Notice of Conversion under Senior Convertible Debenture – Sigyn Therapeutics Inc.
This document allows a debenture holder to convert part or all of the principal amount of a Senior Convertible Debenture issued by Sigyn Therapeutics Inc. into shares of the company’s common stock. The holder must confirm compliance with ownership limits and securities laws, and may be responsible for any transfer taxes if shares are issued to another person. No conversion fee is charged except for such taxes. The form requires details such as the amount to convert, number of shares to be issued, and delivery instructions.
Exhibit 10.1
ANNEX A
NOTICE OF CONVERSION
The undersigned hereby elects to convert principal under the Senior Convertible Debenture due [ ] of Sigyn Therapeutics Inc. (the “Company”), into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any.
By the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common Stock does not exceed the amounts specified under Section 4 of this Debenture, as determined in accordance with Section 13(d) of the Exchange Act.
The undersigned agrees to comply with the prospectus delivery requirements under the applicable securities laws in connection with any transfer of the aforesaid shares of Common Stock.
| Conversion calculations: | |
| Date to Effect Conversion: | |
| Principal Amount of Debenture to be Converted: $[ ] | |
| Number of shares of Common Stock to be issued: | |
| Signature: | |
| Name: | |
| Address for Delivery of Common Stock Certificates: | |
| Or | |
| DWAC Instructions: | |
| Broker No:______________ | |
| Account No:______________ |
| 1 |
