Number of Warrant Shares represented by this certificate: [*]
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Issue Date: , 2025
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d) |
Mechanics of Exercise.
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e) |
Notice to Holder.
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d) |
Authorized Shares.
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IM CANNABIS CORP.
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By:
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Name: Oren Shuster
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Title: Chief Executive Officer
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Name:
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(Please Print)
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Address:
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(Please Print)
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Phone Number:
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Email Address:
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Dated:______________________________,__________________________
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Holder’s Signature:_______________________________________________
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Holder’s Address:________________________________________________
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TO:
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IM CANNABIS CORP. (THE “COMPANY”)
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AND TO:
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COMPUTERSHARE INVESTOR SERVICES INC., AS REGISTRAR AND TRANSFER AGENT FOR THE COMPANY’S COMMON SHARES (THE “TRANSFER AGENT”)
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X
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Signature of individual (if Seller is an individual)
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X
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Authorized signatory (if Seller is not an individual)
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Name of Seller (please print)
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Name of authorized signatory (please print)
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Official capacity of authorized signatory (please print)
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(1) |
no offer to sell the Common Shares was made to a person in the United States;
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(2) |
the sale of the Common Shares was executed in, on or through the facilities of the Toronto Stock Exchange, the TSX Venture Exchange, the Canadian Securities Exchange, the Cboe Canada Exchange or another “designated offshore securities
market” (as defined in Regulation S under the U.S. Securities Act), and, to the best of our knowledge, the sale was not pre-arranged with a buyer in the United States;
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(3) |
no “directed selling efforts” were made in the United States by the undersigned, any affiliate of the undersigned, or any person acting on behalf of the undersigned; and
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(4) |
we have done no more than execute the order or orders to sell the Common Shares as agent for the Seller and will receive no more than the usual and customary broker’s commission that would be received by a person executing such
transaction as agent.
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