<SEC-DOCUMENT>0001213900-19-012136.txt : 20190705
<SEC-HEADER>0001213900-19-012136.hdr.sgml : 20190705
<ACCEPTANCE-DATETIME>20190705161530
ACCESSION NUMBER:		0001213900-19-012136
CONFORMED SUBMISSION TYPE:	8-K
PUBLIC DOCUMENT COUNT:		3
CONFORMED PERIOD OF REPORT:	20190628
ITEM INFORMATION:		Entry into a Material Definitive Agreement
ITEM INFORMATION:		Unregistered Sales of Equity Securities
ITEM INFORMATION:		Financial Statements and Exhibits
FILED AS OF DATE:		20190705
DATE AS OF CHANGE:		20190705

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			NEUROONE MEDICAL TECHNOLOGIES Corp
		CENTRAL INDEX KEY:			0001500198
		STANDARD INDUSTRIAL CLASSIFICATION:	SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
		IRS NUMBER:				270863354
		STATE OF INCORPORATION:			DE
		FISCAL YEAR END:			0930

	FILING VALUES:
		FORM TYPE:		8-K
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	000-54716
		FILM NUMBER:		19943857

	BUSINESS ADDRESS:	
		STREET 1:		10901 RED CIRCLE DR.
		STREET 2:		SUITE 150
		CITY:			MINNETONKA
		STATE:			MN
		ZIP:			55343
		BUSINESS PHONE:		(952) 426-1383

	MAIL ADDRESS:	
		STREET 1:		10901 RED CIRCLE DR.
		STREET 2:		SUITE 150
		CITY:			MINNETONKA
		STATE:			MN
		ZIP:			55343

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	Original Source Entertainment, Inc.
		DATE OF NAME CHANGE:	20100830
</SEC-HEADER>
<DOCUMENT>
<TYPE>8-K
<SEQUENCE>1
<FILENAME>f8k0719_neuroone.htm
<DESCRIPTION>FORM 8-K
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<!-- Field: Rule-Page --><DIV ALIGN="LEFT" STYLE="margin-top: 12pt; margin-bottom: 3pt"><DIV STYLE="font-size: 1pt; border-top: Black 2pt solid; border-bottom: Black 1pt solid; width: 100%">&nbsp;</DIV></DIV><!-- Field: /Rule-Page -->

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>UNITED STATES</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>SECURITIES AND EXCHANGE COMMISSION</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>WASHINGTON, D.C.&nbsp; 20549</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>FORM 8-K</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>&nbsp;</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>CURRENT REPORT</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>Pursuant to Section 13 or 15(d) of The Securities
Exchange Act of 1934</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">Date of Report (Date of Earliest Event Reported):
June 28, 2019</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>NeuroOne Medical Technologies Corporation</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">(Exact name of registrant as specified in its
charter)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;&nbsp;</P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR>
    <TD STYLE="width: 49%; text-align: center; border-bottom: Black 1.5pt solid"><FONT STYLE="font-size: 10pt">&nbsp;<B>000-54716</B></FONT></TD>
    <TD STYLE="width: 2%; padding-bottom: 1pt">&nbsp;</TD>
    <TD STYLE="width: 49%; text-align: center; border-bottom: Black 1.5pt solid"><FONT STYLE="font-size: 10pt">&nbsp;<B>27-0863354</B></FONT></TD></TR>
<TR>
    <TD STYLE="text-align: center"><FONT STYLE="font-size: 10pt">&nbsp;(Commission File Number)</FONT></TD>
    <TD>&nbsp;</TD>
    <TD STYLE="text-align: center"><FONT STYLE="font-size: 10pt">&nbsp;(IRS Employer Identification No.)</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>10901 Red Circle Dr., Suite 150, Minnetonka,
MN 55343</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">(Address of principal executive offices and
zip code)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>952-426-1383</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">(Registrant's telephone number including area
code)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">(Registrant's former name or former address,
if changed since last report)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">Check the appropriate box below if the Form 8-K filing is intended
to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&#9744; Written communications pursuant to Rule 425 under the Securities
Act (17 CFR 230.425)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&#9744; Soliciting material pursuant to Rule 14a-12 under the Exchange
Act (17 CFR 240.14a-12)</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&#9744; Pre-commencement communications pursuant to Rule 14d-2(b)
under the Exchange Act (17 CFR 240.14d-2(b))</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&#9744; Pre-commencement communications pursuant to Rule 13e-4(c)
under the Exchange Act (17 CFR 240.13e-4(c))</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 6pt; text-align: justify">Securities registered pursuant to Section
12(b) of the Act:</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0.3pt 0 0.05pt; color: #0070C0">&nbsp;</P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR STYLE="vertical-align: bottom">
    <TD STYLE="width: 32%; text-align: center; border-bottom: Black 1.5pt solid"><FONT STYLE="font-size: 10pt"><B>Title of each class</B></FONT></TD>
    <TD STYLE="width: 2%; text-align: center">&nbsp;</TD>
    <TD STYLE="width: 32%; text-align: center; text-indent: 4.15pt; border-bottom: Black 1.5pt solid"><FONT STYLE="font-size: 10pt"><B>Trading Symbol(s)</B></FONT></TD>
    <TD STYLE="width: 2%; text-align: center">&nbsp;</TD>
    <TD STYLE="width: 32%; text-align: center; border-bottom: Black 1.5pt solid"><FONT STYLE="font-size: 10pt"><B>Name of each exchange on which registered</B></FONT></TD></TR>
<TR STYLE="vertical-align: top; background-color: #CCEEFF">
    <TD STYLE="text-align: center"><FONT STYLE="font-size: 10pt">N/A</FONT></TD>
    <TD>&nbsp;</TD>
    <TD STYLE="text-align: center"><FONT STYLE="font-size: 10pt">N/A</FONT></TD>
    <TD>&nbsp;</TD>
    <TD STYLE="text-align: center"><FONT STYLE="font-size: 10pt">N/A</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">Indicate by check mark whether the registrant is an emerging growth
company as defined in Rule 405 of the Securities Act of 1933 (&sect;230.405 of this chapter) or Rule 12b-2 of the Securities Exchange
Act of 1934 (&sect;240.12b-2 of this chapter).</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: right">Emerging Growth Company &#9744;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 10pt">If an emerging growth company, indicate by check mark if
the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting
standards provided pursuant to Section 13(a) of the Exchange Act. &#9744;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 10pt"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 10pt">&nbsp;<B>Item&nbsp;1.01.&nbsp;&nbsp;Entry into a Material
Definitive Agreement.</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>2019 Private Placement</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>&nbsp;</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">As previously disclosed in a Current Report
on <A HREF="http://www.sec.gov/Archives/edgar/data/1500198/000121390019000211/f8k122818_neuroonemed.htm" STYLE="-sec-extract: exhibit">Form 8-K</A> filed by NeuroOne Medical Technologies Corporation (the &ldquo;<B><I>Company</I></B>&rdquo;) with the Securities and
Exchange Commission (the &ldquo;<B><I>SEC</I></B>&rdquo;) on January 4, 2019, the Company entered into subscription agreements
(each, a &ldquo;<B><I>Purchase Agreement</I></B>&rdquo;) with a number of institutional and accredited investors (the &ldquo;<B><I>Purchasers</I></B>&rdquo;)
pursuant to which the Company, in a private placement (the &ldquo;<B><I>2019 Private Placement</I></B>&rdquo;), agreed to issue
and sell to the Purchasers units (each, a &ldquo;<B><I>Unit</I></B>&rdquo;), each consisting of (i) 1 share (each, a &ldquo;<B><I>Share</I></B>&rdquo;)
of the Company&rsquo;s common stock, par value $0.001 per share (the &ldquo;<B><I>Common Stock</I></B>&rdquo;), and (ii) a warrant
to purchase 1 share of Common Stock at an initial exercise price of $3.00 per share (the &ldquo;<B><I>Warrants</I></B>&rdquo;).&nbsp;
Between June 28, 2019 and July 1, 2019, the Company entered into Purchase Agreements with 7 additional Purchasers, and issued
and sold an aggregate of 116,000 Units to the Purchasers, for total gross proceeds to the Company of approximately $290,000 before
deducting offering expenses. On July 1, 2019, the Board of Directors of the Company&nbsp;terminated&nbsp;the 2019 Private Placement.
As of the date of this Current Report on Form 8-K, the Company has issued an aggregate of 2,338,179 Units, for total gross proceeds
to the Company of approximately $5,845,448 in connection with the 2019 Private Placement.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">In connection with the 2019 Private
Placement and pursuant to engagement letters with Paulson Investment Company, LLC (&ldquo;<B><I>Paulson</I></B>&rdquo;) and
HRA Capital (&ldquo;<B><I>HRA</I></B>&rdquo;), the placement agents, the Company issued (i) 5-year warrants to Paulson and
its affiliates (the &ldquo;<B><I>Paulson Warrants</I></B>&rdquo;) to purchase 193,417 shares of Common Stock at an
exercise price of $2.75 per share and (ii) 5-year warrants to Corinthian Partners, LLC, an affiliate of HRA, and certain
other HRA affiliates, to purchase 17,760 shares of Common Stock at an exercise price of $3.00 per share (the &ldquo;<B><I>HRA
2019 PIPE Warrants</I></B>,&rdquo; and together with the Paulson Warrants, the &ldquo;<B><I>2019 Broker
Warrants</I></B>&rdquo;). The 2019 Broker Warrants are exercisable beginning on the date of issuance, July 1, 2019, and will
expire on July 1, 2024, five years from the date of the 2019 Private Placement final closing.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">HRA is affiliated with Chromium 24 LLC, which
was previously a greater than 5% beneficial owner, and Lifestyle Healthcare LLC, a current greater than 5% beneficial owner.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">On July 2, 2019, the Company entered into an
amendment to its agreement with Paulson, pursuant to which the Company agreed to file a registration statement with the SEC covering
the resale of the Shares sold in the 2019 Private Placement and the shares of Common Stock issuable upon exercise of the Warrants
within 14 days of the termination of the 2019 Private Placement.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>2018 Private Placement Broker Warrants</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>&nbsp;</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">From July 9, 2018 through November 30, 2018,
the Company entered into purchase agreements with accredited investors, pursuant to which the Company, agreed to issue and sell
units, each consisting of (i) one share of our Common Stock and (ii) a warrant to purchase 1 share of Common Stock at an initial
exercise price of $3.00 per share (the &ldquo;<B><I>2018 Private Placement</I></B>&rdquo;). In connection with the 2018 Private
Placement, on July 1, 2019, the Company issued to affiliates of HRA warrants to purchase 36,096 shares of Common Stock at an exercise
price of $3.00 per share, which warrants were exercisable beginning on the date of issuance, July 1, 2019, and expiring on July
1, 2024 (the &ldquo;<B><I>2018 Broker Warrants</I></B>&rdquo;).</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>Note Transaction Broker Warrants</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>&nbsp;</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">From November 2016 to June 2017, the Company
issued 8% convertible promissory notes in an aggregate principal amount of $1.6 million (the &ldquo;<B><I>Series 1 Notes</I></B>&rdquo;)
and warrants to purchase shares of the Company&rsquo;s capital stock. In August 2017, the Company entered into a subscription agreement
and issued interest free promissory notes in an aggregate principal amount of $253,000 to certain accredited investors, which notes
were subsequently amended to become 8% convertible promissory notes and to increase warrant coverage among other items (the &ldquo;<B><I>Series
2 Notes</I></B>&rdquo;). From October 2017 to May 2018, the Company issued 8% convertible promissory notes (the &ldquo;<B><I>Series
3 Notes</I></B>&rdquo; and, together with the Series 1 Notes and Series 2 Notes, the &ldquo;<B><I>Notes</I></B>&rdquo;) in an aggregate
principal amount of $1.5 million and warrants to purchase shares of the Company&rsquo;s capital stock. The Series 1 Notes, Series
2 Notes and Series 3 Notes were converted to Common Stock in accordance with their terms. In connection with the Notes transactions,
on July 1, 2019, the Company issued to affiliates of HRA warrants to purchase 135,512 shares of Common Stock at an exercise
price of $2.00 per share, which warrants were exercisable beginning on the date of issuance, July 1, 2019 and expiring on July
1, 2024  (together with the 2018 Broker Warrants
and the HRA 2019 PIPE Warrants, the &ldquo;<B><I>HRA Warrants</I></B>&rdquo; and, together with the 2019 Broker Warrants, the &ldquo;<B><I>Broker
Warrants</I></B>&rdquo;).</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">Prior to expiration, subject to the terms and
conditions set forth in the Broker Warrants, the holders of such Broker Warrants may exercise the Broker Warrants for shares of
Common Stock by providing notice to the Company and paying the exercise price per share for each share so exercised.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">The foregoing summary descriptions of the Broker
Warrants do not purport to be complete and are qualified in their entirety by reference to the Form of Paulson Warrant and Form
of HRA Warrant, which are attached as Exhibits 4.2 and 4.3 hereto, respectively, and incorporated herein by reference.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">The representations, warranties and covenants
contained in the Broker Warrants were made solely for the benefit of the parties to the Broker Warrants and may be subject to limitations
agreed upon by the contracting parties. Accordingly, the Broker Warrants are incorporated herein by reference only to provide investors
with information regarding the terms of such documents and not to provide investors with any other factual information regarding
the Company or its business, and should be read in conjunction with the disclosures in the Company&rsquo;s periodic reports and
other filings with the SEC.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><B>Item 3.02.&nbsp;&nbsp;Unregistered Sales of Equity Securities.</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">The description set forth in Item 1.01 above
is hereby incorporated by reference into this Item 3.02.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>&nbsp;</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">In connection with the 2019 Private Placement,
the Company issued Shares and Warrants to the Purchasers, and Broker Warrants to the placement agents and their affiliates, all
of whom are accredited investors, in reliance on the exemption from registration provided by Section 4(a)(2) of the Securities
Act of 1933, as amended (the &ldquo;<B><I>Securities Act</I></B>&rdquo;), and Rule 506 of Regulation D promulgated thereunder.
The Company will rely on this exemption from registration based in part on representations made by the Purchasers and the placement
agents and their affiliates. The Shares, Warrants, Broker Warrants and the shares of Common Stock issuable upon exercise of the
Warrants and Broker Warrants have not been and may not be registered under the Securities Act or applicable state securities laws
and may not be offered or sold in the United States absent registration under the Securities Act or an exemption from such registration
requirements. Neither this Current Report on Form 8-K nor any exhibit attached hereto shall constitute an offer to sell or the
solicitation of an offer to buy the Shares, Warrants, Broker Warrants, shares of Common Stock issuable upon exercise of the Warrants
or Broker Warrants or any other securities of the Company.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;<B>Item&nbsp;9.01.&nbsp;</B>&nbsp;<B>Financial Statements
and Exhibits.</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">(d)&nbsp; Exhibits.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR STYLE="vertical-align: top; background-color: #CCEEFF">
    <TD STYLE="width: 8%"><FONT STYLE="font-size: 10pt">4.1*</FONT></TD>
    <TD STYLE="width: 92%"><FONT STYLE="font-size: 10pt"><A HREF="http://www.sec.gov/Archives/edgar/data/1500198/000121390019000211/f8k122818ex4-1_neuroone.htm" STYLE="-sec-extract: exhibit">Form of Warrant.</A></FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD><FONT STYLE="font-size: 10pt">4.2</FONT></TD>
    <TD><FONT STYLE="font-size: 10pt"><A HREF="f8k0719ex4-2_neuroone.htm">Form of Paulson Warrant</A>.</FONT></TD></TR>
<TR STYLE="vertical-align: top; background-color: #CCEEFF">
    <TD><FONT STYLE="font-size: 10pt">4.3</FONT></TD>
    <TD><FONT STYLE="font-size: 10pt"><A HREF="f8k0719ex4-3_neuroone.htm">Form of HRA Warrant.</A></FONT></TD></TR>
<TR STYLE="vertical-align: top; background-color: white">
    <TD><FONT STYLE="font-size: 10pt">10.1*</FONT></TD>
    <TD><FONT STYLE="font-size: 10pt"><A HREF="http://www.sec.gov/Archives/edgar/data/1500198/000121390019000211/f8k122818ex10-1_neuroone.htm" STYLE="-sec-extract: exhibit">Form of Purchase Agreement.</A></FONT></TD></TR>
<TR STYLE="vertical-align: top; background-color: #CCEEFF">
    <TD><FONT STYLE="font-size: 10pt">10.2*</FONT></TD>
    <TD><FONT STYLE="font-size: 10pt"><A HREF="http://www.sec.gov/Archives/edgar/data/1500198/000121390019000211/f8k122818ex10-2_neuroone.htm" STYLE="-sec-extract: exhibit">Form of Registration Rights Agreement.</A></FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">* Incorporated by reference to our Current
Report on Form 8-K filed with the Securities and Exchange Commission on January 4, 2019.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>SIGNATURE </B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 12pt 0 0; text-indent: 0.5in">Pursuant to the requirements of the Securities
Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR>
    <TD STYLE="width: 46%">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom; width: 1%">&nbsp;</TD>
    <TD STYLE="width: 9%">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="width: 2%">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom; width: 1%">&nbsp;</TD>
    <TD STYLE="width: 35%">&nbsp;</TD></TR>
<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD COLSPAN="4" STYLE="vertical-align: bottom"><FONT STYLE="font-size: 10pt"><B>NEUROONE MEDICAL TECHNOLOGIES CORPORATION </B></FONT></TD></TR>
<TR>
    <TD>&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-size: 10pt">Dated: July 5, 2019</FONT></TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD></TR>
<TR>
    <TD>&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD></TR>
<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-size: 10pt">By:</FONT></TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top; border-bottom: Black 1.5pt solid">
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 1pt">/s/ David Rosa</P></TD></TR>
<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-size: 10pt">David Rosa</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-size: 10pt">Chief Executive Officer</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"></P>

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</DOCUMENT>
<DOCUMENT>
<TYPE>EX-4.2
<SEQUENCE>2
<FILENAME>f8k0719ex4-2_neuroone.htm
<DESCRIPTION>FORM OF PAULSON WARRANT
<TEXT>
<HTML>
<HEAD>
     <TITLE></TITLE>
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<P STYLE="margin: 0; text-align: right"><B>Exhibit 4.2</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">PURCHASE
WARRANT</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Issued
to:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Exercisable
to Purchase</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center">_________<FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Shares
of Common Stock</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">of</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center">&nbsp;</P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>NEUROONE
MEDICAL</B></FONT></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>TECHNOLOGIES</B></FONT></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>CORPORATION</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Warrant
No. P - <U>&#9; ______  </U></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Void
after July 1, 2024</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">THE
SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE &ldquo;SECURITIES
ACT&rdquo;), OR THE SECURITIES LAWS OF ANY STATE OR OTHER JURISDICTION. THE SECURITIES MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE
TRANSFERRED EXCEPT (1) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OR (2) PURSUANT TO AN EFFECTIVE REGISTRATION
STATEMENT UNDER THE SECURITIES ACT, IN EACH CASE IN ACCORDANCE WITH ALL APPLICABLE STATE SECURITIES LAWS AND THE SECURITIES LAWS
OF OTHER JURISDICTIONS AND, IN THE CASE OF A TRANSACTION EXEMPT FROM REGISTRATION, UNLESS THE COMPANY HAS RECEIVED AN OPINION
OF COUNSEL REASONABLY SATISFACTORY TO IT THAT SUCH TRANSACTION DOES NOT REQUIRE REGISTRATION UNDER THE SECURITIES ACT AND SUCH
OTHER APPLICABLE LAWS.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>


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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">This
is to certify that, for value received and subject to the terms and conditions set forth below, the Warrantholder (hereinafter
defined) is entitled to purchase, and the Company (hereinafter defined) promises and agrees to sell and issue to the Warrantholder,
at any time on or after the Issue Date and on or before the fifth anniversary of the Issue Date, up to [_] shares of Common Stock
(hereinafter defined) at the per share Exercise Price (hereinafter defined).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">This
Warrant Certificate is issued subject to the following terms and conditions:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">1.
<U>Definitions of Certain Terms</U>. Except as may be otherwise clearly required by the context, the following terms have the
following meanings:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(a)
&ldquo;Cashless Exercise&rdquo; means an exercise of a Warrant in which, in lieu of payment of the Exercise Price in cash, the Warrantholder
elects to receive a lesser number of Securities in payment of the Exercise Price, as determined in accordance with Section 2(b).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(b)
&ldquo;Closing Date&rdquo; means the date or dates on which a closing under the Offering occurs.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(c)
&ldquo;Commission&rdquo; means the Securities and Exchange Commission.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(d)
&ldquo;Common Stock&rdquo; means the common stock, $0.001 par value, of the Company.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(e)
&ldquo;Company&rdquo; means NeuroOne Medical Technologies Corporation, a Delaware corporation.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(f)
&ldquo;Exercise Price&rdquo; means the price at which the Warrantholder may purchase one share of Common Stock or other Securities
upon exercise of a Warrant as determined from time to time pursuant to the provisions hereof, multiplied by the number of Securities
as to which the Warrant is being exercised. The initial Exercise Price is $2.75 per share of Common Stock.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(g)
&ldquo;Issue Date&rdquo; means the Closing Date on which this Warrant is issued.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(h)
&ldquo;Memorandum&rdquo; means the offering materials described in the Placement Agent Agreement.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(i) &nbsp;
&ldquo;Offering&rdquo; means the private offering of shares of Common Stock and warrants made pursuant to the Memorandum and the
Placement Agent Agreement.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(j) &nbsp;
&ldquo;Placement Agent Agreement&rdquo; means that certain Placement Agent Agreement, dated December 12, 2018 between the Company,
Paulson Investment Company, LLC and any Additional Placement Agents as defined therein, as amended.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(k)
&ldquo;Rules and Regulations&rdquo; means the rules and regulations of the Commission adopted under the Securities Act.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(l) &nbsp;
&ldquo;Securities&rdquo; means the securities obtained or obtainable upon exercise of the Warrant or securities obtained or obtainable
upon exercise, exchange, or conversion of such securities.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(m)
&ldquo;Securities Act&rdquo; means the Securities Act of 1933, as amended.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(n)
&ldquo;Warrant&rdquo; means the warrant evidenced by this certificate, any similar certificate issued in connection with the Offering,
or any certificate obtained upon transfer or partial exercise of the Warrant evidenced by any such certificate.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(o)
&ldquo;Warrant Certificate&rdquo; means a certificate evidencing the Warrant.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(p)
&ldquo;Warrantholder&rdquo; means a record holder of the Warrant or Securities.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">2.
<U>Exercise of Warrant</U>.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(a)
All or any part of the Warrant represented by this Warrant Certificate may be exercised commencing on the Issue Date and ending
at 5:00 p.m. Pacific Time on (the &ldquo;Expiration Date&rdquo;) by surrendering this Warrant Certificate, together with the Exercise
Price and appropriate instructions, duly executed by the Warrantholder or by its duly authorized attorney, at the office of the
Company, 10006 Liatris Lane Eden Prairie, MN 55347; or at such other office or agency as the Company may designate. The date on
which such instructions are received by the Company shall be the date of exercise. If the Warrantholder has elected a Cashless
Exercise, such instructions shall so state.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(b)
If the Warrantholder elects a Cashless Exercise, the Warrantholder may surrender in payment of the Exercise Price, shares of Common
Stock equal in value to the Exercise Price by surrender of this Warrant at the principal office of the Company together with notice
of such election, in which event the Company shall issue to the Warrantholder a number of shares of Common Stock computed using
the following formula:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt -2in; text-align: center">X =&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<I><U>Y
</U></I><U>( <I>A</I> - <I>B</I>)</U></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt -1.5in; text-align: center"><I>A</I></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><I></I></FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt"><TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="width: 59pt; font: 10pt Times New Roman, Times, Serif"></TD><TD COLSPAN="2" STYLE="padding-right: 47.85pt; font: 10pt Times New Roman, Times, Serif; text-align: justify"></TD></TR>
</TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt">
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="font: 10pt Times New Roman, Times, Serif; padding-left: 0.75in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">Where:</FONT></TD><TD STYLE="font: 10pt Times New Roman, Times, Serif">X
=&#9;</TD><TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-align: justify">The number of shares of Common Stock to
                 be issued to the Warrantholder pursuant to this Cashless Exercise</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify">&nbsp;</TD><TD STYLE="font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify">&nbsp;</TD><TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-align: justify">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="width: 113pt; font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify"></TD><TD STYLE="width: 36pt; font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Y
                              =</FONT></TD><TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
                                         number of shares of Common Stock in respect of which the Cashless Exercise election is
                                         made</FONT></TD></TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt"><TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="width: 113pt; font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify"></TD><TD STYLE="width: 36pt; font: 10pt Times New Roman, Times, Serif; padding: 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">A
                              =</FONT></TD><TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
                                         fair market value of one share of Common Stock at the time the Cashless Exercise election
                                         is made</FONT></TD></TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; margin-bottom: 0pt"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 113pt; padding: 0; text-align: justify"></TD><TD STYLE="width: 36pt; text-align: justify; padding: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">B</FONT>&nbsp;=
</TD><TD STYLE="text-align: justify; padding: 0">The
Exercise Price (as adjusted to the date of the Cashless Exercise)</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0pt; text-align: justify; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">For
purposes of this Section 2(b), the fair market value of one share of Common Stock as of a particular date shall be determined
as follows: (i) if traded on a securities exchange, the value shall be deemed to be the closing price of the Common Stock on such
exchange one (1) trading day prior to the Cashless Exercise; (ii) if traded over-the-counter, the value shall be deemed to be
the closing bid or sale price (whichever is applicable) of the Common Stock one (1) trading day prior to the Cashless Exercise;
and (iii) if there is no active public market, the value shall be the fair market value thereof, as determined in good faith by
the Board of Directors of the Company.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(c)
Subject to the provisions below, upon receipt of notice of exercise, the Company shall promptly prepare or cause the preparation
of certificates for the Securities to be received by the Warrantholder upon completion of the Warrant exercise. After such certificates
are prepared, the Company shall notify the Warrantholder and, upon payment in full by the Warrantholder, in lawful money of the
United States, of the Exercise Price payable with respect to the Securities being purchased, or, in the case of a Cashless Exercise,
upon deemed surrender of Securities equal in value to the Exercise Price, deliver such certificates to the Warrantholder, or as
per the Warrantholder&rsquo;s instructions, promptly after such funds are available, if applicable, and otherwise promptly thereafter.
The Securities to be obtained on exercise of the Warrant will be deemed to have been issued, and any person exercising the Warrant
will be deemed to have become a holder of record of those Securities, as of the date of receipt by the Company of (a) available
funds in cash in payment of the Exercise Price, or (b) notice of Cashless Exercise.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(d)
If fewer than all the Securities purchasable under the Warrant are purchased, the Company will, upon such partial exercise, execute
and deliver to the Warrantholder a new Warrant Certificate (dated the date hereof), in form and tenor similar to this Warrant
Certificate, evidencing that portion of the Warrant not exercised.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(e)
Notwithstanding the foregoing, in no event shall such Securities be issued, and the Company is authorized to refuse to honor the
exercise of the Warrant, if such exercise would result in the opinion of the Company&rsquo;s Board of Directors, upon advice of counsel,
in the violation of any law.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">3.
<U>Adjustments in Certain Events</U>. The number, class, and price of Securities for which this Warrant Certificate may be exercised
are subject to adjustment from time to time upon the happening of certain events as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(a)
If the outstanding shares of the Company&rsquo;s Common Stock are divided into a greater number of shares or a dividend in stock is
paid on the Common Stock, the number of shares of Common Stock for which the Warrant is then exercisable will be proportionately
increased and the Exercise Price will be proportionately reduced; and, conversely, if the outstanding shares of Common Stock are
combined into a smaller number of shares of Common Stock, the number of shares of Common Stock for which the Warrant is then exercisable
will be proportionately reduced and the Exercise Price will be proportionately increased. The increases and reductions provided
for in this Section 3(a) will be made with the intent and, as nearly as practicable, the effect that neither the percentage of
the total equity of the Company obtainable on exercise of the Warrants nor the price payable for such percentage upon such exercise
will be affected by any event described in this Section 3(a).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(b)
In case of any change in the Common Stock through merger, consolidation, reclassification, reorganization, partial or complete
liquidation, purchase of substantially all the assets of the Company, or other change in the capital structure of the Company,
then, as a condition of such change, lawful and adequate provision will be made so that the Warrantholder will have the right
thereafter to receive upon the exercise of the Warrant the kind and amount of shares of stock or other securities or property
to which the Warrantholder would have been entitled if, immediately prior to such event, the Warrantholder had held the number
of shares of Common Stock obtainable upon the exercise of the Warrant. In any such case, appropriate adjustment will be made in
the application of the provisions set forth herein with respect to the rights and interest thereafter of the Warrantholder, to
the end that the provisions set forth herein will thereafter be applicable, as nearly as reasonably may be, in relation to any
shares of stock or other securities or property thereafter deliverable upon the exercise of the Warrant. The Company will not
permit any change in its capital structure to occur unless the issuer of the shares of stock or other securities to be received
by the holder of this Warrant Certificate, if not the Company, agrees to be bound by and comply with the provisions of this Warrant
Certificate.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(c)
When any adjustment is required to be made in the number of shares of Common Stock, other securities, or the property purchasable
upon exercise of the Warrant, the Company will promptly determine the new number of such shares or other securities or property
purchasable upon exercise of the Warrant and (i) prepare and retain on file a statement describing in reasonable detail the method
used in arriving at the new number of such shares or other securities or property purchasable upon exercise of the Warrant and
(ii) cause a copy of such statement to be mailed to the Warrantholder within thirty (30) days after the date of the event giving
rise to the adjustment.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(d)
No fractional shares of Common Stock or other Securities will be issued in connection with the exercise of the Warrant, and the
number of shares of Common Stock to be issued shall be rounded to the nearest whole number.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(e)
If securities of the Company or securities of any subsidiary of the Company are distributed pro rata to holders of Common Stock,
such number of securities will be distributed to the Warrantholder or its assignee upon exercise of its rights hereunder as such
Warrantholder or assignee would have been entitled to if this Warrant had been exercised prior to the record date for such distribution.
The provisions with respect to adjustment of the Common Stock provided in this Section 3 will also apply to the securities to
which the Warrantholder or its assignee is entitled under this Section 3(e).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.75in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(f)
Notwithstanding anything herein to the contrary, there will be no adjustment made hereunder on account of the sale by the Company
of the Common Stock or any other Securities purchasable upon exercise of the Warrant.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">4.
<U>Reservation of Securities</U>. The Company agrees that the number of shares of Common Stock or other Securities sufficient
to provide for the exercise of the Warrant upon the basis set forth above will, at all times during the term of the Warrant, be
reserved for issuance.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">5.
<U>Validity of Securities</U>. All Securities delivered upon the exercise of the Warrant will be duly and validly issued in accordance
with their terms and, upon payment of the Exercise Price, will be fully paid and non-assessable. The Company will pay all documentary
and transfer taxes, if any, in respect of the original issuance thereof upon exercise of the Warrant.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">6.
<U>Transferability</U>. This Warrant Certificate and the Warrant may be transferred to Additional Placement Agents in the Offering
as defined in the Placement Agent Agreement or to individuals who are a partner, officer or other representative of the Lead Placement
Agent or any Additional Placement Agent. The Warrant may be divided or combined, upon request to the Company by the Warrantholder,
into a certificate or certificates evidencing the same aggregate number of Warrants.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">7.
<U>Securities Act Compliance</U>. The Warrantholder hereby represents: (a) that this Warrant and any Common Stock to be acquired
by the Warrantholder on exercise of the Warrant will be acquired for investment for the Warrantholder&rsquo;s own account and not with
a view to the resale or distribution of any part thereof, and (b) that the Warrantholder is an accredited investor as defined
in Rule 501(a) of Regulation D promulgated under the Securities Act. In addition, as a condition of its delivery of certificates
for the Common Stock, the Company will require the Warrantholder to deliver to the Company representations regarding the Warrantholder&rsquo;s
sophistication, investor status, investment intent, acquisition for its own account and such other matters as are reasonable and
customary for purchasers of securities in an unregistered private offering as set forth in the attached Exercise Form. The Company
may place conspicuously upon each certificate representing the Common Stock a legend substantially in the following form, the
terms of which are agreed to by the Warrantholder:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 44.9pt 0pt 41pt; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&ldquo;THE
SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE &ldquo;SECURITIES
ACT&rdquo;), OR THE SECURITIES LAWS OF ANY STATE OR OTHER JURISDICTION. THE SECURITIES MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE
TRANSFERRED EXCEPT (1) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OR (2) PURSUANT TO AN EFFECTIVE REGISTRATION
STATEMENT UNDER THE SECURITIES ACT, IN EACH CASE IN ACCORDANCE WITH ALL APPLICABLE STATE SECURITIES LAWS AND THE SECURITIES LAWS
OF OTHER JURISDICTIONS AND, IN THE CASE OF A TRANSACTION EXEMPT FROM REGISTRATION, UNLESS THE COMPANY HAS RECEIVED AN OPINION
OF COUNSEL REASONABLY SATISFACTORY TO IT THAT SUCH TRANSACTION DOES NOT REQUIRE REGISTRATION UNDER THE SECURITIES ACT AND SUCH
OTHER APPLICABLE LAWS.&rdquo;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">8.
<U>No Rights as a Shareholder</U>. Except as otherwise provided herein, the Warrantholder will not, by virtue of ownership of
the Warrant, be entitled to any rights of a shareholder of the Company but will, upon written request to the Company, be entitled
to receive such quarterly or annual reports as the Company distributes to its shareholders.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="margin: 0"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
    <!-- Field: /Page -->

<P STYLE="margin: 0"></P>

<P STYLE="margin: 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">9.
<U>Notice</U>. Any notices required or permitted to be given hereunder will be in writing and may be served personally or by mail,
including by e-mail; and if served will be addressed as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 8.7pt 0pt 5pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 8.7pt 0pt 5pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR STYLE="vertical-align: top">
    <TD STYLE="width: 0.5in">&nbsp;</TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">If to the Company:</FONT></TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">NeuroOne Medical Technologies Corporation</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">Attn: Dave Rosa </FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">10901 Red Circle Drive, Suite 150, <BR>
Minnetonka, MN 55343</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD></TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">Email: daver@neurooneinc.com</FONT></TD></TR>

<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="width: 0.5in">&nbsp;</TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">with a copy to:</fONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Honigman LLP </FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Attn: Phillip Torrence</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">650 Trade Centre Way, Suite 200</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Portage, Michigan 49002</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Email: ptorrence@honigman.com</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">If to the Warrantholder:</FONT></TD>
    <TD><U>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</U>&nbsp;</TD></TR>
</TABLE>


<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 8.7pt 0pt 5pt; text-align: justify; text-indent: 0.5in"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Any
notice so given by mail will be deemed effectively given 48 hours after mailing when deposited in the United States mail, registered
or certified mail, return receipt requested, postage prepaid and addressed as specified above. Any notice given by e-mail must
be accompanied by confirmation of receipt, and will be deemed effectively given upon confirmation of such receipt. Any party may
by written notice to the other specify a different address for notice purposes.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">10.
<U>Applicable Law</U>. This Warrant Certificate will be governed by and construed in accordance with the laws of the State of
Washington, without reference to conflict of laws principles thereunder. All disputes relating to this Warrant Certificate shall
be tried before the courts of Washington located in Clark County, Washington to the exclusion of all other courts that might have
jurisdiction.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">[<FONT STYLE="font-variant: small-caps">The
remainder of this page intentionally left blank</FONT>]</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>


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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: small-caps 10pt Times New Roman, Times, Serif"><B>In
Witness Whereof</B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">, the Company has caused this
Warrant to be signed by its duly authorized officer.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

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<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Dated as of July 1, 2019</FONT></TD>
    <TD COLSPAN="2" STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>NEUROONE MEDICAL TECHNOLOGIES CORPORATION</B></FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD COLSPAN="2" STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; width: 60%; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; width: 5%; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">By:</FONT></TD>
    <TD STYLE="padding: 0; width: 35%; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Name: </FONT></TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Dave Rosa</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Title: </FONT></TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Chief Executive Officer</FONT></TD></TR>
</TABLE>


<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center"><FONT STYLE="font-variant: small-caps"><B>Signature
Page to Purchase Warrant</B></FONT></P>



<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
    <!-- Field: /Page -->

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; text-decoration: none">&nbsp;</FONT></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin: 0pt 155.95pt 0pt 152.05pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B><U>EXERCISE
FORM</U></B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 149.4pt 0pt 145.55pt; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(To
Be Executed by the Warrantholder to Exercise the Warrant)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">TO:</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">NEUROONE
MEDICAL TECHNOLOGIES CORPORATION</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">1.</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
                                         undersigned hereby irrevocably elects to exercise the right to purchase<U>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</U>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</FONT>&nbsp;&nbsp;&nbsp;</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.25in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">shares
of Common Stock, represented by Warrant No. P &ndash; <U>&#9;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</U>&#9;as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><U>Exercise for
                                                                                                                                                                        Cash</U>. Pursuant to Section 2(a) of the Warrant, the Holder hereby elects to exercise the Warrant for cash and tenders
                                                                                                                                                                        payment herewith (or has made a wire transfer) to the order of NeuroOne Medical Technologies Corporation in the amount of </FONT></TD>
</TR>               <TR STYLE="vertical-align: top; text-align: justify">
<TD>&nbsp;</TD><TD STYLE="text-align: left">&nbsp;</TD><TD STYLE="text-align: justify">$
<U>&#9;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</U>.&nbsp;</TD></TR>
</TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 77pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in">2.</TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&#9744;</FONT></TD>
                                                                                                                                                              <TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><U>Cashless Exercise</U>. Pursuant to Section 2(b)
of the Warrant, the Holder hereby elects to exercise the Warrant on a cashless basis.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0"></TD><TD STYLE="width: 0.25in; text-align: left">3.</TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned requests that the applicable number of shares of Common Stock be issued and delivered to the following address:</FONT></TD>
</TR></TABLE>



<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="font: 10pt Times New Roman, Times, Serif; width: 100%; border-collapse: collapse">
<TR STYLE="vertical-align: top">
    <TD STYLE="width: 0.25in; padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="width: 7%; padding: 0; text-indent: 0">Name:</TD>
    <TD STYLE="width: 33%; padding: 0; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">Address:</TD>
    <TD STYLE="padding: 0; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD COLSPAN="3" STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">Email:</TD>
    <TD STYLE="padding: 0; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">SSN:</TD>
    <TD STYLE="padding: 0; text-indent: 0; border-bottom: Black 1.5pt solid">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD></TR>
</TABLE>


<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0; padding: 0; text-indent: 0"></TD><TD STYLE="width: 0.25in; text-align: left; padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">4.</FONT></TD><TD STYLE="text-align: justify; padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned understands, agrees and recognizes that:</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.5in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(a)</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">No
federal or state agency has made any finding or determination as to the fairness of the investment or any recommendation or endorsement
of the securities.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
<TD STYLE="width: 0.25in; font: 10pt Times New Roman, Times, Serif"></TD><TD STYLE="width: 0.5in; font: 10pt Times New Roman, Times, Serif"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(b)</FONT></TD><TD STYLE="text-align: justify; font: 10pt Times New Roman, Times, Serif"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">All
                                         certificates evidencing the shares of Common Stock, if any, may bear a legend substantially
                                         similar to the legend set forth in <U>Section 7</U> of the Warrant regarding resale restrictions.</FONT></TD></TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.25in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><U>Representations
of the undersigned</U>.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">5.</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned acknowledges that the undersigned has received, read and understood the Warrant and agrees to abide by and be bound
by its terms and conditions.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0%"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">6.</FONT></TD><TD STYLE="text-align: justify; width: 0.25in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(i) </FONT></TD>
                                                                                                                                                              <TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The undersigned has such knowledge and experience in
business and financial matters that the undersigned is capable of evaluating the Company and the proposed activities thereof,
and the risks and merits of this prospective investment.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;&nbsp;&nbsp;
YES&nbsp;&nbsp;&#9744; NO</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 77pt; text-indent: 93.05pt">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 77pt; text-indent: 93.05pt"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 77pt; text-indent: 93.05pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 77pt; text-indent: 93.05pt"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(ii)</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">If
&ldquo;No&rdquo;, the undersigned is represented by a &ldquo;purchaser representative,&rdquo; as that term is defined in Regulation
D under the Securities Act of 1933, as amended (the &ldquo;Securities Act&rdquo;).</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt">&#9744;&nbsp;&nbsp;
YES&nbsp;&nbsp;&#9744; NO</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0%"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">7.</FONT></TD><TD STYLE="text-align: justify; width: 0.25in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(i) </FONT></TD>
                                                                                                                                                              <TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The undersigned is an &ldquo;accredited investor,&rdquo;
as that term is defined in the Securities Act.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; text-align: center; margin-bottom: 0pt">&#9744;&nbsp;&nbsp;
YES&nbsp;&nbsp;&#9744; NO</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(ii)</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">If
&ldquo;Yes,&rdquo; the undersigned comes within the following category of that definition (check one):</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is a natural person whose present net worth (or whose joint net worth with his or her spouse), excluding the value
of the undersigned&rsquo;s primary residence, exceeds $1,000,000. For purposes of calculating the undersigned&rsquo;s present
net worth, the undersigned has included the following as liabilities: (i) any indebtedness that is secured by the undersigned&rsquo;s
primary residence in excess of the estimated fair market value of the undersigned&rsquo;s primary residence at the time of the
sale of the shares, and (ii) any incremental debt secured by the undersigned&rsquo;s primary residence that was incurred in the
60 days before the sale of the shares, other than as a result of the acquisition of the undersigned&rsquo;s primary residence.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is a natural person who had individual income in excess of $200,000 in each of the last two years or joint income
with the undersigned&rsquo;s spouse in excess of&nbsp;$300,000 during such two years, and the undersigned reasonably expects to
have the same income level in the current year.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is an officer or director of the Company.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is a corporation or partnership not formed for the specific purpose of acquiring the securities offered, with total
assets in excess of $5,000,000.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 113pt"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is a trust with total assets in excess of $5,000,000 whose purchase is directed by a person with such knowledge and
experience in financial and business matters that such person is capable of evaluating the merits and risks of the prospective
investment.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9744;</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned is an entity, all of whose equity owners are accredited investors under one or more of the categories above.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0"></TD><TD STYLE="width: 0.25in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">8.</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned understands that the shares purchased hereunder have not been registered under the Securities Act, in reliance upon
the exemption from the registration requirements under the Securities Act pursuant to Section 4(2) of the Securities Act and Rule
506 promulgated thereunder; and, therefore, that the undersigned must bear the economic risk of
the investment for an indefinite period of time since the securities cannot be sold, transferred or assigned to any person or
entity without compliance with the provisions of the Securities Act.</FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 9pt 0pt 41pt; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

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<P STYLE="margin: 0">&nbsp;</P>

<P STYLE="margin: 0"></P>

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<TR STYLE="vertical-align: top">
    <TD STYLE="width: 60%"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">Dated:<U>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    </U>, 2019</FONT></TD>
    <TD STYLE="width: 5%">&nbsp;</TD>
    <TD STYLE="width: 35%">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD>By:</TD>
    <TD STYLE="border-bottom: Black 1.5pt solid">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding-right: 12.4pt; text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">Name:</FONT></TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify; border-bottom: Black 1.5pt solid">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding-right: 12.4pt; text-align: justify">&nbsp;</TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify">Print:</TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify; border-bottom: Black 1.5pt solid">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding-right: 12.4pt; text-align: justify">&nbsp;</TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify">&nbsp;</TD>
    <TD STYLE="padding-right: 12.4pt; text-align: justify">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD COLSPAN="2" STYLE="text-align: justify"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT> <FONT STYLE="font: 10pt Times New Roman, Times, Serif">Note: Signature must correspond with the name as written upon the face of the Warrant in all respects, without alteration or enlargement or any change whatsoever.</FONT></TD></TR>
</TABLE>

<P STYLE="margin-top: 0; text-align: center; margin-bottom: 0">&nbsp;</P>

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<P STYLE="margin-top: 0; text-align: center; margin-bottom: 0">11</P>

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<DOCUMENT>
<TYPE>EX-4.3
<SEQUENCE>3
<FILENAME>f8k0719ex4-3_neuroone.htm
<DESCRIPTION>FORM OF HRA WARRANT
<TEXT>
<HTML>
<HEAD>
     <TITLE></TITLE>
</HEAD>
<BODY STYLE="font: 10pt Times New Roman, Times, Serif">

<P STYLE="margin-top: 0; text-align: right; margin-bottom: 0; font: 10pt Times New Roman, Times, Serif"><B>Exhibit 4.3</B></P>

<P STYLE="margin-top: 0; text-align: right; margin-bottom: 0; font: 10pt Times New Roman, Times, Serif">&nbsp;</P>

<P STYLE="margin: 0 0.5in; text-align: justify; font: 10pt Times New Roman, Times, Serif"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>NEITHER
THIS SECURITY NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE
COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT
OF 1933, AS AMENDED (THE &ldquo;SECURITIES ACT&rdquo;), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO,
THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A
LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.
&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; border-collapse: collapse">
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="width: 52%; padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">No.
    [__]</FONT></TD>
    <TD STYLE="width: 48%; padding: 0; font: 10pt Times New Roman, Times, Serif; text-align: right; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">[__],
    2019</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; text-transform: uppercase">NeuroOne
Medical Technologies Corporation</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-weight: normal; text-transform: uppercase">&nbsp;</FONT></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; text-transform: uppercase">BROKER
Warrant</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>_________________</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>This
Certifies That</B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">, for value received, [__],
or his/her/our registered assigns (the <B><I>&ldquo;Holder&rdquo;</I></B>), is entitled to subscribe for and purchase from <FONT STYLE="font-variant: small-caps"><B>NeuroOne
Medical Technologies Corporation</B></FONT></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">,
a Delaware corporation (the <B><I>&ldquo;Company&rdquo;</I></B>), at any time commencing on [__], 2019 and expiring on [__], 2024
(such period, the <B><I>&ldquo;Warrant Exercise Term&rdquo;</I></B>), the Shares at the Exercise Price (each as defined in <U>Section
1</U> below). This Warrant is issued in connection with that certain Placement Agent Agreement, dated [___], by and between the
Company and [___], [an affiliate of Holder], as amended.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">This
Warrant is subject to the following terms and conditions:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>1.&nbsp;<FONT STYLE="font-variant: small-caps">Shares</FONT>.
</B>The Holder has, subject to the terms set forth herein, the right to purchase, at any time during the Warrant Exercise Term,
up to [___] ([___]) shares of the Company&rsquo;s common stock (&ldquo;<B><I>Common Stock</I></B>&rdquo;), at a per share exercise
price of $[___] (as the same may be adjusted as provided in <U>Section 5</U> hereof, the <B><I>&ldquo;Exercise Price&rdquo;</I></B>).
The shares of Common Stock received upon any exercise of this Warrant are referred to herein as the <B><I>&ldquo;Shares&rdquo;</I></B>.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>2.&nbsp;Exercise
of Warrant. </B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(a)&nbsp;Exercise.
</B>This Warrant may be exercised by the Holder at any time during the Warrant Exercise Term, in whole or in part, by delivering
to the Company at its principal office, or at such other office as the Company may designate (i) the notice of exercise attached
as <FONT STYLE="font-variant: small-caps"><U>Exhibit A</U></FONT></FONT> <FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">hereto
(the <B><I>&ldquo;Notice of Exercise&rdquo;</I></B>), duly executed by the Holder and (ii) this Warrant certificate, accompanied
by (iii) payment, in cash or by wire transfer of immediately available funds or by check payable to the order of the Company of
the amount obtained by multiplying the number of Shares designated in the Notice of Exercise by the Exercise Price (the <B><I>&ldquo;Purchase
Price&rdquo;</I></B>). For purposes hereof, <B><I>&ldquo;Exercise Date&rdquo;</I></B> shall mean the date on which all deliveries
required to be made to the Company upon exercise of this Warrant pursuant to this <U>Section 2(a)</U> shall have been made. In
no event shall the Company be required to net cash settle any Warrant exercise.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(b)&nbsp;Redemption.</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(i)</B>&#9;All
of the outstanding Warrants (but not less than all) may be redeemed, at the option of the Company, at any time beginning after
the one-year anniversary of the date hereof and during the Warrant Exercise Term upon notice to the Holder at the price of $[__]
per Warrant (the <B><I>&ldquo;Redemption Price&rdquo;</I></B>), provided that the VWAP (as defined below) of the Common Stock
is at least 200% of the Exercise Price for 20 consecutive Trading Days prior to the date on which notice of the redemption is
given. <B><I>&ldquo;VWAP&rdquo;</I></B> means, for any date, the price determined by the first of the following clauses that applies:
(A) if the Common Stock is then listed or quoted on a Trading Market (other than the OTC Bulletin Board or OTC Markets, Inc.),
the daily volume weighted average price of the Common Stock for such date (or the nearest preceding Trading Day) on the Trading
Market on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (based on a Trading Day from 9:30 a.m.
(New York City time) to 4:02 p.m. (New York City time)), (B) if the Common Stock is then quoted on the OTC Bulletin Board, the
volume weighted average price of the Common Stock for such date (or the nearest preceding Trading Day) on the OTC Bulletin Board,
(C) if the Common Stock is not then listed or quoted for trading on the OTC Bulletin Board and if prices for the Common Stock
are then reported on OTC Markets, Inc. (or a similar organization or agency succeeding to its functions of reporting prices),
the most recent bid price per share of the Common Stock so reported, or (D)&nbsp;in all other cases, the fair market value of
a share of Common Stock as determined by an independent appraiser selected in good faith by the Holder, the fees and expenses
of which shall be paid by the Company. <B><I>&ldquo;Trading Day&rdquo;</I></B> means a day on which the principal Trading Market
is open for trading. <B><I>&ldquo;Trading Market&rdquo;</I></B> means any of the following markets or exchanges on which the Common
Stock is listed or quoted for trading on the date in question: the NYSE MKT, the Nasdaq Capital Market, the Nasdaq Global Market,
the Nasdaq Global Select Market, the New York Stock Exchange (or any successors to any of the foregoing), the OTC Bulletin Board
or OTC Markets, Inc.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9;<B>(ii)</B>&#9;The
Company shall fix a date for the redemption (the <B><I>&ldquo;Redemption Date&rdquo;</I></B>). Notice of redemption shall be mailed
by first class mail, postage prepaid, by the Company not less than 30&nbsp;days prior to the Redemption Date to the Holder to
be redeemed at their last addresses as they shall appear on the registration books. Any notice mailed in the manner herein provided
shall be conclusively presumed to have been duly given whether or not the Holder received such notice.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9;<B>(iii)</B>&#9;The
notice of redemption shall contain the information necessary to calculate the number of Shares to be received upon exercise of
the Warrants, including the VWAP calculations. On and after the Redemption Date, the record holder of the Warrants shall have
no further rights except to receive, upon surrender of the Warrants, the Redemption Price.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(c)</B>&nbsp;<B>Issuance
of Certificates.</B> As soon as practicable after the exercise of this Warrant, in whole or in part, in accordance with <U>Section
2(a)</U> hereof, the Company, at its expense, shall cause to be issued in the name of and delivered to the Holder (i) a certificate
or certificates for the number of validly issued, fully paid and non-assessable Shares to which the Holder shall be entitled upon
such exercise (or uncertificated shares) and, if applicable, (ii) a new warrant of like tenor to purchase all of the Shares that
may be purchased pursuant to the portion, if any, of this Warrant not exercised by the Holder. The Holder shall for all purposes
hereof be deemed to have become the Holder of record of such Shares on the date on which the Notice of Exercise and payment of
the Purchase Price in accordance with <U>Section 2(a)</U> hereof were delivered and made, respectively, irrespective of the date
of delivery (physically or electronically) of such certificate or certificates, except that if the date of such delivery, notice
and payment is a date when the stock transfer books of the Company are closed, such person shall be deemed to have become the
holder of record of such Shares at the close of business on the next succeeding date on which the stock transfer books are open.
Shares purchased hereunder shall be transmitted by the transfer agent to the Holder by crediting the account of the Holder&rsquo;s
prime broker with The Depository Trust Company through its Deposit or Withdrawal at Custodian system (<B><I>&ldquo;DWAC&rdquo;</I></B>)
if the Company is then a participant in such system and either (A) there is an effective registration statement permitting the
issuance of the Shares to or resale of the Shares by the Holder or (B) the Shares are eligible for resale by the Holder without
volume or manner-of-sale limitations pursuant to Rule 144, and otherwise by physical delivery to the address specified by the
Holder in the Notice of Exercise by the date that is three Trading Days after the latest of (A) the delivery to the Company of
the Notice of Exercise and (B) surrender of this Warrant (if required).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>3.&nbsp;Net
Exercise</B></FONT><B><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">. </FONT></B><FONT STYLE="font: 10pt Times New Roman, Times, Serif">
Notwithstanding any provisions herein to the contrary, if the fair market value of one share of the Common Stock is greater than
the Exercise Price (at the date of calculation as set forth below), in lieu of exercising this Warrant by payment of cash, the
Holder may elect to receive shares equal to the value (as determined below) of this Warrant (or the portion thereof being canceled)
by surrender of this Warrant at the principal office of the Company together with the properly endorsed Notice of Exercise, in
which event the Company shall issue to the Holder a number of shares of the Common Stock computed using the following formula:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">X
= <U>Y(A-B)</U></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 1.5in">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">A</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Where
X= the number of shares of the Common Stock to be issued to the Holder</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Y
= the number of shares of the Common Stock purchasable under this Warrant or, if only a portion of this Warrant is being exercised,
the portion of this Warrant being canceled (at the date of such calculation)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">A
= the fair market value of one share of the Common Stock (at the date of such calculation)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">B
= Exercise Price (as adjusted to the date of such calculation)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">For
purposes of the above calculation, the fair market value of one share of the Common Stock shall be determined by the Company&rsquo;s
Board of Directors in good faith.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>4.&nbsp;Change
in Control. </B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 9pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(a)&nbsp;</B>For
the purpose of this Warrant, &ldquo;<B><I>Change in Control</I></B>&rdquo; means a merger or consolidation of the Company with
or into any other corporation or corporations in which the stockholders of the Company immediately prior to the merger or consolidation
do not own more than fifty percent (50%) of the outstanding voting power (assuming conversion of all convertible securities and
the exercise of all outstanding options) of the surviving corporation or the sale, lease, licensing, transfer or other disposition
of all or substantially all the assets of the Company, unless the requisite stockholders of the Company elect, pursuant to the
Company&rsquo;s Certificate of Incorporation, as amended and in effect from time to time (the &ldquo;<B><I>Certificate of Incorporation</I></B>&rdquo;),
for such transaction or transactions not to be a change in control of the Company.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 9pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 9pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(b)&nbsp;</B>Upon
the written request of the Company, the Holder agrees that, in the event of a Change in Control that is not an asset sale and
in which the sole consideration is cash, either (i) the Holder shall exercise its conversion or purchase right under this Warrant
and such exercise will be deemed effective immediately prior to the consummation of such Change in Control or (ii) if the Holder
elects not to exercise the Warrant, this Warrant will expire upon the consummation of such Change in Control. The Company shall
provide the Holder with written notice of its request relating to the foregoing (together with such reasonable information as
such Holder may request in connection with such contemplated Change in Control giving rise to such notice), which is to be delivered
to the Holder not less than 10 days prior to the closing of the proposed Change in Control.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 9pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(c)&nbsp;</B>Upon
the written request of the Company, the Holder agrees that, in the event of a Change in Control that is an &ldquo;arms-length&rdquo;
sale of all or substantially all of the Company&rsquo;s assets (and only its assets) to a third party that is not an Affiliate
(as defined below) of the Company (a <B><I>&ldquo;True Asset Sale&rdquo;</I></B>), either (i) the Holder shall exercise its conversion
or purchase right under this Warrant and such exercise will be deemed effective immediately prior to the consummation of such
Change in Control or (ii) if the Holder elects not to exercise the Warrant, this Warrant will continue until the expiration of
the Warrant Exercise Term if the Company continues as a going concern following the closing of any such True Asset Sale. The Company
shall provide the Holder with written notice of its request relating to the foregoing (together with such reasonable information
as such Holder may request in connection with such contemplated Change in Control giving rise to such notice), which is to be
delivered to the Holder not less than 10 days prior to the closing of the proposed Change in Control. As used herein <B><I>&ldquo;Affiliate&rdquo;
</I></B>shall mean any person or entity that owns or controls directly or indirectly 10% or more of the stock of the Company,
and any person or entity that controls or is controlled by or is under common control with such persons or entities.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(d)&nbsp;</B>Upon
the written request of the Company, the Holder agrees that, in the event of a stock for stock Change in Control of the Company
by a publicly traded acquirer if, on the record date for the Change in Control, the fair market value of the Shares (or other
securities issuable upon exercise of this Warrant) is equal to or greater than two times the Exercise Price, the Company may require
the Warrant to be deemed automatically exercised and the Holder shall participate in the Change in Control as a holder of the
Shares (or other securities issuable upon exercise of the Warrant) on the same terms as other holders of the same class of securities
of the Company.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(e)&nbsp;</B>Upon
the closing of any Change in Control other than those particularly described in subsections (b), (c) and (d) above of this <U>Section
4</U>, the successor entity, if any, and if applicable, shall assume the obligations of this Warrant, and this Warrant shall be
exercisable for the same securities, cash, and property as would be payable for the Shares issuable upon exercise of the unexercised
portion of this Warrant as if such Shares were outstanding on the record date for the Change in Control and subsequent closing.
The Exercise Price and/or number of Shares shall be adjusted accordingly.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>5.&nbsp;Adjustment
of Exercise Price and Number of Shares. </B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(a)&nbsp;Adjustment
for Reclassification or Substitution.</B> Upon any reclassification, exchange, substitution, or other event that results in a
change of the number and/or class of the securities issuable upon exercise or conversion of this Warrant, Holder shall be entitled
to receive, upon exercise or conversion of this Warrant, the number and kind of securities and property that Holder would have
received for the Shares if this Warrant had been exercised immediately before such reclassification, exchange, substitution, or
other event. Such an event shall include any automatic conversion of the outstanding or issuable securities of the Company of
the same class pursuant to the terms of the Certificate of Incorporation of the Company. The Company or its successor shall promptly
issue to Holder an amendment to this Warrant setting forth the number and kind of such new securities or other property issuable
upon exercise or conversion of this Warrant as a result of such reclassification, exchange, substitution or other event that results
in a change of the number and/or class of securities issuable upon exercise or conversion of this Warrant. The amendment to this
Warrant shall provide for adjustments which shall be as nearly equivalent as may be practicable to the adjustments provided for
in this <U>Section 5(a)</U> including, without limitation, adjustments to the Exercise Price and to the number of securities or
property issuable upon exercise of the new Warrant. The provisions of this <U>Section 5(a)</U> shall similarly apply to successive
reclassifications, exchanges, substitutions, or other events.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(b)&nbsp;Adjustments
for Split, Subdivision or Combination of Shares.</B> If the Company shall at any time subdivide (by any stock split, stock dividend,
recapitalization, reorganization, reclassification or otherwise) the shares of Common Stock subject to acquisition hereunder,
then, after the date of record for effecting such subdivision, the Exercise Price in effect immediately prior to such subdivision
will be proportionately reduced and the number of shares of Common Stock subject to acquisition upon exercise of the Warrant will
be proportionately increased. If the Company at any time combines (by reverse stock split, recapitalization, reorganization, reclassification
or otherwise) the shares of Common Stock subject to acquisition hereunder, then, after the record date for effecting such combination,
the Exercise Price in effect immediately prior to such combination will be proportionately increased and the number of shares
of Common Stock subject to acquisition upon exercise of the Warrant will be proportionately decreased.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(c)&nbsp;Adjustments
for Dividends in Stock or Other Securities or Property.</B> If while this Warrant, or any portion hereof, remains outstanding
and unexpired, the holders of any class of securities as to which purchase rights under this Warrant exist at the time shall have
received or, on or after the record date fixed for the determination of eligible stockholders, shall have become entitled to receive,
without payment therefor, other or additional stock or other securities or property (other than cash) of the Company by way of
dividend, then and in each case, this Warrant shall represent the right to acquire, in addition to the number of shares of such
class of security receivable upon exercise of this Warrant, and without payment of any additional consideration therefor, the
amount of such other or additional stock or other securities or property (other than cash) of the Company that such holder would
be entitled to receive had it been the holder of record of the class of security receivable upon exercise of this Warrant on the
record date fixed for the determination of stockholders eligible to receive such dividend, giving effect to all adjustments called
for by the provisions of this <U>Section 5</U> that occur from such record date to the date of such exercise.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(d)</B>&nbsp;[Reserved.]</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(e)&nbsp;Notice
of Adjustments.</B> Upon any adjustment of the Exercise Price and any increase or decrease in the number of Shares purchasable
upon the exercise of this Warrant, then, and in each such case, the Company, within 30 days thereafter, shall give written notice
thereof to the Holder at the address of such Holder as shown on the books of the Company, which notice shall state the Exercise
Price as adjusted and, if applicable, the increased or decreased number of Shares purchasable upon the exercise of this Warrant,
setting forth in reasonable detail the method of calculation of each. <B>The Holder and any assignee, by acceptance of this Warrant,
acknowledge and agree that, by reason of the provisions of this <U>Section 5</U>, following any adjustment hereunder, the number
of Shares available for purchase hereunder at any given time may be less than the amount stated on the face hereof. </B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>6.&nbsp;Transfer
of Warrant. </B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(a)&nbsp;Transfer
Restrictions.</B> If, at the time of the surrender of this Warrant in connection with any transfer of this Warrant, the transfer
of this Warrant shall not be either (i) registered pursuant to an effective registration statement under the Securities Act and
under applicable state securities or blue sky laws or (ii) eligible for resale without volume or manner-of-sale restrictions or
current public information requirements pursuant to Rule 144, the Company may require, as a condition of allowing such transfer,
that the Holder or transferee of this Warrant, as the case may be, comply with certain transfer restrictions.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(b)&nbsp;Holder
Representation.</B> The Holder, by the acceptance hereof, represents and warrants that it is acquiring this Warrant and, upon
any exercise hereof, will acquire the Shares issuable upon such exercise, for its own account and not with a view to or for distributing
or reselling such Shares or any part thereof in violation of the Securities Act or any applicable state securities law, except
pursuant to sales registered or exempted under the Securities Act.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>7.
&nbsp;Notices.</B></FONT> <FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">All
notices, requests, consents and other communications required or permitted under this Warrant shall be in writing and shall be
deemed delivered (i) three business days after being sent by registered or certified mail, return receipt requested, postage prepaid
or (ii) one business day after being sent via a reputable nationwide overnight courier service guaranteeing next business day
delivery or (iii) on the business day of delivery if sent by facsimile or electronic transmission, in each case to the intended
recipient as set forth below:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><U>If
to the Company to</U>:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">NeuroOne
Medical Technologies Corporation&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">10901
Red Circle Drive, Suite 150&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Minnetonka,
MN 54343&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Attention:
David A. Rosa&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Email:
daver@neurooneinc.com</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">With
a copy (that shall not constitute notice) to:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Honigman
LLP&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">650
Trade Centre Way Suite 200&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Portage,
Michigan 49002&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Attention:
Phillip D. Torrence&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Facsimile:
(269) 337-7703&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Email:
ptorrence@honigman.com</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><U>If
to the Holder</U> at [&#9679;].</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Either
party may give any notice, request, consent or other communication under this Warrant using any other means, but no such notice,
request, consent or other communication shall be deemed to have been duly given unless and until it is actually received by the
party for whom it is intended. Either party may change the address to which notices, requests, consents or other communications
hereunder are to be delivered by giving the other party notice in the manner set forth in this <U>Section 7</U>.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>8.&nbsp;Legends.
</B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The Holder acknowledges that each certificate
evidencing the Shares acquired upon the exercise of this Warrant will have restrictions upon resale imposed by state and federal
securities laws. Each such certificate shall be stamped or imprinted with a legend substantially in the following form:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 63pt 0 1in; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">THE
SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE &ldquo;ACT&rdquo;),
OR THE SECURITIES LAWS OF ANY STATE AND MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER
APPLICABLE FEDERAL AND STATE SECURITIES LAWS OR PURSUANT TO AN APPLICABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO,
THE REGISTRATION REQUIREMENTS OF THE ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS AS EVIDENCED BY A LEGAL OPINION
OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, WHICH OPINION SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 63pt 0 1in; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>9.&nbsp;Removal
of Legend.</B></FONT> <FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Upon request of a holder of a certificate
with the legends required by <U>Section 8</U> hereof, the Company shall issue to such holder a new certificate free of any transfer
legend, if, with such request, the Company shall have received an opinion of counsel satisfactory to the Company in form and substance
to the effect that any transfer by such holder of the Shares evidenced by such certificate will not violate the Act or any applicable
state securities laws.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>10.&nbsp;Fractional
Shares.</B></FONT> <FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">No fractional Shares will be issued
in connection with any exercise hereunder. Instead, the Company shall round the number of Shares to be issued up to the nearest
whole Share. This Warrant may only be exercised for whole shares.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>11.&nbsp;Rights
of Stockholders.</B></FONT> <FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Except as expressly provided
in <U>Section 5(c)</U> hereof, the Holder, as such, shall not be entitled to vote or receive dividends or be deemed the holder
of the Shares or any other securities of the Company that may at any time be issuable on the exercise hereof for any purpose,
nor shall anything contained herein be construed to confer upon the Holder, as such, any of the rights of a stockholder of the
Company or any right to vote for the election of directors or upon any matter submitted to stockholders at any meeting thereof,
or to give or withhold consent to any corporate action (whether upon any recapitalization, issuance of stock, reclassification
of stock, change of par value, consolidation, merger, conveyance, or otherwise) or to receive notice of meetings, or otherwise
until this Warrant shall have been exercised and the Shares purchasable upon the exercise hereof shall have been issued, as provided
herein.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>12.&nbsp;Miscellaneous.</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(a)&nbsp;</B>Wherever
possible, each provision of this Warrant shall be interpreted in such manner as to be effective and valid under applicable law,
but if any provision of this Warrant shall be prohibited by or invalid under applicable law, such provision shall be ineffective
to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions or the remaining provisions
of this Warrant.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(b)</B>&nbsp;The
headings in this Warrant are for purposes of reference only, and shall not limit or otherwise affect any of the terms hereof.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(c)</B>&nbsp;The
terms of this Warrant shall be binding upon and shall inure to the benefit of any successors or permitted assigns of the Company
and of the Holder and of the Shares issued or issuable upon the exercise hereof.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(d)</B>&nbsp;This
Warrant and the other documents delivered pursuant hereto constitute the full and entire understanding and agreement between the
parties with regard to the subject hereof.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(e)</B>&nbsp;The
Company shall not, by amendment of the Certificate of Incorporation or bylaws, or through any other means, directly or indirectly,
avoid or seek to avoid the observance or performance of any of the terms of this Warrant and shall at all times in good faith
assist in the carrying out of all such terms and in the taking of all such action as may be necessary or appropriate in order
to protect the rights of the Holder contained herein against impairment.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(f)</B>&nbsp;Upon
receipt of evidence reasonably satisfactory to the Company of the loss, theft, destruction or mutilation of this Warrant and,
in the case of any such loss, theft or destruction, upon delivery of an indemnity agreement reasonably satisfactory in form and
amount to the Company, or, in the case of any such mutilation, upon surrender and cancellation of such Warrant, the Company, at
its expense, will execute and deliver to the Holder, in lieu thereof, a new Warrant of like date and tenor.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>(g)&nbsp;</B>This
Warrant and any provision hereof may be amended, waived or terminated only by the written consent of the Company and Holder.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>signature
page follows</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>




<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>In
Witness Whereof</B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">, the Company has caused this
Warrant to be signed by its duly authorized officer.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 3in"></P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; border-collapse: collapse">
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD COLSPAN="2" STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>Neuroone
    Medical Technologies Corporation</B></FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0; width: 60%">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0; width: 5%">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0; width: 35%">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0 0 1.5pt; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0 0 1.5pt; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">By:</FONT></TD>
    <TD STYLE="padding-top: 0; padding-right: 0; border-bottom: Black 1.5pt solid; padding-left: 0; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Name:</FONT></TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">David A. Rosa</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="padding: 0; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Title:</FONT></TD>
    <TD STYLE="padding: 0; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Chief Executive Officer</FONT></TD></TR>
</TABLE>


<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 0 2.5in; text-indent: 0.5in"></P>




<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center"><FONT STYLE="font-variant: small-caps"><B>Signature
Page to<BR>
Common Stock Purchase Warrant</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"></P>

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    <DIV STYLE="page-break-before: always; margin-top: 6pt; margin-bottom: 12pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
    <!-- Field: /Page -->

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B><U>Exhibit
A</U></B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; font-variant: small-caps"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>NOTICE
OF EXERCISE</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>&nbsp;</B></FONT></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.5in; text-align: left"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; text-transform: uppercase">To:</FONT></TD><TD STYLE="text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>NeuroOne
Medical Technologies Corporation</B></FONT></TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>&nbsp;</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(1)&nbsp;&nbsp;&nbsp;&nbsp;&#9744;&nbsp;&nbsp;&nbsp;&nbsp;The
undersigned hereby elects to purchase _____ shares of the Common Stock (the <B><I>&ldquo;Shares&rdquo;</I></B>) of <FONT STYLE="font-variant: small-caps">NeuroOne
Medical Technologies Corporation</FONT>, a Delaware corporation, or its successors or assigns (the <B><I>&ldquo;Company&rdquo;</I></B>),
pursuant to the terms of the attached Warrant, and tenders herewith payment of the exercise price in full, together with all applicable
transfer taxes, if any.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&#9744;&nbsp;&nbsp;&nbsp;<FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">The
undersigned hereby elects to purchase _____ Shares, pursuant to the terms of the net exercise provisions set forth in <U>Section
3</U> of the attached Warrant, and shall tender payment of all applicable transfer taxes, if any.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(2)&nbsp;Please
issue said Shares in the name of the undersigned or in such other name as is specified below:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">________________________________
(Holder&rsquo;s Name)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">_________________________________&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">_________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(Address)</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in; text-align: justify"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(3)
The undersigned is an &ldquo;accredited investor&rdquo; as defined in Regulation D promulgated under the Securities Act of 1933,
as amended.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt; text-transform: uppercase">[Holder]</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Name
of Investing Entity: ______________________________________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><I>Signature
of Authorized Signatory of Investing Entity</I>: ________________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Name
of Authorized Signatory: __________________________________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Title
of Authorized Signatory: ___________________________________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Date:
______________________________________________________________________________</FONT></P>




<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>ASSIGNMENT
FORM</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><I>(To
assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.)</I></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><I>&nbsp;</I></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">FOR
VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">&nbsp;</P>

<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; border-collapse: collapse">
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="width: 50%; padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Name:</FONT></TD>
    <TD STYLE="width: 50%; padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">______________________________________</FONT></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(Please
    Print)</FONT></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Address:</FONT></TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">______________________________________</FONT></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; text-indent: 0; font: 10pt Times New Roman, Times, Serif"><P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Phone
        Number:</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Email
        Address:</FONT></P></TD>
    <TD STYLE="padding: 0; text-indent: 0; font: 10pt Times New Roman, Times, Serif"><P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">(Please
                                         Print)</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">______________________________________</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">______________________________________</FONT></P></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; text-indent: 0; font: 10pt Times New Roman, Times, Serif">&nbsp;</TD>
    <TD STYLE="padding: 0; text-indent: 0; font: 10pt Times New Roman, Times, Serif">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Dated:
    _______________ __, ______</FONT></TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Holder&rsquo;s
    Signature:&#9;</FONT></TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD>
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0">&nbsp;</TD></TR>
<TR STYLE="vertical-align: top; font: 10pt Times New Roman, Times, Serif">
    <TD STYLE="padding: 0; font: 10pt Times New Roman, Times, Serif; text-indent: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">Holder&rsquo;s
    Address:&#9;</FONT></TD>
    <TD STYLE="padding: 0; text-indent: 0; font: 10pt Times New Roman, Times, Serif"><P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"></P></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif"></FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font: 10pt Times New Roman, Times, Serif">&nbsp;</FONT></P>

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