Document:

Exhibit 10.1

 

PROMISSORY
NOTE

 

		$[________]	As of July 15, 2021

 

Capitol Investment
Corp. V (“Maker”) promises to pay to the order of [] or his successors or assigns (“Payee”) the principal
sum of [     ] ($[      ]) in lawful money of the United States of America, on the terms and conditions described below.

 

1. Principal. The
principal balance of this Note shall be repayable on the consummation of the Maker’s initial merger, share exchange, asset
acquisition or other similar business combination with one or more businesses or entities (a “Business Combination”).
Holder understands that if a Business Combination is not consummated, this Note will not be repaid and all amounts owed hereunder
will be forgiven except to the extent that the Maker has funds available to it outside of its trust account established in
connection with its initial public offering.

 

2.
Interest. No interest shall accrue on the unpaid principal balance of this Note.

 

3.
Application of Payments. All payments shall be applied first to payment in full of any costs incurred in the collection
of any sum due under this Note, including (without limitation) reasonable attorneys’ fees, then to the payment in full of
any late charges and finally to the reduction of the unpaid principal balance of this Note.

 

4.
Events of Default. The following shall constitute Events of Default:

 

(a)
Failure to Make Required Payments. Failure by Maker to pay the principal of this Note within five (5) business days
following the date when due.

 

(b)
Voluntary Bankruptcy, Etc. The commencement by Maker of a voluntary case under the Federal Bankruptcy Code, as now
constituted or hereafter amended, or any other applicable federal or state bankruptcy, insolvency, reorganization, rehabilitation
or other similar law, or the consent by it to the appointment of or taking possession by a receiver, liquidator, assignee, trustee,
custodian, sequestrator (or other similar official) of Maker or for any substantial part of its property, or the making by it of
any assignment for the benefit of creditors, or the failure of Maker generally to pay its debts as such debts become due, or the
taking of corporate action by Maker in furtherance of any of the foregoing.

 

(c)
Involuntary Bankruptcy, Etc. The entry of a decree or order for relief by a court having jurisdiction in the premises
in respect of maker in an involuntary case under the Federal Bankruptcy Code, as now or hereafter constituted, or any other applicable
federal or state bankruptcy, insolvency or other similar law, or appointing a receiver, liquidator, assignee, custodian, trustee,
sequestrator (or similar official) of Maker or for any substantial part of its property, or ordering the winding-up or liquidation
of its affairs, and the continuance of any such decree or order unstayed and in effect for a period of 60 consecutive days.

 

    1

     

    

 

5.
Remedies.

 

(a)
Upon the occurrence of an Event of Default specified in Section 4(a), Payee may, by written notice to Maker, declare this
Note to be due and payable, whereupon the principal amount of this Note, and all other amounts payable thereunder, shall become
immediately due and payable without presentment, demand, protest or other notice of any kind, all of which are hereby expressly
waived, anything contained herein or in the documents evidencing the same to the contrary notwithstanding.

 

(b)
Upon the occurrence of an Event of Default specified in Sections 4(b) and 4(c), the unpaid principal balance of, and all
other sums payable with regard to, this Note shall automatically and immediately become due and payable, in all cases without any
action on the part of Payee.

 

6.
Conversion. Upon consummation of a Business Combination, the Holder shall have the option, but not the obligation,
to convert the principal balance of this Note, in whole or in part at the option of the Holder, into warrants (“Warrants”)
of the Maker at a price of $1.50 per Warrant; provided, however, that the Holder shall be permitted to convert this Note only if
the shareholders of the Maker or the target business in any such Business Combination, whichever may be required in connection
with such Business Combination, have approved the issuance of the Warrants to the Holder if such approval is necessary under applicable
rules. The Warrants will be identical to the “private placement warrants” (as such term is defined in the Maker’s
final prospectus for its initial public offering, dated December 1, 2020). As promptly after notice by Holder to Maker to convert
the principal balance of this Note, which must be made at least 24 hours prior to the consummation of the Business Combination,
as reasonably practicable and after Holder’s surrender of this Note, Maker shall have issued and delivered to Holder, without
any charge to Holder, a certificate or certificates (issued in the name(s) requested by Holder) for the number of Warrants of Maker
issuable upon the conversion of this Note.

 

7.
Waivers. Maker and all endorsers and guarantors of, and sureties for, this Note waive presentment for payment, demand,
notice of dishonor, protest, and notice of protest with regard to the Note, all errors, defects and imperfections in any proceedings
instituted by Payee under the terms of this Note, and all benefits that might accrue to Maker by virtue of any present or future
laws exempting any property, real or personal, or any part of the proceeds arising from any sale of any such property, from attachment,
levy or sale under execution, or providing for any stay of execution, exemption from civil process, or extension of time for payment;
and Maker agrees that any real estate that may be levied upon pursuant to a judgment obtained by virtue hereof, on any writ of
execution issued hereon, may be sold upon any such writ in whole or in part in any order desired by Payee.

 

8.
Unconditional Liability. Maker hereby waives all notices in connection with the delivery, acceptance, performance,
default, or enforcement of the payment of this Note, and agrees that its liability shall be unconditional, without regard to the
liability of any other party, and shall not be affected in any manner by any indulgence, extension of time, renewal, waiver or
modification granted or consented to by Payee, and consents to any and all extensions of time, renewals, waivers, or modifications
that may be granted by Payee with respect to the payment or other provisions of this Note, and agree that additional makers, endorsers,
guarantors, or sureties may become parties hereto without notice to them or affecting their liability hereunder.

 

9.
Notices. Any notice called for hereunder shall be deemed properly given if (i) sent by certified mail, return receipt
requested, (ii) personally delivered, (iii) dispatched by any form of private or governmental express mail or delivery service
providing receipted delivery, (iv) sent by telefacsimile or (v) sent by e-mail, to the following addresses or to such other address
as either party may designate by notice in accordance with this Section:

 

    2

     

    

 

If to Maker:

 

Capitol Investment Corp.
V

1300 17th Street, Suite 820

Arlington, VA 22209

 

If to Payee:

 

[      ]

 

Notice shall be deemed
given on the earlier of (i) actual receipt by the receiving party, (ii) the date shown on a telefacsimile transmission confirmation,
(iii) the date on which an e-mail transmission was received by the receiving party’s on-line access provider (iv) the date
reflected on a signed delivery receipt, or (vi) two (2) Business Days following tender of delivery or dispatch by express mail
or delivery service.

 

10.
Construction. This Note shall be construed and enforced in accordance with the domestic, internal law, but not the
law of conflict of laws, of the State of New York.

 

11.
Severability. Any provision contained in this Note which is prohibited or unenforceable in any jurisdiction shall,
as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining
provisions hereof, and any such prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable
such provision in any other jurisdiction.

 

IN WITNESS WHEREOF,
Maker, intending to be legally bound hereby, has caused this Note to be duly executed the day and year first above written.

 

	 	CAPITOL INVESTMENT CORP. V
	 	 
	 	By: 	                  
	 	Name:
	 	Title:

 

    3Exhibit 4.1

 

	
    NUMBER

     

    PAFOU
	 	UNITS

 

PACIFICO ACQUISITION CORP.

 

	
    SEE REVERSE FOR

    CERTAIN DEFINITIONS
	 	CUSIP  69512X 202

 

UNITS CONSISTING OF ONE SHARE OF COMMON STOCK
AND

ONE RIGHT TO RECEIVE ONE-TENTH OF ONE SHARE OF COMMON STOCK

 

THIS CERTIFIES THAT _________________________________________________________________________
is the owner of _________________________________________________________________________ Units.

 

Each Unit (“Unit”) consists
of one (1) share of common stock, par value $0.0001 per share (“Common Stock”), of Pacifico Acquisition Corp.,
a Delaware corporation (the “Company”) and one right (the “Right(s)”). Every ten Rights
entitles the holder thereof to receive one share of Common Stock upon the consummation of a merger, share exchange, asset acquisition,
stock purchase, recapitalization, reorganization or other similar business combination (“Business Combination”).
The Common Stock and Rights comprising the Units represented by this certificate are not transferable separately prior to the 90th day
after the date of the prospectus relating to the closing of the Company’s initial public offering (“IPO”),
subject to earlier separation in the discretion of Chardan Capital Markets, LLC, provided that the Company has filed with the Securities
and Exchange Commission a Current Report on Form 8-K which includes an audited balance sheet reflecting the Company’s receipt of
the gross proceeds of the IPO and issued a press release announcing when separate trading will begin. The terms of the Rights are governed
by a rights agreement (the “Rights Agreement”), dated as of [*], 2021, between the Company and American Stock
Transfer & Trust Company, as the rights agent, and is subject to the terms and provisions contained therein, all of which terms and
provisions the holder of this certificate consents to by acceptance hereof. A copy of the Rights Agreement is on file at the office of
American Stock Transfer & Trust Company at 6201 15th Ave, Brooklyn, NY 11219 and is available to Rights holder on written
request and without cost.

 

This certificate is not valid
unless countersigned by the Transfer Agent and Registrar of the Company.

 

Witness the facsimile seal
of the Company and the facsimile signatures of its duly authorized officers.

 

	By	 	 	 
	 	Chairman of the Board	 	Chief Executive Officer

 

    	 

    	 

    

 

Pacifico Acquisition Corp.

 

The Company will furnish without
charge to each stockholder who so requests, a statement of the powers, designations, preferences and relative, participating, optional
or other special rights of each class of stock or series thereof of the Company and the qualifications, limitations, or restrictions of
such preferences and/or rights.

 

The following abbreviations,
when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to
applicable laws or regulations:

 

	TEN COM	—	as tenants in common	 	UNIF GIFT MIN ACT	—	 	Custodian	 
	 	 	 	 	 	 	(Cust)	 	(Minor)
	TEN ENT	—	as tenants by the entireties	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 
	JT TEN	—	as joint tenants with right of survivorship and not as tenants in common	 	 	under Uniform Gifts to Minors Act
	 	 	 	 	(State)

 

Additional abbreviations may also be used though
not in the above list.

 

	For value received, ___________________________ hereby sell, assign and transfer unto

 

	PLEASE INSERT SOCIAL SECURITY OR

                                                     OTHER
 IDENTIFYING NUMBER OF ASSIGNEE
	 
	 	 
	 	 

 

	(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE)
	 

____________________________________________________________________________ Units
represented by the within Certificate, and do hereby irrevocably constitute and appoint

 

____________________________________________________________________________ Attorney to transfer
the said Units on the books of the within named Company will full power of substitution in the premises.

 

	Dated	 	 	 	 
	 	 	 	 	 
	 	 	 	 	 
	 	 	 	Notice: 	The signature to this assignment must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever.

 

	Signature(s) Guaranteed:	 
	 	 
	THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO S.E.C. RULE 17Ad-15).	 

 

The holder(s) of this certificate shall be entitled
to receive a pro-rata portion of the funds from the trust account with respect to the common stock underlying this certificate only in
the event that (i) the Company is forced to liquidate because it does not consummate an initial business combination within the period
of time set forth in the Company’s Amended and Restated Certificate of Incorporation, as the same may be amended from time to time
(the “Charter”) or (ii) if the holder seeks to convert his shares upon consummation of, or sell his shares in a tender offer
in connection with, an initial business combination or in connection with certain amendments to the Charter. In no other circumstances
shall the holder(s) have any right or interest of any kind in or to the trust account.

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