Company, and represents that this Subscription Agreement constitutes a legal,
valid and binding obligation of such entity. The execution and delivery of this Subscription Agreement will not violate or be in conflict
with any order, judgment, injunction, agreement or controlling document to which the Purchaser is a party or by which it is bound.

 

    4

     

    

 

(q)   The
Purchaser and the Advisers, if any, have had the opportunity to obtain any additional information, to the extent the Company has such
information in their possession or could acquire it without unreasonable effort or expense, necessary to verify the accuracy of the information
contained in the Memorandum and all documents received or reviewed in connection with the purchase of the Units and have had the opportunity
to have representatives of the Company provide them with such additional information regarding the terms and conditions of this particular
investment and the financial condition, results of operations, and business of the Company and the Subsidiaries deemed relevant by the
Purchaser or the Advisers, if any, and all such requested information, to the extent the Company has such information in their possession
or could acquire it without unreasonable effort or expense, has been provided to the full satisfaction of the Purchaser and the Advisers,
if any.

 

(r)   Any
information which the Purchaser has heretofore furnished or is furnishing herewith to the Company or the Placement Agent is complete and
accurate and may be relied upon by the Company and the Placement Agent in determining the availability of an exemption from registration
under federal and state securities laws in connection with the offering of securities as described in the Memorandum. The Purchaser further
represents and warrants that it will notify and supply corrective information to the Company and the Placement Agent immediately upon
the occurrence of any change therein occurring prior to the Company's issuance of the securities contained in the Units.

 

(s)   The
Purchaser has significant prior investment experience, including investment in non-listed and non-registered securities. The Purchaser
is knowledgeable about investment considerations in development-stage companies with limited operating histories. The Purchaser has a
sufficient net worth to sustain a loss of its entire investment in the Company and the Units in the event such a loss should occur. The
Purchaser's overall commitment to investments which are not readily marketable is not excessive in view of the Purchaser’s net worth
and financial circumstances and the purchase of the Units will not cause such commitment to become excessive. Investment in the Company
and the Units as contemplated by this Subscription Agreement is suitable for the Purchaser.

 

(t)   The
Purchaser is satisfied that the Purchaser has received adequate information with respect to all matters which it or the Advisers, if any,
consider material to its decision to make an investment in the Company and the Units as contemplated by this Subscription Agreement.

 

(u)   The
Purchaser acknowledges that any estimates or forward-looking statements or projections included in the Memorandum were prepared by the
Company in good faith but that the attainment of any such projections, estimates or forward-looking statements cannot be guaranteed by
the Company or the Subsidiaries and should not be relied upon.

 

    5

     

    

 

(v)   No
oral or written representations have been made, or oral or written information furnished, to the Purchaser or the Advisers, if any, in
connection with the Offering which are in any way inconsistent with the information contained in the Memorandum.

 

(w)   Within
five (5) days after receipt of a request from the Company or the Placement Agent, the Purchaser will provide such information and deliver
such documents as may reasonably be necessary to comply with any and all laws and ordinances to which the Company or the Placement Agent
is subject.

 

(x)   The
Purchaser's substantive relationship with either the Company, the Placement Agent or subagent through which the Purchaser is subscribing
for Units predates such Placement Agent's or such subagent's contact with the Purchaser regarding an investment in the Units.

 

(y)   THE
UNITS OFFERED HEREBY (INCLUDING THE SHARES COMPRISING THE UNITS AND THE CONVERSION SECURITIES UNDERLYING SUCH SHARES) HAVE NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR ANY STATE SECURITIES LAWS AND ARE BEING OFFERED AND SOLD IN RELIANCE ON EXEMPTIONS FROM
THE REGISTRATION REQUIREMENTS OF SAID ACT AND SUCH LAWS. SUCH SECURITIES ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY AND RESALE AND
MAY NOT BE TRANSFERRED OR RESOLD EXCEPT AS PERMITTED UNDER SAID ACT AND SUCH LAWS PURSUANT TO REGISTRATION OR EXEMPTION THEREFROM. SUCH
SECURITIES HAVE NOT BEEN RECOMMENDED, APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE COMMISSION, ANY STATE SECURITIES COMMISSION
OR ANY OTHER REGULATORY AUTHORITY, NOR HAVE ANY OF THE FOREGOING AUTHORITIES PASSED UPON OR ENDORSED THE MERITS OF THIS OFFERING OR THE
ACCURACY OR ADEQUACY OF THE MEMORANDUM OR THIS SUBSCRIPTION AGREEMENT. ANY REPRESENTATION TO THE CONTRARY IS UNLAWFUL.

 

(z)   In
making an investment decision, investors must rely on their own examination of the Company, the Subsidiaries and the terms of the Offering,
including the merits and risks involved. The Purchaser should be aware that it will be required to bear the financial risks of investment
in the Company and the Units for an indefinite period of time.

 

(aa) (For ERISA plans
only) The fiduciary of the ERISA plan (the “Plan”) represents that such fiduciary has been informed of and understands
the Company’s investment objectives, policies and strategies, and that the decision to invest “plan assets” (as such
term is defined in ERISA) in the Company is consistent with the provisions of ERISA that require diversification of plan assets and impose
other fiduciary responsibilities. The Purchaser fiduciary or Plan (a) is responsible for the decision to invest in the Company; (b) is
independent of the Company or any of its affiliates; (c) is qualified to make such investment decision; and (d) in making such decision,
the Purchaser fiduciary or Plan has not relied primarily on any advice or recommendation of the Company or any of its affiliates.

 

    6

     

    

 

(bb) The Purchaser should
check the Office of Foreign Assets Control (“OFAC”) website at <http://www.treas.gov/ofac> before making the following
representations. The Purchaser represents that the amounts invested by it in the Company in the Offering were not and are not directly
or indirectly derived from activities that contravene federal, state or international laws and regulations, including anti-money laundering
laws and regulations. Federal regulations and Executive Orders administered by OFAC prohibit, among other things, the engagement in transactions
with, and the provision of services to, certain foreign countries, territories, entities and individuals. The lists of OFAC prohibited
countries, territories, persons and entities can be found on the OFAC website at <http://www.treas.gov/ofac>. In addition, the programs
administered by OFAC (the “OFAC Programs”) prohibit dealing with individuals1
or entities in certain countries regardless of whether such individuals or entities appear on the OFAC lists.

 

(cc) To the best of the
Purchaser’s knowledge, none of: (1) the Purchaser; (2) any person controlling or controlled by the Purchaser; (3) if the Purchaser
is a privately-held entity, any person having a beneficial interest in the Purchaser; or (4) any person for whom the Purchaser is acting
as agent or nominee in connection with this investment is a country, territory, individual or entity named on an OFAC list, or a person
or entity prohibited under the OFAC Programs. Please be advised that the Company may not accept any amounts from a prospective investor
if such prospective investor cannot make the representation set forth in the preceding paragraph. The Purchaser agrees to promptly notify
the Company and the Placement Agent should the Purchaser become aware of any change in the information set forth in these representations.
The Purchaser understands and acknowledges that, by law, the Company may be obligated to “freeze the account” of the Purchaser,
either by prohibiting additional subscriptions from the Purchaser, declining any redemption requests and/or segregating the assets in
the account in compliance with governmental regulations, and the Placement Agent may also be required to report such action and to disclose
the Purchaser’s identity to OFAC. The Purchaser further acknowledges that the Company may, by written notice to the Purchaser, suspend
the redemption rights, if any, of the Purchaser if the Company reasonably deems it necessary to do so to comply with anti-money laundering
regulations applicable to the Company and the Placement Agent or any of the Company’s other service providers. These individuals
include specially designated nationals, specially designated narcotics traffickers and other parties subject to OFAC sanctions and embargo
programs.

 

(dd) To the best of the
Purchaser’s knowledge, none of: (1) the Purchaser; (2) any person controlling or controlled by the Purchaser; (3) if the Purchaser
is a privately-held entity, any person having a beneficial interest in the Purchaser; or (4) any person for whom the Purchaser is acting
as agent or nominee in connection with this investment is a senior foreign political figure,2
or any immediate family3 member or close
associate4 of a senior foreign political
figure, as such terms are defined in the footnotes below.

 

 

	1	These individuals include specially designated nationals,
specially designated narcotics traffickers and other parties subject to OFAC sanctions and embargo programs.

 

	2	A “senior foreign political figure” is defined
as a senior official in the executive, legislative, administrative, military or judicial branches of a foreign government (whether elected
or not), a senior official of a major foreign political party, or a senior executive of a foreign government-owned corporation. In addition,
a “senior foreign political figure” includes any corporation, business or other entity that has been formed by, or for the
benefit of, a senior foreign political figure.

 

	3	“Immediate family” of a senior foreign political
figure typically includes the figure’s parents, siblings, spouse, children and in-laws.

 

	4	A “close associate” of a senior foreign political
figure is a person who is widely and publicly known to maintain an unusually close relationship with the senior foreign political figure,
and includes a person who is in a position to conduct substantial domestic and international financial transactions on behalf of the
senior foreign political figure.

 

    7

     

    

 

(ee) If the Purchaser is
affiliated with a non-U.S. banking institution (a “Foreign Bank”), or if the Purchaser receives deposits from, makes payments
on behalf of, or handles other financial transactions related to a Foreign Bank, the Purchaser represents and warrants to the Company
that: (1) the Foreign Bank has a fixed address, other than solely an electronic address, in a country in which the Foreign Bank is authorized
to conduct banking activities; (2) the Foreign Bank maintains operating records related to its banking activities; (3) the Foreign Bank
is subject to inspection by the banking authority that licensed the Foreign Bank to conduct banking activities; and (4) the Foreign Bank
does not provide banking services to any other Foreign Bank that does not have a physical presence in any country and that is not a regulated
affiliate.

 

6.   Registration
Rights.

 

(a)   “Piggy-back”
Registration. If the Company shall determine (i) at any time after the consummation of the Company’s first firm commitment underwritten
public offering of its Common Stock under the Securities Act of 1933, as amended, and the rules and regulations promulgated thereunder,
to register for sale any of its Common Stock in an underwritten offering or (ii) to file a registration statement covering the resale
of any shares of the common stock issuable upon conversion of the Company’s Series B Preferred Stock, par value $0.0001 per share
(“Series B Preferred Stock”), the Company shall, to the extent the inclusion of the Registrable Securities (as defined below)
in such registration statement (A) will not cause a secondary offering to be deemed to be a primary offering; and (B) is not prohibited
by applicable securities laws or interpretations of the SEC or its staff provide written notice to the holders of Series B-1 Preferred
(each a “Holder”), which notice shall be provided no less than fifteen (15) calendar days prior to the filing of such applicable
registration statement (the “Company Notice”). In that event, the right of any Holder to include the Common Stock issued or
issuable (directly or indirectly) upon conversion of such Holder’s Series B-1 Preferred (the “Registrable Securities”)
in such a registration shall be conditioned upon such Holder’s written request to participate which shall be delivered to the Company
within ten (10) calendar days after the Company Notice, as well as such Holder’s participation in such underwriting (if applicable,
for purposes of this paragraph) and the inclusion of such holder’s Registrable Securities in the underwriting to the extent provided
herein. All Holders proposing to sell any of their Registrable Securities through such underwriting shall (together with the Company and
any other stockholders of the Company selling their securities through such underwriting) enter into an underwriting agreement in customary
form with the underwriter selected for such underwriting by the Company or the selling stockholders, as applicable. Notwithstanding anything
herein to the contrary, if the underwriter or the Company determines that marketing factors require a limitation on the number of shares
of Common Stock or the amount of other securities to be underwritten, the underwriter may exclude some or all Registrable Securities from
such registration and underwriting. The Company shall so advise all Holders (except those Holders who failed to timely elect to include
their Registrable Securities through such underwriting or have indicated to the Company their decision not to do so), and indicate to
each such Holder the number of shares of Registrable Securities that may be included in the registration and underwriting, if any. The
number of shares of Registrable Securities to be included in such registration and underwriting shall be allocated first to the Company
(if a Company registration pursuant to Section 6(a)(i) hereof), then to the holders of Series B Preferred Stock, and then, subject to
obligations and commitments existing as of the date hereof, to all other selling stockholders, including the Holders, who have requested
to sell in the registration on a pro rata basis according to the number of shares requested to be included therein. If any Holder disapproves
of the terms of any such underwriting, such Holder may elect to withdraw such Holder’s Registrable Securities therefrom by delivering
a written notice to the Company and the underwriter. The Registrable Securities so withdrawn from such underwriting shall also be withdrawn
from such registration; provided, however, that, if by the withdrawal of such Registrable Securities, a greater number of Registrable
Securities held by other Holders may be included in such registration (up to the maximum of any limitation imposed by the underwriters),
then the Company shall offer to all Holders who have included Registrable Securities in the registration the right to include additional
Registrable Securities pursuant to the terms and limitations set forth herein in the same proportion used above in determining the underwriter
limitation. A Holder with Registrable Securities included in any registration shall furnish to the Company such information regarding
itself, the Registrable Securities held by it, and the intended method of disposition of such securities as shall be required in order
to comply with any applicable law or regulation in connection with the registration of such Holder’s Registrable Securities or any
qualification or compliance with respect to such Holder’s Registrable Securities and referred to in this Agreement. The Company
shall have the right to terminate or withdraw any registration initiated by it before the effective date of such registration, whether
or not any Holder has elected to include Registrable Securities in such registration.

 

    8

     

    

 

(b)   Holdback
Agreements. Each Holder understands and agrees that (i) it shall not sell, offer, pledge, contract to sell, grant any option or contract
to purchase, purchase any option or contract to sell, grant any right or warrant to purchase, lend or otherwise transfer or encumber,
directly or indirectly, any shares of its Registrable Securities (each, a “Transfer”), nor shall such Holder enter into any
swap, hedging or other arrangement that transfers to another, in whole or in part, any of the economic consequences of ownership of any
shares of its Registrable Securities until six (6) months from the date the SEC declares the applicable registration statement effective
(the “Release Date”). Each Holder hereby covenants and agrees that (x) it shall abide by the restrictions set forth above
and (y) the Company shall be entitled to place “stop transfer” instructions with the Company’s transfer agent in compliance
with the above restrictions. The foregoing provisions of this Subsection 6(b) shall not apply to the sale of any shares to an underwriter
pursuant to an underwriting agreement, or the Transfer of any Registrable Securities to Permitted Assignees, provided that such Permitted
Assignee agrees to be bound in writing by the restrictions set forth herein, and provided, further, that any such Transfer shall not involve
a disposition for value. The underwriters in connection with such registration are intended third-party beneficiaries of this Subsection
6(b) and shall have the right, power and authority to enforce the provisions hereof as though they were a party hereto. Each Holder further
agrees to execute such agreements as may be reasonably requested by the underwriters in connection with such registration that are consistent
with this Subsection 6(b) or that are necessary to give further effect thereto. Any discretionary waiver or termination of the restrictions
of any or all of such agreements by the Company or the underwriters shall apply pro rata to all Holders subject to such agreements, based
on the number of shares subject to such agreements. For the purposes of this Agreement, (x) “Permitted Assignees” means (a)
with respect to a person, Affiliates of such person, (b) with respect to a partnership, its general and limited partners, (c) with respect
to a limited liability company, its members and (d) with respect to an individual party, any Immediate Family Member of such party or
any trust for the direct or indirect benefit of the individual or any Immediate Family Member, (y) “Immediate Family Member”
means a child, stepchild, grandchild, parent, stepparent, grandparent, spouse, sibling, mother-in-law, father-in-law, son-in-law, daughter-in-law,
brother-in-law, or sister-in-law, including, adoptive relationships, of a natural person referred to herein and (z) “Affiliate”
means with respect to any specified person, any other person who, directly or indirectly, controls, is controlled by, or is under common
control with such person, including without limitation any general partner, managing member, officer or director of such person or any
venture capital fund now or hereafter existing that is controlled by one or more general partners or managing members of, or shares the
same management company with, such person.

 

7.   Indemnification.
The Purchaser agrees to indemnify and hold harmless the Company the Subsidiaries, the Placement Agent (including its selected dealers,
if any), and their respective officers, directors, employees, agents, control persons and affiliates from and against all losses, liabilities,
claims, damages, costs, fees and expenses whatsoever (including, but not limited to, any and all expenses incurred in investigating, preparing
or defending against any litigation commenced or threatened) based upon or arising out of any actual or alleged false acknowledgment,
representation or warranty, or misrepresentation or omission to state a material fact, or breach by the Purchaser of any covenant or agreement
made by the Purchaser herein or in any other document delivered in connection with this Subscription Agreement.

 

8.   Irrevocability;
Binding Effect. The Purchaser hereby acknowledges and agrees that the subscription hereunder is irrevocable by the Purchaser, except
as required by applicable law, and that this Subscription Agreement shall survive the death or disability of the Purchaser 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 Purchaser is more than one person, the obligations of the Purchaser hereunder shall be joint and several and
the agreements, representations, warranties, and acknowledgments herein shall be deemed to be made by and be binding upon each such person
and such person's heirs, executors, administrators, successors, legal representatives, and permitted assigns.

 

9.   Modification.
This Subscription Agreement shall not be modified or waived except by an instrument in writing signed by the party against whom any such
modification or waiver is sought.

 

10.   Immaterial
Modifications to the Voting Agreement. The Company may, at any time prior to the First Closing, modify the Voting Agreement if necessary
to clarify any provision therein, without first providing notice or obtaining prior consent of the Purchaser, if, and only if, such modification
is not material in any respect.

 

11.   Notices.
Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be deemed effectively given:
(a) upon personal delivery to the party notified, (b) when sent by confirmed email or facsimile if sent during normal business hours of
the recipient, if not confirmed, then on the next business day, (c) five days after having been sent by registered or certified mail,
return receipt requested, postage prepaid, or (d) one day after deposit with a nationally recognized overnight courier, specifying next
day delivery, with written verification of receipt. The Company and the Purchaser hereby consent to the delivery of communications and
notices to such parties at their respective address, email or facsimile number set forth on the signature page hereto, or to such other
address as such party shall have furnished in writing in accordance with the provisions of this Section 11.

 

    9

     

    

 

12.   Assignability.
This Subscription Agreement and the rights, interests and obligations hereunder are not transferable or assignable by the Purchaser and
the transfer or assignment of the Units, the Shares constituting the Units or the Conversion Securities shall be made only in accordance
with all applicable laws.

 

13.   Applicable
Law. This Subscription Agreement shall be governed by and construed in accordance with the laws of the State of New York applicable
to contracts to be wholly-performed within said State.

 

14.   Arbitration.
The parties agree to submit all controversies to arbitration in accordance with the provisions set forth below and understand that:

 

(a)   Arbitration
is final and binding on the parties.

 

(b)   The
parties are waiving their right to seek remedies in court, including the right to a jury trial.

 

(c)   Pre-arbitration
discovery is generally more limited and different from court proceedings.

 

(d)   The
arbitrator’s award is not required to include factual findings or legal reasoning and any party’s right to appeal or to seek
modification of rulings by arbitrators is strictly limited.

 

(e)   The
panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securities industry.

 

(f)   All
controversies which may arise between the parties concerning this Subscription Agreement shall be determined by arbitration pursuant to
the rules then pertaining to the Financial Industry Regulatory Authority, Inc. (“FINRA”) in New York City, New York. Judgment
on any award of any such arbitration may be entered in the Supreme Court of the State of New York or in any other court having jurisdiction
of the person or persons against whom such award is rendered. Any notice of such arbitration or for the confirmation of any award in any
arbitration shall be sufficient if given in accordance with the provisions of this Agreement. The parties agree that the determination
of the arbitrators shall be binding and conclusive upon them.

 

15.   Blue
Sky Qualification. The purchase of Units under this Subscription Agreement is expressly conditioned upon the exemption from qualification
of the offer and sale of the Units from applicable federal and state securities laws. The Company shall not be required to qualify this
transaction under the securities laws of any jurisdiction and, should qualification be necessary, the Company shall be released from any
and all obligations to maintain its offer, and may rescind any sale contracted, in the jurisdiction.

 

    10

     

    

 

16.   Use
of Pronouns. All pronouns and any variations thereof used herein shall be deemed to refer to the masculine, feminine, neuter, singular
or plural as the identity of the person or persons referred to may require.

 

17.   Confidentiality.
The Purchaser acknowledges and agrees that any information or data the Purchaser has acquired from or about the Company or the Subsidiaries,
not otherwise properly in the public domain, was received in confidence. The Purchaser agrees not to divulge, communicate or disclose,
except as may be required by law or for the performance of this Agreement, or use to the detriment of the Company or the Subsidiaries
or for the benefit of any other person or persons, or misuse in any way, any confidential information of the Company or the Subsidiaries,
including any scientific, technical, trade or business secrets of the Company or the Subsidiaries and any scientific, technical, trade
or business materials that are treated by the Company or the Subsidiaries as confidential or proprietary, including, but not limited to,
ideas, discoveries, inventions, developments and improvements belonging to the Company or the Subsidiaries and confidential information
obtained by or given to the Company or the Subsidiaries about or belonging to third parties.

 

18.   Miscellaneous.

 

(a)   This
Subscription Agreement, together with the Voting Agreement, constitute the entire agreement between the Purchaser and the Company with
respect to the subject matter hereof and supersede all prior oral or written agreements and understandings, if any, relating to the subject
matter hereof. The terms and provisions of this Subscription Agreement may be waived, or consent for the departure therefrom granted,
only by a written document executed by the party entitled to the benefits of such terms or provisions.

 

(b)   The
representations and warranties of the Purchaser made in this Subscription Agreement shall survive the execution and delivery hereof and
delivery of the Shares constituting the Units.

 

(c)   Each
of the parties hereto shall pay its own fees and expenses (including the fees of any attorneys, accountants, appraisers or others engaged
by such party) in connection with this Subscription Agreement and the transactions contemplated hereby whether or not the transactions
contemplated hereby are consummated.

 

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

 

(e)   Each
provision of this Subscription Agreement shall be considered separable and, if for any reason any provision or provisions hereof are determined
to be invalid or contrary to applicable law, such invalidity or illegality shall not impair the operation of or affect the remaining portions
of this Subscription Agreement.

 

(f)   Paragraph
titles are for descriptive purposes only and shall not control or alter the meaning of this Subscription Agreement as set forth in the
text.

 

(g)   The
Purchaser understands and acknowledges that there may be multiple closings for this Offering.

 

19.   Omnibus
Signature Page. This Subscription Agreement is intended to be read and construed in conjunction with the Voting Agreement pertaining
to the issuance by the Company of the Shares to subscribers pursuant to the Memorandum. Accordingly, pursuant to the terms and conditions
of this Subscription Agreement and such related agreements it is hereby agreed that the execution by the Purchaser of this Subscription
Agreement, in the place set forth herein, shall constitute agreement to be bound by the terms and conditions hereof and the terms and
conditions of the Voting Agreement, with the same effect as if each of such separate but related agreement were separately signed.

 

[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

 

    11

     

    

 

PRIVATE PLACEMENT OFFERING OF 

Orchestra
Biomed, INC. 

 

SUBSCRIPTION INSTRUCTIONS

 

To subscribe for Units in the private offering
of Orchestra Biomed, Inc.:

 

	1.	Date and Fill in the number of Units being purchased and
Complete and Sign the Omnibus Signature Page to the Subscription Agreement (page 16).

 

		2.	Initial the Accredited Investor Certification page attached
to the Subscription Agreement (pages 17-18).

 

		3.	Complete and return the Investor Profile (page 19).

 

		4.	Complete and Sign the Tax Certification for U.S. Persons
or Non-U.S. Persons, as applicable (beginning on page 21).

 

		5.	Fax or e-mail all forms to Tierney S. Picardal at 347-772-3121/Tierney@sternaegis.com.

 

		6.	Please wire funds directly to the escrow account pursuant to
the following instructions (unless other arrangements have been made); checks cannot be accepted:

 

Bank Name: Signature Bank

 

Bank Address: 950 Third Avenue, NY, NY 10022 (IF wiring banker requests
this info)

 

ABA Number: 026013576

 

SWIFT CODE: SIGNUS33

 

A/C Name: Signature Bank, as Agent for Orchestra BioMed, Inc.

 

Orchestra BioMed, Inc. Address (if requested): 150 Union Square
Drive, New Hope, PA 18938

 

A/C Number: 1503539914

 

REF. outgoing wire with the following information

 

FBO: Investor Name____________

 

SSN/TIN ____________________

 

Address _____________________

 

    12

     

    

 

ANTI MONEY LAUNDERING REQUIREMENTS

 

	
    The USA PATRIOT Act
	What is money laundering?	How big is the problem and why is it important?
	
     

    The USA PATRIOT Act is designed to detect, deter, and punish terrorists
    in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions.
    Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs.

     

    To help you understand these efforts, we want to provide you with some
    information about money laundering and the Placement Agent’s efforts to implement the USA PATRIOT Act.
	
     

    Money laundering is the process of disguising illegally obtained money
    so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes,
    including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism.
	
     

    The use of the U.S. financial system by criminals to facilitate terrorism
    or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of
    worldwide money laundering activity at $1 trillion a year.

 

	What the Placement Agent is required to do to help eliminate money laundering?
	
     

    Under new rules required by the USA PATRIOT Act, the Placement Agent’s
    anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish
    policies and procedures to detect and report suspicious transaction and ensure compliance with the new laws.
	
     

    As part of the Placement Agent’s required program, it may ask
    you to provide various identification documents or other information. Until you provide the information or documents that the Placement
    Agent needs, it may not be able to effect any transactions for you.

 

    13

     

    

 

Orchestra
Biomed, Inc.

OMNIBUS SIGNATURE PAGE TO THE

SUBSCRIPTION AGREEMENT AND VOTING AGREEMENT

 

Subscriber hereby elects to subscribe under
the Subscription Agreement for a total of $_______ of Shares at a price of $15.00 per Share (NOTE: to be completed by subscriber) and,
by execution and delivery hereof, Subscriber hereby executes the Subscription Agreement and agrees to be bound by the terms and conditions
of the Subscription Agreement and the Voting Agreement.

 

 

If the Purchaser is an INDIVIDUAL, and if purchased
as JOINT TENANTS, as TENANTS IN COMMON, or as COMMUNITY PROPERTY:

 

	 	 	 
	Print
    Name(s)	 	Social
    Security Number(s)
	 	 	 
	 	 	 
	Signature(s)
    of Subscriber(s)	 	Signature
	 	 	 
	 	 	 
	Date	 	Address
	 	 	 
	If
    the Purchaser is a PARTNERSHIP, CORPORATION, LIMITED LIABILITY COMPANY or TRUST:
	 	 	 
	 	 	 
	Name
    of Entity	 	Federal
    Taxpayer
	 	 	Identification
    Number
	 	 	 
	By:	 	 	 
		Name:	 	State
    of Organization
		Title:	 	 
	 	 	 
	 	 	 
	Date	 	Address
	 	 	 
	 	 	 
	Fax
    Number	 	Email
    Address
	 	 	 
	Orchestra
    Biomed, Inc.	 	AEGIS
    CAPTIAL CORP.
	 	 	 
	By:		 	By:	
	 	Authorized
    Officer	 	 	Authorized
    Officer

 

    14

     

    

 

Orchestra
Biomed, INC.

ACCREDITED INVESTOR CERTIFICATION

 

For Individual Investors Only

(all Individual Investors must INITIAL
where appropriate):

 

	Initial	_______ 	I have an individual net worth, or joint net worth with my spouse, as of the date hereof in excess of $1 million. For purposes of calculating
net worth under this category, (i) the undersigned’s primary residence shall not be included as an asset, (ii) indebtedness
that is secured by the undersigned’s primary residence, up to the estimated fair market value of the primary residence at the time
of the sale of securities, shall not be included as a liability, (iii) to the extent that the indebtedness that is secured by
the primary residence is in excess of the fair market value of the primary residence, the excess amount shall be included as a liability,
and (iv) if the amount of outstanding indebtedness that is secured by the primary residence exceeds the amount outstanding 60 days prior
to the execution of this Subscription Agreement, other than as a result of the acquisition of the primary residence, the amount of such
excess shall be included as a liability.

 

	Initial	_______ 	I have had an annual gross income for the past two years of at least $200,000 (or $300,000 jointly with my spouse) and expect my income
(or joint income, as appropriate) to reach the same level in the current year.

 

	Initial	_______ 	I am a director or executive officer of Orchestra BioMed, Inc.

 

For Non-Individual
Investors

(all Non-Individual
Investors must INITIAL where appropriate):

 

	Initial	_______ 	The investor certifies that it is a partnership, corporation, limited liability company or business trust that is 100% owned by persons
who meet at least one of the criteria for Individual Investors set forth above.

 

	Initial	_______	The
                                            investor certifies that it is a partnership, corporation, limited liability company or any
                                            organization described in Section 501(c)(3) of the Internal Revenue Code, Massachusetts
                                            or similar business trust that has total assets of at least $5 million and was not formed
                                            for the purpose of investing the Company.

 

	Initial	_______	 The investor certifies that it is an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974,
whose investment decision is made by a plan fiduciary (as defined in ERISA §3(21)) that is a bank, savings and loan association,
insurance company or registered investment adviser.

 

	Initial	_______ 	The investor certifies that it is an employee benefit plan whose total assets exceed $5,000,000 as of the date of this Agreement.

 

    15

     

    

 

	Initial	_______ 	The undersigned certifies that it is a self-directed employee benefit plan whose investment decisions are made solely by persons who
meet either of the criteria for Individual Investors.

 

	Initial	_______ 	The investor certifies that it is a U.S. bank, U.S. savings and loan association or other similar U.S. institution acting in its individual
or fiduciary capacity.

 

	Initial	_______ 	The undersigned certifies that it is a broker-dealer registered pursuant to §15 of the Securities Exchange Act of 1934.

 

	Initial	_______ 	The investor certifies that it is an organization described in §501(c)(3) of the Internal Revenue Code with total assets exceeding
$5,000,000 and not formed for the specific purpose of investing in the Company.

 

	Initial	_______ 	The investor certifies that it is a trust with total assets of at least $5,000,000, not formed for the specific purpose of investing
in the Company, and whose purchase is directed by a person with such knowledge and experience in financial and business matters that
he is capable of evaluating the merits and risks of the prospective investment.

 

	Initial	_______ 	The investor certifies that it is a plan established and maintained by a state or its political subdivisions, or any agency or instrumentality
thereof, for the benefit of its employees, and which has total assets in excess of $5,000,000.

 

	Initial	_______ 	The investor certifies that it is an insurance company as defined in §2(13) of the Securities Act, or a registered investment company.

 

	Initial	_______ 	An investment company registered under the Investment Company Act of 1940 or a business development company as defined in Section 2(a)(48)
of that Act.

 

	Initial	_______	 A Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the
Small Business Investment Act of 1958.

 

	Initial	_______	A private business development company as defined in Section 202(a)(22) of the Investment Advisers Act of 1940.

 

    16

     

    

 

Orchestra
Biomed, INC.

Investor Profile (Must
be completed by Investor)

 

Section A - Personal Investor Information

 

For All Purchasers

 

Certificate Title: ______________________________________________________________________________

 

Individual(s) executing this subscription: __________________________________________________________

 

Social Security Number(s) for all signatories: ________________________________

 

Entity Federal I.D. Number: _____________________________________________

 

Date(s) of Birth: ______________

 

Marital Status: _______________

 

Years Investment Experience: ______________

 

Aegis Capital Acct Executive or Outside Broker/Dealer: ______ /Aegis
Rep 3-Digit I.D._____/Aegis Acct #_______

 

Check if you are a FINRA member or affiliate of a FINRA member firm:
____

 

Check Investment Objective(s) (See definitions
on following page): ____Preservation of Capital ____Income

 

____Capital Appreciation ____Trading Profits
____Speculation

 

____Other (please specify)

 

The source of funds for this investment is my personal or my entity's
assets _____Yes  _____No

 

For Purchasers as Individual or as Joint Tenants, Tenants in Common,
and Community Property

 

Annual Income(s): ___________________

 

Liquid Net Worth(s):__________________

 

Net Worth(s) (excluding value of primary residence): ________________

 

Select Tax Bracket(s): ____ 15% or below ____ 25% - 27.5% ____ Over
27.5%

 

For All Purchasers, by the Primary Contact

 

Home Street Address: ______________________________________________________________________

 

Home City, State & Zip Code: _______________________________________________________________

 

Home Phone: ___________________ Home Fax: _________________Home Email:
____________________

 

Employer: ___________________________________

 

Type of Business: _____________________________

 

Employer Street Address: ___________________________________________________________________

 

Employer City, State & Zip Code: ____________________________________________________________

 

Bus. Phone: _____________________Bus. Fax: ___________________Bus.
Email: ____________________

 

    17

     

    

 

For All Purchasers

 

If you are a United States citizen,
please list the number and jurisdiction of issuance of any other government-issued document evidencing residence and bearing a photograph
or similar safeguard (such as a driver’s license or passport), and provide a photocopy of each of the documents you have listed.

 

If you are NOT a United
States citizen, for each jurisdiction of which you are a citizen or in which you work or reside, please list (i) your passport
number and country of issuance or (ii) alien identification card number AND (iii) number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard, and provide a photocopy of each of these documents
you have listed. These photocopies must be certified by a lawyer as to authenticity.

 

Government-Issued Identification Document Number(s) and
Jurisdiction(s):_______________________

 

In addition, please provide a legible photocopy of your
Identification Document(s) with your subscription

 

Section B – Securities Delivery Instructions

 

____ Please deliver securities to the Employer Address listed in Section
A.

 

____ Please deliver securities to the Home Address listed in Section
A.

 

____ Please deliver securities to the following address: _____________________________________________

 

Section C –Wire Transfer Instructions 

 

____ I will wire funds from my outside account
according to the “Subscription Instructions” Page.

 

____ I will wire funds from my Aegis Capital Account.

 

____The funds for this investment are rolled over,
tax deferred from __________ within the allowed 60 day window.

 

	 	 	 
	Investor Signature	 	Date
	 	 	 
	 	 	 
	Investor Signature	 	Date

 

    18

     

    

 

Investment Objectives: The typical investment
listed with each objective are only some examples of the kinds of investments that have historically been consistent with the listed objectives.
However, neither the Company nor the Placement Agent can assure that any investment will achieve your intended objective. You must make
your own investment decisions and determine for yourself if the investments you select are appropriate and consistent with your investment
objectives.

 

Neither the Company nor the Placement Agent assumes
responsibility to you for determining if the investments you selected are suitable for you.

 

Preservation of Capital: An investment
objective of Preservation of Capital indicates you seek to maintain the principal value of your investments and are interested
in investments that have historically demonstrated a very low degree of risk of loss of principal value. Some examples of typical investments
might include money market funds and high quality, short-term fixed income products.

 

Income: An investment objective of Income
indicates you seek to generate income from investments and are interested in investments that have historically demonstrated a low
degree of risk of loss of principal value. Some examples of typical investments might include high quality, short and medium-term fixed
income products, short-term bond funds and covered call options.

 

Capital Appreciation: An investment objective
of Capital Appreciation indicates you seek to grow the principal value of your investments over time and are willing to invest
in securities that have historically demonstrated a moderate to above average degree of risk of loss of principal value to pursue this
objective. Some examples of typical investments might include common stocks, lower quality, medium-term fixed income products, equity
mutual funds and index funds.

 

Trading Profits: An investment objective
of Trading Profits indicates you seek to take advantage of short-term trading opportunities, which may involve establishing and
liquidating positions quickly. Some examples of typical investments might include short-term purchases and sales of volatile or low priced
common stocks, put or call options, spreads, straddles and/or combinations on equities or indexes. This is a high-risk strategy.

 

Speculation: An investment objective of
Speculation indicates you seek a significant increase in the principal value of your investments and are willing to accept a corresponding
greater degree of risk by investing in securities that have historically demonstrated a high degree of risk of loss of principal value
to pursue this objective. Some examples of typical investments might include lower quality, long-term fixed income products, initial public
offerings, volatile or low priced common stocks, the purchase or sale of put or call options, spreads, straddles and/or combinations on
equities or indexes, and the use of short-term or day trading strategies.

 

Other: Please specify.

 

 

19

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00348-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00348-of-00352.parquet"}]]