Common use of Exercise Form Clause in Contracts

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants The undersigned holder, _______________, hereby irrevocably elects to exercise ______________________ (_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to ____________________________________________________________________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (Signature)

Appears in 4 contracts

Samples: Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc)

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Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants The undersigned holder, _______________, hereby irrevocably elects to exercise ______________________ (_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to ____________________________________________________________________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (Signature)

Appears in 4 contracts

Samples: Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc)

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants The undersigned holder, _______________, hereby irrevocably elects to exercise ______________________ (_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to ____________________________________________________________________ __________________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (Signature)

Appears in 3 contracts

Samples: Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc), Warrant Agreement (Symmetry Holdings Inc)

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants The undersigned holder, _______________, Registered Owner hereby irrevocably elects to exercise ______________________ (_________) Warrants evidenced represented by this Warrant Certificate, and to purchase the shares of Common Stock of PSM Holdings, Inc., a Delaware corporation issuable upon the exercise of such Warrants, and requests that certificates for such shares shall be issued in the name of and be delivered to ____________________________________________________________________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ ________________________________ ________________________________ ________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEEPlease print or type name and address) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______be delivered to: ________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. ________________________________ ________________________________ ________________________________ (SignaturePlease print or type name and address) Please insert social security or other identifying number: _______________________ By executing this Exercise Form, the undersigned confirms that he, she or it is an “accredited investor” as defined in Rule 501(a) of Regulation D promulgated by the U.S. Securities and Exchange Commission. If such number of Warrants shall not be all of the Warrants evidenced by the Warrant Certificate, a new Warrant Certificate for the balance of such Warrants be registered in the name of and delivered to, the Registered Owner at the address stated below. IMPORTANT: The name of the person exercising this Warrant must correspond with the name of the Registered Owner written on the face of this Warrant Certificate in every particular, without alteration or any change whatever, unless it has been assigned by completing the Assignment form below. Dated: ________________, 201___ Signature of Registered Owner (Please Print Address) ASSIGNMENT FORM FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfers unto: ________________________________ ________________________________ ________________________________ ________________________________ (Please print or type name and address) Please insert social security or other identifying number: _______________________ ________________ of the Warrants represented by this Warrant Certificate, and hereby irrevocably constitutes and appoints any officer of PSM Holdings, Inc., a Delaware corporation (the “Company”), or its transfer agent and registrar as lawful Attorney to transfer this Warrant Certificate on the books of the Company, with full power of substitution in the premises. Dated: ________________, 201___ Signature of Registered Owner

Appears in 2 contracts

Samples: PSM Holdings Inc, PSM Holdings Inc

Exercise Form. (To Be Executed by the Holder in Order to Exercise Warrants be executed upon exercise of this Warrant) The undersigned holder, _______________, hereby irrevocably elects to exercise ________the right, represented by this Warrant, to purchase ______________ (_________) Warrants evidenced by this of the Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates Shares and: o herewith tenders payment for such shares be issued Warrant Shares to the order of CopyTele, Inc. in the name amount of and be delivered to $______________________________________________________, in accordance with the terms of this Warrant; or o elects the cashless exercise option to be conducted in accordance with Section 1.1(b) and the other terms of this Warrant. The undersigned requests (a) that a certificate for such Warrant Shares be registered in the name of the undersigned (b) if such shares shall not include all of the shares issuable as provided in such Warrant, that a new Warrant of like tenor and date for the balance of the shares issuable thereunder be issued to the undersigned and (c) that such certificates and Warrant, if any, be delivered to the undersigned’s address below. The undersigned represents that it is acquiring such Warrant Shares for its own account for investment and not with a view to or for sale in connection with any distribution thereof. Dated:______________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ ____________________________ (Print Name) ____________________________ (Xxxxxx Xxxxxxx) ____________________________ (City) (State) (Zip Code) ____________________________ Social Security or Tax Identification Number Signed in the presence of: __________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (Signature)

Appears in 1 contract

Samples: Copytele Inc

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants MEDICAL MEDIA TELEVISION, INC. The undersigned holder, _______________, pursuant to the provisions of the within Warrant, hereby irrevocably elects to exercise _________________purchase _____ (_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon of Medical Media Television, Inc. covered by the exercise within Warrant. Dated: Signature ------------------ --------------------------- Address --------------------------- --------------------------- Number of such Warrants, and requests that certificates for such shares be issued in of Common Stock beneficially owned or deemed beneficially owned by the name Holder on the date of and be delivered to ___________________________________________Exercise: _________________________ ______ ____________________________________________________________________ASSIGNMENT FOR VALUE RECEIVED, _________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto __________________ the within Warrant and all rights evidenced thereby and does irrevocably constitute and appoint _____________, attorney, to transfer the said Warrant on the books of the within named corporation. Dated: Signature ------------------ --------------------------- Address --------------------------- --------------------------- PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ___________________________________________________ hereby sells, assigns and transfers unto __________________ ____________________________________________________________________________the right to purchase _________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented shares of Warrant Stock evidenced by the within Warrant Certificatetogether with all rights therein, and does hereby irrevocably constitute and appoint ______________________________________ Attorney , attorney, to transfer that part of the said Warrants Warrant on the books of the within-within named Corporation and Warrant Agent with full power of substitution in the premisescorporation. __________________________________ (Signature)Dated: Signature ------------------ --------------------------- Address --------------------------- --------------------------- FOR USE BY THE ISSUER ONLY:

Appears in 1 contract

Samples: Medical Media Television, Inc.

Exercise Form. (To Be Executed by the Holder in Order to Exercise Warrants be executed upon exercise of this Warrant) The undersigned holderhereby irrevocably elects to exercise the right, represented by this Warrant, to purchase __________ shares of Common Stock and herewith tenders payment for such Common Stock to the order of CD Radio Inc. in the amount of $__________, hereby irrevocably elects to exercise which amount includes payment of the par value for _________ of the Common Stock, in accordance with the terms of this Warrant. The undersigned requests that a certificate for such shares of Common Stock be registered in the name of __________________ (and that such certificates be delivered to _________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to _________ whose address is ______________________________________________________. Dated:______________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ ________________________________________________________ (Print Name) ______________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEEXxxxxx Xxxxxxx) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (City) (State) (Zip Code) Signed in the Presence of: __________________________ Exhibit B FORM OF ASSIGNMENT (To be executed only upon transfer of this Warrant) For value received, the undersigned registered holder of the within Warrant hereby sells, assigns and transfers unto ______________________ the right represented by such Warrant to purchase ________________ shares of Common Stock of CD Radio Inc. to which such Warrant relates and all other rights of the Warrantholder under the within Warrant, and appoints ______________________ Attorney to make such transfer on the books of CD Radio Inc. maintained for such purpose, with full power of substitution in the premises. This sale, assignment and transfer has been previously approved in writing by CD Radio Inc. Dated:______________ Signature)______________________________ ______________________________ (Print Name) ______________________________ (Xxxxxx Xxxxxxx) ______________________________ (City) (State) (Zip Code) Signed in the Presence of: __________________________

Appears in 1 contract

Samples: Cd Radio Inc

Exercise Form. (To Be Executed by the Holder in Order to Exercise Warrants be executed upon exercise of this Warrant) The undersigned holderhereby irrevocably elects to exercise the right, represented by this Warrant, to purchase __________ shares of Common Stock and herewith tenders payment for such Common Stock to the order of Sirius Satellite Radio Inc. in the amount of $__________, hereby irrevocably elects to exercise which amount includes payment of the par value for _________ of the Common Stock, in accordance with the terms of this Warrant. The undersigned requests that a certificate for such shares of Common Stock be registered in the name of __________________ (and that such certificates be delivered to _________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to _________ whose address is ____________________________________________________________________ ______ _______________________________________________________________________. Dated:______________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ _______________________________________________________ (Print Name) _______________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEEXxxxxx Xxxxxxx) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (City) (State) (Zip Code) Signed in the Presence of: _______________________________ Exhibit B FORM OF ASSIGNMENT (To be executed only upon transfer of this Warrant) For value received, the undersigned registered holder of the within Warrant hereby sells, assigns and transfers unto ______________________ the right represented by such Warrant to purchase ________________ shares of Common Stock of Sirius Satellite Radio Inc. to which such Warrant relates and all other rights of the Warrantholder under the within Warrant, and appoints ______________________ Attorney to make such transfer on the books of Sirius Satellite Radio Inc. maintained for such purpose, with full power of substitution in the premises. This sale, assignment and transfer has been previously approved in writing by Sirius Satellite Radio Inc. Dated: ___________________ Signature)_______________________________ _______________________________ (Print Name) _______________________________ (Xxxxxx Xxxxxxx) _______________________________ (City) (State) (Zip Code) Signed in the presence of:

Appears in 1 contract

Samples: Sirius Satellite Radio Inc

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Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants TO: INTERNET LIQUIDATORS INTERNATIONAL INC. The undersigned holder, _______________, hereby irrevocably elects exercises the right to exercise _________ Special Warrants for ________ Common Shares and __________ Share Purchase Warrants of INTERNET LIQUIDATORS INTERNATIONAL INC. (or such number of other securities or property to which such Special Warrants entitle the undersigned in lieu thereof or in addition thereto under the provisions of the Indenture mentioned in the within Special Warrant Certificate) according to the terms of the Indenture mentioned in the within Special Warrant Certificate. If any of the Common Shares and Share Purchase Warrants are to be issued to a person or persons other than the holder in those circumstances as set forth in the within Special Warrant Certificate, the holder must pay to CIBC Mellon Trust Company all requisite stamp or security transfer taxes or other governmental charges related thereto. (Print clearly) Name: Address in Full: Number of Special Warrants being Exercised: DATED this day of , 199_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to ______________________________________. ______________________________ ______ _______________________________________________________Signature of Special Warrantholder ______________________________ Name of Special Warrantholder (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this As registered on Special Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ ________________________________________________________ ______________________________ Print Full Address SCHEDULE "B" NOTICE TO SPECIAL WARRANTHOLDERS Reference is made to the Special Warrant Indenture made as of October 3, 1997 (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESSthe "Special Warrant Indenture") between Internet Liquidators International Inc. and CIBC Mellon Trust Company. Unless defined herein, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) capitalized terms used herein have the respective meanings ascribed to them in the Special Warrant Indenture. We hereby confirm that receipts have been issued by the securities commissions in each of the Qualifying Jurisdictions in respect of the prospectus qualifying the distribution of the Common Shares and Share Purchase Warrants issuable upon exercise of the Special Warrants. The last receipt was issued on __________________________ (by the _________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint _____________ Securities Commission. The Expiry Time is therefore 5:00 p.m. (Toronto Time) on ______________. A copy of the prospectus is enclosed herewith. SCHEDULE "C" NOTICE OF RETRACTION OF SPECIAL WARRANTS TO: INTERNET LIQUIDATORS INTERNATIONAL INC. The undersigned hereby exercises the right to retract _________ Special Warrants (not to exceed 25% of the Special Warrants represented by the within certificate) of INTERNET LIQUIDATORS INTERNATIONAL INC. according to the terms of the Indenture mentioned in the within Special Warrant Certificate. The undersigned hereby requests payment of the sum of $1.50 for each Special Warrant being retracted plus any accrued interest thereon. The undersigned further surrenders herewith the written Special Warrant Certificate and requests the issue and delivery of a new certificate representing those of the holder's Special Warrants which have not been retracted. Number of Special Warrants being Retracted: DATED this day of , 199_______. ______________________________ Attorney to transfer the said Warrants on the books Signature of the within-named Corporation and Warrant Agent with full power of substitution in the premises. ____Special Warrantholder ______________________________ Name of Special Warrantholder (Signature)As registered on Special Warrant Certificate) ______________________________ ______________________________ Print Full Address

Appears in 1 contract

Samples: Bid Com International Inc

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants TO: Agnico-Eagle Mines Limited The undersigned holder, _______________, holder of the within Warrants hereby irrevocably elects to exercise ______________________ (_________) exercises the Warrants evidenced by this Warrant Certificate, represented hereby and to purchase subscribes for the shares maximum number of Common Stock Shares (or other shares or securities or property issuable upon in accordance with the exercise Indenture) of such Warrants, Agnico-Eagle Mines Limited issuable pursuant to the within Warrants on the terms specified in the said Warrants and requests the Indenture. The undersigned hereby directs that certificates for such shares the said Common Shares be issued in the name of the undersigned and be delivered to _______________________________________the address of the undersigned as shown on the register of holders of Warrants, unless otherwise specified in the space provided below. ------------------------ ---------------------- -------------------------------- NAME(S) IN FULL ADDRESS(ES) NUMBER OF COMMON SHARES (include Postal Code) ------------------------ ---------------------- -------------------------------- ------------------------ ---------------------- -------------------------------- ------------------------ ---------------------- -------------------------------- ------------------------ ---------------------- -------------------------------- ------------------------ ---------------------- -------------------------------- (Please Print) Number of Warrants being Exercised: _____________________________ ______ [ ] Please check box if these certificates are to be delivered to the office where this Warrant Certificate is surrendered, failing which the certificates will be mailed to the address shown on the register. Please note that if Common Shares are to be issued to a person other than the registered holder, the registered holder must pay to the Trustee all exigible taxes and duly execute the form of transfer and the signature of the registered holder must be guaranteed. DATED this __________________________________________________________________ day of ____________________ , 2002. ------------------------------------------------------ Signature of Warrantholder ------------------------------------------------------ Print full name ------------------------------------------------------ Address in full ------------------------------------------------ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEESignature of Guarantor) ______________________ Name: ------------------------------------------------ (_________Authorized Signature Number) and, if such number Note: If the signature of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to person executing this form is to be guaranteed, it must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed be guaranteed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ______________________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ (Signature)an Eligible Institution.

Appears in 1 contract

Samples: Agnico Eagle Mines LTD

Exercise Form. (To Be Executed by the Holder in Order to Exercise Warrants be executed upon exercise of this Warrant) The undersigned holder, _______________, hereby irrevocably elects to exercise ____________the right, represented by this Warrant, to purchase __________ of the Warrant Shares and herewith tenders (i) payment for such Warrant Shares to the order of Midway Games Inc. in the amount of $_________ or (ii) Warrants to purchase _________) Warrants evidenced by this Warrant Certificate, and to purchase the _ shares of Common Stock issuable upon in order to exercise the exercise Conversion Right (as defined in Section 1.2 of such Warrantsthe Warrant) and payment of the par value for ________ of the Warrant Shares, and in either case, in accordance with the terms of this Warrant. The undersigned requests that certificates a certificate for such shares Warrant Shares be issued registered in the name of __________ and that such certificates be delivered to __________ whose address is ___________________________________________________________ ______ _____________________________________________________________________________________ . Dated: ------------------------ Signature ------------------------------------- ------------------------------------- (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEEPrint Name) ______________________ ------------------------------------- (_________Street Address) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered ------------------------------------- (City) (State) (Zip Code) Signed in the name Presence of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). --------------------------- Exhibit B ASSIGNMENT FORM (To Be Executed by the Holder in Order to Transfer Warrants be executed only upon transfer of this Warrant) For value received, the undersigned holder, _________________________________, registered holder of the within Warrant hereby sells, assigns and transfers unto ________________________________________________________________________ the right represented by such Warrant to purchase ______________ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by shares of Common Stock of Midway Games Inc. to which such Warrant relates and all other rights of the Warrantholder under the within Warrant Certificate(including, without limitation, the registration rights provided in Section 7 of the within Warrant), and does hereby irrevocably constitute and appoint ___________________appoints ___________________ Attorney to make such transfer the said Warrants on the books of the within-named Corporation and Warrant Agent Midway Games Inc. maintained for such purpose, with full power of substitution in the premises. __________________________________ Dated: ------------------------ Signature ------------------------------------- ------------------------------------- (Signature)Print Name) ------------------------------------- (Street Address) ------------------------------------- (City) (State) (Zip Code) Signed in the Presence of: ---------------------------

Appears in 1 contract

Samples: Midway Games Inc

Exercise Form. To Be Executed Dated:_____________ TO: Winsonic Digital Media Group, Ltd. (the “Company”) The undersigned hereby irrevocably elects to exercise the right to purchase represented by the Holder in Order attached Warrant for, and to Exercise Warrants The undersigned holderpurchase thereunder, ________________ shares of the Company’s common stock, par value $0.001 (the “Common Stock”), and hereby irrevocably elects makes payment of $______________ in payment of the actual Exercise Price thereof. [The number of share of Common Stock to exercise be issued does not include all shares of Common Stock purchasable as provided in the attached Warrant and, accordingly, a certificate evidencing a new Warrant for _________ shares of Common Stock is to be issued in the name of ______________________ (_________) Warrants evidenced by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to _______________________whose address is _____________________________________________ _________________________________ and whose (SS#)(FEIN#) is ____________________.] I ACKNOWLEDGE THAT SUCH SHARES OF COMMON STOCK HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED OR UNDER ANY APPLICABLE STATE SECURITIES LAWS AND SUCH SHARES OF COMMON STOCK MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF REGISTRATION OR AN EXEMPTION THEREFROM UNDER SUCH ACT AND UNDER ANY APPLICABLE STATE SECURITIES LAWS. THE COMPANY, IN ITS SOLE DISCRETION, SHALL HAVE THE RIGHT TO REQUIRE AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE COMPANY TO THE EFFECT THAT REGISTRATION UNDER THE ACT IS NOT REQUIRED IN CONNECTION WITH ANY PROPOSED TRANSFER NOR IS SUCH TRANSFER IN VIOLATION OF ANY APPLICABLE STATE SECURITIES LAWS. INSTRUCTIONS FOR REGISTRATION OF COMMON STOCK Name: ________________________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEEPlease type or print in block letters) (SS#)(FEIN#): ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________________________________________ (Signature) NOTICEAddress: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto _____________________________________________________________________________________ ________________________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) Signature: ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint __________________________________________________________________ Attorney (Signature must conform in all respects to transfer the said Warrants name of the Warrantholder as set forth on the books face of the within-named Corporation and Warrant Agent with full power of substitution in the premises. this Warrant.) ASSIGNMENT FORM FOR VALUE RECEIVED, _____________________________________________________________________________________________________________________ (Please type or print in block letters) hereby sells, assigns and transfers all rights of the undersigned under the attached Warrant with respect to the number of shares of Common Stock covered thereby set forth below, unto: Name of Assignee(s) SS#/FEIN# Address(es) No. of Shares Dated: _____________________ Signature): ________________________________________________________________________________________________ (Signature must conform in all respects to the name of the Warrantholder as set forth on the face of this Certificate.) By: ________________________________________________________________________________________________ Title: ________________________________________________________________________________________________ Dated: _____________________

Appears in 1 contract

Samples: Winsonic Digital Media Group LTD

Exercise Form. To Be Executed by the Holder in Order to Exercise Warrants [ISSUER] The undersigned holder, _______________, pursuant to the provisions of the within Warrant, hereby irrevocably elects to exercise purchase _____ shares of Common Stock of ____________________ (_________) Warrants evidenced covered by this Warrant Certificate, and to purchase the shares of Common Stock issuable upon the exercise of such Warrants, and requests that certificates for such shares be issued in the name of and be delivered to within Warrant. Dated: __________________________________________ Signature ___________________________ ______ _____________________________________________________________________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, requests that a new Warrant Certificate of like tenor for the balance of such Warrants be registered in the name of, and delivered to, the holder at the address stated below. __________________________________ (Signature) NOTICE: The signature to this form must correspond with the name as written upon the face of the certificate in every particular, without alteration or enlargement or any change whatever. __________________________________ (Dated) __________________________________ (Signature Guaranteed) THE SIGNATURE SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO SEC RULE 17Ad-15). ASSIGNMENT FORM To Be Executed by the Holder in Order to Transfer Warrants For value received, the undersigned holder, _________________________________, hereby sells, assigns and transfers unto __________________________________________________________Address ___________________________ ___________________________ Number of shares of Common Stock beneficially owned or deemed beneficially owned by the Holder on the date of Exercise: _________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________ hereby sells, assigns and transfers unto __________________ the within Warrant and all rights evidenced thereby and does irrevocably constitute and appoint _____________, attorney, to transfer the said Warrant on the books of the within named corporation. Dated: _________________ Signature ___________________________ (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, AND INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE) ______________________ (_________) Warrants represented by the within Warrant Certificate, and does hereby irrevocably constitute and appoint ___________Address ___________________________ Attorney to transfer the said Warrants on the books of the within-named Corporation and Warrant Agent with full power of substitution in the premises. __________________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________ hereby sells, assigns and transfers unto __________________ the right to purchase _________ shares of Warrant Stock evidenced by the within Warrant together with all rights therein, and does irrevocably constitute and appoint ___________________, attorney, to transfer that part of the said Warrant on the books of the within named corporation. Dated: _________________ Signature ___________________________ Address ___________________________ FOR USE BY THE ISSUER ONLY: This Warrant No. W-___ canceled (Signature)or transferred or exchanged) this _____ day of ___________, _____, shares of Common Stock issued therefor in the name of _______________, Warrant No. W-_____ issued for ____ shares of Common Stock in the name of _______________.

Appears in 1 contract

Samples: Silver Star Energy Inc

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