Common use of Amount of Subscription Clause in Contracts

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ Shares. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): ____________________________ Business Phone: ( ) ____________________________ Residence Address (including zip code) ____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: Business or Residence Address Name Shares should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: __________________________________________________________________ Address for registration of shares:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Corporation (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: __________________________________________ Name: ________________________________________ Title: _________________________________________ 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 2016. By:______________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY, INC. (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: __________________________________ 2. Residence Address: __________________________________ 3. Social Security Number: ______________________________ 4. Present Employer: __________________________________ 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Common Stock Subscription Agreement (Panther Biotechnology, Inc.)

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ Shares. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): _______________________________________ Business Phone: ( ) ____________________________________________________ Residence Address (including zip code) ____________________________________________ Residence Phone: ( __) _________________________________________________________ All communications to be sent to: __ Business or __ Residence Address Name Shares should be registered in:___________________________________________________ If different than subscriber name please advise of the reason for such difference: _____________________________________________________________________ Address for registration of shares:_____________________________________________________ Email Address:______________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. _____________________________________________ Name of Corporation (please type or print) By: __________________________________________ Name: ______________________________________ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: ________________________________________________ Name: ______________________________________________ Title: _______________________________________________ 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. ____________________________________________ Name of Trust (Please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. _____________________________________________ Name of Company (please type or print) By: __________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 2016. By:______________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY, INC. (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: ________________________________________ 2. Residence Address: __________________________________ 3. Social Security Number: ____________ 3. Social Security Number:_____________________ 4. Present Employer: ________________________________________ 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Common Stock Subscription Agreement (Panther Biotechnology, Inc.)

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares for purchase an aggregate amount of 7,333,529 Units for a total of $___________2,500,000. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ 2,500,000.00 Subscribed forFor: _______________ Shares. $2,500,000 in Units Social Security or Taxpayer I.D. Number [required if applicable]: _________:___________________ Business Address (including zip code): ____________________Attention: ▇▇▇ Prychitka, CFO & VP Shared Services________ Business Phone: ( ) ____________________________ ▇▇▇ ▇▇▇ ▇▇▇▇ Residence Address (including zip code) Residence Phone: (____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: x Business or Residence Address Name Shares should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: __________________________________________________________________ Address for registration of shares:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages page the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES CONSTI­TUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s 's domicile and his or her particular personal circumstances. Subscription Agreement Please select one of the following forms of ownership: ________ INDIVIDUAL OWNERSHIP (one signature required) ________ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ________ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ________ TENANTS IN COMMON (both or all parties must sign) ________ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ________ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized autho­rized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ________ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) __X_____ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s 's Articles and certified Corporate Resolution authorizing the signature) ________ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print)) Subscription Agreement 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares Units and, further, that the Corporation has all requisite authority to acquire such SharesUnits. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Corporation (please type or print) By: __/s/ ▇▇▇▇ ▇▇▇▇▇▇▇, Jr.___ By: _________________________________/s/ ▇▇▇▇▇▇▇ Higgins___ Name: ______________________________________ ▇▇▇▇ ▇▇▇▇▇▇▇, Jr. Name: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Title: _______________________________________Co-Chief Executive Officer Title: Co-Chief Executive Officer 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares Units and that he has all requisite authority to acquire such Shares Units for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: __________________________________________ Name: ___________________________________________ Title: _____________________________________________ Subscription Agreement 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares Units and the undersigned, as trustee, has all requisite authority to acquire such Shares Units for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ 24th day of _________April, 20162014. By:______________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY: /s/ ▇▇▇ ▇▇▇▇ ▇▇▇ ▇▇▇▇, INCPresident Subscription Agreement JAMMIN JAVA CORP. (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. . PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: __________________________________ 2. Residence Address: __________________________________: 3. Social Security Number: _________:_____________________ 4. Present Employer: __________________________________: 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Subscription Agreement (Jammin Java Corp.)

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares Units for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ SharesUnits. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): _________________________________________ Business Phone: ( ) ________________________________________________________ Residence Address (including zip code) _________________________________________ Residence Phone: ( ) ________________________________________________________ All communications to be sent to: Business or Residence Address Name Shares Units should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: _____________________________________________________________________ Address for registration of sharesSecurities:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES CONSTI-TUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares Units and, further, that the Corporation has all requisite authority to acquire such SharesUnits. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Corporation (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________: 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares Units and that he has all requisite authority to acquire such Shares Units for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: __________________________________________ Name: ________________________________________ Title: _________________________________________: 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares Units and the undersigned, as trustee, has all requisite authority to acquire such Shares Units for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________: 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares Units and, further, that the Company has all requisite authority to acquire such SharesUnits. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company Trust (please Please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 20162020. By:______________________________ : Name:____________________________ : Title:_____________________________ PANTHER BIOTECHNOLOGY: GOLDEN MATRIX GROUP, INC. (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: ______________________________________________________________ 2. Residence Address: ____________________________________________________ 3. Social Security Number: :_________________________________________________ 4. Present Employer: __________________________________: 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Subscription Agreement (Golden Matrix Group, Inc.)

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares Units for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ SharesUnits. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): ____________________________ Business Address (including zip code): Business Phone: ( ) ____________________________ Residence Address (including zip code) ____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: Business or Residence Address Name Shares Units should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: _____________________________________________________________________ Address for registration of sharesSecurities:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized autho-rized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Corporation (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: __________________________________________ Name: ________________________________________ Title: _________________________________________ 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 2016. By:______________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY, INC. (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: __________________________________ 2. Residence Address: __________________________________ 3. Social Security Number: ______________________________ 4. Present Employer: __________________________________ 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Subscription Agreement (Golden Matrix Group, Inc.)

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ Shares. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): ____________________________ Business Phone: ( ) ____________________________ Residence Address (including zip code) ____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: Business or Residence Address Name Shares should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: __________________________________________________________________ Address for registration of shares:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) PLEASE ALSO COMPLETE PAGES 16, 17 OR 18 AS APPLICABLE, BELOW, AND THE QUESTIONNAIRE BEGINNING ON PAGE 19 OF THIS SUBSCRIPTION AGREEMENT, WHICH IS A REQUIRED PART OF THIS AGREEMENT. EXECUTION Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Corporation (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: __________________________________________ Name: ________________________________________ Title: _________________________________________ 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 2016. PANTHER BIOTECHNOLOGY, INC. By:______________________________ Name:____________________________ Title:_____________________________ PLEASE ALSO COMPLETE THE QUESTIONNAIRE BEGINNING ON PAGE 18 OF THIS SUBSCRIPTION AGREEMENT, WHICH IS A REQUIRED PART OF THIS AGREEMENT. Subscription Documents - Continued PANTHER BIOTECHNOLOGY, INC. (THE “COMPANY”) INVESTOR APPLICATION (QUALIFICATION QUESTIONNAIRE) (CONFIDENTIAL) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: __________________________________ 2. Residence Address: __________________________________ Residence Telephone: _____________________________ 3. Social Security Number: ______________________________ Date of Birth: __________________________________ Citizenship: __________________________________ 4. Present Employer: __________________________________ Business Address: __________________________________ Business Telephone: __________________________________ Title/Position: __________________________________ Length of Time: __________________________________ 5. I prefer to have communications sent to:: Home Address or _________Business Address

Appears in 1 contract

Sources: Common Stock Subscription Agreement

Amount of Subscription. The undersigned hereby subscribes to _____________ Shares for an aggregate amount of $___________. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $__________ Subscribed for: _______________ Shares. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________________ Business Address (including zip code): ____________________________ Business Phone: ( ) ____________________________ Residence Address (including zip code) ____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: Business or Residence Address Name Shares should be registered in:___________________________________________________ If different than subscriber name please advise of the reason for such difference: _____________________________________________________________________ Address for registration of shares:_____________________________________________________ Email Address:______________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES CONSTI-TUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized autho-rized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. _____________________________________________ Name of Corporation (please type or print) By: __________________________________________ Name: ______________________________________ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned is a general partner of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) By: ________________________________________________ Name: ______________________________________________ Title: _______________________________________________ 4. If the subscriber is a TRUST, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. ____________________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________: 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. _____________________________________________ Name of Company (please type or print) By: __________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of _________, 20162017. By:______________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY, INC. PETROLIA ENERGY CORPORATION (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, or meet the requirements of applicable securities and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART II) 1. Name: 2. Residence Address: Residence Telephone: 3. Social Security Number:__________________________________ 2. Residence Address: __________________________________ 3. Social Security Number: ______________________________ 4. Present Employer: __________________________________ 5. I prefer to have communications sent to:

Appears in 1 contract

Sources: Preferred Stock Subscription Agreement (Petrolia Energy Corp)

Amount of Subscription. The undersigned hereby subscribes $ Print Name of Purchaser ------------------ Number of Units to _____________ Shares for an aggregate amount be Purchased: ---------------------------------- , including Signature of $___________. “PURCHASER” Check enclosed in the amount of a Purchaser $____________ or Wire Transfer Sent in the Amount principal amount of $__Purchased Debentures and ________ Subscribed forPurchased Warrants ----------------------------------- Social Security Number ----------------------------------- Print Name of Spouse or Other Purchaser ----------------------------------- Signature of Spouse or Other Purchaser ----------------------------------- Social Security Number ----------------------------------- Address ----------------------------------- Fax Number ------------------------------------ E-mail Address ACCEPTED AND AGREED: TEGAL CORPORATION By: -------------------------------------------------- Dated: -------------------------------------- SIGNATURE PAGE TO TEGAL CORPORATION SUBSCRIPTION AGREEMENT Dated ______, 2003 IF the PURCHASER is a PARTNERSHIP, CORPORATION, LIMITED LIABILITY COMPANY, TRUST or OTHER ENTITY, please complete the following: IN WITNESS WHEREOF, the undersigned has executed this Agreement this ____ day of ____, 2003. Number of Units to be Purchased: , including $____________ Shares. Social Security or Taxpayer I.D. Number [required if applicable]: ____________________principal amount of Purchased Debentures and ________ Business Address (including zip code): ____________________________ Business Phone: ( ) ____________________________ Residence Address (including zip code) ____________________________ Residence Phone: ( ) ____________________________ All communications to be sent to: Business or Residence Address Name Shares should be registered in:_________________________________________________ If different than subscriber name please advise of the reason for such difference: __________________________________________________________________ Address for registration of shares:___________________________________________________ Email Address:__________________________________________________________________ Please indicate on the following pages the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor’s domicile and his or her particular personal circumstances. Please select one of the following forms of ownership: ___ INDIVIDUAL OWNERSHIP (one signature required) ___ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ___ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ___ TENANTS IN COMMON (both or all parties must sign) ___ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ___ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ___ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agreement and any other documents necessary to show the investment is authorized.) ___ CORPORATION (fill out all documents in the name of the CORPORATION, by the President or other officer authorized to sign, and include a copy of the Corporation’s Articles and certified Corporate Resolution authorizing the signature) ___ TRUST (fill out all documents in the name of the TRUST, by the Trustee, and include a copy of the instrument creating the trust and any other documents necessary to show the investment by the Trustee is authorized. The date of the trust must appear on the Notarial where indicated.) Please execute this Subscription Agreement by completing the appropriate section below. 1. If the subscriber is an INDIVIDUAL, complete the following: _____________________________________________ Signature of Subscriber _____________________________________________ Name (please type or print) _____________________________________________ Signature of Spouse or Co-Owner if funds are to be invested as joint tenants by the entirety or community property. _____________________________________________ Name (please type or print) 2. If the subscriber is a CORPORATION, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the corporation listed below (“Corporation”) to acquire the Shares and, further, that the Corporation has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Corporation and that he has authority under the articles of incorporation, bylaws, and resolutions of the board of directors of such Corporation to execute this Subscription Agreement. Such officer encloses a true copy of the articles of incorporation, the bylaws and, as necessary, the resolutions of the board of directors authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Purchased Warrants ----------------------------------- Print Full Legal Name of Corporation (please type Partnership, Company, Limited Liability Company, Trust or print) Other Entity By: ________________________________________ ------------------------------- (Authorized Signatory) Name: ______________________________________ ------------------------------ Title: _______________________________________ 3. If the subscriber is a PARTNERSHIP, complete the following---------------------------- Address and Fax Number: The undersigned hereby represents, warrants ------------ ----------------------------------- Taxpayer Identification Number: -------------- Date and covenants that the undersigned is a general partner State of the partnership named below (“Partnership”), and has been duly authorized by the Partnership to acquire the Shares and that he has all requisite authority to acquire such Shares for the Partnership. The undersigned represents and warrants that each of the above representations Incorporation or agreements or understandings set forth herein applies to that Partnership and he is authorized by such Partnership to execute this Subscription Agreement. Such partner encloses a true copy of the partnership agreement of said Partnership, as amended to date, together with a current and complete list of all partners thereof. _____________________________________________ Name of Partnership (please type or print) Organization: ------------------------------ Date on which Taxable Year Ends: ----------------------------------------------- E-mail Address: ------------------------------- ACCEPTED AND AGREED: TEGAL CORPORATION By: __________________________________________ -------------------------------------------------- Name: ________________________________________ ----------------------------------------------- Title: _________________________________________ ----------------------------------------------- Dated: ---------------------------------------------- EXHIBITS AND SCHEDULES TO THE UNIT SUBSCRIPTION AGREEMENT Exhibit 1: Form of Debentures Exhibit 2: Form of Warrants Exhibit 3: Form of Registration Rights Agreement Exhibit 4. If the subscriber is a TRUST: Form of Financial Advisory Agreement Exhibit 5: Form of Subsidiary Guaranty Exhibit 6: Form of Security Agreement Exhibit 7: Legal Opinion Exhibit 8: Risk Factors Exhibit 9: Company Disclosure Letter EXHIBIT 5 Form of SUBSIDIARY GUARANTY New York, complete the following: The undersigned hereby represents, warrants and covenants that he is duly authorized by the terms of the trust instrument (“Trust Instrument”) for the (“Trust”) set forth below to acquire the Shares and the undersigned, as trustee, has all requisite authority to acquire such Shares for the Trust. The undersigned, as trustee, executing this Subscription Agreement on behalf of the Trust, represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Trust and he is authorized by such Trust to execute this Subscription Agreement. Such trustee encloses a true copy of the Trust Instrument of said Trust as amended to date. __________________________________ Name of Trust (Please type or print) By: _______________________________ Name: _____________________________ Title: ______________________________ 5. If the subscriber is a LIMITED LIABILITY COMPANY, complete the following: The undersigned hereby represents, warrants and covenants that the undersigned has been duly authorized by all requisite action on the part of the Limited Liability Company listed below (“Company”) to acquire the Shares and, further, that the Company has all requisite authority to acquire such Shares. The officer signing below represents and warrants that each of the above representations or agreements or understandings set forth herein applies to that Company and that he has authority under the articles of organization, company agreement, and resolutions of the managers and/or members, as applicable, of such Company to execute this Subscription Agreement. Such officer encloses a true copy of the articles of organization, the operating agreement and, as necessary, the resolutions of the managers and/or members authorizing a purchase of the investment herein, in each case as amended to date. ___________________________________________ Name of Company (please type or print) By: ________________________________________ Name: ______________________________________ Title: _______________________________________ ACCEPTED BY THE COMPANY this the _____ day of __New York _______, 2016. By:2003 FOR VALUE RECEIVED, and in consideration of the purchase of the Debentures by the Holders (as those terms are defined below) from TEGAL CORPORATION (the "Corporation") and for other good and valuable consideration, and to induce the Holders to purchase the Debentures, the undersigned (and each of them if more than one, the liability under this Guaranty being joint and several) (jointly and severally referred to as "Guarantor" or "the undersigned") unconditionally guarantee to the Holders, their appointed representative or collateral agent (the "Agent"), their successors, endorsees and assigns, the prompt payment and performance when due (whether by acceleration or otherwise) of all present and future obligations and liabilities of any and all kinds of the Corporation to Agent and the Holders and of all instruments of any nature evidencing or relating to any such obligations and liabilities upon which the Corporation is or may become liable to Agent and the Holders, whether due or to become due, secured or unsecured, absolute or contingent, joint or several, and however or whenever acquired by Agent and the Holders, arising under, out of, or in connection with those certain 2% Convertible Secured Debentures due June __, 2011 dated as of June ____________________________ Name:____________________________ Title:_____________________________ PANTHER BIOTECHNOLOGY, INC. 2003 (THE “COMPANY”) ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED CONFIDENTIALLY. The undersigned understands, however, that the Company may present this application to such parties as the Company, in its discretion, deems appropriate when called upon to establish that the proposed offer and sale of the Securities are exempt from registration of the Securities Act of 1933, as amended, modified, restated or meet supplemented from time to time, collectively, the requirements "Debentures") made by the Corporation to the holders listed therein (collectively, the "Holders") or any documents, instruments or agreements relating to or executed in connection with the Debentures (together with the Debentures, as each may be amended, modified, restated or supplemented from time to time, the "Debenture Documents"; all of applicable securities such obligations and blue sky laws. PART I - INDIVIDUALS (OTHERS COMPLETE PART IIliabilities are herein collectively referred to as the "Obligations") 1, and irrespective of the genuineness, validity, regularity or enforceability of such Obligations, or of any instrument evidencing any of the Obligations or of any collateral therefor or of the existence or extent of such collateral, and irrespective of the allowability, allowance or disallowance of any or all of the Obligations in any case commenced by or against the Corporation under Title 11, United States Code, including, without limitation, obligati▇▇▇ ▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇ the Corporation for post-petition interest, fees, costs and charges that would have accrued or been added to the Obligations but for the commencement of such case. Name: __________________________________ 2. Residence Address: __________________________________ 3. Social Security Number: ______________________________ 4. Present Employer: __________________________________ 5. I prefer to have communications sent toIn furtherance of the foregoing, the undersigned hereby agree as follows:

Appears in 1 contract

Sources: Unit Subscription Agreement (Tegal Corp /De/)