Common use of FORM OF ELECTION TO EXERCISE Clause in Contracts

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.)

Appears in 1 contract

Samples: Shareholder Rights Agreement (Cel Sci Corp)

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FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to upon exercise Rights represented by of Warrants on the Right CertificateExercise Date) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise [ ]of the Warrants represented by this Warrant Certificate for the whole number of Warrant Shares issuable upon the exercise of such Warrants. The undersigned requests that a certificate representing such Warrant Shares be registered in the name of _____________________________whose address is _______________________ Rights represented by this Right Certificate and that such certificate be delivered to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: ____________________ whose address is _______________________________________. Any cash payments to be paid in lieu of a fractional Warrant Share should be made to ________________________ whose address is ___________________ and the check representing payment thereof should be delivered to ________________________ whose address is ____________________. Dated: Name of holder of Warrant Certificate:_________________________________ (Please print name and address of transfereePrint) Tax Identification or Social Security Number:__________________________ Address:_______________________________________________________________ _______________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) Signature:_____________________________________________________________ Note: The above signature must correspond with the name as written upon the face of this Warrant Certificate in every particular, without alteration or enlargement or any change whatever and if the certificate representing the Warrant Shares or any Warrant Certificate representing Warrants not exercised is to be registered in a name other than that in which this Warrant Certificate is registered, or if any cash payment to be paid in lieu of a fractional share is to be made to a person other than the registered holder of this Warrant Certificate, the signature of the holder hereof must be guaranteed as provided in the Warrant Agreement. Dated: Signature:_____________________________________________________________ Please insert social security Note: The above signature must correspond with the name as written upon the face of this Warrant Certificate in every particular, without alteration or other identifying number: enlargement or any change whatever. Signature Guaranteed:__________________________________________________ [FORM OF ASSIGNMENT] For value received __________________________hereby sells, assigns and transfers unto ______________________ the within Warrant Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint __________________ attorney, to transfer said Warrant Certificate on the books of the within-named Company, with full power of substitution in the premises. Dated: ` Signature Signature:_____________________________________________________________ Note: The above signature must correspond with the name as written upon the face of this Warrant Certificate in every particular, without alteration or enlargement or any change whatever. Signature Guaranteed:__________________________________________________ I SCHEDULE OF EXCHANGES OF CERTIFICATED WARRANTS I The following exchanges of a part of this Global Warrant for certificated Warrants have been made: Number of Warrants Amount of decrease Amount of Increase this Global Signature of in Number of in Number of Warrant following authorized office Date of Warrants of this Warrants of this such decrease (or of Warrant Exchange Global Warrant Global Warrant increase) Agent This is to be included only if the Warrant is in global form. EXHIBIT B FORM OF LEGEND FOR GLOBAL WARRANT Any Global War-rant authenticated and delivered hereunder shall bear a legend in substantially the following form: THIS SECURITY IS A GLOBAL WARRANT WITHIN THE MEANING OF THE WARRANT AGREEMENT HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITORY OR A NOMINEE OF A DEPOSITORY OR A SUCCESSOR DEPOSITORY. THIS SECURITY IS NOT EXCHANGEABLE FOR SECURITIES REGISTERED IN THE NAME OF A PERSON OTHER THAN THE DEPOSITORY OR ITS NOMINEE EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE WARRANT AGREEMENT, AND NO TRANSFER OF THIS SECURITY (OTHER THAN A TRANSFER OF THIS SECURITY AS A WHOLE BY THE DEPOSITORY TO A NOMINEE OF THE DEPOSITORY OR BY A NOMINEE OF THE DEPOSITORY TO THE DEPOSITORY OR ANOTHER NOMINEE OF THE DEPOSITORY) MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE WARRANT AGREEMENT. UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION ("DTC"), TO ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE, OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. EXHIBIT C CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFER OF WARRANTS Re: Warrants to Purchase Common Shares (the "Warrants") of Dayton Superior Corporation This Certificate relates to __________ Warrants held by (the "Transferor"). The signature must be medallion guaranteed Transferor has requested the Warrant Agent by written order to exchange or register the transfer of a financial institution Warrant or Warrants. In connection with such request and in respect of each such Warrant, the Transferor hereby certifies that the Transferor is familiar with the Warrant Agreement dated as of June 16, 2000, among Dayton Superior Corporation, an Ohio corporation, and United States Trust Company of New York, as warrant agent (commercial bankthe "Warrant Agreement") relating to the above captioned Warrants and the restrictions on transfers thereof as provided in Section 1.08 of such Warrant Agreement, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 transfer of this Warrant does not require registration under the Securities Exchange Act of 19341933, as amendedamended (the "Act"), because*: [ ] Such Warrant is being acquired for the Transferor's own account, without transfer (in satisfaction of Section 1.08(a)(y)(A) of the Warrant Agreement).' [ ] Such Warrant is being transferred to a qualified institutional buyer (as defined in Rule 144A under the Act) in reliance on Rule 144A or is being transferred in accordance with Regulation S under the Act. A notary public [ ] Such Warrant is being transferred in accordance with Rule 144 under the Act. [ ] Such Warrant is being transferred in reliance on and in compliance with an exemption from the registration requirements of the Act, other than Rule 144A or Rule 144 or Regulation S under the Act. An opinion of counsel to the effect that such transfer does not sufficient.require registration under the Act accompanies this Certificate. [INSERT NAME OF TRANSFEROR] By:_____________________________ Date:__________________________ *Check applicable box. EXHIBIT D [Form of Transferee Letter of Representation in Connection with Transfers to Institutional Accredited Investors] DAYTON SUPERIOR CORPORATION 0000 Xxxxxxxxxx Xxxxxxx Xxxxx, Xxxxx 000 Xxxxxx, Xxxx 00000 Attention: General Counsel Ladies and Gentlemen: In connection with our proposed purchase of warrants to purchase Common Shares, no par value (the "Securities"), of Dayton Superior Corporation (the "Company "), we confirm that:

Appears in 1 contract

Samples: Warrant Agreement (Dayton Superior Corp)

FORM OF ELECTION TO EXERCISE. (To be executed by the registered holder if such holder desires to exercise the Rights represented by the Right Certificate.) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name ofTO: __________________________________________ (Please print name and address of transferee) The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by the attached Rights Certificate to purchase the 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: _______________________________________ If such number Signature (Please print name of Signatory) Signature Guaranteed: (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 an eligible guarantor institution with membership in an 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 shall not be all and Shares, that the Rights evidenced by this Right CertificateRights 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 new Right Certificate for Person acting jointly or in concert with any of the balance remaining of such Rights foregoing. Capitalized terms shall be registered have the meaning ascribed thereto in the name of and delivered to: Shareholder Rights Agreement. Signature (Please print name and address of transfereeSignatory) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must (To be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant attached to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficienteach Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Asanko Gold Inc.)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.).

Appears in 1 contract

Samples: Shareholder Rights Agreement (Cel Sci Corp)

FORM OF ELECTION TO EXERCISE. (To be executed exercised by the registered holder if such holder desires to exercise the Rights represented by the Right Certificate.) To CEL-SCI CORPORATION TO: Silvercorp Metals Inc. and Computershare Investor Services Inc. The undersigned hereby irrevocably Irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ 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: (Please print 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 address of transfereedelivered to: (Name) _____________(Address) (City and Province) Social Insurance Number or other taxpayer identification number. Dated: _____________________________ ____________________________________________ If such number Signature Signature Guaranteed: (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.) *The signature of the person executing this form of election to exercise must be guaranteed by a chartered bank or an eligible guarantor institution with membership in an approved signature guarantee medallion program. Silvercorp\Shareholder rights plan CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights shall not be all and Common Shares, that the Rights evidenced by this Right CertificateRights 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 new Right Certificate for Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the balance remaining of such Rights shall be registered meaning ascribed thereto in the name of and delivered toShareholder Rights Plan Agreement. Dated: (Please print name and address of transferee) __________________________________________ ____________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must (To be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant attached to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficienteach Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Silvercorp Metals Inc)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise the Rights represented by the Right Certificate.) To CEL-SCI CORPORATION TO: CBL & ASSOCIATES PROPERTIES, INC. The undersigned hereby irrevocably elects to exercise _______________________ whole Rights represented by this Right the attached Rights Certificate to purchase the Common Shares shares of Participating Preferred Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) _______Address: ___________________________________ _______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: ___________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered toAddress: (Please print name and address of transferee) __________________________________________ Social Security or Other Taxpayer Identification Number: Dated: _______________, ____ Signature Guaranteed: _________________________ Please insert social security Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or other identifying number: Dated: ` Signature Signature Guaranteed: The signature enlargement or any change whatsoever) Signatures must be medallion guaranteed by a financial an eligible guarantor institution (commercial bankbanks, stockbrokerstockbrokers, savings and loan, loan associations and credit union or trust company) that is a participant unions with membership in the Securities Transfer Agents an [To be attached to each Rights Certificate] approved signature guarantee Medallion Programprogram), pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amendedRule 17Ad‑15. A notary public is not sufficient.. (To be completed if true) The undersigned hereby represents, for the benefit of all holders of Rights and shares of Common Stock, that the Rights evidenced by 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 (as defined in the Rights Agreement). _________________________ Signature

Appears in 1 contract

Samples: Stockholder Protection Rights Agreement (CBL & Associates Properties Inc)

FORM OF ELECTION TO EXERCISE. (To be executed if the holder desires to exercise the Rights represented by the Right Certificate) To CEL-SCI CORPORATION TO: COMPUTERSHARE INVESTOR SERVICES INC. 3rd floor, 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, X.X. X0X 0X0 Attention: Manager, Client Services The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print whole Rights represented by the attached Rights Certificate to purchase the Common Shares issuable upon the exercise of such Rights and requests that certificates for such Common Shares be issued in the name of: Address: Social Insurance or Other Taxpayer Identification Number: If such number of Rights shall not be all the whole Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such whole Rights shall be registered in the name of and address of transferee) _____________________________delivered to: Full Address, including postal code: Social Insurance or Other Taxpayer Identification Number: Dated: _____________ __________________________________________ If such number [month, day, year] 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.) The signature of the person executing this power must be guaranteed by a participant of a recognized Medallion Guarantee Program, for example, a bank, credit union, brokerage house or by a member of a recognized stock exchange. CERTIFICATION (To be completed if true) The undersigned hereby represents, warrants and certifies for the benefit of all holders of Rights shall not be all and Common Shares, that the Rights evidenced by this Right CertificateCertificate are not, a new Right Certificate for and, to the balance remaining knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate of an Acquiring Person or any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate of an Acquiring Person (as such Rights shall be registered terms are defined in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amendedShareholder Rights Agreement). A notary public is not sufficient.)Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Canarc Resource Corp)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI FORTITUDE GOLD CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: ______________ Dated: ` ______________ Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.)

Appears in 1 contract

Samples: Shareholder Rights Agreement (Fortitude Gold Corp)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: ____________________ Dated: ` ____________________ Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.)

Appears in 1 contract

Samples: Shareholder Rights Agreement (Cel Sci Corp)

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FORM OF ELECTION TO EXERCISE. (To be executed if the holder desires to exercise the Rights represented by the Right Certificate) To CEL-SCI CORPORATION TO: COMPUTERSHARE INVESTOR SERVICES INC. 3rd floor, 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, X.X. X0X 0X0 Attention: Manager, Client Services The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by this Right the attached Rights Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares Common Shares be issued in the name of: Address: Social Insurance or Other Taxpayer Identification Number: If such number of Rights shall not be all the whole Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such whole Rights shall be registered in the name of and delivered to: Full Address, including postal code: Social Insurance or Other Taxpayer Identification Number: Dated: _____________[month, day, year] 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.) The signature of the person executing this power must be guaranteed by a participant of a recognized Medallion Guarantee Program, for example, a bank, credit union, brokerage house or by a member of a recognized stock exchange. CERTIFICATION (To be completed if true) The undersigned hereby represents, warrants and certifies for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Right Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate of an Acquiring Person or any Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate of an Acquiring Person (as such terms are defined in the Shareholder Rights Agreement). ______________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.)Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Endeavour Silver Corp)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise the Rights represented by the Right Certificate.) To CEL-SCI CORPORATION TO: UTILICORP UNITED INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print whole Rights represented by the attached Rights Certificate to purchase the shares of Preference Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name and address of transferee) __________________________________________ __________________________________________ of: ------------------------------------------- Address: ----------------------------------- Social Security or Other Taxpayer Identification Number: --------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security ------------------------------------------- Address: ----------------------------------- Social Security or other identifying numberOther Taxpayer Identification Number: --------------------- Dated: ` Signature ------------------ Signature Guaranteed: The 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) Signatures must be medallion guaranteed by a financial an eligible guarantor institution (commercial bankbanks, stockbrokerstockbrokers, savings and loan, loan associations and credit union or trust company) that is a participant unions with membership in the Securities Transfer Agents an approved signature guarantee Medallion Programprogram), pursuant to SEC Rule 17Ad-15 under 17Ad-15. -------------------------------------------------------------------------------- (To be completed if true) The undersigned hereby represents, for the Securities Exchange Act benefit of 1934all holders of Rights and shares of Common Stock, that the Rights evidenced by 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 (as amendeddefined in the Rights Agreement). A notary public --------------------------------- Signature -------------------------------------------------------------------------------- NOTICE In the event the certification set forth above is not sufficient.)completed in connection with a purported exercise, the Company will deem the Beneficial owner of the Rights. evidenced by the attached Rights Certificate to be an Acquiring Person or an Affiliate or Associate thereof (as defined in the Rights Agreement) or a transferee of any of the foregoing and accordingly will deem the Rights evidenced by such Rights Certificate to be void and not transferable or exercisable. EXHIBIT B FORM OF CERTIFICATE OF DESIGNATION OF UTILICORP UNITED INC. SERIES A PARTICIPATING CUMULATIVE PREFERENCE STOCK Pursuant to Sections 151 of the General Corporation Law of the State of Delaware UtiliCorp United Inc., a corporation organized and existing under and by virtue of The General Corporation Law of Delaware, DOES HEREBY CERTIFY: That at a meeting of the Board of Directors of UtiliCorp United Inc. (the "Corporation") the following resolution was duly adopted creating 60,000 shares of Preference Stock, designated as Series A Participating Cumulative Preference Stock. RESOLVED, that pursuant to the authority granted to and vested in the Board of Directors of this Corporation in accordance with the provisions of the Certificate of Incorporation, a series of Preference Stock of the Corporation be, and it hereby is created, and the designation and amount thereof and the relative rights, preferences and limitations thereof (in addition to the provisions set forth in the Certificate of Incorporation, of the Corporation, which are applicable to the Preference Stock of all classes and series) are as follows:

Appears in 1 contract

Samples: Rights Agreement (Utilicorp United Inc)

FORM OF ELECTION TO EXERCISE. (To be executed by the registered holder if such holder desires to exercise the Rights represented by the Right Certificate.) To CEL-SCI CORPORATION TO: Crosshair Exploration & Mining Corp. Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise ______________________________ whole Rights represented by this Right the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares securities be issued in the name of: (Name) (Address) (City and Province) 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) (Address) (City and Province) Social Insurance, Social Security or other taxpayer identification number. Dated: _______________________________________________ (Please print name and address of transferee) Signature: ______________________________________________ Signature Guaranteed: (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.) The signature of the person executing this Form of Election to Exercise must be guaranteed by a chartered bank or an eligible guarantor institution with membership in an approved signature guarantee medallion 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. __________________________________________________ If such number of Signature (To be attached to each Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Crosshair Exploration & Mining Corp)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` ___________________ Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.).

Appears in 1 contract

Samples: Shareholder Rights Agreement (Cel Sci Corp)

FORM OF ELECTION TO EXERCISE. (To be executed if holder desires to exercise Rights represented by the Right Certificate) To CEL-SCI CORPORATION TO: The undersigned hereby irrevocably elects to exercise _______________________________________ whole Rights represented by this Right the Rights Certificate to purchase the Common Shares issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon exercise of the Rights) and requests that certificates for such shares be issued in the name of: Address 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: Address Social Insurance, Social Security or Other Taxpayer Identification Number Date: __________________________________________ (Please print name and address of transferee) __________________________________________ __________________________________________ If such number Signature Signature Guarantee: (Signature must correspond to the name as written upon the face of the Rights Certificate, in every particular, without alteration or enlargement, or any change whatsoever). Signature must be guaranteed by a Canadian chartered bank, or an eligible guarantor institution with membership in an approved Medallion signature guarantee program. (To be completed by the exercisor if true) The undersigned hereby represents, for the benefit of all holders of Rights shall not be all and Common Shares, that the Rights evidenced by this Right CertificateRights Certificate are not, a new Right Certificate for and, to the balance remaining knowledge of such Rights the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or by any Person acting jointly or in concert therewith. Capitalized terms shall be registered have the meaning ascribed thereto in the Rights Agreement. Signature (please print name of and delivered to: (Please print name and address of transferee) __________________________________________ __________________________________________ Please insert social security or other identifying number: Dated: ` Signature Signature Guaranteed: The signature must be medallion guaranteed by a financial institution (commercial bank, stockbroker, savings and loan, credit union or trust company) that is a participant in the Securities Transfer Agents Medallion Program, pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934, as amended. A notary public is not sufficient.Signatory)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Hemisphere Energy Corp)

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