RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of __________ shares of Common Stock of [Company Name], a Delaware corporation (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Common Stock Purchase Agreement that Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the aforementioned [shares] OR [certificate] issued in the undersigned’s name. Dated: PURCHASER: (Print Name) By: (Signature) Name: Title:
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. for shares of Common Stock of Embarcadero Technologies, Inc. (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Restricted Stock Purchase Agreement the undersigned has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: (Signature)
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of 5,860,000 shares of Common Stock of Legion Works Inc, a Delaware corporation (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Common Stock Purchase Agreement that Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the aforementioned shares issued in the undersigned's name. PURCHASER: Xxxx Xxxx (PRINT NAME) Dated: 01 / 10 / 2020 By: (Signature) Name: Xxxx Xxxx Title: President Address: Email: Spouse of Purchaser (if applicable)
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. ______ for ________ shares of Common Stock of Rxxxxx Pharmaceuticals, Inc. (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Exercise Notice and Restricted Stock Purchase Agreement Participant has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: _______________ Mxxxxxx X. Step EXHIBIT B INVESTMENT REPRESENTATION STATEMENT PARTICIPANT MXXXXXX X. STEP COMPANY RXXXXX PHARMACEUTICALS, INC. SECURITY COMMON STOCK AMOUNT _______ SHARES In connection with the purchase of the above-listed Securities, the undersigned Participant represents to the Company the following:
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. for Ordinary Shares of Jupai Investment Group (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Series A Convertible Preferred Shares Purchase Agreement that the Founding Shareholder has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: , 2013 Name of Founder: Name of Founding Shareholder: By: Signature: Name: Title: Address: Address:
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of Certificate No. for shares of Common Stock of Neothetics, Inc. The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Early Exercise Notice and Restricted Stock Purchase Agreement Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: [ ] RECEIPT Neothetics, Inc. (the “Company”) hereby acknowledges receipt of (check as applicable): A check in the amount of $ The cancellation of indebtedness in the amount of $ A promissory note in the amount of $ Certificate No. representing shares of the Company’s Common Stock with a fair market value of $ given by as consideration for Certificate No. for shares of Common Stock of the Company. Dated: NEOTHETICS, INC. By: Name: Title: EXHIBIT B NEOTHETICS, INC. 2007 STOCK PLAN EXERCISE NOTICE AND RESTRICTED STOCK PURCHASE AGREEMENT This Agreement (“Agreement”) is made as of , by and between Neothetics, Inc., a Delaware corporation (the “Company”), and (“Purchaser”). To the extent any capitalized terms used in this Agreement are not defined, they shall have the meaning ascribed to them in the Company’s 2007 Stock Plan (the “Plan”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges issuance of ____________shares of Common Stock of Sezzle Inc., a Delaware corporation (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Common Stock Purchase Agreement that Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned shares issued in the undersigned’s name. Dated: PURCHASER: (PRINT NAME) By: (Signature) Name: Xxxx Xxxxxxx Title: CBDO Address: Spouse of Purchaser (if applicable)
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. _________ for 193,125 shares of Common Stock of Simplex Solutions, Inc. (the "Company"). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Restricted Stock Purchase Agreement Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned's name. Dated: ----------------------------- ------------------------------------ Stevx Xxxx
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a notice of issuance recorded as Certificate No. C-8 for 25,500,000 shares of Common Stock of Healthcare Triangle Inc., a Nevada corporation (the “Company”). Dated: January 1, 2020 PURCHASER: 8K MILES SOFTWARE SERVICES INC. By: /s/ Xxxxxxxxxx Xxxxxxxxx Name: Xxxxxxxxxx Xxxxxxxxx Title: Chief Operating Officer Address: 0000 Xxxxxxxx Xx., Xxxxx 000 Xxxxxxxxxx, XX 00000 Email: xxxxxxxxxx@0xxxxxx.xxx
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. for 50,000 shares of Common Stock of Avanir Pharmaceuticals (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Restricted Stock Purchase Agreement the undersigned has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: Rxxxxxx Xxxx EXHIBIT B MUTUAL ARBITRATION AGREEMENT This MUTUAL ARBITRATION AGREEMENT (“Agreement”), dated as of December 21, 2005, is made by and between AVANIR Pharmaceuticals, a California corporation (“the Company”) and Rxxxxxx Xxxx (“Employee”) (collectively, the “Parties” or “we”).
