INSITE VISION INCORPORATED Warrant for the Purchase of Shares of Common Stock
Exhibit
4.9
THIS
WARRANT AND THE SECURITIES ISSUABLE UPON EXERCISE HEREOF HAVE BEEN ACQUIRED
FOR
INVESTMENT AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED (THE “ACT”), OR ANY STATE SECURITIES LAW. THIS WARRANT AND SUCH
SECURITIES MAY NOT BE OFFERED, SOLD OR OTHERWISE PLEDGED, TRANSFERRED OR
HYPOTHECATED IN THE ABSENCE OF SUCH REGISTRATION OR DELIVERY OF AN OPINION
OF
COUNSEL IN FORM AND SUBSTANCE REASONABLY SATISFACTORY TO THE COMPANY THAT SUCH
OFFER, SALE OR TRANSFER, PLEDGE OR HYPOTHECATION IS IN COMPLIANCE WITH THE
ACT
OR UNLESS SOLD IN FULL COMPLIANCE WITH RULE 144 UNDER THE ACT.
INSITE
VISION INCORPORATED
Warrant
for the Purchase of Shares of
Common
Stock
| No. [ ] |
______ Shares
|
FOR
VALUE
RECEIVED, INSITE VISION INCORPORATED, a Delaware corporation (the "Company"),
hereby certifies that Paramount BioCapital, Inc., its designee or its permitted
assigns is entitled to purchase from the Company, at any time or from time
to
time commencing on November 26, 2005 and prior to 5:00 P.M., New York City
time,
on May 26, 2010, ________________ fully paid and non-assessable shares of common
stock, $0.01 par value per share, of the Company for an aggregate purchase
price
of [($___)].
(Hereinafter, (i) said common stock, $0.01 par value per share, of the Company,
is referred to as the "Common
Stock";
(ii)
the shares of the Common Stock purchasable hereunder or under any other Warrant
(as hereinafter defined) are referred to as the "Warrant
Shares";
(iii)
the aggregate purchase price payable for the Warrant Shares purchasable
hereunder is referred to as the "Aggregate
Warrant Price";
(iv)
the price payable (initially $0.6325 per share subject to adjustment) for each
of the Warrant Shares hereunder is referred to as the "Per
Share Warrant Price";
(v)
this Warrant, all similar Warrants issued on the date hereof as compensation
pursuant to the Engagement Agreement and all warrants hereafter issued in
exchange or substitution for this Warrant or such similar Warrants are referred
to as the "Warrants";
(vi)
the holder of this Warrant is referred to as the "Holder"
and the
holder of this Warrant and all other Warrants and Warrant Shares are referred
to
as the "Holders"
and
Holders of more than fifty percent (50%) of the outstanding Warrants and Warrant
Shares are referred to as the "Majority
of the Holders");
and
(vii) the then current market price per share of the Common Stock (the
"Current
Market Price")
shall
be deemed to be the last reported trade of the Common Stock on the trading
day
prior to such date or, in case no such reported sales take place on such day,
the average of the last reported bid and asked prices of the Common Stock on
such day, in either case on the principal national securi--ties exchange on
which the Common Stock is admitted to trading or listed, or if not listed or
admitted to trading on any such exchange, the representative closing sale price
of the Common Stock as reported by the National Association of Securities
Dealers, Inc. Automated Quota-tions System ("NASDAQ"),
or
other similar organization if NASDAQ is no longer reporting such information,
or, if the Common Stock is not reported on NASDAQ, the high per share sale
price
for the Common Stock in the over-the-counter market as reported by the National
Quotation Bureau or similar organization, or if not so available, the fair
market value of the Common Stock as determined in good faith by the Company’s
board of directors (the “Board
of Directors”).
The
Aggregate Warrant Price is not subject to adjustment. The Per Share Warrant
Price is subject to adjustment as hereinafter provided; in the event of any
such
adjustment, the number of Warrant Shares deliverable upon exercise of this
Warrant shall be adjusted by dividing the Aggregate Warrant Price by the Per
Share Warrant Price in effect immediately after such adjustment.
This
Warrant, was originally issued pursuant to a Placement Agent Agreement dated
February 24, 2005 (the “Engagement
Agreement”)
between
the Company and Paramount BioCapital, Inc. in connection with a private
placement by the Company of its securities (the “Units”).
1. Exercise
of Warrant.
(a) This
Warrant may be exercised in whole at any time, or in part from time to time,
commencing on November 26, 2005 and prior to 5:00 P.M., New York City time,
on
May 26, 2010 by the Holder:
(i) by
the
surrender of this Warrant (with the subscription form at the end hereof duly
executed) at the address set forth in Section 9(a) hereof, together with proper
payment of the Aggregate Warrant Price, or the proportionate part thereof if
this Warrant is exercised in part, with payment for the Warrant Shares made
by
certified or official bank check payable to the order of the Company;
or
(ii) by
the
surrender of this Warrant (with the cashless exercise form at the end hereof
duly executed) (a "Cashless
Exercise")
at the
address set forth in Section 9(a) hereof. Pursuant to such Cashless Exercise,
the aggregate purchase price for Warrant Shares being purchased hereunder shall
be paid by surrender of a number of Warrant Shares available for exercise under
this Warrant that have a Current Market Price equal to the aggregate purchase
price of the Warrant Shares being purchased as determined herein. If the Holder
elects the Cashless Exercise method of payment, the Company shall issue to
Holder upon exercise a number of shares of Warrant Shares determined in
accordance with the following formula:
|
X=
|
Y(A-B)
A
|
| where: | X = | the number of Warrant Shares to be issued to the Holder; |
| Y = | the number of Warrant Shares with respect to which the Holder is exercising its purchase rights under this Warrant; |
|
A
=
|
the
Current Market Price of one (1) share of the Warrant Shares on
the date of
exercise; and
|
| B = | the Per Share Warrant Price. |
No
fractional shares arising out of the above formula for determining the number
of
shares to be issued to the Holder shall be issued, and the Company shall in
lieu
thereof make payment to the Holder of cash in the amount of such fraction
multiplied by the Current Market Price of one (1) share of the Warrant Shares
on
the date of exercise.
C-2
(b) If
this
Warrant is exercised in part, this Warrant must be exercised for a number of
whole shares of the Common Stock and the Holder is entitled to receive a new
Warrant covering the Warrant Shares that have not been exercised and setting
forth the proportionate part of the Aggregate Warrant Price applicable to such
Warrant Shares. Upon surrender of this Warrant, the Company will (i) issue
a
certificate or certificates in the name of the Holder for the largest number
of
whole shares of the Common Stock to which the Holder shall be entitled and,
if
this Warrant is exercised in whole, in lieu of any fractional share of the
Common Stock to which the Holder shall be entitled, pay to the Holder cash
in an
amount equal to the fair value of such fractional share (determined in such
reasonable manner as the Board of Directors of the Company shall determine),
and
(ii) deliver the other securities and properties receivable upon the exercise
of
this Warrant, or the proportionate part thereof, if this Warrant is exercised
in
part, pursuant to the provisions of this Warrant.
2. Reservation
of Warrant Shares; Listing.
The
Company agrees that, prior to the expiration of this Warrant, the Company shall
at all times (a) have authorized and in reserve, and shall keep available,
solely for issuance and delivery upon the exercise of this Warrant, the shares
of the Common Stock and other securities and properties as from time to time
shall be receivable upon the exercise of this Warrant, free and clear of all
restrictions on sale or transfer, other than under Federal or state securities
laws, and free and clear of all preemptive rights and rights of first refusal
and (b) if the Company hereafter lists its Common Stock on any national
securities exchange, the Nasdaq National Market or the Nasdaq Smallcap Market,
use its commercially reasonable efforts to keep the Warrant Shares authorized
for listing on such exchange upon notice of issuance.
3. Certain
Adjustments.
(a) If,
at
any time or from time to time after the date of this Warrant, the Company shall
issue or dis-tribute to all holders of shares of Common Stock by reason of
their
ownership thereof evidence of its indebtedness, any other securities of the
Company or any cash, property or other assets (excluding a subdivision,
combination or reclassification, or dividend or distribution payable in shares
of Common Stock, referred to in S-ection 3(b), and also excluding cash dividends
or cash distributions paid out of net profits legally available therefor in
the
full amount thereof (any such non-excluded event being herein called a
"Special
Dividend")),
the
Per Share Warrant Price shall be adjusted by multiplying the Per Share Warrant
Price then in effect by a fraction, the numerator of which shall be the then
Current Market Price in effect on the record date of such issuance or
distribution less the fair market value (as determined in good faith by the
Company's Board of Directors) of the evidence of indebtedness, cash, securities
or property, or other assets issued or distributed in such Special Dividend
applicable to one share of Common Stock and the denominator of which shall
be
the then Current Market Price in effect on the record date of such issuance
or
distribution. An adjustment made pursuant to this Subsection 3(a) shall become
effective immediately after the record date of any such Special
Dividend.
C-3
(b) In
case
the Company shall hereafter (i) pay a dividend or make a distribution on its
capital stock in shares of Common Stock, (ii) subdivide its outstanding shares
of Common Stock into a greater number of shares, (iii) combine its outstanding
shares of Common Stock into a smaller number of shares or (iv) issue by
reclassification of its Common Stock any shares of capital stock of the Company,
the Per Share Warrant Price shall be adjusted to be equal to a fraction, the
numerator of which shall be the Aggregate Warrant Price and the denominator
of
which shall be the number of shares of Common Stock or other capital stock
of
the Company that the Holder would have owned immediately following such action
had such Warrant been exercised immediately prior thereto. An adjustment made
pursuant to this Subsection 3(b) shall become effective immediately after the
record date in the case of a dividend or distribution, and shall become
effective immediately after the effective date in the case of a subdivision,
combination or reclassification.
(c) In
case
of any capital reorganization or reclassification, or any consolidation or
merger to which the Company is a party other than a merger or consolidation
in
which the Company is the continuing corporation, or in case of any sale or
conveyance to another entity of all or substantially all of the assets of the,
or in the case of any statutory exchange of securities with another corporation
(including any exchange effected in connection with a merger of a third
corporation into the Company, but excluding any exchange of securities or merger
with another corporation in which the Company is a continuing corporation and
that does not result in any reclassification of or similar change in the Common
Stock), the Holder of this Warrant shall have the right thereafter to receive
on
the exercise of this Warrant the kind and amount of securities, cash or other
property which the Holder would have owned or have been entitled to receive
immediately after such reorganization, reclassification, consolidation, merger,
statutory exchange, sale or conveyance had this Warrant been exercised
immediately prior to the effective date of such reorganization,
reclassification, consolidation, merger, statutory exchange, sale or conveyance
and in any such case, if necessary, appropriate adjustment shall be made in
the
application of the provisions set forth in this Section 3 with respect to the
rights and interests thereafter of the Holder of this Warrant to the end that
the provisions set forth in this Section 3 shall thereafter cor-res-pondingly
be
made applicable, as nearly as may reasonably be, in relation to any shares
of
stock or other securities or property thereafter deliverable on the exercise
of
this Warrant. The above provisions of this Section 3(c) shall similarly apply
to
successive reorganizations, reclassifica-tions, consolidations, mergers,
statutory exchanges, sales or conveyances. The Company shall require the issuer
of any shares of stock or other securities or property thereafter deliverable
on
the exercise of this Warrant to be responsible for all of the agreements and
obligations of the Company hereunder. Notice of any such reorganization,
reclassification, consolidation, merger, statutory exchange, sale or conveyance
and of said provisions so proposed to be made, shall be mailed to the Holders
of
the Warrants not less than twenty (20) days prior to such event. A sale of
all
or substantially all of the assets of the Company for a consideration consisting
primarily of securities shall be deemed a consolidation or merger for the
foregoing purposes.
C-4
(d) No
adjustment in the Per Share Warrant Price shall be required unless such
adjustment would require an increase or decrease of at least $0.01 per share
of
Common Stock; provided,
however,
that
any adjustments which by reason of this Subsection 3(d) are not required to
be
made shall be carried forward and taken into account in any subsequent
adjustment; provided,
further,
however, that adjustments shall be required and made in accordance with the
provisions of this Section 3 (other than this Subsection 3(d)) not later than
such time as may be required in order to preserve the tax-free nature of a
distribution (if any) to the Holder of this Warrant or Common Stock issuable
upon the exercise hereof. All calculations under this Section 3 shall be made
to
the nearest cent or to the nearest 1/100th of a share, as the case may be.
Anything in this Section 3 to the contrary notwithstanding, the Company shall
be
entitled to make such reductions in the Per Share Warrant Price, in addition
to
those required by this Section 3, as it in its discretion shall deem to be
advisable in order that any stock dividend, subdivision of shares or
distribution of rights to purchase stock or securities convertible or
exchangeable for stock hereafter made by the Company to its stockholders shall
not be taxable.
(e) Whenever
the Per Share Warrant Price is adjusted as provided in this Section 3 and upon
any modifi-cation of the rights of a Holder of Warrants in accordance with
this
Section 3, the Company shall promptly prepare a brief statement of the facts
requiring such adjustment or modification and the manner of computing the same
and cause copies of such certificate to be mailed to the Holders of the
Warrants. The Company may, but shall not be obligated to unless requested by
a
Majority of the Holders, obtain, at its expense, a certificate of a firm of
independent public accountants of recognized standing selected by the Board
of
Directors (who may be the regular auditors of the Company) setting forth the
Per
Share Warrant Price and the number of Warrant Shares in effect after such
adjustment or the effect of such modification, a brief statement of the facts
requiring such adjustment or modification and the manner of computing the same
and cause copies of such certificate to be mailed to the Holders of the
Warrants.
(f) If
the
Board of Directors of the Company shall declare any dividend or other
distribution with respect to the Common Stock other than a cash distribution
out
of earned surplus, the Company shall mail notice thereof to the Holders of
the
Warrants not less than ten (10) days prior to the record date fixed
for
determining stock-holders entitled to participate in such dividend or other
distribution.
(g) If,
as a
result of an adjustment made pursuant to this Section 3, the Holder of any
Warrant thereafter surrendered for exercise shall become entitled to receive
shares of two or more classes of capital stock or shares of Common Stock and
other capital stock of the Company, the Board of Directors (whose determination
shall be conclusive and shall be described in a written notice to the Holder
of
any Warrant promptly after such adjustment) shall determine the allocation
of
the adjusted Per Share Warrant Price between or among shares or such classes
of
capital stock or shares of Common Stock and other capital stock.
C-5
(h) Upon
the
expiration of any rights, options, warrants or conversion privileges with
respect to the issuance of which an adjustment to the Per Share Warrant Price
had been made, if such option, right warrant or conversion shall not have been
exercised, the number of Warrant Shares purchasable upon exercise of this
Warrant, to the extent this Warrant has not then been exercised, shall, upon
such expiration, be readjusted and shall thereafter be such as they would have
been had they been originally adjusted (or had the original adjustment not
been
required, as the case may be) on the basis of (A) the fact that Common Stock,
if
any, actually issued or sold upon the exercise of such rights, options, warrants
or conversion privileges, and (B) the fact that such shares of Common Stock,
if
any, were issued or sold for the consideration actually received by the Company
upon such exercise plus the consideration, if any, actually received by the
Company for the issuance, sale or grant of all such rights, options, warrants
or
conversion privileges whether or not exercised; provided,
however,
that no
such readjustment shall have the effect of decreasing the number of Warrant
Shares purchasable upon exercise of this Warrant by an amount in excess of
the
amount of the adjustment initially made in respect of the issuance, sale or
grant of such rights, options, warrants or conversion privileges.
(i) In
case
any event shall occur as to which the other provisions of this Section 3 are
not
strictly applicable but as to which the failure to make any adjustment would
not
fairly protect the purchase rights represented by this Warrant in accordance
with the essential intent and principles of the adjustments set forth in this
Section 3, then, in each such case, the Board of Directors of the Company shall
in good faith determine the adjustment, if any, on a basis consistent with
the
essential intent and principles established herein, necessary to preserve the
purchase rights represented by the Warrants. Upon such determination, the
Company will promptly mail a copy thereof to the Holder of this Warrant and
shall make the adjustments described therein.
4. Fully
Paid Stock; Taxes.
The
shares of the Common Stock represented by each and every certificate for Warrant
Shares delivered on the exercise of this Warrant shall, subject to the Holder’s
compliance with the terms hereof, at the time of such delivery, be duly
authorized, validly issued and outstanding, fully paid and nonassessable, and
not subject to preemptive rights or rights of first refusal on the part of
the
Company, and the Company will take all such actions as may be necessary to
assure that the par value, if any, per share of the Common Stock is at all
times
equal to or less than the then Per Share Warrant Price. The Company shall pay,
when due and payable, any and all Federal and state stamp, original issue or
similar taxes which may be payable in respect of the issue of any Warrant Share
or any certificate thereof to the extent required because of the issuance by
the
Company of such security.
5. Registration
Under Securities Act of 1933.
(a) The
Holder shall have the right to participate in the registration rights granted
to
purchasers of the Units pursuant to Article VI of the Subscription Agreement
between such purchasers and the Company that were entered into at the time
of
the initial sale of the Units. By acceptance of this Warrant, the Holder agrees
to comply with the provisions in Article VI of the Subscription Agreement to
same extent as if it were a party thereto.
C-6
(b) Until
all
of the Warrant Shares have been sold under a Registration Statement or pursuant
to Rule 144(k), the Company shall use its commercially reasonable efforts to
file with the Securities and Exchange Commission all current reports and the
information as may be necessary to enable the Holder to effect sales of its
shares in reliance upon Rule 144(K) promulgated under the Act.
6. Investment
Intent; Limited Transferability.
(a) The
Holder represents to
the Company, by accepting this Warrant, that it understands that this Warrant
and any securities obtainable upon exercise of this Warrant have not been
registered for sale under Federal or state securities laws and are being offered
and sold to the Holder pursuant to one or more exemptions from the registration
requirements of such securities laws. In the absence of an effective
registration of such securities or an exemption therefrom, any certificates
for
such securities shall bear the legend set forth on the first page hereof. The
Holder understands that it must bear the economic risk of its investment in
this
Warrant and any securities obtainable upon exercise of this Warrant for an
indefinite period of time, as this Warrant and such securities have not been
registered under Federal or state securities laws and therefore cannot be sold
unless subsequently registered under such laws, unless an exemption from such
registration is available. The Holder further represents to the Company, by
accepting this Warrant, that is has full power and authority to enter into
this
Warrant and make the representations set forth herein.
(b) The
Holder, by its
acceptance of this Warrant, represents to the Company that it is acquiring
this
Warrant and will acquire any securities obtainable upon exercise of this Warrant
for its own account for investment and not with a view to, or for sale in
connection with, any distribution thereof in violation of the Act. The Holder,
by acceptance of this Warrant, agrees that this Warrant and any such securities
will not be sold or otherwise transferred unless (i) a registration statement
with respect to such transfer is effective under the Act and any applicable
state securities laws or (ii) such sale or transfer is made pursuant to one
or
more exemptions from the Act and in accordance with the legend set forth on
the
first page hereof.
(c) The
Holder, by its
acceptance of this Warrant, represents to the Company that that it is able
to
fend for itself, can bear the economic risk of its investment, has such
knowledge and experience in financial or business matters that it is capable
of
evaluating the merits and risks of the investment in this Warrant, has received
and reviewed a copy of the Confidential Private Offering Memorandum provided
by
the Company in connection with the Subscription Agreements, the Company’s public
filings with the Securities and Exchange Commission and has had the opportunity
to ask questions and receive answers from the Company regarding its business
and
financial condition. Holder also represents it has not been organized for the
purpose of acquiring this Warrant.
C-7
(d) This
Warrant may not be sold,
transferred, assigned or hypothecated for six (6) months from the date hereof
except (i) to any firm or corporation that succeeds to all or substantially
all
of the business of Paramount Capital, Inc., (ii) to any of the officers,
employees, associates or affiliated companies of Paramount Capital, Inc., or
of
any such successor firm, (iii) to any NASD member participating in the Offering
or any officer or employee of any such NASD member or (iv) in the case of an
individual, pursuant to such individual's last will and testament or the laws
of
descent and distribution, and is so transferable only upon the books of the
Company which the Company shall cause to be maintained for such purpose;
provided, however, in no event shall any portion of this
Warrant be sold, transferred, assigned or hypothecated to more than 35 persons
or entities. In addition to the foregoing limitations and in accordance with
the
legend on the first page hereof, this Warrant may not be sold, transferred,
assigned or hypothecated by the Holder except in compliance with the provisions
of the Securities Act and the applicable state securities “blue sky” laws, and
is so transferable only upon the books of the Company which it shall cause
to be
maintained for such purpose. By acceptance of this Warrant each Holder
(including any transferee of this Warrant or any portion hereof), makes the
representations set forth herein. The Company may treat the registered Holder
of
this Warrant as it appears on the Company's books at any time as the Holder
for
all purposes. The Company shall permit any Holder of a Warrant or its duly
authorized attorney, upon written request during ordinary business hours, to
inspect and copy or make extracts from its books showing the registered Holders
of Warrant. All Warrants issued upon the transfer or assignment of this Warrant
will be dated the same date as this Warrant, and all rights and obligations
of
the holder thereof shall be identical to those of the Holder.
(e) Such
Holder is acquiring the Warrants for its own account and not with a present
view
to, or for sale in connection with, any distribution thereof in violation of
the
registration requirements of the Act, without prejudice, however, to such
Holder’s right, subject to the provisions of the Subscription Agreement and this
Warrant, at all times to sell or otherwise dispose of all or any part of such
Warrants and Warrant Shares.
7. Loss,
etc., of Warrant.
Upon
receipt of evidence satisfactory to the Company of the loss, theft, destruction
or mutilation of this Warrant, and of indemnity reasonably satisfactory to
the
Company, if lost, stolen or destroyed, and upon surrender and cancellation
of
this Warrant, if mutilated, the Company shall execute and deliver to the Holder
a new Warrant of like date, tenor and denomination.
8. Warrant
Holder Not Stockholder.
This
Warrant does not confer upon the Holder any right to vote on or consent to
or
receive notice as a stockholder of the Company, as such, in respect of any
matters whatsoever, nor any other rights or liabilities as a stockholder, prior
to the exercise hereof; this Warrant does, however, require certain notices
to
Holders as set forth herein.
9. Communication.
No
notice or other communi-cation under this Warrant shall be effective or deemed
to have been given unless, the same is in writing and is mailed by first-class
mail, postage prepaid, or via recognized overnight courier with confirmed
receipt, addressed to:
(a) the
Company at Insite Vision Incorporated, Chief Financial Officer, ▇▇▇ ▇▇▇▇▇▇▇▇
▇▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇, or other such address as the Company has designated
in writing to the Holder.
C-8
(b) the
Holder at c/o Paramount BioCapital, Inc., ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇
▇▇▇▇▇,
▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇ or other such address as the Holder has designated in writing
to the Company.
10. Headings.
The
headings of this Warrant have been inserted as a matter of convenience and
shall
not affect the construction hereof.
11. Applicable
Law.
This
Warrant shall be governed by and construed in accordance with the law of the
State of New York without giving effect to the principles of conflicts of law
thereof.
12. Amendment,
Waiver, etc.
Except
as expressly provided herein, neither this Warrant nor any term hereof may
be
amended, waived, discharged or terminated other than by a written instrument
signed by the party against whom enforcement of any such amendment, waiver,
discharge or termination is sought; provided, however, that any provisions
hereof may be amended, waived, discharged or terminated upon the written consent
of the Company and the Majority of the Holders.
C-9
IN
WITNESS WHEREOF, the Company has caused this Warrant to be signed by its
President and attested by its Secretary this 26th day of May, 2005.
INSITE
VISION INCORPORATED
By:__________________________
Name:
_______________________
Title:
_______________________
ATTEST:
_____________________________
Secretary
C-10
SUBSCRIPTION (cash)
The
undersigned, ___________________, pursuant to the provisions of the foregoing
Warrant, hereby agrees to subscribe for and purchase ____________________ shares
of the Common Stock, par value $0.01 per share, of InSite Vision Incorporated
covered by said Warrant, and makes payment therefor in full at the price per
share provided by said Warrant.
Dated:_______________ Signature:____________________
Address:______________________
CASHLESS
EXERCISE
The
undersigned _____________, pursuant to the provisions of the foregoing Warrant,
hereby elects to exchange its Warrant for ___________________ shares of Common
Stock, par value $0.01 per share, of InSite Vision Incorporated pursuant to
the
Cashless Exercise provisions of the Warrant.
Dated:_______________ Signature:____________________
Address:______________________
C-11
ASSIGNMENT
FOR
VALUE
RECEIVED _______________ hereby sells, assigns and transfers unto
____________________ (“Transferee”)
the
foregoing Warrant and all rights evidenced thereby, and does irrevocably
constitute and appoint _____________________, attorney, to transfer said Warrant
on the books of InSite Vision Incorporated. By acceptance of the foregoing
Warrant, Transferee shall become a Holder under said Warrant and subject to
the
rights, obligations and representations of Holder set forth in said
Warrant.
Dated:_______________ Signature:____________________
Address:______________________
PARTIAL
ASSIGNMENT
FOR
VALUE
RECEIVED _______________ hereby assigns and transfers unto ____________________
the right to purchase _______ shares of Common Stock, par value $0.01 per share,
of InSite Vision Incorporated covered by the foregoing Warrant, and a
proportionate part of said Warrant and the rights evidenced thereby, and does
irrevocably constitute and appoint ____________________, attorney, to transfer
such part of said Warrant on the books of InSite Vision Incorporated. By
acceptance of the proportionate part of foregoing Warrant, Transferee shall
become a Holder under said proportionate part of said Warrant and subject to
the
rights, obligations and representations of Holder set forth in said
Warrant.
Dated:_______________ Signature:____________________
Address:______________________
C-12