Document:

Form of Debenture

 Exhibit 10.2 
 THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR THE SECURITIES LAWS OF ANY STATE AND MAY NOT BE SOLD OR OFFERED FOR SALE IN THE ABSENCE OF AN EFFECTIVE
REGISTRATION STATEMENT FOR THE SECURITIES OR AN OPINION OF COUNSEL OR OTHER EVIDENCE ACCEPTABLE TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED. 
  

				
	 No.                    
	  	US $	150,000

 OMNICOMM SYSTEMS, INC. 
 12% SECURED CONVERTIBLE DEBENTURE SERIES 09 
 DUE March
    , 2011 
 FOR VALUE RECEIVED, OMNICOMM SYSTEMS, INC., a corporation organized and
existing under the laws of the State of Delaware (the “Company”), promises to pay to the Aspen Opportunity Fund, LP, Delaware limited partnership or its assigns as the registered holder hereof (the “Holder”), the principal sum of
ONE HUNDRED FIFTY THOUSAND and  00/100 Dollars (US
$150,000.00) on March     , 2011 (the “Maturity Date”) and to pay interest on the principal sum outstanding from time to time in arrears at the rate of 12% per annum, accruing from the date of initial issuance of
this Debenture (the “Issue Date”), on the date (each, an “Interest Payment Date”) which is the earlier of (i) the next Conversion Date (as defined below), (ii) the date which is one month from the Issue Date and every
one month thereafter, or (iii) the Maturity Date, as the case may be. Interest shall accrue monthly (pro-rated on a daily basis for any period longer or shorter than a month) from the later of the Issue Date or the previous Interest Payment
Date and shall be payable, subject to the other provisions of this Debenture, in cash or in Common Stock at the option of the Holder. If not paid in full on an Interest Payment Date, interest shall be fully cumulative and shall accrue on a daily
basis, based on a 365-day year, and compound monthly until paid. Additional provisions regarding the payment of interest are provided in Section 4(D) below (the terms of which shall govern as if this sentence were not included in this
Debenture). 
 This Debenture is subject to the following additional provisions: 
 1. The Debentures will initially be issued in denominations determined by the Company, but are exchangeable for an equal aggregate principal
amount of Debentures of different denominations, as requested by the Holder surrendering the same. No service charge will be made for such registration or transfer or exchange. 
 2. The Company shall be entitled to withhold from all payments of principal of, and interest on, this Debenture any amounts required to be
withheld under the applicable provisions of the United States income tax laws or other applicable laws at the time of such payments, and Holder shall execute and deliver all required documentation in connection therewith. 
  

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 3. This Debenture has been issued subject to investment representations of the original
purchaser hereof and may be transferred or exchanged only in compliance with the Securities Act of 1933, as amended (the “Act”), and other applicable state and foreign securities laws. In the event of any proposed transfer of this
Debenture, the Company may require, prior to issuance of a new Debenture in the name of such other person, that it receive reasonable transfer documentation that is sufficient to evidence that such proposed transfer complies with the Act and other
applicable state and foreign securities laws and the terms of the Securities Purchase Agreement between the Company, the Holder and the other parties to the Securities Purchase Agreement of even date herewith (Securities Purchase Agreement”).
Prior to due presentment for transfer of this Debenture, the Company and any agent of the Company may treat the person in whose name this Debenture is duly registered on the Company’s Debenture Register as the owner hereof for the purpose of
receiving payment as herein provided and for all other purposes, whether or not this Debenture be overdue, and neither the Company nor any such agent shall be affected by notice to the contrary. 
 4. A. (i) At any time on or after the Issue Date and prior to the time this Debenture is paid in full in accordance with its terms
(including, without limitation, after the occurrence of an Event of Default, as defined below, or, if the Debenture is not fully paid or converted after the Maturity Date), the Holder of this Debenture is entitled, at its option, subject to the
following provisions of this Section 4, to convert this Debenture at any time into shares of Common Stock, $0.001 par value (“Common Stock”), of the Company at the Conversion Price (as defined below). Any such conversion is referred
to as a “Voluntary Conversion.” 
 (ii) On the Maturity Date the Company shall pay the principal and accrued interest
(through the actual date of payment) of any portion of this Debenture which is then outstanding. 
 (iii) For purposes of this
Debenture, the following terms shall have the meanings indicated below: 
 “Conversion Price” means the Fixed
Conversion Price or the Interest Conversion Price, as the case may be. 
 “Conversion Shares” has the meaning ascribed
to in Section 4(H) hereof. 
 “Fixed Conversion Price” means initially $0.25 (which amount is subject to the
adjustment provisions specified in Section 4(g) of the Securities Purchase Agreement). 
 “Interest Conversion
Price” means (i) the VWAP for the ten (10) Regular Trading Days ending on the Trading Day immediately before the relevant Conversion Date, multiplied by (ii) ninety percent (90%). 
 “Regular Trading Day,” “Reporting Service,” “Trading Day,” and “VWAP” have the meanings ascribed to
them in the Securities Purchase Agreement. “Conversion Date” means the date on which the Holder faxes or otherwise delivers a Notice of Conversion to the Company so that it is received by the Company on or before such specified date.

  

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 B. A Voluntary Conversion shall be effectuated by the Holder by faxing a notice of
conversion (“Notice of Conversion”) to the Company as provided in this paragraph. The Notice of Conversion shall be executed by the Holder of this Debenture and shall evidence such Holder’s intention to convert this Debenture or a
specified portion hereof in the form annexed hereto as Exhibit A. Delivery of the Notice of Conversion shall be accepted by the Company by hand, mail or courier delivery at the address specified in said Exhibit A or at the facsimile number specified
in said Exhibit A (each of such address or facsimile number may be changed by notice given to the Holder in the manner provided in the Securities Purchase Agreement). 
 C. (i) Subject to the terms of this Section 4(C), interest on the principal amount of this Debenture payable on an Interest Payment Date shall be due and payable, at the option of the Holder, in cash
or in shares of Common Stock on the Interest Payment Date. 
 (ii) If the interest payable hereunder is to be paid in cash, the
Company shall make such payment within three (3) Trading Days after the Interest Payment Date. 
 (iii) If interest is to
be paid in Common Stock, the number of shares of Common Stock to be received shall be determined by dividing the dollar amount of the interest by Interest Conversion Price in effect on the relevant Interest Payment Date. 
 D. (i) The following provisions apply to the issuances of Common Stock in payment of the amounts due under this Debenture, whether as
principal or interest, as provided in the preceding provisions of this Section 4. 
 (ii) No fractional shares of Common
Stock or scrip representing fractions of shares will be issued on conversion, but the number of shares issuable shall be rounded to the nearest whole share. 
 (iii) All shares issuable with respect to a Conversion Date or an Interest Payment Date shall be deemed “Conversion Shares” for all purposes of this Debenture. Certificates representing the
relevant Conversion Shares (“Conversion Certificates”) will be delivered to the Holder at the address specified in the relevant Notice of Conversion. which address the Holder may change from time to time, via express courier, by electronic
transfer or otherwise, within three (3) Trading Days (such third Trading Day, the “Delivery Date”) after the relevant Conversion Date. The Holder shall be deemed to be the holder of the shares issuable to it in accordance with the
relevant provisions of this Debenture on the Conversion Date or Interest Payment Date, as the case may be. 
 E. Except as may
be specified in a specific provision of this Debenture, any payments under this Debenture shall be applied in the following order of priority: (i) first to amounts due to the Holder for accrued but unpaid interest on this Debenture; and
(ii) then, to principal of this Debenture. 
  

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 5. This Debenture is secured by a Security Interest Agreement of even date herewith (the
“Security Agreement”), in the form attached as Exhibit B hereto, between the Company, the Holder and the other parties to the Securities Purchase Agreement. 
 6. No provision of this Debenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay the principal of, and interest on, this Debenture at the time, place, and
rate, and in the coin or currency or where contemplated herein in shares of its Common Stock, as applicable, as herein prescribed. This Debenture and all other Debentures now or hereafter issued of similar terms are direct obligations of the
Company. 
 7. No recourse shall be had for the payment of the principal of, or the interest on, this Debenture, or for any
claim based hereon, or otherwise in respect hereof against any incorporator, shareholder, officer or director, as such, past, present or future, of the Company or any successor corporation, whether by virtue of any constitution, statute or rule of
law, or by the enforcement of any assessment or penalty or otherwise, all such liability being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released. Notwithstanding the forgoing, it is
expressly understood and agreed between the Company and the Holder that the Holder is not waiving any rights or remedies it may have as a result of any fraud, gross negligence or malfeasance on the part of any incorporator, shareholder, officer or
director of the Company or any successor corporation. 
 8. All payments contemplated hereby to be made “in cash”
shall be made in immediately available good funds of United States of America currency by wire transfer to an account designated in writing by the Holder to the Company (which account may be changed by notice similarly given). All payments of cash
and each delivery of shares of Common Stock issuable to the Holder as contemplated hereby shall be made to the Holder at the address last appearing on the Debenture Register of the Company as designated in writing by the Holder from time to time;
except that the Holder can designate, by notice to the Company, a different delivery address for any one or more specific payments or deliveries. 
 9. If, for as long as this Debenture remains outstanding, the Company enters into a merger (other than where the Company is the surviving entity) or consolidation with another corporation or other entity
or a sale or transfer of all or substantially all of the assets of the Company to another person (collectively, a “Sale”), the Company will require, in the agreements reflecting such transaction, that the surviving entity expressly assume
the obligations of the Company hereunder. Notwithstanding the foregoing, if the Company enters into a Sale and the holders of the Common Stock are entitled to receive stock, securities or property in respect of or in exchange for Common Stock, then
as a condition of such Sale, the Company and any such successor, purchaser or transferee will agree that the Debenture may thereafter be converted on the terms and subject to the conditions set forth above into the kind and amount of stock,
securities or property receivable upon such merger, consolidation, sale or transfer by a holder of the number of shares of Common Stock into which this Debenture might have been converted immediately before such merger, consolidation, sale or
transfer, subject to adjustments which shall be as nearly equivalent as may be practicable. In the event of any such proposed Sale, (i) the Holder hereof shall have the right to convert by delivering a Notice of Conversion to the Company within
fifteen (15) days of receipt of notice of such Sale from the Company, except that Section 4(C) shall not apply to such conversion. 
  

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 10. If, at any time while any portion of this Debenture remains outstanding, the Company
spins off or otherwise divests itself of a part of its business or operations or disposes of all or of a part of its assets in a transaction (the “Spin Off”) in which the Company, in addition to or in lieu of any other compensation
received and retained by the Company for such business, operations or assets, causes securities of another entity (the “Spin Off Securities”) to be issued to security holders of the Company, the Company shall cause (i) to be reserved
Spin Off Securities equal to the number thereof which would have been issued to the Holder had all of the Holder’s Debentures outstanding on the record date (the “Record Date”) for determining the amount and number of Spin Off
Securities to be issued to security holders of the Company (the “Outstanding Debentures”) been converted as of the close of business on the Trading Day immediately before the Record Date (the “Reserved Spin Off Shares”), and
(ii) to be issued to the Holder on the conversion of all or any of the Outstanding Debentures, such amount of the Reserved Spin Off Shares equal to (x) the Reserved Spin Off Shares multiplied by (y) a fraction, of which (I) the
numerator is the principal amount of the Outstanding Debentures then being converted, and (II) the denominator is the principal amount of the Outstanding Debentures. 
 11. If, at any time while any portion of this Debenture remains outstanding, the Company effectuates a stock split or reverse stock split of its Common Stock or issues a dividend on its Common Stock
consisting of shares of Common Stock, the prices used in determining the Conversion Price from dates prior to such action or and any other fixed amounts calculated as contemplated hereby or by any of the other Transaction Agreements shall be
equitably adjusted to reflect such action. 
 12. The Holder of the Debenture, by acceptance hereof, agrees that this Debenture
is being acquired for investment and that such Holder will not offer, sell or otherwise dispose of this Debenture or the shares of Common Stock issuable upon conversion thereof except under circumstances which will not result in a violation of the
Act or any applicable state Blue Sky or foreign laws or similar laws relating to the sale of securities. 
 13. This Debenture
shall be governed by and construed in accordance with the laws of the State of Florida for contracts to be wholly performed in such state and without giving effect to the principles thereof regarding the conflict of laws. Each of the parties
consents to the exclusive jurisdiction of the federal courts whose districts encompass any part of the County of Broward or the state courts of the State of Florida sitting in the County of Broward in connection with any dispute arising under this
Debenture and hereby waives, to the maximum extent permitted by law, any objection, including any objection based on forum non coveniens, to the bringing of any such proceeding in such jurisdictions. To the extent determined by such court, the
Company shall reimburse the Holder for any reasonable legal fees and disbursements incurred by the Holder in enforcement of or protection of any of its rights under any of this Debenture. 
  

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 14. JURY TRIAL WAIVER. The Company and the Holder hereby waive a trial by jury in any
action, proceeding or counterclaim brought by either of the Parties hereto against the other in respect of any matter arising out of or in connection with this Debenture. 
 15. The term “Event of Default” means the occurrence of any one or more of the following events: 
  

	 	a.	The Company shall default in the payment of principal or interest on this Debenture or any other amount due hereunder when due and such default, shall continue for a
period of five (5) Trading Days; or 

  

	 	b.	Any of the representations or warranties made by the Company herein, or in any certificate or financial or other written statements heretofore or hereafter furnished by
the Company in connection with the execution and delivery of this Debenture or the Securities Purchase Agreement shall be false or misleading in any material respect at the time made; or 

  

	 	c.	The Company fails to authorize or to cause its Transfer Agent to issue shares of Common Stock upon exercise by the Holder of the conversion rights of the Holder in
accordance with the terms of this Debenture (provided, however, that for purposes of this provision, such failure to cause the Transfer Agent to issue such shares shall not be deemed to occur until two (2) Trading Days after the Delivery Date),
fails to transfer or to cause its Transfer Agent to transfer any certificate for shares of Common Stock issued to the Holder upon conversion of this Debenture and when required by this Debenture, and such transfer is otherwise lawful, or fails to
remove any restrictive legend on any certificate or fails to cause its Transfer Agent to remove such restricted legend, in each case where such removal is lawful, as and when required by this Debenture, and any such failure shall continue uncured
for ten (10) Trading Days; or 

  

	 	d.	The Company shall fail to perform or observe, in any material respect, any other covenant, term, provision, condition, agreement or obligation of this Debenture (other
than a failure to pay money) and such failure shall continue uncured for a period of ten (10) days after the Company’s receipt written notice from the Holder of such failure, or the Company shall fail to observe or perform any other
covenant, agreement or warranty contained in, or otherwise commit any breach or default of any provision of any the Transaction Agreements (as such term is defined in the Securities Purchase Agreement) which is not cured with in the time prescribed;
or 

  

	 	e.	The Company shall make any principal payment on any unsecured indebtedness in excess of an aggregate of $500,000 prior to the repayment or conversion of all of the
principal amount outstanding under this Debenture; or 

  

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	 	f.	The Company shall (1) admit in writing its inability to pay its debts generally as they mature; (2) make an assignment for the benefit of creditors or
commence proceedings for its dissolution; or (3) apply for or consent to the appointment of a trustee, liquidator or receiver for its or for a substantial part of its property or business; or 

  

	 	g.	A trustee, liquidator or receiver shall be appointed for the Company or for a substantial part of its property or business without its consent and shall not be
discharged within sixty (60) days after such appointment; or 

  

	 	h.	Any governmental agency or any court of competent jurisdiction at the instance of any governmental agency shall assume custody or control of the whole or any
substantial portion of the properties or assets of the Company and shall not be dismissed within sixty (60) days thereafter; or 

  

	 	i.	Bankruptcy, reorganization, insolvency or liquidation proceedings or other proceedings for relief under any bankruptcy law or any law for the relief of debtors shall be
instituted by or against the Company and, if instituted against the Company, shall not be dismissed within sixty (60) days after such institution or the Company shall by any action or answer approve of, consent to, or acquiesce in any such
proceedings or admit the material allegations of, or default in answering a petition filed in any such proceeding; or 

 If an Event of Default shall have occurred and is continuing, then, unless and until such Event of Default shall have been cured or waived in writing by the Holder (which waiver shall not be deemed to be a waiver of any subsequent default),
at the option of the Holder and in the Holder’s sole discretion, but without further notice from the Holder, the unpaid amount of this Debenture, computed as of such date, will bear interest at the rate (the “Default Rate”) equal to
eighteen percent (18%) per annum or the highest rate allowed by law, whichever is lower, from the date of the Event of Default to until and including the date actually paid; and any partial payments shall be applied as provided in
Section 4(I) hereof. In addition, the Holder shall have the option to declare that all principal and accrued interest under this Debenture is immediately due and payable and the Holder shall have the rights to any remedies expressly provided
under the Security Agreement. 
 16. Ranking; Seniority. This Debenture is a direct obligation of the Company.
This Debenture ranks pari passu with all other Debentures now or hereafter issued under the terms set forth herein. Except as referenced in Sections 3(t) and 3(u) of the Securities Purchase Agreement and an amount not exceeding
$500,000, no indebtedness of the Company is senior to this Debenture in right of payment, whether with respect to interest, damages or upon liquidation or dissolution or otherwise. Without the Holder’s consent, the Company will not and will not
permit any of their subsidiaries to, directly or indirectly, enter into, create, incur, assume or suffer to exist any indebtedness of any kind, on or with respect to any of its property or assets now owned or hereafter acquired or any interest
therein or any income or profits there from that is senior in any respect to the obligations of the Company under this Debenture. 
  

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 17. Nothing contained in this Debenture shall be construed as conferring upon the Holder the
right to vote or to receive dividends or to consent or receive notice as a shareholder in respect of any meeting of shareholders or any rights whatsoever as a shareholder of the Company, unless and to the extent converted in accordance with the
terms hereof. 
 18. In the event for any reason, any payment by or act of the Company or the Holder shall result in payment of
interest which would exceed the limit authorized by or be in violation of the law of the jurisdiction applicable to this Debenture, then ipso facto the obligation of the Company to pay interest or perform such act or requirement shall be reduced to
the limit authorized under such law, so that in no event shall the Company be obligated to pay any such interest, perform any such act or be bound by any requirement which would result in the payment of interest in excess of the limit so authorized.
In the event any payment by or act of the Company shall result in the extraction of a rate of interest in excess of a sum which is lawfully collectible as interest, then such amount (to the extent of such excess not returned to the Company) shall,
without further agreement or notice between or by the Company or the Holder, be deemed applied to the payment of principal, if any, hereunder immediately upon receipt of such excess funds by the Holder, with the same force and effect as though the
Company had specifically designated such sums to be so applied to principal and the Holder had agreed to accept such sums as an interest free prepayment of this Debenture. If any part of such excess remains after the principal has been paid in full,
whether by the provisions of the preceding sentences of this Section or otherwise, such excess shall be deemed to be an interest-free loan from the Company to the Holder, which loan shall be payable immediately upon demand by the Company. The
provisions of this Section shall control every other provision of this Debenture. 
 19. All terms not otherwise defined herein
shall have the meaning ascribed to them in the Securities Purchase Agreement. 
  

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 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed by an officer
thereunto duly authorized. 
 Dated: September     , 2009 
  

			
	 OMNICOMM SYSTEMS, INC.

		
	 By:
	 	  

		 	Ronald T. Linares, Chief Financial Officer

  

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 EXHIBIT A 
 OMNICOMM SYSTEMS, INC. 
 NOTICE OF CONVERSION 
 OF 
 12% SECURED
CONVERTIBLE DEBENTURE SERIES 09 DUE March     , 2011 
 (To be Executed by the Registered Holder in Order to
Convert the 
 Debenture) 
  

	TO:	OMNICOMM SYSTEMS, INC . VIA FAX: (954) 473-1256 

 2101 W. Commercial Blvd., Suite 4000 
 Ft. Lauderdale, FL 33309 
 Attn: Chief Financial Officer 
 FROM:                     (“Holder”) 
 DATE:                                       
                                         
(the “Conversion Date”) 
 RE: Conversion of
$                     principal amount (the “Converted Debenture”) of the 12% Secured Convertible Debenture Series 09 Due March
    , 2011, No. 09-     (the “Debenture”) of OMNICOMM SYSTEMS, INC. (the “Company”) into
                 shares (the “Principal Conversion Shares”) of Common Stock (defined below) 
 The captioned Holder hereby gives notice to the Company, pursuant to the Debenture of OMNICOMM SYSTEMS, INC. that the Holder elects to
convert the Converted Debenture into fully paid and non-assessable shares of Common Stock, $0.001 par value (the “Common Stock”), of the Company as of the Conversion Date specified above. Said conversion shall be based on Conversion Price
of $0.25. 
  

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 As contemplated by the Debenture, the Company should also pay all accrued but unpaid
interest on the Converted Debenture to the Holder. The Holder elects that such accrued but unpaid interest should be paid 
  

	 	•	 	 in                      shares of Common Stock
(“Interest Conversion Shares”), representing such interest amount converted at the Interest Conversion Price of $            , which Interest Conversion Shares should be delivered
together with the Principal Conversion Shares, or 

  

	 	•	 	 in cash, which should be paid as provided in the Debenture by wire transfer as follows:1 

  

	
	  

	  

	  

  

	1	 Information should include the following: 

 All Wires: 

	(1)	Bank Name 

	(2)	Bank Address (including street, city, state) 

	(3)	ABA or Wire Routing No. 

	(4)	Account Name 

	(5)	Account Number 

 If Wire is going to
International (Non-US) Bank, all of the above plus: 

	(6)	SWIFT Number 

  

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 Based on the relevant Conversion Prices, the number of Principal Conversion Shares plus Interest Conversion
Shares (collectively, “Conversion Shares”) indicated above should be issued in the following name(s): 
  

			
	 Name and Record Address
	  	Conversion Shares
		  	
	 	  	 
		  	
	 	  	 
		  	
	 	  	 

 As contemplated by the Debenture, this Notice of Conversion is being sent by
facsimile to the telecopier number and officer indicated above. 
 If this Notice of Conversion represents the full conversion
of the outstanding balance of the Converted Debenture, the Holder either (1) has previously surrendered the Converted Debenture to the Company or (2) will surrender (or cause to be surrendered) the Converted Debenture to the Company at the
address indicated above by express courier within five (5) Trading Days after delivery or facsimile transmission of this Notice of Conversion. 
 The certificates representing the Conversion Shares should be transmitted by the Company to the Holder 
  

	 	•	 	 via express courier, or 

  

	 	•	 	 by electronic transfer 

 within the time contemplated by the Debenture after receipt of this Notice of Conversion (by facsimile transmission or otherwise) to: 
  

	
	  

	  

	  

  

									
		 		 		 	  
	 	
		 		 		 	(Print name of Holder)	 	

  

			
	 By:
	 	  

	 (Signature of Authorized Person)

	
	  

	 (Printed Name and Title)

	 (Printed Name and Title)

  

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 EXHIBIT B 
 FORM OF SECURITY INTEREST AGREEMENT 
  

 13Form of Warrant

 Exhibit 10.3 
 THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR THE SECURITIES LAWS OF ANY STATE AND MAY NOT BE SOLD OR OFFERED FOR SALE IN THE ABSENCE OF AN EFFECTIVE
REGISTRATION STATEMENT FOR THE SECURITIES OR AN OPINION OF COUNSEL OR OTHER EVIDENCE ACCEPTABLE TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED. 
 No. 09-         
 OMNICOMM
SYSTEMS, INC. 
 COMMON STOCK PURCHASE WARRANT 
 CLASS 2009 
 1.
Issuance. In consideration of good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged by OMNICOMM SYSTEMS, INC., a Delaware corporation
(the “Company”),                      or registered assigns (the “Holder”) is hereby granted the right to purchase at any time,
on or after the Issue Date (as defined below) until 5:00 P.M., New York City time, on the Expiration Date (as defined below),
                                        
(                    ) fully paid and nonassessable shares of the Company’s Common Stock, $0.001 par value per share (the “Common
Stock”), at an initial exercise price per share (the “Exercise Price”) of $0.275 per share, subject to further adjustment as set forth herein. This Warrant is being issued pursuant to the terms of that certain Securities Purchase
Agreement, dated as of August     , 2009 (the “Securities Purchase Agreement”), to which the Company and Holder (or Holder’s predecessor in interest) are parties. Capitalized terms not otherwise defined herein
shall have the meanings ascribed to them in the Securities Purchase Agreement. This Warrant was originally issued to the Holder or the Holder’s predecessor in interest on August     , 2009 (the “Issue Date”).

 2. Exercise of Warrants. 
 2.1 General. 
 (a) This Warrant is exercisable in whole or in part at any
time and from time to time commencing on the Issue Date. Such exercise shall be effectuated by submitting to the Company (either by delivery to the Company or by facsimile transmission as provided in Section 8 hereof) a completed and duly
executed Notice of Exercise (substantially in the form attached to this Warrant Certificate) as provided in the Notice of Exercise (or revised by notice given by the Company as contemplated by the Section headed “NOTICES” in the Securities
Purchase Agreement). The date such Notice of Exercise is faxed to the Company shall be the “Exercise Date,” provided that, if such exercise represents the full exercise of the outstanding balance of the Warrant, the Holder of this Warrant
tenders this Warrant Certificate to the Company within five (5) Trading Days thereafter. The Notice of Exercise shall be executed by

  

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the Holder of this Warrant and shall indicate (i) the number of shares then being purchased pursuant to such exercise and (ii) whether the exercise is a cashless exercise. 

(b) If the Notice of Exercise form elects a “cashless” exercise, the Holder shall thereby be entitled to receive a number of
shares of Common Stock equal to (w) the excess of the Current Market Value (as defined below) over the total cash exercise price of the portion of the Warrant then being exercised, divided by (x) the Market Price of the Common Stock. For
the purposes of this Warrant, the terms (y) “Current Market Value” shall mean an amount equal to the Market Price of the Common Stock, multiplied by the number of shares of Common Stock specified in the applicable Notice of Exercise,
and (z) “Market Price of the Common Stock” shall mean the average Closing Price of the Common Stock for the three (3) Trading Days ending on the Trading Day immediately prior to the Exercise Date. 
 (c) If the Holder provides on the Notice of Exercise form that the Holder has elected a “cash” exercise (or if the cashless
exercise referred to in the immediately preceding paragraph (b) is not available in accordance with its terms), the Exercise Price per share of Common Stock for the shares then being exercised shall be payable, at the election of the Holder, in
cash or by certified or official bank check or by wire transfer in accordance with instructions provided by the Company at the request of the Holder. 
 (d) Upon the appropriate payment, if any, of the Exercise Price for the shares of Common Stock purchased, together with the surrender of this Warrant Certificate (if required), the Holder shall be
entitled to receive a certificate or certificates for the shares of Common Stock so purchased. The Company shall deliver such certificates representing the Warrant Shares in accordance with the instructions of the Holder as provided in the Notice of
Exercise (the certificates delivered in such manner, the “Warrant Share Certificates”) within three (3) Trading Days (such third Trading Day, a “Delivery Date”) of (i) with respect to a “cashless exercise,”
the Exercise Date or the Automatic Exercise Date, as the case may be, or, (ii) with respect to a “cash” exercise, the later of the Exercise Date or the date the payment of the Exercise Price for the relevant Warrant Shares is received
by the Company. 
 (e) The Holder shall be deemed to be the holder of the shares issuable to it in accordance with the
provisions of this Section 2.1 on the Exercise Date. 
 2.2 Automatic Exercise. If any portion of this Warrant
remains unexercised as of the Expiration Date and the Market Price of the Common Stock as of the Expiration Date is greater than the applicable Exercise Price as of the Expiration Date, then, without further action by the Holder, this Warrant shall
be deemed to have been exercised automatically on the date (the “Automatic Exercise Date”) which is the day immediately prior to the close of business on the Expiration Date (or, in the event that the Expiration Date is not a Business Day,
the immediately preceding Business Day) as if the Holder had duly given a Notice of Exercise for a “cashless” exercise as contemplated by Section 2.1(b) hereof, and the Holder (or such other person or persons as directed by the
Holder) shall be treated for all purposes as the holder of record of such Warrant Shares as of the close of business on such Automatic Exercise Date. This Warrant shall be deemed to be surrendered to the Company on the Automatic Exercise Date by
virtue of this Section 2.2 without any action by the Holder. 
  

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 2.3 Certain Definitions. As used herein, the term “Expiration Date” means
the date which is the last calendar day of the month in which the fourth anniversary of the Closing Date occurs. 
 3.
Reservation of Shares. The Company hereby agrees that, at all times during the term of this Warrant, there shall be reserved for issuance upon exercise of this Warrant, one hundred percent (100%) of the number of shares of its Common
Stock as shall be required for issuance of the Warrant Shares for the then unexercised portion of this Warrant. For the purposes of such calculations, the Company should assume that the outstanding portion of this Warrants was exercisable in full at
any time, without regard to any restrictions which might limit the Holder’s right to exercise all or any portion of this Warrant held by the Holder. 
 4. Mutilation or Loss of Warrant. Upon receipt by the Company of evidence satisfactory to it of the loss, theft, destruction or mutilation of this Warrant, and (in the case of loss, theft or
destruction) receipt of reasonably satisfactory indemnification, and (in the case of mutilation) upon surrender and cancellation of this Warrant, the Company will execute and deliver a new Warrant of like tenor and date and any such lost, stolen,
destroyed or mutilated Warrant shall thereupon become void. 
 5. Rights of the Holder. The Holder shall not, by virtue
hereof, be entitled to any rights of a stockholder in the Company, either at law or equity, and the rights of the Holder are limited to those expressed in this Warrant and are not enforceable against the Company except to the extent set forth
herein. 
 6. Protection Against Dilution and Other Adjustments. 
 6.1 Adjustment Mechanism. If an adjustment of the Exercise Price is required pursuant to this Section 6 (other than pursuant to
Section 6.4), the Holder shall be entitled to purchase such number of shares of Common Stock as will cause (i) (x) the total number of shares of Common Stock Holder is entitled to purchase pursuant to this Warrant following such
adjustment, multiplied by (y) the adjusted Exercise Price per share, to equal the result of (ii) (x) the dollar amount of the total number of shares of Common Stock Holder is entitled to purchase before adjustment, multiplied by
(y) the total Exercise Price before adjustment. 
 6.2 Capital Adjustments. In case of any stock split or reverse
stock split, stock dividend, reclassification of the Common Stock, recapitalization, merger or consolidation (where the Company is not the surviving entity), the provisions of this Section 6 shall be applied as if such capital adjustment event
had occurred immediately prior to the date of this Warrant and the original Exercise Price had been fairly allocated to the stock resulting from such capital adjustment; and in other respects the

  

 3 

 
provisions of this Section shall be applied in a fair, equitable and reasonable manner so as to give effect, as nearly as may be, to the purposes hereof. A rights offering to stockholders shall
be deemed a stock dividend to the extent of the bargain purchase element of the rights. The Company will not effect any consolidation or merger, unless prior to the consummation thereof, the successor or acquiring entity (if other than the Company)
and, if an entity different from the successor or acquiring entity, the entity whose capital stock or assets the holders of the Common Stock of the Company are entitled to receive as a result of such consolidation or merger assumes by written
instrument the obligations under this Warrant (including under this Section 6) and the obligations to deliver to the holder of this Warrant such shares of stock, securities or assets as, in accordance with the foregoing provisions, the holder
may be entitled to acquire. 
 6.3 Adjustment for Spin Off. If, for any reason, prior to the exercise of this Warrant in
full, the Company spins off or otherwise divests itself of a part of its business or operations or disposes all or of a part of its assets in a transaction (the “Spin Off”) in which the Company does not receive compensation for such
business, operations or assets, but causes securities of another entity (the “Spin Off Securities”) to be issued to security holders of the Company, then the Company shall cause (i) to be reserved Spin Off Securities equal to the
number thereof which would have been issued to the Holder had all of the Holder’s unexercised Warrants outstanding on the record date (the “Record Date”) for determining the amount and number of Spin Off Securities to be issued to
security holders of the Company (the “Outstanding Warrants”) been exercised as of the close of business on the Trading Day immediately before the Record Date (the “Reserved Spin Off Shares”), and (ii) to be issued to the
Holder on the exercise of all or any of the Outstanding Warrants, such amount of the Reserved Spin Off Shares equal to (x) the Reserved Spin Off Shares, multiplied by (y) a fraction, of which (I) the numerator is the amount of the
Outstanding Warrants then being exercised, and (II) the denominator is the amount of the Outstanding Warrants. 
 6.4
Adjustment for Certain Transactions. Reference is made to the provisions of Section 4(g) of the Securities Purchase Agreement, the terms of which are incorporated herein by reference. The number of shares covered by this Warrant and the
Exercise Price shall be adjusted as provided in the applicable provisions of said Section 4(g) of the Securities Purchase Agreement. 
 7. Transfer to Comply with the Securities Act. This Warrant has not been registered under the Securities Act of 1933, as amended, (the “1933 Act”) and has been issued to the Holder for
investment and not with a view to the distribution of either the Warrant or the Warrant Shares. Neither this Warrant nor any of the Warrant Shares or any other security issued or issuable upon exercise of this Warrant may be sold, transferred,
pledged or hypothecated in the absence of an effective registration statement under the 1933 Act relating to such security or an opinion of counsel satisfactory to the Company that registration is not required under the 1933 Act. Each certificate
for the Warrant, the Warrant Shares and any other security issued or issuable upon exercise of this Warrant shall contain a legend on the face thereof, in form and substance satisfactory to counsel for the Company, setting forth the restrictions on
transfer contained in this Section. 
  

 4 

 8. Late Delivery of Warrant Shares. Reference is made to Section 5(b) of the
Securities Purchase Agreement, the terms of which are incorporated herein by reference. 
 9. Notices. Any notice
required or permitted hereunder shall be given in manner provided in the Section headed “NOTICES” in the Securities Purchase Agreement, the terms of which are incorporated herein by reference. 
 10. Supplements and Amendments; Whole Agreement. This Warrant may be amended or supplemented only by an instrument in writing signed
by the parties hereto. This Warrant contains the full understanding of the parties hereto with respect to the subject matter hereof and thereof and there are no representations, warranties, agreements or understandings other than expressly contained
herein and therein. 
 11. Governing Law. This Warrant shall be deemed to be a contract made under the laws of the State
of Florida for contracts to be wholly performed in such state and without giving effect to the principles thereof regarding the conflict of laws. Each of the parties consents to the jurisdiction of the federal courts whose districts encompass any
part of the County of Broward or the state courts of the State of Florida sitting in the County of Broward in connection with any dispute arising under this Warrant and hereby waives, to the maximum extent permitted by law, any objection, including
any objection based on forum non conveniens, to the bringing of any such proceeding in such jurisdictions. To the extent determined by such court, the Company shall reimburse the Holder for any reasonable legal fees and disbursements incurred
by the Holder in enforcement of or protection of any of its rights under any of the Transaction Agreements. 
 12. JURY
TRIAL WAIVER. The Company and the Holder hereby waive a trial by jury in any action, proceeding or counterclaim brought by either of the Parties hereto against the other in respect of any matter arising out or in connection with this
Warrant. 
 13. Remedies. The Company stipulates that the remedies at law of the Holder of this Warrant in the event of
any default or threatened default by the Company in the performance of or compliance with any of the terms of this Warrant are not and will not be adequate and that, to the fullest extent permitted by law, such terms may be specifically enforced by
a decree for the specific performance of any agreement contained herein or by an injunction against a violation of any of the terms hereof or otherwise. 
 14. Counterparts. This Warrant may be executed in any number of counterparts and each of such counterparts shall for all purposes be deemed to be an original, and all such counterparts shall
together constitute but one and the same instrument. 
  

 5 

 15. Descriptive Headings. Descriptive headings of the several Sections of this
Warrant are inserted for convenience only and shall not control or affect the meaning or construction of any of the provisions hereof. 
 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed by an officer thereunto duly authorized. 
 Dated:
August     , 2009 
  

			
	OMNICOMM SYSTEMS, INC.
		
	By:	 	  

	
	 Ronald T. Linares    

	 (Print Name)

	
	 Chief Financial Officer

	 (Title)

  

 6 

 NOTICE OF EXERCISE OF WARRANT 
  

					
	 TO:
	  	OMNICOMM SYSTEMS, INC	 	VIA FAX: (954) 473-1256
		  	2101 W. Commercial Blvd., Suite 4000	 	
		  	Ft. Lauderdale, FL 33309	 	
		  	Attn: President	 	

 The undersigned hereby irrevocably elects to exercise the right, represented by the
Common Stock Purchase Warrant Class 2009, No. 09-             dated as of August     , 2009, to purchase
                     shares of the Common Stock, $0.001 par value (“Common Stock”), of OMNICOMM
SYSTEMS, INC. and tenders herewith payment in accordance with Section 2 of said Common Stock Purchase Warrant, as follows: 
  

	 	•	 	 CASH: $                      = (Exercise Price x
Exercise Shares) 

 Payment is being made by: 
  

	 	 ̈	enclosed check 

  

	 	 ̈	wire transfer 

  

	 	 ̈	other 

  

	 	•	 	 CASHLESS EXERCISE: 

 Net number of Warrant Shares to be issued to Holder :                     * 
 * based on: Current Market Value - (Exercise Price x Exercise Shares) 
                           Market Price of Common Stock 
  

					
	where:	  		  	
	Market Price of Common Stock [“MP”]	  	=	  	$                     
	Current Market Value [MP x Exercise Shares]	  	=	  	$                     

 As contemplated by the Warrant, this Notice of Exercise is being sent by facsimile to
the telecopier number and officer indicated above. 
 If this Notice of Exercise represents the full exercise of the outstanding
balance of the Warrant, the Holder either (1) has previously surrendered the Warrant to the Company or (2) will surrender (or cause to be surrendered) the Warrant to the Company at the address indicated above by express courier within five
(5) Trading Days after delivery or facsimile transmission of this Notice of Exercise. 
  

 7 

 The certificates representing the Warrant Shares should be transmitted by the Company to the
Holder 
  

	 	 ̈	via express courier, or 

  

	 	 ̈	by electronic transfer 

 after receipt of this
Notice of Exercise (by facsimile transmission or otherwise) to: 
  

							
		 	  
	  		  	
		 	  
	  		  	
		 	  
	  		  	

  

			
	 Dated:
	 	  

			
	
	  

	[Name of Holder]
		
	By:	 	  

  

 8

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