Common use of SUBSCRIPTION FORM Clause in Contracts

SUBSCRIPTION FORM. TO: Element79 Gold Corp. ▇▇▇▇▇ ▇▇▇ - ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇ ▇▇▇ Attention: ▇▇▇▇▇ ▇▇▇▇▇▇, Chief Executive Officer The undersigned Holder of the within Warrant Certificate hereby subscribes for common shares (the “Shares”) of Element79 Gold Corp. (the “Company) pursuant to the within Warrant Certificate at the Exercise Price per Share and on the Terms and Conditions of the within Warrant Certificate. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder represents that, at the time of exercise of the Warrants, all of the representations and warranties contained in the Subscription Agreement between the Company and the undersigned Holder pursuant to which these Warrants were issued are true and accurate. Capitalized terms used but not otherwise defined herein shall have the meaning ascribed thereto in the Warrant Certificate dated ♦, 2022 to which this Subscription Form is attached. The undersigned hereby directs that the Shares hereby subscribed for be issued and delivered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this day of , 20 . In the presence of: Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Address

Appears in 1 contract

Sources: Share Purchase Agreement

SUBSCRIPTION FORM. TO: Element79 Gold Corp. ▇▇▇▇▇ ▇▇▇ - ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇ ▇▇▇ Attention: ▇▇▇▇▇ ▇▇▇▇▇▇, Chief Executive Officer [To be executed only upon exercise of Warrant] The undersigned Holder registered owner of this Warrant irrevocably exercises this Warrant for the purchase of ______ shares Common Stock of Norand Corporation and herewith makes payment therefor, all at the price and on the terms and conditions specified in this Warrant and requests that certificates for the shares of Common Stock hereby purchased (and any securities or other property issuable upon such exercise) be issued in the name of and delivered to _________________ whose address is ___________________________________________________ and, if such shares of Common Stock shall not include all of the shares of Common Stock issuable as provided in this Warrant, that a new Warrant of like tenor and date for the balance of the shares of Common Stock issuable hereunder be delivered to the undersigned. _______________________________ (Name of Registered Owner) _______________________________ (Signature of Registered Owner) _______________________________ (Street Address) _______________________________ (City) (State) (Zip Code) NOTICE: The signature on this subscription must correspond with the name as written upon the face of the within Warrant Certificate in every particular, without alteration or enlargement or any change whatsoever. ANNEX B ASSIGNMENT FORM FOR VALUE RECEIVED the undersigned registered owner of this Warrant hereby subscribes for common shares (sells, assigns and transfers unto the “Shares”) Assignee named below all of Element79 Gold Corp. (the “Company) pursuant rights of the undersigned under this Warrant, with respect to the within Warrant Certificate at number of shares of Common Stock set forth below: No. of Shares of Name and Address of Assignee Common Stock and does hereby irrevocably constitute and appoint ________ _____________ attorney-in-fact to register such transfer onto the Exercise Price per Share and books of Norand Corporation maintained for the purpose, with full power of substitution in the premises. Dated:___________________ Print Name:___________________ Signature:____________________ Witness:______________________ NOTICE: The signature on this assignment must correspond with the Terms and Conditions name as written upon the face of the within Warrant Certificatein every particular, without alteration or enlargement or any change whatsoever. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder represents that, at the time of exercise of the Warrants, all of the representations and warranties contained in the Subscription Agreement between the Company and the undersigned Holder pursuant to which these Warrants were issued are true and accurate. Capitalized terms used but not otherwise defined herein shall have the meaning ascribed thereto in the Warrant Certificate dated ♦, 2022 to which this Subscription Form is attached. The undersigned hereby directs that the Shares hereby subscribed for be issued and delivered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER TABLE OF SHARES (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this day of , 20 . In the presence of: Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) AddressCONTENTS

Appears in 1 contract

Sources: Warrant Agreement (Norand Corp /De/)

SUBSCRIPTION FORM. TO: Element79 Sandstorm Gold Corp. Ltd. ▇▇▇▇▇ ▇▇▇ - ▇▇, ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇ Attention: ▇▇▇▇▇ ▇▇▇▇▇▇, Chief Executive Officer The undersigned Holder holder of the within Warrant Certificate hereby irrevocably subscribes for common shares Warrant Shares of Sandstorm Gold Ltd. (the “SharesCorporation) of Element79 Gold Corp. (the “Company) pursuant to the within Warrant Certificate at the Exercise Price per Share and on the Terms and Conditions of the within Warrant Certificate. This subscription is accompanied by tenders herewith a certified cheque or bank draft payable for $ (US$4.50 per Warrant Share, subject to or to the order adjustment in accordance with Section 12 of the Company for the whole amount of the purchase price of the SharesWarrant Certificate) in full payment therefor. The undersigned Holder represents thatholder represents, warrants and certifies that the undersigned holder (i) at the time of exercise of the Warrants, all of the representations and warranties contained Warrant is not in the Subscription Agreement between United States; (ii) is not a “U.S. person” as defined in Rule 902(k) of Regulation S under the Company and United States Securities Act of 1933, as amended; (iii) is not exercising the undersigned Holder pursuant to which these Warrants were issued are true and accurate. Capitalized terms used but not otherwise defined herein shall have the meaning ascribed thereto Warrant on behalf of a “U.S. person” or a person in the Warrant Certificate dated ♦, 2022 to which United States; and (iv) did not execute or deliver this Subscription Form is attachedexercise form in the United States. The undersigned hereby directs that the Warrant Shares hereby subscribed for be issued as follows: Please check if the certificates representing the Warrant Shares are to be delivered at the office where this Warrant Certificate is surrendered, failing which the certificates representing the Warrant Shares will be mailed to the address in the registration instructions set out above. If any Warrants represented by this Warrant Certificate are not being exercised, a new Warrant Certificate representing the unexercised Warrants will be issued and delivered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES (Please print full name in which share certificates with the certificate representing the Warrant Shares. If the Subscription Form indicates that Warrant Shares are to be issuedissued to a person or persons other than the registered holder of the Warrant Certificate, stating whether Mr.the signature on this Subscription Form must be guaranteed by a Canadian chartered bank, Mrs. or Miss is applicable)eligible guarantor institution with membership in an approved signature guarantee medallion program. The guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. DATED this day of , 20 . In the presence of: Signature of Warrantholder guaranteed by: Medallion Signature Guarantee Stamp of Warrantholder Signature of Warrantholder Witness Signature of Warrant Holder Please print below your name and address in full. Warrantholder Name (Mr./Mrs./Miss) Addressof Warrantholder Name of Authorized Representative Address of Warrantholder

Appears in 1 contract

Sources: Royalty Purchase and Sale Agreement (Sandstorm Gold LTD)

SUBSCRIPTION FORM. TO: Element79 Gold Corp. ▇▇▇▇▇ ▇▇▇ - ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇ ▇▇▇ Attention: ▇▇▇▇▇ ▇▇▇▇▇▇, Chief Executive Officer The undersigned Holder hereby irrevocably subscribes for _______ shares of the within Warrant Certificate hereby subscribes for common shares Common Stock (the “SharesStock”) of Element79 Gold Corp. __________________ (the “Company) pursuant to and in accordance with the within Warrant Certificate at the Exercise Price per Share terms and on the Terms and Conditions conditions of the within attached Warrant CertificateNo. This subscription is accompanied __ (the “Warrant”), and hereby makes payment of $_______ therefor by [tendering cash, wire transferring or delivering a certified cheque check or bank draft cashier’s check, payable to or to the order of the Company for the whole amount Company] [surrendering _______ shares of Common Stock received upon exercise of the purchase price Warrant, which shares have an aggregate fair market value equal to such payment as required in Section 2 of the SharesWarrant]. The undersigned Holder represents that, requests that a certificate for the Stock be issued in the name of the undersigned and be delivered to the undersigned at the time of exercise of address stated below. If the Warrants, Stock is not all of the representations and warranties contained in shares purchasable pursuant to the Subscription Agreement between Warrant, the undersigned requests that a new Warrant of like tenor for the balance of the remaining shares purchasable thereunder be delivered to the undersigned at the address stated below. In connection with the issuance of the Stock, I hereby represent to the Company that I am acquiring the Stock for my own account for investment and not with a view to, or for resale in connection with, a distribution of the undersigned Holder shares within the meaning of the Securities Act of 1933, as amended (the “Securities Act”). I understand that if at this time the Stock has not been registered under the Securities Act, I must hold such Stock indefinitely unless the Stock is subsequently registered and qualified under the Securities Act or is exempt from such registration and qualification. I shall make no transfer or disposition of the Stock unless (a) such transfer or disposition can be made without registration under the Securities Act by reason of a specific exemption from such registration and such qualification, or (b) a registration statement has been filed pursuant to which these Warrants were issued are true the Securities Act and accuratehas been declared effective with respect to such disposition. Capitalized terms used but not otherwise defined herein I agree that each certificate representing the Stock delivered to me shall have bear substantially the meaning ascribed thereto in same as set forth on the Warrant Certificate dated ♦, 2022 to which this Subscription Form is attachedfront page of the Warrant. I further agree that the Company may place stop transfer orders with its transfer agent same effect as the above legend. The undersigned hereby directs legend and stop transfer notice referred to above shall be removed only upon my furnishing to the Company an opinion of counsel (reasonably satisfactory to the Company) to the effect that the Shares hereby subscribed for such legend may be issued and delivered as followsremoved. Date:_______________________________ Signed: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this day of , 20 . In the presence of: Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) _______________________________ Print Name:____________________________ Address:______________________________

Appears in 1 contract

Sources: Warrant Agreement (GRANDPARENTS.COM, Inc.)