<SEC-DOCUMENT>0001213900-20-010673.txt : 20200430
<SEC-HEADER>0001213900-20-010673.hdr.sgml : 20200430
<ACCEPTANCE-DATETIME>20200430172703
ACCESSION NUMBER:		0001213900-20-010673
CONFORMED SUBMISSION TYPE:	8-K
PUBLIC DOCUMENT COUNT:		2
CONFORMED PERIOD OF REPORT:	20200424
ITEM INFORMATION:		Entry into a Material Definitive Agreement
ITEM INFORMATION:		Creation of a Direct Financial Obligation or an Obligation under an Off-Balance Sheet Arrangement of a Registrant
ITEM INFORMATION:		Unregistered Sales of Equity Securities
ITEM INFORMATION:		Financial Statements and Exhibits
FILED AS OF DATE:		20200430
DATE AS OF CHANGE:		20200430

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:		20836960

	BUSINESS ADDRESS:	
		STREET 1:		7599 ANAGRAM DR
		CITY:			EDEN PRAIRIE
		STATE:			MN
		ZIP:			55344
		BUSINESS PHONE:		(952) 426-1383

	MAIL ADDRESS:	
		STREET 1:		7599 ANAGRAM DR
		CITY:			EDEN PRAIRIE
		STATE:			MN
		ZIP:			55344

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	Original Source Entertainment, Inc.
		DATE OF NAME CHANGE:	20100830
</SEC-HEADER>
<DOCUMENT>
<TYPE>8-K
<SEQUENCE>1
<FILENAME>ea121249-8k_neuroonemedical.htm
<DESCRIPTION>CURRENT REPORT
<TEXT>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B></B></P>

<!-- Field: Rule-Page --><DIV STYLE="margin: 3pt auto; width: 100%"><DIV STYLE="font-size: 1pt; border-top: Black 1.5pt solid; border-bottom: Black 1pt solid">&nbsp;</DIV></DIV><!-- Field: /Rule-Page -->

<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):
<B>April 24, 2020</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: 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; text-align: center">&nbsp;</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">
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    <TD STYLE="vertical-align: top; width: 33%; border-bottom: black 1.5pt solid; text-align: center"><FONT STYLE="font-size: 10pt"><B>Delaware</B></FONT></TD>
    <TD STYLE="vertical-align: top; width: 1%; text-align: center">&nbsp;</TD>
    <TD STYLE="width: 32%; border-bottom: black 1.5pt solid; text-align: center"><FONT STYLE="font-size: 10pt">&nbsp;<B>000-54716</B></FONT></TD>
    <TD STYLE="width: 1%">&nbsp;</TD>
    <TD STYLE="width: 33%; border-bottom: black 1.5pt solid; text-align: center"><FONT STYLE="font-size: 10pt">&nbsp;<B>27-0863354</B></FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top; text-align: center"><FONT STYLE="font-size: 10pt">(State or other jurisdiction of incorporation)</FONT></TD>
    <TD STYLE="vertical-align: top; text-align: center">&nbsp;</TD>
    <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>7599 Anagram Dr., Eden Prairie, MN 55344</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"><B>N/A</B></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">&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: 34%; border-bottom: black 1.5pt solid; text-align: center"><FONT STYLE="font-size: 10pt"><B>Title of each class</B></FONT></TD>
    <TD STYLE="width: 1%; text-align: center">&nbsp;</TD>
    <TD STYLE="width: 32%; border-bottom: black 1.5pt solid; text-align: center; text-indent: 4.15pt"><FONT STYLE="font-size: 10pt"><B>Trading Symbol(s)</B></FONT></TD>
    <TD STYLE="width: 1%; text-align: center">&nbsp;</TD>
    <TD STYLE="width: 32%; border-bottom: black 1.5pt solid; text-align: center"><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>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 6pt 0"></P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>Second Amendment to Convertible Promissory
Notes</I></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">As previously disclosed in a Current Report
on Form 8-K 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 November 7, 2019 (the &ldquo;<B><I>Initial Form 8-K</I></B>&rdquo;),
the Company entered into a Subscription Agreement with certain accredited investors (the &ldquo;<B><I>Subscribers</I></B>&rdquo;),
pursuant to which the Company, in a private placement, agreed to issue and sell to the Subscribers 13% convertible promissory notes
(each, a &ldquo;<B><I>Note</I></B>&rdquo; and collectively, the &ldquo;<B><I>Notes</I></B>&rdquo;) and warrants (each, a &ldquo;<B><I>Warrant</I></B>&rdquo;
and collectively, the &ldquo;<B><I>Warrants</I></B>&rdquo;) to purchase shares of the Company&rsquo;s common stock, par value $0.001
per share (&ldquo;<B><I>Common Stock</I></B>&rdquo;). Additionally, as previously disclosed in a Current Report on Form 8-K filed
by the Company with the SEC on December 5, 2019, the Company and holders of a majority in aggregate principal amount of the Notes
entered into an amendment to the Notes (the &ldquo;<B><I>First Amendment</I></B>&rdquo;). Capitalized terms not otherwise defined
herein shall have the meanings assigned to such terms in the Initial Form 8-K.</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>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">On April 24, 2020, the Company and holders
of a majority in aggregate principal amount of the Notes entered into an amendment to the Notes (the &ldquo;<B><I>Second Amendment</I></B>&rdquo;)
to, among other things:</P>

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

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in">i.</TD><TD STYLE="text-align: justify"><B><I>Extend the Maturity Date</I></B><I> &ndash; </I>The Second Amendment extends the maturity
date of the Notes from May 1, 2020 to November 1, 2020 (in either case, unless a Change in Control happens prior to such date);</TD></TR></TABLE>

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

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in">ii.</TD><TD STYLE="text-align: justify"><B><I>Revise Optional Conversion Terms</I></B><I> &ndash; </I>The Second Amendment provides that
the amount of shares to be received upon the a Subscriber&rsquo;s optional conversion of the Notes prior to a Qualified Financing
will be equal to: (1) the Outstanding Balance elected by the Subscriber to be converted (the &ldquo;<B><I>Conversion Amount</I></B>&rdquo;)
divided by (2) an amount equal to 0.6 multiplied by the volume weighted average price of the Common Stock for the ten (10) Trading
Days immediately preceding the date of conversion; and</TD></TR></TABLE>

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

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in">iii.</TD><TD STYLE="text-align: justify"><B><I>Revise the Registration Date &ndash;</I></B> The Second Amendment provides that promptly
following the earlier of (1) May 1, 2020, if the applicable Subscriber has converted all or a majority of the Outstanding Balance
of such Subscriber&rsquo;s Note prior to such date; (2) the final closing a Qualified Financing; and (3) the Maturity Date (the
&ldquo;<B><I>Registration Date</I></B>&rdquo;), the Company will enter into a registration rights agreement with the applicable
Subscriber containing customary and usual terms pursuant to which the Company shall agree to prepare and file with the SEC a Registration
Statement on or prior to the 90th calendar day following the Registration Date, covering the resale of any Conversion Shares, and
shares of Common Stock underlying the Warrants.</TD></TR></TABLE>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">Pursuant to Section 7.6 of the Notes, the Notes
may be amended with the written consent of the Company and the holders of a majority in aggregate principal amount of the Notes,
which consents shall be binding upon each holder of the Notes, whether or not each holder has signed such consents. All other provisions
of the Notes not specifically modified by the Second Amendment remain unchanged.</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 description of the Second Amendment
is qualified in its entirety by reference to the form of Second Amendment, which is attached as Exhibit 10.1 hereto 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"><B><I>Conversion of Convertible Promissory
Notes</I></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B>&nbsp;</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">Between April 24 and April 29, certain Subscribers
elected to convert $2,472,565.81 of the outstanding principal and interest of the Notes into 1,996,198 Conversion Shares.</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"></P>

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

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<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">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B><I>Placement Agent Fee</I></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">In connection with the Second Amendment, Paulson
Investment Company, LLC (&ldquo;<B><I>Paulson</I></B>&rdquo;) entered into an agreement with the Company whereby the Company agreed
to pay Paulson a cash fee equal to 5% of (i) the principal amount of the Notes held by Subscribers that entered into the Second
Amendment, and (ii) the principal amount of the Notes held by Subscribers (not otherwise included in (i)) that elect to convert
their Notes prior to the Maturity Date.</P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify"><B>Item 2.03 Creation of a Direct Financial
Obligation or an Obligation Under an Off Balance Sheet Arrangement of a Registrant.</B></P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">The information included in Item 1.01 of this
Current Report on Form 8-K is hereby incorporated by reference into this Item 2.03.&nbsp;</P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: justify">As described more fully in Item 1.01 above,
which description&nbsp;is hereby incorporated by reference into this Item 3.02, the Company issued Conversion Shares to certain
Subscribers, all of whom are accredited investors, in reliance on the exemption from registration provided by Section&nbsp;4(a)(2)&nbsp;of
the Securities Act of 1933, as amended (the &ldquo;<B><I>Securities Act</I></B>&rdquo;), and Rule&nbsp;506 of Regulation D promulgated
thereunder. The Company is relying on this exemption from registration based in part on representations made by the Subscribers.&nbsp;
The Conversion Shares have not been 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&nbsp;8-K nor any exhibit attached hereto shall constitute an offer to sell or the solicitation
of an offer to buy the Conversion Shares 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; text-align: justify"><B>Item 9.01. Financial Statement and Exhibits</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"><B>(d) Exhibits.</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><B>&nbsp;</B></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>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center; border-bottom: black 1.5pt solid"><B>Exhibit</B></P></TD>
    <TD>&nbsp;</TD>
    <TD>
        <P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center; border-bottom: black 1.5pt solid"><B>Description</B></P></TD></TR>
<TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
<TR STYLE="background-color: #CCEEFF">
    <TD STYLE="vertical-align: top; text-align: center"><FONT STYLE="font-size: 10pt">&nbsp;10.1</FONT></TD>
    <TD>&nbsp;</TD>
    <TD STYLE="text-align: left; vertical-align: top"><FONT STYLE="font-size: 10pt; color: Black"><A HREF="ea121249ex10-1_neuroonemed.htm">Form of Second Amendment</A></FONT></TD></TR>
<TR>
    <TD STYLE="width: 12%">&nbsp;</TD>
    <TD STYLE="width: 1%">&nbsp;</TD>
    <TD STYLE="width: 78%">&nbsp;</TD></TR>
</TABLE>
<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"><B>SIGNATURE </B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 12pt; margin-right: 0; margin-left: 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>

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<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD COLSPAN="2" 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></TR>
<TR>
    <TD STYLE="vertical-align: top; width: 62%"><FONT STYLE="font-size: 10pt">Dated: April 30, 2020</FONT></TD>
    <TD STYLE="vertical-align: bottom; width: 3%"><FONT STYLE="font-size: 10pt">By:</FONT></TD>
    <TD STYLE="vertical-align: bottom; width: 35%; border-bottom: black 1.5pt solid"><FONT STYLE="font-size: 10pt">/s/ David Rosa</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom">&nbsp;</TD>
    <TD STYLE="vertical-align: bottom"><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: bottom"><FONT STYLE="font-size: 10pt">Chief Executive Officer</FONT></TD></TR>
</TABLE>
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<DOCUMENT>
<TYPE>EX-10.1
<SEQUENCE>2
<FILENAME>ea121249ex10-1_neuroonemed.htm
<DESCRIPTION>FORM OF SECOND AMENDMENT
<TEXT>
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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: right"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>Exhibit
10.1</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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"><B><U>SECOND
AMENDMENT TO </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"><B><U>CONVERTIBLE
PROMISSORY NOTES </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">&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">This
<FONT STYLE="font-variant: small-caps"><B>Second Amendment to Convertible Promissory Notes </B></FONT>(this <B><I>&ldquo;Amendment&rdquo;</I></B>)
is made effective as of April __, 2020, by and among <FONT STYLE="font-variant: small-caps"><B>NeuroOne Medical Technologies Corporation</B></FONT>,
a Delaware corporation (the <B><I>&ldquo;Company&rdquo;</I></B>), and the holders of the Company&rsquo;s Convertible Promissory
Notes as named on the signature page hereto (collectively, the <B><I>&ldquo;Subscribers&rdquo;</I></B> and each, without distinction,
a <B><I>&ldquo;Subscriber&rdquo;</I></B>).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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-variant: small-caps"><B><U>Background</U></B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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">The
Company and the Subscribers previously entered into a series of Subscription Agreements, pursuant to which the Company issued
its Convertible Promissory Notes, as amended on December 6, 2019 (collectively, the <B><I>&ldquo;Related Notes&rdquo;</I></B>
and each, without distinction, a <B><I>&ldquo;Note&rdquo;</I></B>) and Common Stock Purchase Warrants (collective the &ldquo;<B><I>Warrants</I></B>&rdquo;
and each, without distinction, a <B><I>&ldquo;Warrant&rdquo;</I></B>).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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-variant: small-caps">P</FONT><FONT STYLE="font-family: Times New Roman, Times, Serif">ursuant
to <U>Section 7.6</U> of the Note, the Company and the holders of a majority in original aggregate principal amount of the Related
Notes desire to amend the Related Notes as set forth herein.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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-variant: small-caps"><B>Now</B>,
<B>Therefore</B>, </FONT><FONT STYLE="font-family: Times New Roman, Times, Serif">in consideration of the foregoing, and for other
good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto hereby agree
as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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-variant: small-caps"><B><U>Agreement</U></B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;</FONT></P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<FONT STYLE="font-variant: small-caps">Maturity Date. </FONT></B>The definition of &ldquo;Maturity Date&rdquo; in <U>Section 1.1
</U>of each Note is hereby deleted in its entirety and amended to read as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt 0.5in; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&ldquo;<B><I>&ldquo;Maturity
Date&rdquo;</I></B> shall mean the earlier of (i) November 1, 2020 and (ii) a Change in Control.&rdquo;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<FONT STYLE="font-variant: small-caps">Conversion. </FONT></B><U>Section 3.1</U> of each Note is hereby deleted in its entirety
and amended to read as follows:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt 1in; text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&ldquo;<FONT STYLE="font-variant: small-caps"><B>3.1&#9;Conversion.</B></FONT></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt 40.5pt; text-align: justify; text-indent: 67.5pt"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(a)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Conversion upon Qualified Financing.</B> Subject to the applicable provisions of this <U>Section 3.1</U>, at any time on or following
a Qualified Financing, prior to the Maturity Date, at the sole election of the Holder, all or a portion of the outstanding principal
and accrued and unpaid interest on this Note (the <B><I>&ldquo;Outstanding Balance&rdquo;</I></B>) may be converted into that
number of shares of New Round Stock equal to: (i) the Outstanding Balance elected by the Holder to be converted (the <B><I>&ldquo;Conversion
Amount&rdquo;</I></B>) divided by (ii) the lower of 0.6 multiplied by (A) the actual per share price of New Round Stock and (B)
the VWAP of the Common Stock for the ten (10) Trading Days immediately preceding the date of the Qualified Financing.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(b)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Conversion Prior to a Qualified Financing.</B> Subject to the applicable provisions of this <U>Section 3.1</U>, at any time prior
to a Qualified Financing, at the sole election of the Holder, all or a portion of the Outstanding Balance of this Note may be
converted into that number of shares of the Company&rsquo;s common stock, par value $0.001 per share (the<BR>
<B><I>&ldquo;Common Stock&rdquo;</I></B>) equal to: (i) the Conversion Amount divided by (ii) an amount equal to 0.6 of the VWAP
of the Common Stock for the ten (10) Trading Days immediately preceding the Conversion Date (as defined below).</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt; text-align: justify; text-indent: 1in"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt 40.5pt; text-align: justify; text-indent: 67.5pt"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(c)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Conversion Mechanics. </B>To convert any Conversion Amount into New Round Stock or shares of the Common Stock (in either case,
the &ldquo;<B><I>Conversion Shares</I></B>&rdquo;), the Holder shall by delivering to the Company at its principal office, or
at such other office as the Company may designate (i) the notice of conversion attached as <FONT STYLE="font-variant: small-caps"><U>Exhibit
A</U></FONT> hereto (the <B><I>&ldquo;Notice of Conversion&rdquo;</I></B>), duly executed by the Holder and (ii) this Note (or
an indemnification undertaking with respect to this Note in the case of its loss, theft or destruction) (together, the &ldquo;<B><I>Conversion
Materials</I></B>&rdquo;). As soon as practicable after the date that the Company receives the Conversion Materials, or a later
date, if selected by the Holder in the Notice of Conversion (the &ldquo;<B><I>Conversion Date</I></B>&rdquo;), the Company, at
its expense, shall cause to be issued in the name of and delivered to the Holder (x) written confirmation that the Conversion
Shares have been issued in the name of the Holder, and (y) a new Note of like tenor representing the Outstanding Balance not converted
by the Holder. The person or persons entitled to receive the shares of the Common Stock issuable upon a conversion of this Note
shall be treated for all purposes as the record holder or holders of such shares of the Common Stock on the Conversion Date.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 12pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(d)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Definitions.</B> For the purposes of this Note the following defined terms shall have the following meanings: (i) <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 Holders of a majority in interest of the Warrants then outstanding and
reasonably acceptable to the Company, the fees and expenses of which shall be paid by the Company; (ii) <B><I>&ldquo;Trading Day&rdquo;
</I></B>means a day on which the principal Trading Market is open for trading; and (iii) <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 0.5in 12pt; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(e)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Warrants.</B> On the issuance date of this Note, the Holder shall receive a Warrant granting the Holder the right to purchase
up to a number of shares of Common Stock equal to (i) 0.5 <I>multiplied by </I>(ii) the Outstanding Balance <I>divided by </I>1.87,
with an exercise price per share equal to $1.87.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(f)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Registration Rights.</B> Promptly following the earlier of (i) May 1, 2020, if Holder has converted all or a majority of the Outstanding
Balance of the Note prior to such date; (ii) the final closing a Qualified Financing; and (iii) the Maturity Date (the &ldquo;<B><I>Registration
Date</I></B>&rdquo;), the Company shall enter into a registration rights agreement with the Holder and the holders of outstanding
Related Notes containing customary and usual terms pursuant to which the Company shall agree to prepare and file with the SEC
a Registration Statement on or prior to the 90<SUP>th</SUP> calendar day following the Registration Date, covering the resale
of any Conversion Shares, and shares of Common Stock underlying the Warrants (the <B><I>&ldquo;Registration Rights Agreement&rdquo;</I></B>).
The Holder agrees to execute the Registration Rights Agreement as a condition to the Holder&rsquo;s right to receive the registration
rights set forth in the Registration Rights Agreement.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in 0 1.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>(g)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Trading Market Regulation.</B> &nbsp;Notwithstanding anything to the contrary, if on the Conversion Date the Common Stock is listed
on a national securities exchange, the Holder may only convert an amount of the Outstanding Balance such that the total cumulative
number of Conversion Shares and all shares issued upon the conversion of the Related Notes and the exercise of the Warrants and
all warrants issued to holders of the Related Notes shall not exceed the requirements of Nasdaq Listing Rule 5635(d), except that
such limitation shall not apply to the extent that the Company obtains the approval of its stockholders for such issuance.&rdquo;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0.5in; text-align: justify; text-indent: 1in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></P>

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<FONT STYLE="font-variant: small-caps">Notice to Transferees.</FONT></B> Each Subscriber hereby covenants and agrees to provide
any transferee of such Subscriber&rsquo;s Note and Warrant with a copy of this Amendment.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<FONT STYLE="font-variant: small-caps">Construction</FONT>.</B> Unless otherwise defined herein, capitalized terms shall have
the meanings set forth in the Subscription Agreement. The terms of this Amendment amend and modify the Related Notes as if fully
set forth in each Related Note. If there is any conflict between the terms, conditions and obligations of this Amendment and the
Related Notes, this Amendment&rsquo;s terms, conditions and obligations shall control. All other provisions of the Related Notes
not specifically modified by this Amendment are preserved.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0 0 12pt; text-align: justify; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>5.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<FONT STYLE="font-variant: small-caps">Counterparts; Electronic Transmission.</FONT></B> This Amendment may be executed in one
or more counterparts and by facsimile, each of which shall constitute an original and all of which together shall constitute one
and the same instrument. Signatures of the parties transmitted by facsimile or via .pdf format shall be deemed to be their original
signatures for all purposes. The words &ldquo;execution,&rdquo; &ldquo;signed,&rdquo; &ldquo;signature,&rdquo; and words of like
import shall be deemed to include electronic signatures or the keeping of records in electronic form, each of which shall be of
the same legal effect, validity or enforceability as a manually executed signature or the use of a paper-based recordkeeping system,
as the case may be, to the extent and as provided for in any applicable law, including the Federal Electronic Signatures in Global
and National Commerce Act, the Delaware Electronic Transactions Act, or any other similar state laws based on the Uniform Electronic
Transactions Act. This Amendment and any signed agreement or instrument entered into in connection with this Amendment, and any
amendments hereto or thereto, to the extent delivered by means of a facsimile machine or electronic mail (any such delivery, an
<I>&ldquo;<B>Electronic Delivery</B>&rdquo;</I>), will be treated in all manner and respects as an original agreement or instrument
and will be considered to have the same binding legal effect as if it were the original signed version thereof delivered in person.
At the request of any party hereto or to any such agreement or instrument, each other party hereto or thereto will re-execute
original forms thereof and deliver them to the other party. No party hereto or to any such agreement or instrument will raise
the use of Electronic Delivery to deliver a signature or the fact that any signature or agreement or instrument was transmitted
or communicated through the use of Electronic Delivery as a defense to the formation of a contract, and each such party forever
waives any such defense, except to the extent such defense related to lack of authenticity.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0.25in 0 12pt; text-align: center; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-variant: small-caps"><B>Signatures
on the Following Pages</B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0.25in 0 12pt; text-align: center; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-variant: small-caps"><B><BR></B></FONT></P>

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<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-variant: small-caps"><B>In
Witness Whereof</B></FONT><FONT STYLE="font-family: Times New Roman, Times, Serif">, this Second Amendment to Convertible Promissory
Notes is hereby executed as of the date first above written.</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">&nbsp;</FONT></P>

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

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="border-collapse: collapse; font: 10pt Times New Roman, Times, Serif; width: 100%">
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B>THE COMPANY:</B></FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="3"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-variant: small-caps"><B>NeuroOne Medical Technologies
    Corporation</B></FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD STYLE="width: 1%"><FONT STYLE="font-family: Times New Roman, Times, Serif">By:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; width: 25%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</FONT></TD>
    <TD STYLE="width: 34%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="width: 45%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif">Name:&#9;David A. Rosa</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif">Title:&#9;President and Chief Executive Officer &nbsp;
    </FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top; text-align: left">
    <TD COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
</TABLE>

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

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

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

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0pt; 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: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">The
undersigned hereby consents to this Second Amendment to Convertible Promissory Notes pursuant. This Consent shall constitute a
consent pursuant to Section 7.6 of the Notes and, upon the Company&rsquo;s receipt of the signatures to this Consent by the holders
of at least a majority in original aggregate principal amount of the Notes, this Consent shall be binding upon each Holder of
the Notes to the same extent as if set forth in each such Holder&rsquo;s Note, whether or not such Holder has signed a counterpart
hereof.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 12.1pt 0 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">Each
of the undersigned Consent Parties hereby covenants and agrees to provide any transferee of the Note a copy of this Second Amendment
to Convertible Promissory Note.</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">&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">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</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 COLSPAN="2"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt"><B>SUBSCRIBER:&nbsp;&nbsp;_____________________</B></FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD COLSPAN="2" STYLE="text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="padding-left: 12.6pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="text-align: justify; text-indent: 0in; width: 1%"><FONT STYLE="font-family: Times New Roman, Times, Serif">By:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; text-align: justify; text-indent: 0in; width: 25%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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;&nbsp;&nbsp;</FONT></TD>
    <TD STYLE="padding-left: 12.6pt; width: 71%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">Name:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="padding-left: 12.6pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD STYLE="text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">Title:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="padding-left: 12.6pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR STYLE="vertical-align: top">
    <TD COLSPAN="2" STYLE="text-align: justify; text-indent: 0in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="padding-left: 12.6pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></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: 6pt"><P STYLE="margin: 0pt">&nbsp;</P></DIV>
    <!-- Field: /Page -->

<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">&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-variant: small-caps"><B><U>Exhibit
A</U></B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-align: center"><FONT STYLE="font-family: Times New Roman, Times, Serif"><B><U>NOTICE
OF CONVERSION</U></B></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</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: 4%"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">To:</FONT></TD>
    <TD STYLE="width: 96%"><FONT STYLE="font-family: Times New Roman, Times, Serif; font-size: 10pt">&#9;NEUROONE MEDICAL TECHNOLOGIES
    CORPORATION</FONT></TD></TR>
</TABLE>
<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">Reference
is made to the Convertible Promissory Note (the <B><I>&ldquo;Note&rdquo;</I></B>) issued to the undersigned by NeuroOne Medical
Technologies Corporation, a Delaware corporation (the <B><I>&ldquo;Company&rdquo;</I></B>). In accordance with and pursuant to
the Note, the undersigned hereby elects to convert the Conversion Amount (as defined in the Note) of the Note indicated below
into shares of the Company&rsquo;s Common Stock, $0.001 par value per share (the <B><I>&ldquo;Common Stock&rdquo;</I></B>), of
the Company, as of the date specified below. Capitalized terms not defined herein shall have the meaning as set forth in the Note.</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;Date
of Conversion:_____________________________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;Aggregate
Outstanding Balance to be converted: _______________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">Please
issue the Common Stock into which the Note is being converted to the Holder, or for its benefit, as follows: ______________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">Check
here if requesting delivery as a certificate to the following name and to the following address: &#9744;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;Issue
to:</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;____________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;<U>&#9;____________________________________</U></FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;&#9;____________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">Check
here if requesting delivery by Deposit/Withdrawal at Custodian as follows: &#9744;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;DTC
Participant:&#9; &#9;____________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;DTC
Number: _______________________________________</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 9.9pt 0 0; text-indent: 23.1pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&#9;Account
Number: &#9;____________________________________</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">&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">The
undersigned represents that: (i) the undersigned is an Accredited Investor (as that term is defined in Rule 501(a) of Regulation
D promulgated under the Securities Act (as defined below)); (ii) the shares of the Common Stock are being acquired for the account
of the undersigned for investment and not with a view to, or for resale in connection with, the distribution thereof and that
the undersigned has no present intention of distributing or reselling such shares of the Common Stock; (iii) the undersigned is
aware of the Company&rsquo;s business affairs and financial condition and has acquired sufficient information about the Company
to reach an informed and knowledgeable decision regarding its investment in the Company; (iv) the undersigned is experienced in
making investments of this type and has such knowledge and background in financial and business matters that the undersigned is
capable of evaluating the merits and risks of this investment and protecting the undersigned&rsquo;s own interests; (v) the undersigned
understands that the shares of the Common Stock issuable upon conversion of the Note have not been registered under the Securities
Act of 1933, as amended (the <B><I>&ldquo;Securities Act&rdquo;</I></B>), by reason of a specific exemption from the registration
provisions of the Securities Act, which exemption depends upon, among other things, the bona fide nature of the investment intent
as expressed herein, and, because such securities have not been registered under the Securities Act, they must be held indefinitely
unless subsequently registered under the Securities Act or an exemption from such registration is available; (vi) the undersigned
is aware that the shares of the Common Stock may not be sold pursuant to Rule 144 adopted under the Securities Act unless certain
conditions are met and until the undersigned has held the shares of the Common Stock for the period prescribed by Rule 144, that
among the conditions for use of Rule 144 is the availability of current information to the public about the Company and that the
Company has not made such information available and has no present plans to do so; and (vii) the undersigned agrees not to make
any disposition of all or any part of the shares of the Common Stock unless and until there is then in effect a registration statement
under the Securities Act covering such proposed disposition and such disposition is made in accordance with said registration
statement, or the undersigned has provided the Company with an opinion of counsel satisfactory to the Company, stating that such
registration is not required.</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">&nbsp;</FONT></P>

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

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

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0; text-indent: 0.5in"><FONT STYLE="font-family: Times New Roman, Times, Serif">&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">&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-variant: small-caps"><B>In
Witness Whereof</B></FONT><B><FONT STYLE="font-family: Times New Roman, Times, Serif">,</FONT></B><FONT STYLE="font-family: Times New Roman, Times, Serif">
the undersigned, intending to be legally bound by the terms hereof, has caused this conversion notice to be duly executed as of
the date set forth below by the undersigned.</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">&nbsp;&nbsp;</FONT></P>

<TABLE BORDER="0" CELLSPACING="0" CELLPADDING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif">
<TR>
    <TD STYLE="vertical-align: top; width: 46%"><FONT STYLE="font-family: Times New Roman, Times, Serif">Dated:____________________</FONT></TD>
    <TD STYLE="width: 7%"><FONT STYLE="font-family: Times New Roman, Times, Serif">By:&nbsp;</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top; width: 38%"></TD>
    <TD STYLE="width: 9%"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">Name:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">Title:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">Tax ID:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><P STYLE="margin: 0; font: 10pt Times New Roman, Times, Serif"><FONT STYLE="font-family: Times New Roman, Times, Serif">Facsimile:</FONT></P>


</TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
<TR>
    <TD STYLE="vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><P STYLE="margin: 0; font: 10pt Times New Roman, Times, Serif"><FONT STYLE="font-family: Times New Roman, Times, Serif">Email
        Address:</FONT></P>


</TD>
    <TD STYLE="border-bottom: Black 1pt solid; vertical-align: top"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD>
    <TD><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></TD></TR>
</TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; text-align: left; text-indent: 0pt; margin-top: 0pt; margin-bottom: 6pt"><FONT STYLE="font-family: Times New Roman, Times, Serif">&nbsp;</FONT></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; text-align: left; text-indent: 0pt; margin-top: 0pt; margin-bottom: 6pt"></P>

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