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: Canplats Resources Corporation and Computershare Investor Services 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 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: ________________________________ 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.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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 (Canplats Resources Corp)

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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.Be Executed Upon Exercise of Contingent Warrant) TO: Canplats Resources Corporation and Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise ____ of the Contingent Warrants represented by this Warrant Certificate and purchase the number of Warrant Shares issuable upon the exercise of such Contingent Warrants and herewith tenders payment for such Warrant Shares as follows: (Check One) [ ] $__________ in cash or by certified or official bank check; or [ ] by surrender of Contingent Warrants pursuant to a Cashless Exercise (as defined in the Warrant Agreement) at the current Cashless Exercise Ratio. The undersigned requests that a certificate representing such Warrant Shares be registered 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: whose address is _______________________________________________________________ and that such Warrant Shares be delivered to ___________________________________ whose address is ______________________________________________________________. Any cash payments to be paid in lieu of a fractional Warrant Share should be made to ________________________________________________________________________ (Name) 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) Tax Identification or Social Security Number: ________________________________________________________ Address: _____________________________________________________________________ (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 toSignature: _____________________________________________________________________ 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 Contingent 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 Warrant 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. Signature Guaranteed: ______________________________ (Name) [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: ___________________________________________ (Address) _____________________________________________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: _________________________________ EXHIBIT B Form of Certificate for Transfers of Certificated Warrants Continental Stock Transfer & Trust Company 0 Xxxxxxxx Xxx Xxxx, Xxx Xxxx 00000 Attention: Compliance Department Re: Contingent Warrants of NEXTLINK Communications, Inc. (City the "Warrants") Reference is made to the Warrant Agreement, dated as of January 31, 1997 (the "Warrant Agreement"), between NEXTLINK Communications, Inc. (the "Company") and ProvinceContinental Stock Transfer & Trust Company, as Warrant Agent. Terms used herein and defined in the Warrant Agreement or in Regulation S, Rule 144A or Rule 144 under the Securities Act of 1933 (the "Securities Act") are used herein as so defined. This certificate relates to ________________________________________________ Contingent Warrants, which are evidenced by the following certificate(s) (the "Specified Warrants"): CUSIP No. _______________________________ Social Insurance, Social Security or other taxpayer identification numberCERTIFICATE No(s). Dated: ________________________________ Signature: _____________________________ Signature GuaranteedThe person in whose name this certificate is executed below (the "Undersigned") hereby certifies that either (i) it is the sole beneficial owner of the Specified Warrants or (ii) it is acting on behalf of all the beneficial owners of the Specified Warrants and is duly authorized by them to do so. Such beneficial owner or owners are referred to herein collectively as the "Owner". The Specified Warrants are registered in the name of the Undersigned, as or on behalf of the Owner. The Owner has requested that the Specified Warrants be transferred to a person (the "Transferee") who will take delivery in the form of an interest in the Global Warrant. In connection with such transfer, the Owner hereby certifies that such transfer is being effected in accordance with (a) either: (Signature must correspond to name as written upon Check one) |_| Rule 144A, |_| Rule 904, or |_| Rule 144 under the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.Securities Act and (b) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members all applicable securities laws of the STAMP Programstates of the United States and other jurisdictions. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring Rights hereunderAccordingly, the Owner hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, further certifies as follows with respect to the knowledge type 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.)transfer indicated herein:

Appears in 1 contract

Samples: Warrant Agreement (Nextlink Communications LLC)

FORM OF ELECTION TO EXERCISE. (To be exercised by executed is the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise _:_____________________________ whole 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, Social Security Insurance or other taxpayer identification number. 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: ______________________________________________________________________________ (Name) _______________________________________________________________________________________ (Address) : ____________________________________________________________________________________________________________________________________________________________________ (City and Province) ____________________________________________________________________________________________________________________________________________________________________ Social Insurance, Social Security Insurance or other taxpayer identification number. Dated: Other Taxpayer Identification 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.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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. _____________________________________________________ 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.) Signatures must be guaranteed by a Canadian chartered bank or eligible guarantor institution with membership in an approved signature guarantee medallion program. CERTIFICATION (To be attached 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 each 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 Certificate.Agreement). Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Coral Gold Resources, Ltd.)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise __________________________ 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, Social Security 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, Social Security Insurance Number or other taxpayer identification number. Dated: _______________________ __________ Signature: _____________________________ 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.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, member firm of a major trust company recognized stock exchange in Canada or a member of commercial bank or trust company having an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions office or Caisse Populaires unless they are members of the STAMP Programcorrespondent in Canada. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring Rights hereunder, under this Form of Election to Exercise hereby represents, represents for the benefit of all holders of Rights and Common Shares, Shares that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially owned 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 (Triant Technologies Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor Services 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 of: ______________________________________________________________________________ (Name) ______________________________________________________________________________ (Address) ______________________________________________________________________________ (City and Province) ________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 toOther Taxpayer Identification Number DATE: ____________________________ ______________________________________________ Signature Signature Guarantee: (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) Note: Signature must be guaranteed by a major Canadian trust company, a Schedule I Canadian chartered bank, or a member of a recognized Medallion Guarantee program. __________________________________________________________________ (NameTo be completed by exercisor if true) The undersigned 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 by any Person acting jointly or in concert therewith. Capitalized terms shall have the meaning ascribed thereto in the Rights Agreement. _________________________________________ Signature _________________________________________ (Address) ______________________________________________________________________________ (City and Province) ______________________________________________________________________________ Social Insurance, Social Security or other taxpayer identification number. Dated: ________________________________ Signature: _____________________________ Signature Guaranteed: (Signature must correspond to please print 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 Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSPSignatory). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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 Protection Rights Agreement (Transglobe Energy Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor Services 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 be issued in the name of: ____________________________________________________________________________________________________ (Name) ____________________________________________________________________________________________________ (Address) ____________________________________________________________________________________________________ (City and Province) ____________________________________________________________________________________________________ Social Insurance, Social Security 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, Social Security Insurance Number or other taxpayer identification number. Dated: __________________________________ Signature: __________________________________ 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 major Schedule 1 Canadian Schedule I chartered bank, a major trust company in Canada bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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 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 Plan Agreement. _________________________________________ Signature _________________________________________ (Please print name of Signatory) (To be attached to each Rights Certificate.)

Appears in 1 contract

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

FORM OF ELECTION TO EXERCISE. (To be exercised by executed if the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor COMPUTERSHARE INVESTOR SERVICES INC. 3rd floor, 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, X.X. X0X 0X0 Attention: Manager, Client Services 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 Common Shares be issued in the name of: Address: ______________________________________________________________________________ (Name) ______________________________________________________________________________ (Address) ______________________________________________________________________________ (City and Province) ______________________________________________________________________________ Social Insurance, Social Security Insurance 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 toOther Taxpayer Identification Number: ______________________________________________________________________________ (Name) ________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: ______________________________________________________________________ (Address) ______________________________________________________________________________ (City and Province) ______________________________________________________________________________ Social Insurance, Social Security Insurance or other taxpayer identification number. DatedOther Taxpayer Identification 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.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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. __________________________________ 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. (To be attached 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 each 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 Certificate.Agreement). _____________________________ Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Endeavour Silver Corp)

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FORM OF ELECTION TO EXERCISE. (To be exercised by executed upon exercise of Warrant during the registered holder if such holder desires to exercise the Rights Certificate.Exercise Period) TO: Canplats Resources Corporation and Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise the right, represented by this Warrant Certificate, to purchase ____________________ Shares and herewith tenders payment for such Shares in the amount of $ ____________________ in accordance with the terms hereof. The undersigned requests that a certificate representing such Shares be registered in the name of ____________________, whose address is __________________________________, and that such certificate be delivered to ________________________________, whose address is ________________________________________. If said number of Shares is less than all the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate representing the balance of the Shares be registered in the name of __________________________, whose address is ________________________________________ whole Rights represented by the attached Rights Certificate . Any cash payments to purchase the Common Shares or other securities, if applicable, issuable upon the exercise be paid in lieu of such Rights and requests that certificates for such securities a fractional Share should be issued in the name of: made to ________________________________________________, whose address is ________________________________________, and the check representing payment thereof should be delivered to ___________________________, whose address is ________________________________________ . Dated:____________ Taxpayer Identification or Social Security Number ________ ____________________________________ ________________________________ (Name of holder of Warrant Certificate. Please print) Signature Address:_______________________________________________________________________ (Name) ___________________Street City State Zip Code Signature Guaranteed:___________________________________________________________ (Address) NOTE: THE ABOVE SIGNATURE OF WARRANT HOLDER MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THIS WARRANT IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATSOEVER. FORM OF ASSIGNMENT For value received,_________________________________________ hereby sells, assigns and transfers unto______________________________________________________ (Please print name and address) 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 Guaranteed:__________________________________________________________ (City and Province) ______________________________________________________________________________ Social InsuranceNOTE: THE ABOVE SIGNATURE OF WARRANT HOLDER MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THIS WARRANT IN EVERY PARTICULAR, 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: ________________________________ 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 whatsoeverWITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATSOEVER.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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: Warrant Agreement (First Bank System Inc)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation STELLAR BIOTECHNOLOGIES INC. and Computershare Investor Services Inc. COMPUTERSHARE INVESTOR SERVICES INC. The undersigned hereby irrevocably 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, Social Security 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 toDated: _________________________________________ ______________________________________ (Name) ______________________________________________________________________________ (Address) ______________________________________________________________________________ (City and Province) ______________________________________________________________________________ Social Insurance, Social Security or other taxpayer identification number. Dated: ________________________________ Signature: _____________________________ 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.) Signature *The signature of the person executing this form of transfer must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company bank or an eligible guarantor institution with membership in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, approved signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Programguarantee medallion program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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. Dated: ___________________________ ___________________________________ Signature (To be attached to each Rights Certificate.)

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Stellar Biotechnologies, Inc.)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: Canplats Resources Corporation and Computershare Investor Services The Descartes Systems Group 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) ___________________________________________ (Street) ___________________________________________ (AddressCity and State or Province) ___________________________________________ (Country, Postal Code or 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) ______________________________________ (Street) ______________________________________ (City and State or Province) ______________________________________ (Country, Postal Code or 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 of a recognized stock exchange or a member of a recognized Medallion Program (STAMP, MSP or SEMP). _____________________________________________________________________________________________ (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: ________________________________ 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.) Signature must be guaranteed by a major Canadian Schedule I chartered bank, a major trust company in Canada or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Please note, signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisse Populaires unless they are members of the STAMP Program. CERTIFICATE (To be completed if true.) The undersigned party exercising and/or transferring 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 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 Plan Agreement). Dated: ______________________________________ Signature (To be attached to each Rights Certificate.)Signature:_____________________________________

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Descartes Systems Group Inc)

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