NEITHER THIS NOTE NOR THE SECURITIES THAT MAY BE ISSUED BY THE BORROWER UPON CONVERSION HEREOF (COLLECTIVELY,
THE “SECURITIES”)
HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT”), OR THE SECURITIES LAWS OF ANY STATE OR OTHER
JURISDICTION. NEITHER THE SECURITIES NOR ANY INTEREST OR PARTICIPATION THEREIN MAY BE OFFERED FOR SALE, SOLD, TRANSFERRED OR
ASSIGNED: (i) IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER THE 1933 ACT, OR APPLICABLE STATE
SECURITIES LAWS; OR (ii) IN THE ABSENCE OF AN OPINION OF COUNSEL, IN A FORM ACCEPTABLE TO THE ISSUER, THAT REGISTRATION IS NOT
REQUIRED UNDER THE 1933 ACT OR; (iii) UNLESS SOLD, TRANSFERRED OR ASSIGNED PURSUANT TO RULE 144 UNDER THE 1933 ACT.
CONVERTIBLE NOTE
__________________ [Location]
, 20___ (the “Issuance Date”) $
FOR VALUE RECEIVED, __________________________[company], a ____________[state] corporation (the
“Company”), hereby promises to pay to the order of or registered assigns (the “Holder”)
the principal amount of Dollars ($ ), on , 20____ (the “Maturity Date”), and to
pay interest on the unpaid principal balance hereof at the rate of ___________[textual amount] percent (_____%) per
annum from the Issuance Date in accordance with the terms hereof or otherwise. The principal balance of this Note shall
be payable pursuant to Paragraph 1. Interest on this Note shall accrue and be payable pursuant to Paragraph I. Each
capitalized term used herein, and not otherwise defined, shall have the meaning ascribed thereto in the
____________________[contract], dated between the Company and the Holder (the “Securities
Purchase Agreement”), pursuant to which this convertible note (the “Note”) was originally issued. The term “Note” and
all reference thereto, as used throughout this instrument, shall mean this instrument as originally executed, or if later
amended or supplemented, then as so amended or supplemented. This Note and the Other Notes (as hereinafter defined)
issued by the Company on the Issuance Date pursuant to Securities Purchase Agreements executed by the Company and
purchasers of the Other Notes (collectively, the “Securities Purchase Agreements”) are collectively referred to in this
Note as the “Notes.”
1. Payments of Principal and Interest.
(a) Payment of Principal. The principal balance of this Note shall be paid to the Holder hereof on the Maturity
Date. The Company shall not prematurely pay or prepay any outstanding principal balance to the Holder.
(b) Payment of Interest. Interest on the unpaid principal balance of this Note shall accrue at a rate of
______[textual amount] percent (______%) per annum commencing on the Issuance Date. Interest shall be computed on
the basis of a 365-day year and actual days elapsed. Interest shall be paid in accordance with Schedule 1(b.) attached hereto.
(c) Default Interest. Any amount of principal or interest on this Note which is not paid when due shall bear
interest at the rate of _____________[textual amount] percent (_____%) per annum from the date thereof until the
same is paid (“Default Interest”) and the Holder, at the Holder’s sole discretion, may include any accrued but unpaid
Default Interest in the Conversion Amount.
(d) General Payment Provisions. All payments of principal and interest on this Note shall be made in lawful
money of ________________________________[country] by check to such account as the Holder may from time to time
designate by written notice to the Company in accordance with the provisions of this Note. Whenever any amount expressed
to be due by the terms of this Note is due on any day which is not a Business Day (as defined below), the same shall instead
be due on the next succeeding day which is a Business Day and, in the case of any interest payment date which is not the
date on which this Note is paid in full, the extension of the due date thereof shall not be taken into account for purposes of
determining the amount of interest due on such date. For purposes of this Note, “Business Day” shall mean any day other
than a Saturday, Sunday or a day on which commercial banks in the ____________________[local jurisdiction] are
authorized or required by law or executive order to remain closed.
2. Conversion of Note. At any time prior to the Maturity Date, this Note shall be convertible into shares of the
Company’s common stock, par value __ ____._____ [amount] per share (the “Common Stock”), on the terms and
conditions set forth in this Paragraph 2.
(a) Certain Defined Terms. For purposes of this Note, the following terms shall have the following meanings:
(1) “Conversion Amount” means the sum of (A) the principal amount of this Note to be
converted with respect to which this determination is being made, (B) accrued and unpaid interest, if
so included at the Holder’s sole discretion and (c) Default Interest, if any, on unpaid interest and
principal, if so included at the Holder’s sole discretion.
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(2) “Conversion Price” means ________________[textual amount] (__ ____.____)[amount]
(3). “Other Notes” means the convertible notes, other than this Note, issued by the Company
pursuant to Securities Purchase Agreements.
(4) “Person” means an individual, a limited liability company, a partnership, a joint venture, a
corporation, a trust, an unincorporated organization and a government or any department or agency
thereof.
(b) Holder’s Conversion Right. At any time or times on or after the Issuance Date, the Holder shall be entitled
to convert any part of the outstanding and unpaid principal amount of this Note into fully paid and nonassessable shares of
Common Stock in accordance with Paragraph 2.(d), at the Conversion Rate (as defined below), provided that the Holder
shall be required to request conversions in increments of __________[amount] or more, The Company shall not issue any
fraction of a share of Common Stock upon any conversion; if such issuance would result in the issuance of a fraction of a
share of Common Stock, the Company shall round such fraction of a share of Common Stock up to the nearest whole share.
(c) Conversion Rate. The number of shares of Common Stock issuable upon conversion of a Conversion
Amount of this Note pursuant to Paragraph 2.(b) shall be determined according to the following formula (the “Conversion
Rate”):
Conversion Amount: ______________________________________________________________________________
Conversion Price: ________________________________________________________________________________
(d) Mechanics of Conversion. The conversion of this Note shall be conducted in the following manner:
(1) Holder’s Delivery Requirements. To convert this Note into shares of Common Stock on
any date set forth in the Conversion Notice by the Holder (the “Conversion Date”), the Holder hereof
shall (A) transmit by facsimile (or otherwise deliver), for receipt on or prior to
__________________[time and time zone] on such date, a copy of a fully executed notice of
conversion in the form attached hereto as Exhibit 2.(d)(1) (the “Conversion Notice”) to the Company;
and (B) surrender to a common carrier for delivery to the Company as soon as practicable following
the date of the Conversion Notice original of the Note being converted.
(2) Company’s Response. Upon receipt by the Company of a copy of a Conversion Notice, the
Company shall as soon as practicable, but in no event later than five (5) Business Days after receipt
of such Conversion Notice, send, via facsimile and overnight courier, a confirmation of receipt of
such Conversion Notice (the “Conversion Confirmation”) to such Holder indicating that the
Company will process such Conversion Notice in accordance with the terms herein. Within fifteen
(15) Business Days after the date of the Conversion Confirmation, the Company shall issue and
surrender to a common carrier for delivery to the address as specified in the Conversion Notice, a
certificate, registered in the name of the Holder, for the number of shares of Common Stock to which
the Holder shall be entitled. If less than the full principal amount of this Note is submitted for
conversion, then the Company shall within fifteen (15) Business Days after receipt of the Note and
at its own expense, issue and deliver to the Holder a new Note for the outstanding principal amount
not so converted; provided that such new Note shall be substantially in the same form as this Note.
(3) Record Holder, The person or persons entitled to receive the shares of Common Stock
issuable upon a conversion of this Note shall be treated for all purposes as the record holder or holders
of such shares of Common Stock on the Conversion Date.
(e) Taxes. The Company shall pay any and all taxes that may be payable with respect to the issuance and
delivery of Common Stock upon the conversion of Notes.
Adjustments to Conversion Price. If the Company at any time subdivides (by any stock split, stock
dividend, recapitalization or otherwise) one or more classes of its outstanding shares of Common
Stock into a greater number of shares, the Fixed Conversion Price in effect immediately prior to such
subdivision will be proportionately reduced. If the Company at any time combines (by combination,
reverse stock split or otherwise) one or more classes of its outstanding shares of Common Stock into
a smaller number of shares, the Fixed Conversion Price in effect immediately prior to such
combination will be proportionately increased.
Other Rights of Holders. ______________________________________________________________.
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(a) Reorganization, Reclassification, Consolidation, Merger or Sale. Any recapitalization, reorganization,
reclassification, consolidation, merger, sale of all or substantially all of the Company’s assets to another Person or other
transaction which is effected in such a way that holders of Common Stock are entitled to receive (either directly or upon
subsequent liquidation) stock, securities or assets with respect to or in exchange for Common Stock is referred to herein as
“Organic Change.” Prior to the consummation of any (i) Organic Change or (ii) other Organic Change following which the
Company is not a surviving entity, the Company will secure from the Person purchasing such assets or the successor
resulting from such Organic Change (in each case, the “Acquiring Entity”) a written agreement (in form and substance
reasonably satisfactory to the holders of a majority of the Notes then outstanding) to deliver to each Holder in exchange
for this Note, a security of the Acquiring Entity evidenced by a written instrument substantially similar in form and
substance to this Note, and reasonably satisfactory to the Holders of a majority of the Conversion Amount of the Notes
then outstanding. Prior to the consummation of any other Organic Change, the Company shall make appropriate provision
(in form and substance reasonably satisfactory to the Holders of a majority of the Conversion Amount of the Notes then
outstanding) to ensure that each of the Holders will thereafter have the right to acquire and receive in lieu of or in addition
to (as the case may be) the shares of Common Stock immediately theretofore acquirable and receivable upon the conversion
of such Holder’s Note, such shares of stock, securities or assets that would have been issued or payable in such Organic
Change with respect to or in exchange for the number of shares of Common Stock which would have been acquirable and
receivable upon the conversion of such Holder’s Note as of the date of such Organic Change (without taking into account
any limitations or restrictions on the convertibility of the Note).
4. Out of _______________[state/province] Execution.
[ ] IF ELECTED, The Company and the Holder hereby acknowledge that this Note was executed by the Company
outside the ______________[state/province] and delivered to Holder outside the ________________[state/province].
Further, the Holder acknowledges that the Holder took possession and custody of the Note outside
the______________________[state/province]. IF NOT ELECTED, IT IS REQUIRED TO INPUT “N/A” IN EACH NON-
APPLICABLE FIELD.
5. Reservation of Shares. The Company shall at all times, so long as any principal amount of the Notes is outstanding,
reserve and keep available out of its authorized and unissued Common Stock, solely for the purpose of effecting the
conversion of the Notes, such number of shares of Common Stock as shall at all times be sufficient to effect the conversion
of all of the principal amount of the Notes then outstanding; provided that the number of shares of Common Stock so
reserved shall at no time be less than one hundred ten percent (110%) of the number of shares of Common Stock for which
the principal amount of the Notes are at any time convertible. The initial number of shares of Common Stock reserved for
conversions of the Notes and each increase in the number of shares so reserved shall be allocated pro rata among the
Holders of the Notes based on the principal amount of the Notes held by each Holder at the time of issuance of the Notes
or increase in the number of reserved shares, as the case may be. In the event a Holder shall sell or otherwise transfer any
of such Holder’s Notes, each transferee shall be allocated a pro rata portion of the number of reserved shares of Common
Stock reserved for such transferor. Any shares of Common Stock reserved and allocated to any Person which ceases to
hold any Notes shall be allocated to the remaining Holders, pro rata based on the principal amount of the Notes then held
by such Holders.
6. Voting Rights. Holders shall have no voting rights, except as required by law, including but not limited to the
____________________________________[regulation (s)] and as expressly provided in this Note.
7. Reissuance of Note. In the event of a conversion or redemption pursuant to this Note of less than all of the
Conversion Amount represented by this Note, the Company shall promptly cause to be issued and delivered to the Holder,
upon tender by the Holder of the Note converted or redeemed, a new note of like tenor representing the remaining principal
amount of this Note which has not been so converted or redeemed and which is in substantially the same form as this Note.
8. Defaults and Remedies.
(a) Events of Default. An “Event of Default” is: (i) default for thirty (30) days in payment of interest or Default
Interest on this Note; (ii) default in payment of the principal amount of this Note when due; (iii) failure by the Company
for thirty (30) days after notice to it to comply with any other material provision of this Note; (iv) if the Company pursuant
to or within the meaning of any Bankruptcy Law; (A) commences a voluntary case; (B) consents to the entry of an order
for relief against it in an involuntary case; (C) consents to the appointment of a Custodian of it or for all or substantially
all of its property; (D) makes a general assignment for the benefit of its creditors; or (E) admits in writing that it is generally
unable to pay its debts as the same become due; or {vi) a court of competent jurisdiction enters an order or decree under
any Bankruptcy Law that: (1) is for relief against the Company in an involuntary case; (2) appoints a Custodian of the
Company or for all or substantially all of its property; or {3) orders the liquidation of the Company or any subsidiary, and
the order or decree remains unstayed and in effect for thirty (30) days. The Term “Bankruptcy Law” means Title 11, U.S.
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Code, or any similar Federal or State Law for the relief of debtors. The term “Custodian” means any receiver, trustee,
assignee, liquidator or similar official under any Bankruptcy Law.
(b) Remedies. If an Event of Default occurs and is continuing, the Holder of this Note may declare this entire
Note, including any interest and Default Interest and other amounts due, to be due and payable immediately.
9. Vote to Change the Terms of this Note. This Note and any provision hereof may only be amended by an instrument
in writing signed by the Company and holders of a majority of the aggregate Conversion Amount of the Notes then
outstanding.
10. Lost or Stolen Note. Upon receipt by the Company of evidence satisfactory to the Company of the loss, theft,
destruction or mutilation of this Note, and, in the case of loss, theft or destruction, of an indemnification undertaking by
the Holder to the Company in a form reasonably acceptable to the Company and, in the case of mutilation, upon surrender
and cancellation of the Notes, the Company shall execute and deliver a new Note of like tenor and date and in substantially
the same form as this Note; provided, however, the Company shall not be obligated to re-issue a Note if the Holder
contemporaneously requests the Company to convert such remaining principal amount into Common Stock.
11. Payment of Collection, Enforcement and Other Costs. If: (i) this Note is placed in the hands of an attorney for
collection or enforcement or is collected or enforced through any legal proceeding; or OD an attorney is retained to
represent the Holder of this Note in any bankruptcy, reorganization, receivership or other proceedings affecting creditors’
rights and involving a claim under this Note, then the Company shall pay to the Holder all reasonable attorneys’ fees, costs
and expenses incurred in connection therewith, in addition to all other amounts due hereunder.
12. Cancellation. After all principal and accrued interest at any time owed on this Note has been paid in full, this
Note shall automatically be deemed canceled, shall be surrendered to the Company for cancellation and shall not be reissued.
13. Waiver of Notice. To the extent permitted by law, the Company hereby waives demand, notice, protest and all
other demands and notices in connection with the delivery, acceptance, performance, default or enforcement of this Note
and the Securities Purchase Agreement.
14. Governing Law. This Note shall be construed and enforced in accordance with, and all questions concerning the
construction, validity, interpretation and performance of this Note shall be governed by, the laws of the
______________________[jurisdiction], without giving effect to provisions thereof regarding conflict of laws. Each party
hereby irrevocably submits to the non-exclusive jurisdiction of the state and federal courts sitting in
__________________________[jurisdiction], for the adjudication of any dispute hereunder or in connection herewith or
with any transaction contemplated hereby or discussed herein, and hereby irrevocably waives, and agrees not to assert in
any suit, action or proceeding, any claim that it is not personally subject to the jurisdiction of any such court, that such suit,
action or proceeding is brought in an inconvenient forum or that the venue of such suit, action or proceeding is improper.
Each party hereby irrevocably waives personal service of process and consents to process being served in any such suit,
action or proceeding by sending by certified mail or overnight courier a copy thereof to such party at the address for such
notices to it under this Agreement and agrees that such service shall constitute good and sufficient service of process and
notice thereof. Nothing contained herein shall be deemed to limit in any way any right to serve process in any manner
permitted by law. EACH PARTY HEREBY IRREVOCABLY WAIVES ANY RIGHT IT MAY HAVE AND
AGREES NOT TO REQUEST, A JURY TRIAL FOR THE ADJUDICATION OF ANY DISPUTE HEREUNDER
OR IN CONNECTION HEREWITH OR ARISING OUT OF THIS AGREEMENT OR ANY TRANSACTION
CONTEMPLATED HEREBY.
15. Remedies, Characterizations, Other Obligations, Breaches and Injunctive Relief. The remedies provided in this
Note shall be cumulative and in addition to all other remedies available under this Note, at law or in equity (including a
decree of specific performance and/or other injunctive relief), and no remedy contained herein shall be deemed a waiver
of compliance with the provisions giving rise to such remedy and nothing herein shall limit a Holder’s. right to pursue
actual damages for any failure by the Company to comply with the terms of this Note. The Company covenants to each
Holder of Notes that there shall be no characterization concerning this instrument other than as expressly provided herein.
Amounts set forth or provided for herein with respect to payments, conversion and the like (and the computation thereof)
shall be the amounts to be received by the Holder thereof and shall not, except as expressly provided herein, be subject to
any other obligation of the Company (or the performance thereof),
16. Specific Shall Not Limit General; Construction. No specific provision contained in this Note shall limit or modify
any more general provision contained herein. This Note shall be deemed to be jointly drafted by the Company and all
Holders and shall not be construed against any person as the drafter hereof,
Page 4 of 7
17. Failure or Indulgence Not Waiver. No failure or delay on the part of this Note in the exercise of any power, right
or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise of any such power, right or
privilege preclude other or further exercise thereof or of any other right, power or privilege.
(Signature Page Follows)
Page 5 of 7
IN WITNESS WHEREOF, the Company has caused this Note to be signed by ________________________, it’s
President, on and as of the Issuance Date.
_______________________________________[company]
_______________________[full name], __________[title]
Page 6 of 7
EXHIBIT 2.(d)(1)
CONVERSION NOTICE
Reference is made to the Convertible Note issued by _____________________________ (the “Note”). In accordance with
and pursuant to the Note, the undersigned hereby elects to convert a portion or all of the principal balance of the Note,
indicated below into shares of Common Stock, par value ____________ per share the “Common Stock”), of the Company,
by tendering the Note specified below as of the date specified below.
Date of Conversion:
Aggregate Principal Amount to be converted:
No(s). of Note to be converted:
Please confirm the following information:
Conversion Amount:
Conversion Price:
Number of shares of Common Stock to be issued:
Please issue the Common Stock into which the Note is being converted in the name of the Holder of the Note and to the
following address:
Telephone Number:
Facsimile Number:
Authorization:
By:
Title:
Dated:
Please issue a new Note(s) for the outstanding principal balance in the name of the Holder and to the following
address’
Outstanding Principal Balance:
Telephone No.:
Facsimile No.:
Authorization:
By:
Title:
Dated:
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