Common use of FORM OF ELECTION TO EXERCISE Clause in Contracts

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 bank, or by a medallion guarantee by a member of a recognized medallion program, STAMP, SEMP and MSP. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature

Appears in 3 contracts

Samples: Shareholder Rights Plan Agreement (Pretium Resources Inc.), Shareholder Rights Plan Agreement (Pretium Resources Inc.), Shareholder Rights Plan Agreement (International Royalty Corp)

AutoNDA by SimpleDocs

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated Signature (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 bank, or by a medallion guarantee by a member of a recognized medallion program, STAMP, SEMP and MSP. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Pretium Resources Inc.)

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address City and Province Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 by a medallion guarantee by a member firm of a recognized medallion program, STAMP, SEMP and MSPMedallion Guarantee Program. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature.

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Agrium Inc)

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 by a medallion guarantee by a member firm of a recognized medallion program, STAMP, SEMP and MSPMedallion Guarantee Program. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature.

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Golden Star Resources LTD)

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 by a medallion guarantee by a member firm of a recognized medallion program, STAMP, SEMP and MSPMedallion Guarantee Program. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (International Royalty Corp)

AutoNDA by SimpleDocs

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise 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 shares be issued in the name of: Name Address Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 by a medallion guarantee by a member firm of a recognized medallion program, STAMP, SEMP and MSPMedallion Guarantee Program. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Golden Star Resources LTD)

FORM OF ELECTION TO EXERCISE. TO: The undersigned hereby irrevocably elects to exercise ________________________________ 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 shares be issued in the name of: Name Address City and Province Social Insurance, Social Security or other Taxpayer Identification Number ________________ Per: Dated 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 major Schedule 1 Canadian bank, chartered bank or by a medallion guarantee by a member of a recognized medallion program, STAMP, SEMP and MSPMedallion Guarantee Program. (To be completed 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 with any of the foregoing (all as defined in the Rights Agreement). ______________________________ Signature

Appears in 1 contract

Samples: Shareholder Rights Plan Agreement (Agrium Inc)

Time is Money Join Law Insider Premium to draft better contracts faster.