Common use of FORM OF ELECTION TO EXERCISE Clause in Contracts

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canada. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)

Appears in 2 contracts

Samples: Shareholder Rights Plan Agreement, Shareholder Rights Plan Agreement

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FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder executed if such holder desires to exercise the Rights Certificate.) TO: PACIFIC SUNWEAR OF CALIFORNIA, INC. The undersigned hereby irrevocably elects to exercise whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, shares of Participating Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such securities shares be issued in the name of: (Name) (Address) (City and Province) : Social Insurance Number Security or other taxpayer identification number. Other Taxpayer Identification Number: If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) : Social Insurance Number Security or other taxpayer identification number. Other Taxpayer Identification Number: Dated: , Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature Signatures must be guaranteed by a member firm of a recognized stock exchange an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in Canadaan approved signature guarantee Medallion program), or a commercial bank or trust company having an office or correspondent in Canadapursuant to Exchange Act Rule 17Ad-15. ……………………………………………………………………………………………………… CERTIFICATE ........................................................................................................................ (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this the attached Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto (as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)......................................................................................................

Appears in 2 contracts

Samples: Shareholder Protection Rights Agreement (Pacific Sunwear of California Inc), Shareholder Protection Rights Agreement (Pacific Sunwear of California Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: GREAT PANTHER MINING LIMITED The undersigned hereby irrevocably elects to exercise ___________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Common Shares be issued in the name ofto: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number Insurance, social security or other taxpayer identification number. Dated: number DATED___________________________ Signature Guaranteed: Guaranteed ______________________________________ Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial Canadian chartered bank or trust company having an office or correspondent eligible guarantor institution with membership in Canadaan approved signature medallion guarantee program. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) true The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Person, any Affiliate or Associate thereof of such Acquiring Person or a any Person acting jointly or in concert with an the Acquiring Person Person, or an with any Affiliate or Associate thereof. Capitalized terms shall have of the meaning ascribed thereto Acquiring Person, or any Affiliate or Associate of such Persons so acting jointly or in concert (each as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (GREAT PANTHER MINING LTD)

FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: Signature (Signature must correspond to the name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank or trust company, a member firm of a recognized stock exchange in CanadaCanada or a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or the Financial Industry Regulatory Authority or a commercial bank or trust company having an office or correspondent in CanadaCanada or the United States or a member of the Securities Transfer Association Medallion (STAMP) Program. ……………………………………………………………………………………………………… ........................................................................................................................................................................ WSLegal\036506\00101\10296983v3 CERTIFICATE (To be completed if true.) The undersigned party Person exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereofany of the foregoing. Capitalized terms in this Certificate shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (Please print name of Signatory) ........................................................................................................................................................................ (To be attached to each Rights Certificate.)) WSLegal\036506\00101\10296983v3

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: _____________________________ The undersigned hereby irrevocably elects to exercise ____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canada. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Tc Energy Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ODYSSEY TRUST COMPANY AND TO: TANZANIAN GOLD CORPORATION The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Common Shares be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed__________________________________ Signature: Signature __________________________________ (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature Guaranteed: Signature must be guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company or a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in CanadaMedallion Signature Guarantee Program. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of the Corporation, the Rights Agent and all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Dated: __________________________________ Signature: __________________________________ (Signature ……………………………………………………………………………………………………… (To must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever) Signature Guaranteed: Signature must be attached to each Rights Certificateguaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company or a member of a recognized Medallion Signature Guarantee Program.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Tanzanian Gold Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise whole Rights represented by the attached Rights Certificate to purchase the Common Shares Units or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: of (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank, a Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canadamember of the Securities Transfer Association Medallion (STAMP) Program. ……………………………………………………………………………………………………… -------------------------------------------------------------------------------------------------------------------------------------- CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common SharesUnits, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Unitholder Rights Agreement. Signature ……………………………………………………………………………………………………… -------------------------------------------------------------------------------------------------------------------------------------- (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Unitholder Rights Plan Agreement (Advantage Energy Income Fund)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: _____________________________ The undersigned hereby irrevocably elects to exercise ____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canada. ………………………………………………………………………………………………………..............................................................................................................................................................................…… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature …………………………………………………………………………………………………………… .............................................................................................................................................................................. (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Transcanada Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ----------------------------------------- The undersigned hereby irrevocably elects to exercise ____________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: -------------------------------------------------------------------------------- (Name) -------------------------------------------------------------------------------- (Address) -------------------------------------------------------------------------------- (City and Province) -------------------------------------------------------------------------------- Social Insurance Number or other taxpayer identification number. If such number of Rights shall are not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Name) -------------------------------------------------------------------------------- (Address) -------------------------------------------------------------------------------- (City and Province) -------------------------------------------------------------------------------- Social Insurance Number or other taxpayer identification number. Dated: ------------------------- ------------------------------------ Signature Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, Canada or a commercial bank or trust company having an office or correspondent in Canada. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Golden Star Resources LTD)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise exercise_____________________________________________________________________________________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: :__________________________________________________________________________________________ Signature Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a major Schedule I Canadian chartered bank, or a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in CanadaMedallion guarantee program. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Transalta Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: _____________________ The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: _______________________________________________________________ (Name) _______________________________________________________________ (Address) _______________________________________________________________ (City and Province) _______________________________________________________________ Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________________________________________ (Name) _______________________________________________________________ (Address) _______________________________________________________________ (City and Province) _______________________________________________________________ Social Insurance Number or other taxpayer identification number. Dated: ________________________ _____________________________________ Signature _____________________________________ (Please print name of Signatory) Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank or trust company, a member firm of a recognized stock exchange in Canada, a member of a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in Canada. ……………………………………………………………………………………………………… Canada or the United States or a member of the Securities Transfer Association Medallion (Stamp) Program CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereofany of the foregoing. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. _____________________________________ Signature ……………………………………………………………………………………………………… _____________________________________ (Please print name of Signatory) (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Banro Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: _____________________________ The undersigned hereby irrevocably elects to exercise ____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canada. - 2 - ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Transcanada Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise _____________________whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: Signature Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in CanadaCanada or the United States. …………………………………………………………………………………………………………… ...…. 242813.v10 CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereofany of the foregoing. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature …………………………………………………………………………………………………………… ...…. (To be attached to each Rights Certificate.)) 242813.v10

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Talisman Energy Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise ----------------------- whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities shares be issued in the name of: (Name) (Address) (City and Province) ---------------------------------------- ---------------------------------------- ---------------------------------------- Address ------------------------------------------------------------ Social Insurance Insurance, Social Security or Other Taxpayer Identification Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) ---------------------------------------- ---------------------------------------- ---------------------------------------- Address ------------------------------------------------------------ Social Insurance Insurance, Social Security or Other Taxpayer Identification Number or other taxpayer identification number. DatedDate: -------------------- ---------------------------------------- Signature Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in CanadaCanada or the United States. ……………………………………………………………………………………………………… CERTIFICATE ------------------------------------------------------------------------------- (To be completed by exercisor if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereoftherewith. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. ------------------------------------ Signature ……………………………………………………………………………………………………… ------------------------------------ (To please print name of Signatory) NOTICE In the event the Certificate set forth above in the applicable Forms of Assignment or Election is not completed, the Corporation will deem the Beneficial Owner of the Rights evidenced by this Rights Certificate to be attached an Acquiring Person or an Affiliate or Associate thereof and, in the case of an Assignment, will affix a legend to each that effect on any Rights Certificates issued in exchange for this Rights Certificate. Capitalized terms shall have the meaning ascribed thereto in the Rights Agreement.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Mdsi Mobile Data Solutions Inc /Can/)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: NEXEN INC. The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such shares (or other, securities or title to such property) be issued in the name of: ___________________________________________ (Name) ___________________________________________ (AddressStreet) ___________________________________________ (City and State or Province) Social Insurance Number ___________________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ___________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________________ (Name) ______________________________________ (AddressStreet) ______________________________________ (City and State or Province) Social Insurance Number ______________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ______________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian Schedule 1 chartered bank, a major Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank member of a recognized Medallion Program (STAMP, MSP or trust company having an office or correspondent in CanadaSEMP). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person any of the foregoing (all capitalized terms, and the phrase "acting jointly or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in concert", are used as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Dated: Signature:

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Nexen Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: CAE INC. The undersigned hereby irrevocably elects to exercise ________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Shares be issued in the name ofto: ---------------------------- (NameNAME) ---------------------------- (AddressADDRESS) ---------------------------- (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ---------------------------- (NameNAME) ---------------------------- (AddressADDRESS) ---------------------------- (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. Dated: ---------------------------------------------------------- SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated --------------------- Signature Guaranteed: Guaranteed ------------------------------------------------------ Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank, a Canadian trust company or a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canadamember of the Securities Transfer Association Medallion Program (Stamp). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) TO BE COMPLETED IF TRUE The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a any Person acting jointly or in concert consent with an Acquiring Person any of the foregoing or an any Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto of such Person (as defined in the Shareholder Rights Agreement). ------------------------------------------ Signature ……………………………………………………………………………………………………… ASSIGNMENT OF AGENCIES AGREEMENT THIS AGREEMENT made as of the 15th day of January, 2001 BETWEEN: CAE INC., a company incorporated under the laws of C.B.C.A (To be attached to each Rights Certificate.)hereinafter called the "Company") PARTY OF THE FIRST PART AND: MONTREAL TRUST COMPANY, a trust company existing under the laws of Canada PARTY OF THE SECOND PART AND: MONTREAL TRUST COMPANY OF CANADA, a trust company existing under the laws of Canada (Montreal Trust Company and Montreal Trust Company of Canada being hereinafter referred to, either individually or collectively as the context may require, as "Montreal Trust") PARTY OF THE THIRD PART AND: COMPUTERSHARE TRUST COMPANY OF CANADA, a trust company existing under the laws of Canada with an office in the City of Toronto, in the Province of Ontario (hereinafter called "Computershare") PARTY OF THE FOURTH PART

Appears in 1 contract

Samples: Agreement (Cae Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ________________________________________ The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated:______________________________________ Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: :______________________________________ Signature (Please print name of Signatory) Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial Canadian chartered bank or trust company having an office or correspondent eligible guarantor institution with membership in Canadaan approved signature medallion guarantee program. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereofany of the foregoing. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature ……………………………………………………………………………………………………… (Please print name of Signatory) ..................................................................................................................................................................................................................................................................................................... (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Taseko Mines LTD)

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FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: CAE INC. The undersigned hereby irrevocably elects to exercise __________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Shares be issued in the name ofto: _______________________________ (NameADDRESS) _______________________________ (AddressCITY AND STATE OR PROVINCE) (City and Province) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________ (NameNAME) _______________________________ (AddressADDRESS) _______________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. Dated: __________________________________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated ___________________________ Signature Guaranteed: Guaranteed ____________________________________________ Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by an - "Eligible Institution" i.e. a Canadian Schedule 1 chartered bank, a major trust company in Canada, a member firm of the Securities Transfer Association Medallion Program (STAMP), a member of the Stock Exchange Medallion Program (SEMP) or a member of the New York Stock Exchange, Inc. Medallion Signature Program (MSP). Members of these programs are usually members of a recognized stock exchange in Canada and the United States, members of the Investment Dealers Association of Canada, or a commercial bank or members of the National Association of Securities Dealers of banks and trust company having an office or correspondent companies in Canadathe United States. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) true The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a any Person acting jointly or in concert consent with an Acquiring Person any of the foregoing or an any Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto of such Person (as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)_____________________________________________ Signature

Appears in 1 contract

Samples: Shareholder Protection Rights Plan Agreement (Cae Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: The undersigned hereby irrevocably elects to exercise _______________________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities shares be issued in the name of: (Name) (Address) (City and Province) _________________________________________ _________________________________________ _________________________________________ Address ___________________________________________________________ Social Insurance Insurance, Social Security or Other Taxpayer Identification Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _________________________________________ _________________________________________ Address ___________________________________________________________ Social Insurance, Social Security or Other Taxpayer Identification Number Date: __________________________ ________________________________ Signature (Nameplease print name of signatory) (Address) (City and Province) Social Insurance Number or other taxpayer identification number. DatedSignature Guarantee: Signature Guaranteed: Signature (Signature must correspond to the name as written upon the face of this the Rights Certificate Certificate, in every particular, without alteration or enlargement enlargement, or any change whatsoever.) ). Signature must be guaranteed by a member firm of a recognized stock exchange in Canada, or a commercial Canadian chartered bank or trust company having an office or correspondent eligible guarantor institution with membership in Canadaan approved signature medallion guarantee program. ……………………………………………………………………………………………………… CERTIFICATE ______________________________________________________________________________ (To be completed by the exercisor if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereoftherewith. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. __________________________________ Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.please print name of Signatory)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Rubicon Minerals Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: __________________________________ The undersigned hereby irrevocably elects to exercise _______________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: ____________________________________ (Name) ____________________________________ (Address) ____________________________________ (City and Province) _________________________________________________________________ Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ____________________________________ (Name) ____________________________________ (Address) ____________________________________ (City and Province) _________________________________________________________________ Social Insurance Number or other taxpayer identification number. Dated: ______________________________ Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank, a Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canadamember of the Securities Transfer Association Medallion (STAMP) Program. ……………………………………………………………………………………………………… ------------------------------------- CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. ______________________________ Signature ……………………………………………………………………………………………………… ------------------------------------- (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Richmont Mines Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: OPEN TEXT CORPORATION The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such shares (or other, securities or title to such property) be issued in the name of: (Name) (AddressStreet) (City and State or Province) Social Insurance Number (Country, Postal Code or other taxpayer identification number. Zip Code) SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (AddressStreet) (City and State or Province) Social Insurance Number (Country, Postal Code or other taxpayer identification number. Zip Code) SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Dated: Signature GuaranteedSignature: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian Schedule 1 chartered bank, a major Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank member of a recognized Medallion Program (STAMP, MSP or trust company having an office or correspondent in CanadaSEMP). ……………………………………………………………………………………………………… CERTIFICATE _____________________________________________________________________________________________ (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized any of the foregoing (all capitalized terms shall have the meaning ascribed thereto are used as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Dated: Signature:

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Open Text Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: OPEN TEXT CORPORATION The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such shares (or other, securities or title to such property) be issued in the name of: ___________________________________________ (Name) ___________________________________________ (AddressStreet) ___________________________________________ (City and State or Province) Social Insurance Number ___________________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ___________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________________ (Name) ______________________________________ (AddressStreet) ______________________________________ (City and State or Province) Social Insurance Number ______________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ______________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian Schedule 1 chartered bank, a major Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank member of a recognized Medallion Program (STAMP, MSP or trust company having an office or correspondent in CanadaSEMP). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized any of the foregoing (all capitalized terms shall have the meaning ascribed thereto are used as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Dated: Signature:

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Open Text Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: CAE INC. The undersigned hereby irrevocably elects to exercise ________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Shares be issued in the name ofto: ____________________________ (NameNAME) ____________________________ (AddressADDRESS) ____________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ____________________________ (NameNAME) ____________________________ (AddressADDRESS) ____________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. Dated: __________________________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated ___________________ Signature Guaranteed: Guaranteed ________________________________________________ Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian chartered bank, a Canadian trust company or a member firm of a recognized stock exchange in Canada, or a commercial bank or trust company having an office or correspondent in Canadamember of the Securities Transfer Association Medallion Program (Stamp). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) TO BE COMPLETED IF TRUE The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a any Person acting jointly or in concert consent with an Acquiring Person any of the foregoing or an any Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto of such Person (as defined in the Shareholder Rights Agreement). __________________________________ Signature ……………………………………………………………………………………………………… ASSIGNMENT OF AGENCIES AGREEMENT THIS AGREEMENT made as of the 15th day of January, 2001 BETWEEN: CAE INC., a company incorporated under the laws of C.B.C.A (To be attached to each Rights Certificate.)hereinafter called the "Company") PARTY OF THE FIRST PART AND: MONTREAL TRUST COMPANY, a trust company existing under the laws of Canada PARTY OF THE SECOND PART AND: MONTREAL TRUST COMPANY OF CANADA, a trust company existing under the laws of Canada (Montreal Trust Company and Montreal Trust Company of Canada being hereinafter referred to, either individually or collectively as the context may require, as "Montreal Trust") PARTY OF THE THIRD PART AND: COMPUTERSHARE TRUST COMPANY OF CANADA, a trust company existing under the laws of Canada with an office in the City of Toronto, in the Province of Ontario (hereinafter called "Computershare") PARTY OF THE FOURTH PART

Appears in 1 contract

Samples: Shareholder Protection Rights Plan Agreement (Cae Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: BAJA MINING CORP. The undersigned hereby irrevocably elects to exercise ________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Common Shares be issued in the name ofto: _______________________________ (NameNAME) _______________________________ (AddressADDRESS) _______________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________ (NameNAME) _______________________________ (AddressADDRESS) _______________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. Dated: __________________________________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated ___________________________ Signature Guaranteed: Guaranteed Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by an - "Eligible Institution" i.e. a Canadian Schedule 1 chartered bank, a major trust company in Canada, a member firm of the Securities Transfer Association Medallion Program (STAMP), a member of the Stock Exchange Medallion Program (SEMP) or a member of the New York Stock Exchange, Inc. Medallion Signature Program (MSP). Members of these programs are usually members of a recognized stock exchange in CanadaCanada and the United States, members of the Investment Industry Regulatory Organization of Canada (IIROC), members of the National Association of Securities Dealers, or a commercial bank or of banks and trust company having an office or correspondent companies in Canadathe United States. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) true The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Person, any Affiliate or Associate thereof of such Acquiring Person or a any Person acting jointly or in concert with an the Acquiring Person Person, or an with any Affiliate or Associate thereof. Capitalized terms shall have of the meaning ascribed thereto Acquiring Person, or any Affiliate or Associate of such Persons so acting jointly or in concert (each as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Baja Mining Corp.)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: AURIZON MINES LTD. The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such shares (or other, securities or title to such property) be issued in the name of: ___________________________________________ (Name) ___________________________________________ (AddressStreet) ___________________________________________ (City and State or Province) Social Insurance Number ___________________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ___________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________________ (Name) ______________________________________ (AddressStreet) ______________________________________ (City and State or Province) Social Insurance Number ______________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ______________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian Schedule 1 chartered bank, a member firm of the Securities Transfer Agent Medallion Program (STAMP), a recognized stock exchange in Canada, member of the Stock Exchange Medallion Program (SEMP) or a commercial bank or trust company having an office or correspondent in Canadamember of the New York Stock Exchange Inc. Medallion Signature Program (MSP). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person any of the foregoing (all capitalized terms, and the phrase “acting jointly or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in concert”, are used as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Dated: Signature:

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Aurizon Mines LTD)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: CAE INC. The undersigned hereby irrevocably elects to exercise _________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities Shares be issued in the name ofto: _______________________________ (NameNAME) _______________________________ (AddressADDRESS) _______________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________ (NameNAME) _______________________________ (AddressADDRESS) _______________________________ (City and ProvinceCITY AND STATE OR PROVINCE) Social Insurance Number or other taxpayer identification number. Dated: __________________________________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated Signature Guaranteed: Guaranteed Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by an - "Eligible Institution" i.e. a Canadian Schedule 1 chartered bank, a major trust company in Canada, a member firm of the Securities Transfer Association Medallion Program (STAMP), a member of the Stock Exchange Medallion Program (SEMP) or a member of the New York Stock Exchange, Inc. Medallion Signature Program (MSP). Members of these programs are usually members of a recognized stock exchange in Canada and the - 2 - United States, members of the Investment Dealers Association of Canada, or a commercial bank or members of the National Association of Securities Dealers of banks and trust company having an office or correspondent companies in Canadathe United States. ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) true The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a any Person acting jointly or in concert consent with an Acquiring Person any of the foregoing or an any Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto of such Person (as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)_____________________________________________ Signature

Appears in 1 contract

Samples: Shareholder Protection Rights Plan Agreement (Cae Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: PEMBINA PIPELINE CORPORATION The undersigned hereby irrevocably elects to exercise ______________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such Common Shares (or other securities or title to such property) be issued in the name of: ___________________________________________ (Name) ___________________________________________ (AddressStreet) ___________________________________________ (City and State or Province) Social Insurance Number ___________________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ___________________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) ______________________________________ (AddressStreet) ______________________________________ (City and State or Province) Social Insurance Number ______________________________________ (Country, Postal Code or other taxpayer identification number. Zip Code) ______________________________________ SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Dated: Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) Signature must be guaranteed by a Canadian Schedule 1 chartered bank, a major Canadian trust company, a member firm of a recognized stock exchange in Canada, or a commercial bank member of a recognized Medallion Program (STAMP, MSP or trust company having an office or correspondent in CanadaSEMP). ……………………………………………………………………………………………………… CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that with the exception of _____________________ Rights, the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a by any Person acting jointly or in concert with an Acquiring Person any of the foregoing (all capitalized terms, and the phrase "acting jointly or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in concert", are used as defined in the Shareholder Rights Agreement). Signature ……………………………………………………………………………………………………… (To be attached to each Rights Certificate.)Dated: Signature:

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Pembina Pipeline Corp)

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