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| | | | | | A-1 | | | |
| | | | | | B-1 | | | |
| | | | | | C-1 | | | |
| | | | | | D-1 | | |
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Name and Address of Beneficial Owner
|
| |
Number of
Shares |
| |
% of
Ownership |
| ||||||
| Other holders of more than 5% | | | | | | | | | | | | | |
|
325 Capital LLC(1)
|
| | | | 12,961,653 | | | | | | 31.0% | | |
|
325 Capital Master Fund LP(2)
|
| | | | 2,166,407 | | | | | | 5.2% | | |
|
Gary Strahan(3)
|
| | | | 3,315,093 | | | | | | 7.9% | | |
| Named executive officers and current directors: | | | | | | | | | | | | | |
|
Stuart V. Flavin III
|
| | | | 78,003 | | | | | | *% | | |
|
David Gow(4)
|
| | | | 793,344 | | | | | | 1.9% | | |
|
Petros Kitsos
|
| | | | 64,638 | | | | | | *% | | |
|
Margaret Chu
|
| | | | 64,638 | | | | | | *% | | |
|
Daniel Friedberg
|
| | | | 101,207 | | | | | | *% | | |
|
Steven Winch(5)
|
| | | | 1,417,005 | | | | | | 3.4% | | |
|
Peter Baird(6)
|
| | | | 1,048,382 | | | | | | 2.5% | | |
|
All current executive officers and current directors as a group (9 individuals)(7)
|
| | | | 3,643,119 | | | | | | 8.71% | | |
| |
MULTISENSOR AI HOLDINGS, INC.
|
| |
Address for Notice:
MultiSensor AI Holdings, Inc. 2105 West Cardinal Drive Beaumont, Texas 77705 Attention: Chief Financial Officer Email:robert.nadolny@multisensorai.com |
|
| Signature of Authorized Signatory of Purchaser: |
|
| Name of Authorized Signatory: |
|
| Title of Authorized Signatory: |
|
| Email Address of Authorized Signatory: |
|
| |
|
| | | ||||
| |
I.
PURCHASE PRICE
Gross Proceeds to be Received
|
| |
$
|
| | ||
| |
II.
DISBURSEMENTS
|
| | | | | ||
| | | | | $ | | | ||
| | | | | $ | | | ||
| | | | | $ | | | ||
| | | | | $ | | | ||
| | | | | $ | | | ||
| | Total Amount Disbursed: | | | $ | | | ||
| |
WIRE INSTRUCTIONS:
Please see attached. |
| | | | | | |
| | Warrant Shares: [•] | | |
Issue Date: [•], 2025
|
|
| Name of Investing Entity: |
|
| | Name: | | |
(Please Print)
|
|
| | Address: | | |
(Please Print)
|
|
| | Phone Number: | | |
|
|
| | Email Address: | | |
|
|
| | Dated: , | | | | |
| | Holder’s Signature: | | | | |
| | Holder’s Address: | | | | |
| |
Page 2 to Conversion Notice dated
|
| |
|
| | for: | | |
|
|
| | | | |
(Conversion Date)
|
| | | | |
(Name of Holder)
|
|
| | |
Number of Series A Preferred Shares converted:
|
| | |
|
| |
| | |
Number of Series A Preferred Shares converted multiplied by 1,000:
|
| | |
(Number of Common Shares to be issued) |
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