Common use of NOTICE OF CONVERSION Clause in Contracts

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture due August 8, 2012 of Ads In Motion, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 6 contracts

Samples: Ads in Motion, Inc., Ads in Motion, Inc., Ads in Motion, Inc.

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NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due August 8March 1, 2012 2018 of Ads In MotionLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 5 contracts

Samples: Legend Oil & Gas, Ltd., Legend Oil & Gas, Ltd., Legend Oil & Gas, Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Convertible Debenture due August 8September __, 2012 2020 of Ads In Motion, Inc.G Medical Innovations Holdings Ltd., a Delaware corporation Cayman Islands company (the “Company”), into shares of common stock Ordinary Shares (the “Common StockOrdinary Shares”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock Ordinary Shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock Ordinary Shares does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockOrdinary Shares. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Ordinary Shares __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock Ordinary Shares to be issued: Signature: Name: Address for Delivery of Common Stock Ordinary Share Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 4 contracts

Samples: G Medical Innovations Holdings Ltd., G Medical Innovations Holdings Ltd., G Medical Innovations Holdings Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 12% Unsecured Subordinated Convertible Debenture due August 8November 30, 2012 2022 of Ads In MotionSmart for Life, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 4 contracts

Samples: Smart for Life, Inc., Smart for Life, Inc., Smart for Life, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 8May __, 2012 2018 of Ads In Motion, Inc.Advanced Medical Isotope Corporation, a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Date of Conversion: Conversion calculations: Date to Effect ConversionPrice: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Remaining Principal Balance Due After This Conversion: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 3 contracts

Samples: ADVANCED MEDICAL ISOTOPE Corp, ADVANCED MEDICAL ISOTOPE Corp, ADVANCED MEDICAL ISOTOPE Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Convertible Debenture Promissory Note due August 8______________, 2012 201___ of Ads In MotionOriginOil, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 3 contracts

Samples: Originoil Inc, Originoil Inc, Originoil Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 12% Senior Convertible Debenture Note due August 8, 2012 2017 of Ads In MotionInterCloud Systems, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. In the event of a partial Conversion, Amortization Dates from which Amortization Amount is to be deducted: Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 2 contracts

Samples: Intercloud Systems, Inc., Intercloud Systems, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Senior Secured Convertible Debenture Promissory Note due August 8September __, 2012 2016 of Ads In Motion, Inc.CannaVest Corp., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1

Appears in 2 contracts

Samples: Securities Purchase Agreement (CannaVEST Corp.), Securities Purchase Agreement (CannaVEST Corp.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 8January 1, 2012 2014 of Ads In Motion, Inc.NutraCea, a Delaware California corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 2 contracts

Samples: Nutracea, Nutracea

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Senior Secured Convertible Debenture Promissory Note due August 8May 19, 2012 2016 of Ads In Motion, Inc.CannaVest Corp., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 2 contracts

Samples: Securities Purchase Agreement (CannaVEST Corp.), Securities Purchase Agreement (CannaVEST Corp.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 12.5% Senior Convertible Debenture Note due August 8_________, 2012 of Ads In Motion2020 issued by Emmaus Life Sciences, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1

Appears in 2 contracts

Samples: Emmaus Life Sciences, Inc., Emmaus Life Sciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal obligations of the Joint Obligors under the Convertible Debenture due August 8Original Revolving Line of Credit, 2012 as amended, of Ads In Motion, Inc., a Delaware corporation JanOne Inc. (the CompanyJanOne), ) into shares of common stock (the “Common Stock”), ) of the Company JanOne according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company XxxXxx in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Companies that its ownership of the Common Stock does not exceed the amounts specified under Section 4 4(d) of the Debenturethis Fourth Amendment, as determined in accordance with Section 13(d) of the Securities Exchange ActAct of 1934. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture obligations to be Converted: $ Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: JanOne Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Senior Secured Convertible Debenture due August 8, 2012 Note of Ads In MotionOncolix, Inc., a Delaware Florida corporation (the “Company”), due on August 1, 2019, into shares of common stock stock, par value $0.0001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Note. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Notes to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____________ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock CertificatesAddress: Or DWAC Instructions: Broker No: Account No:Schedule 1

Appears in 1 contract

Samples: Oncolix, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due August 8______ __, 2012 2013 of Ads In Motion, Inc.Magnolia Solar Corporation, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ____________ Account No:: ___________ Schedule 1

Appears in 1 contract

Samples: Note Amendment Agreement (Magnolia Solar Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Senior Convertible Debenture Note due August 8November [___], 2012 2018 of Ads In Motion, Inc.Probility Media Corp., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Probility Media Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 8September 1, 2012 2017 of Ads In MotionPFO Global, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 1 contract

Samples: PFO Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and accrued interest under the Convertible Debenture due August 8, 2012 (“Debenture”) of Ads In Motion, Inc.KonaRed Corporation, a Delaware Nevada corporation (the CompanyBorrower”), into shares of common stock (the “Common Stock”), ) of the Company Borrower according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Borrower in accordance therewith. No fee will be charged to the holder undersigned for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Borrower that its ownership of the Common Stock does not exceed the amounts amount specified under Section 4 3.4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws Rule 144 in connection with any transfer of the aforesaid shares of Common StockStock pursuant to any prospectus. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Interest Accrued on Account of Conversion at Issue: Number of shares of Common Stock to be issued: Signature: Name: Group 10 Holdings LLC Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Convertible Debenture (KonaRed Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 8October 28, 2012 2016 of Ads In Motion, Inc.Propanc Health Group Corp., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Propanc Health Group Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and accrued but unpaid interest under the Senior Convertible Debenture Note, due August 8on or before the earlier to occur of (i) ten (10) Business Days following the receipt by the Company or ABS of the 2020 Tax Credit, 2012 or (ii) December 31, 2020 of Ads In MotionAzurRx BioPharma, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Applicable Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: AzurRx BioPharma, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 8, 2012 on the Maturity Date of Ads In MotionSG Blocks, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 1 contract

Samples: Sg Blocks, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Senior Secured Convertible Debenture due August 8April 1, 2012 2017 of Ads In MotionStaffing 360 Solutions, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ________________ Account No:_____________ Schedule 1

Appears in 1 contract

Samples: Subordination Agreement (Staffing 360 Solutions, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 8March 21, 2012 2019 of Ads In Motion, Inc.Dthera Sciences, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Information Date to Effect Conversion: Outstanding Principal: Outstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares Note to be Converted: Conversion Price Calculations: Total Shares of Common Stock to be issuedIssued: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:

Appears in 1 contract

Samples: Dthera Sciences

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Zero Coupon Secured Convertible Debenture Note due August 8December 26, 2012 of Ads In MotionPure Bioscience, Inc., a Delaware corporation (the “Company”), ) into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount Issue Price of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: [SIGNATURE OF HOLDER] Name of Holder: Signature of Authorized Signatory of Holder: Name of Authorized Signatory: Title of Authorized Signatory: Date: Schedule 1

Appears in 1 contract

Samples: Pure Bioscience, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 12% Convertible Debenture Note due August 8September 30, 2012 (the “Note”) of Ads In Motion, AtheroNova Inc., a Delaware corporation (the Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Interest Accrued on Account of Conversion at Issue: Number of shares of Common Stock to be issued: issued (not less than 10,000 shares): Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: AtheroNova Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 4% Senior Secured Convertible Debenture Promissory Note due August 8July 13, 2012 2017 of Ads In MotionAscent Solar Technologies, Inc., a Delaware corporation Inc. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1 CONVERSION SCHEDULE This 4% Senior Secured Convertible Promissory Note due on July 13, 2017 in the original principal amount of $250,000 is issued by Ascent Solar Technologies, Inc. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Note.

Appears in 1 contract

Samples: Ascent Solar Technologies, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Convertible Debenture due August 8, 2012 ________ of Ads In MotionRennova Health, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_________________ Account No:: _______________ Schedule 1

Appears in 1 contract

Samples: Securities Purchase Agreement (Rennova Health, Inc.)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August 8September 10, 2012 2021 of Ads In Motion, Inc.Can B Corp., a Delaware Florida corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Information Date to Effect Conversion: Outstanding Principal: Outstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares Note to be Converted: Conversion Price Calculations: Total Shares of Common Stock to be issuedIssued: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:

Appears in 1 contract

Samples: Can B Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Convertible Debenture due August 8January __, 2012 2016 of Ads In MotionMedbox, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Medbox, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture due August 81, 2012 2017 of Ads In MotionPFO Global, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 1 contract

Samples: PFO Global, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Amortizing Senior Secured Convertible Debenture due August 8, 2012 of Ads In MotionAdvanced Cell Technology, Inc., a Delaware corporation (the “Company”), ) into shares of common stock stock, par value $0.001 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of this Debenture. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoAddress:

Appears in 1 contract

Samples: Advanced Cell Technology, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Senior Convertible Debenture due August 8May 10, 2012 2023 of Ads In Motion, Inc., a Delaware corporation SIGYN THERAPEUTICS INC. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: $110,000 Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: :_____________ Account No:___________

Appears in 1 contract

Samples: Sigyn Therapeutics, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Senior Secured Convertible Debenture Promissory Note, due August 8October 23, 2012 2019 of Ads In MotionSpectrum Global Solutions, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Spectrum Global Solutions, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture Note due August 8September 20, 2012 2019 of Ads In MotionCreative Medical Technology Holdings, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company Borrower according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Borrower in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Borrower that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: $ Additional Interest to be Converted: $ Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Creative Medical Technology Holdings, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 12% Senior Secured Convertible Debenture due August 8, 2012 Note of Ads In MotionEnvironmental Service Professionals, Inc., a Delaware Nevada corporation (the "Company"), into shares of common stock stock, par value $0.001 per share (the "Common Stock"), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4 of said Note. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Environmental Service Professionals, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Convertible Debenture due August 8, 2012 of Ads In MotionTruli Media Group, Inc., a Delaware an Oklahoma corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Schedule 1

Appears in 1 contract

Samples: Truli Media Group, Inc.

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NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Original Issue Discount Convertible Debenture Promissory Note due August 8of Electronic Cigarettes International Group, 2012 of Ads In Motion, Inc.Ltd., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:: Appendix A Amortization Schedule Transaction Amount Timing Funding: $ Amortization Payments First Payment Second Payment Third Payment Schedule 1

Appears in 1 contract

Samples: Electronic Cigarettes International Group, Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Senior Convertible Debenture due August 8March 23, 2012 2023 of Ads In Motion, Inc., a Delaware corporation SIGYN THERAPEUTICS INC. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: $110,000 Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ________________ Account No:: _______________

Appears in 1 contract

Samples: Sigyn Therapeutics, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Convertible Debenture due August 8March 1, 2012 2018 of Ads In MotionLegend Oil and Gas, Inc.Ltd., a Delaware Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _____________ Account No:: ___________ Schedule 1

Appears in 1 contract

Samples: Legend Oil & Gas, Ltd.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Convertible Debenture Note due August 8July , 2012 2019 of Ads In MotionEsports Entertainment Group, Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Esports Entertainment Group, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Promissory Note due August May 8, 2012 2021 of Ads In MotionGoIP Global, Inc., a Delaware Colorado corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Information Date to Effect Conversion: Outstanding Principal: Outstanding Interest: Principal Amount of Debenture Note to be Converted: Number Interest Amount of shares Note to be Converted: Conversion Price Calculations: Total Shares of Common Stock to be issuedIssued: SignatureOutstanding Principal After Conversion: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account NoOutstanding Interest After Conversion:

Appears in 1 contract

Samples: GoIP GLOBAL, INC.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Senior Secured Convertible Debenture Promissory Note, due August 8June 20, 2012 2019 of Ads In Motion, Inc.New Age Beverages Corporation, a Delaware Washington corporation (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion Conversion, the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number Payment of shares of Interest in Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker __ Yes __ No: Account No:

Appears in 1 contract

Samples: New Age Beverages Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal and accrued but unpaid interest under the Senior Convertible Debenture Note, due August 8on or before the earlier to occur of (i) ten (10) Business Days following the receipt by the Company or ABS of the 2019 Tax Credit, 2012 or (ii) December 31, 2019, of Ads In MotionAzurRx BioPharma, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Applicable Conversion Price: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: AzurRx BioPharma, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture Unsecured Promissory Note due August 8, 2012 on demand of Ads In Motion, Inc.The Saint Xxxxx Company, a Delaware North Carolina corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of the DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:SCHEDULE 1

Appears in 1 contract

Samples: Saint James CO

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture Unsecured Promissory Note due August 8November 10, 2012 2009 of Ads In Motion, Inc.The Saint Xxxxx Company, a Delaware North Carolina corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 5 of the DebentureNote, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:SCHEDULE 1

Appears in 1 contract

Samples: Whereas (Saint James CO)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due August 8______ __, 2012 2011 of Ads In Motion, Inc.Magnolia Solar Corporation, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _______________ Account No:: ____________ Schedule 1

Appears in 1 contract

Samples: Magnolia Solar Corp

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 3.0% Senior Secured Convertible Debenture Note due August 8June 25, 2012 2017 of Ads In MotionW270, Inc., a Delaware Nevada corporation (the Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockStock pursuant to any prospectus. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Interest Accrued on Account of Conversion at Issue: Number of shares of Common Stock to be issued: issued (not less than 10,000 shares): Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: W270, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture due August 8, 2012 10% Senior Secured Note of Ads In MotionJupiter Neurosciences, Inc., a Delaware corporation (the “Company”), due on April 11, 2023, into shares of common stock stock, of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenture, as determined in accordance with Section 13(d) of the Exchange Act, specified under Section 4(c) of this Note. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Notes to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____________of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Address: Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1

Appears in 1 contract

Samples: Jupiter Neurosciences, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 3.0% Senior Secured Convertible Debenture Note due August 8June 25, 2012 2017 of Ads In MotionSaleen Automotive, Inc., a Delaware Nevada corporation (the Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common StockStock pursuant to any prospectus. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Interest Accrued on Account of Conversion at Issue: Number of shares of Common Stock to be issued: issued (not less than 10,000 shares): Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Saleen Automotive, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 5% Convertible Debenture due August 8July ___, 2012 2009, of Ads In MotionGenSpera, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Genspera Inc

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due August 8______ __, 2012 2013 of Ads In Motion, Inc.Magnolia Solar Corporation, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ___________ Account No:: __________ Schedule 1

Appears in 1 contract

Samples: Second Note Amendment Agreement (Magnolia Solar Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 10% Senior Convertible Debenture Promissory Note due August 8June 9, 2012 2017 of Ads In MotionGrowlife, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), ) of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares Shares of Common Stock to be issuedIssued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1

Appears in 1 contract

Samples: Growlife, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Senior Convertible Debenture Note due August 86, 2012 2022 of Ads In Motion, Slinger Bag Inc., a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: Slinger Bag Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture Note due August 8June 23, 2012 2016 of Ads In MotionAccelerated Pharma, Inc., a Delaware corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company Borrower according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company Borrower in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company Borrower that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery deliver), requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: $ Number of shares Shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: . Account No:

Appears in 1 contract

Samples: Accelerated Pharma, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Convertible Debenture Unsecured Note due August 8March [●], 2012 2026 of Ads In MotionNovaBay Pharmaceuticals, Inc., a Delaware corporation (the “Company”), into shares of common stock stock, par value $0.01 per share (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:

Appears in 1 contract

Samples: NovaBay Pharmaceuticals, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Senior Convertible Debenture due August 8March 23, 2012 2023 of Ads In Motion, Inc., a Delaware corporation SIGYN THERAPEUTICS INC. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the this Debenture, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture to be Converted: $110,000 Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ________________ Account No:: ______________

Appears in 1 contract

Samples: Sigyn Therapeutics, Inc.

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due August 8______ __, 2012 2013 of Ads In Motion, Inc.Magnolia Solar Corporation, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: ______________ Account No:: ______________ Schedule 1

Appears in 1 contract

Samples: Note Amendment Agreement (Magnolia Solar Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the Original Issue Discount Senior Secured Convertible Debenture Note due August 8______ __, 2012 2013 of Ads In Motion, Inc.Magnolia Solar Corporation, a Delaware Nevada corporation (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Number of shares of Common Stock to be issued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: _______________ Account No:: ______________ Schedule 1

Appears in 1 contract

Samples: Second Note Amendment Agreement (Magnolia Solar Corp)

NOTICE OF CONVERSION. The undersigned hereby elects to convert principal under the 8% Convertible Debenture Promissory Note due August 8September [30], 2012 2017 of Ads In Motion, Inc., a Delaware corporation Force Protection Video Equipment Corp. (the “Company”), into shares of common stock of the Company (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of the Debenturethis Note, as determined in accordance with Section 13(d) of the Exchange Act. The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock. Conversion calculations: Date to Effect Conversion: Principal Amount of Debenture Note to be Converted: Payment of Interest in Common Stock __ yes __ no If yes, $_____ of Interest Accrued on Account of Conversion at Issue. Number of shares Shares of Common Stock to be issuedIssued: Signature: Name: Address for Delivery of Common Stock Certificates: Or DWAC Instructions: Broker No: Account No:Schedule 1 CONVERSION SCHEDULE This 8% Convertible Promissory Note due on September [30], 2017 in the original principal amount of $78,750 is issued by Force Protection Video Equipment Corp. This Conversion Schedule reflects conversions made under Section 4 of the above referenced Note.

Appears in 1 contract

Samples: Force Protection Video Equipment Corp.

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