FORM OF NOTICE OF CONVERSION
EX-10.59 2 ex10-59.htm
Exhibit 10.59
FORM OF NOTICE OF CONVERSION
The undersigned hereby elects to convert $____________ principal amount and $___________ interest of the Notes (defined below) into that number of shares of Common Stock to be issued pursuant to the conversion of the Notes (Common Stock) as set forth below, of U.S. Lithium Corp, (the “Borrower”) according to the conditions of the convertible notes of the Borrower (the “Notes”), as of the date written below. No fee will be charged to the Holder for any conversion, except for transfer taxes, if any.
The undersigned hereby requests that the Borrower issue shares of Common Stock as set forth below in the name(s) specified immediately below or, if additional space is necessary, on an attachment hereto:
| Original Date of Note | Principal | Interest | Principal + Interest | |||||||||
| $ | $ | $ | ||||||||||
| $ | $ | $ | ||||||||||
| $ | $ | $ | ||||||||||
| Total: | $ | $ | $ | |||||||||
| Amount | Conversion Price | Shares | ||||||
| $ | $ | 0.195 | ||||||
Please issue the Shares in Book Entry / DRS as follows: -
Name:
Address:
City, State:
Date of Conversion: June 28, 2019
Applicable Conversion Price: $ 0.195
Number of Shares to be Issued Pursuant to Conversion of the Notes:___________
Amount of Principal Balance Due Remaining on the Notes: $ 0.00
__________________________________________
Signature of Note Holder
Accepted and approved this 28th day of June 2019.
U.S. Lithium Corp
__________________________________________
Gregory Rotelli, President
