Common use of Commission Expires Clause in Contracts

Commission Expires. If the Affidavit is being made by a Beneficiary, a statement of the date of death of the Participant (and the Beneficiary in the case of the death of the Beneficiary receiving payments) must be added. I, _________________, under penalties of perjury, do hereby solemnly swear (i) that, pursuant to Section 4.2 of the Xxxxxxx Incorporated Grantor Trust For Senior Management Plans Trust Agreement between The Bank of New York (the “Trustee”) and Xxxxxxx Incorporated (the “Company”), as amended and restated as of [______], 2015 (the “Trust Agreement”), I am providing this Termination Affidavit to the Trustee and the Company in order to secure the benefits to which I am entitled under such Trust Agreement and the Xxxxxxx Incorporated Supplemental Management Retirement Plan (the “SMRP”); (ii) that a Termination (within the meaning of the Trust Agreement) occurred on _________ __, 20__; and (iii) that I am entitled to a [“Change of Control Retirement Benefit”] [Retirement Benefit other than a Change of Control Retirement Benefit] [Disability Benefit other than a “Change of Control Retirement Benefit”] [Pre-Retirement Death Benefit other than a “Change of Control Retirement Benefit” and I was married to the Participant throughout the one-year period ending on the date of Participant’s death] [Post-Retirement Death Benefit other than a “Change of Control Retirement Benefit”]. Participant’s Signature (1) ss.: On this ___ day of ____________, 20__, before me personally came _______________, to me known, who, being by me duly sworn, said that he\she resides at ____________________ __________________________ and that the statements herein are all true and correct. Notary Public

Commission Expires. If the Affidavit is being made by a Beneficiary, a statement of the date of death of the Participant (and the Beneficiary in the case of the death of the Beneficiary receiving payments) must be added. I, _________________, under penalties of perjury, do hereby solemnly swear (i) that, pursuant to Section 4.2 of the Xxxxxxx Incorporated Grantor Trust For Senior Management Plans Trust Agreement between The Bank of New York (the “Trustee”) and Xxxxxxx Incorporated (the “Company”), as amended and restated as of [______], 2015 (the “Trust Agreement”), I am providing this Termination Affidavit to the Trustee and the Company in order to secure the benefits to which I am entitled under such Trust Agreement and the Xxxxxxx Incorporated Amended and Restated Supplemental Management Executive Retirement Plan (the “SMRPSERP”); (ii) that a Termination (within the meaning of the Trust Agreement) occurred on _________ __, 20__; and (iii) that I am entitled to a [“Change of Control Retirement Benefit”] [Retirement Benefit other than a Change of Control Retirement Benefit, and I am an Accrued Vested Participant] [Retirement Benefit other than a “Change of Control Retirement Benefit”, and I am not an Accrued Vested Participant] [Disability Benefit other than a “Change of Control Retirement Benefit”] [Pre-Retirement Death Benefit other than a “Change of Control Retirement Benefit” and I was married to the Participant throughout the one-year period ending on the date of Participant’s death] [Post-Retirement Death Benefit other than a “Change of Control Retirement Benefit”]. Participant’s Signature (1) ss.: On this ___ day of ____________, 20__, before me personally came _______________, to me known, who, being by me duly sworn, said that he\she resides at ____________________ __________________________ and that the statements herein are all true and correct. Notary Public

Commission Expires. If the Affidavit is being made by a Beneficiary, a statement of the date of death of the Participant (and the Beneficiary in the case of the death of the Beneficiary receiving payments) must be added. I, _________________, under penalties of perjury, do hereby solemnly swear (i) that, pursuant to Section 4.2 of the Xxxxxxx Incorporated Grantor Trust For Senior Management Plans Trust Agreement between The Bank of New York (the “Trustee”) and Xxxxxxx Incorporated (the “Company”), as amended and restated as of [________], 2015 (the “Trust Agreement”), I am providing this Termination Affidavit to the Trustee and the Company in order to secure the benefits to which I (or the Participant) am entitled under such Trust Agreement and the Xxxxxxx Incorporated Supplemental Management Retirement Top Hat Restoration Plan (the “SMRPPlan”); (ii) that a Termination (within the meaning of the Trust Agreement) occurred on _________ __, 20___ ; and (iii) that the Participant [was/was not] deceased/that I [was/was not] in pay status as of the date of the Change of Control (as defined in the Plan); (iv) that I (or the Participant) am entitled to a [“Change of Control Retirement Benefit”] [Retirement Benefit other than a Change of Control Retirement Benefit] [Disability Benefit other than a “Change of Control Retirement Benefit”] [Pre-Retirement Death Benefit other than a “Change of Control Retirement Benefit” and I was married to ] under the Participant throughout the one-year period ending on the date of Participant’s death] [Post-Retirement Death Benefit other than a “Change of Control Retirement Benefit”]Plan. Participant’s Signature (1) ss.: On this ___ day of ____________, 20__, before me personally came _______________, to me known, who, being by me duly sworn, said that he\she resides at ____________________ __________________________ and that the statements herein are all true and correct. Notary Public