Common use of Name of Option Recipient Clause in Contracts

Name of Option Recipient. Option Grant Date: , Exercise Price per share: $ . (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment  I enclose a certified check, money order, or bank draft payable to the order of PFF Bancorp, Inc. in the amount of $  I enclose Shares I have owned for at least six months duly endorsed for transfer to PFF Bancorp, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ *Subject to Committee approval as an acceptable method of payment. ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. of Shares _________________________________________________ - - _________________ _________________________________________________ _________________________________________________ - - __________________ _________________________________________________ WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request PFF Bancorp, Inc. to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]:  With a certified or bank check that I will deliver to PFF Bancorp, Inc. on the day after the Effective Date of my Option exercise.  With the proceeds from a sale of Shares that would otherwise be distributed to me.  Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by law. I understand that the withholding elections I have made on this form are not binding on the Committee, and that the Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S H I E G R N E I understand that I must rely on, and consult with, my own tax and legal counsel (and not PFF Bancorp, Inc.) regarding the application of all laws - particularly tax and securities laws - to the transactions to be effected pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I must consult with my own tax advisor regarding how and when such income will be reportable. Signature Date Internal Use Only Received [check one]:  By Hand  By Mail Post Marked Date of Post Xxxx By Authorized Signature Date of Receipt APPENDIX B TO STOCK OPTION CERTIFICATE PFF BANCORP, INC. 2006 EQUITY INCENTIVE PLAN Beneficiary Designation Form

Appears in 1 contract

Samples: Stock Option Agreement (PFF Bancorp Inc)

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Name of Option Recipient. Option Grant Date: , Exercise Price per share: $ . ---------------------------- ---------------- (Month and Day) (Year) Exercise Price per share: $ _______.___ EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ ------------------- --------- ---- (No. of Shares) (Exercise Price) Price --------------------- Total Exercise Price Method of Payment |_| I enclose a certified check, money order, or bank draft payable to the order of PFF BancorpHome Bancorp of Elgin, Inc. in the amount of $ ---------------- |_| I enclose Shares I have owned for at least six months duly endorsed for transfer to PFF Bancorp, Inc. the Company with all stamps attached and $ having a fair market value of $ ---------------- Total Exercise Price $ *Subject to Committee approval as an acceptable method of payment. ---------------- ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. No of Shares _________________________________________________ ------------------------------- - - _________________ _________________________________________________ _________________________________________________ ----- ----- ----- ------------ ------------------------------- ------------------------------- - - __________________ _________________________________________________ ----- ----- ----- ------------ ------------------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries and Outside Directors should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request PFF Bancorp, Inc. the Company to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: |_| With a certified or bank check that I will deliver to PFF Bancorp, Inc. the Committee on the day after the Effective Date of my Option exercise. |_| With the proceeds from a sale of Shares that would otherwise be distributed to me. |_| Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Committee, and that the Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S H I E G R N E I understand that I must rely on, and consult with, my own tax and legal S H counsel (and not PFF Bancorp, Inc.the Company) regarding the application of all laws - particularly tax and securities laws - to the transactions to be effected I E pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become G R due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I N E must consult with my own tax advisor regarding how and when such income will be reportable. I further understand that if I have elected to have Shares sold to satisfy tax withholding I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. ---------------------------------------------------- ---------------- Signature Date --------------------------------------------------------------------------- Address -------------------------------------------------------------------------------- Internal Use Only -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Corporate Secretary Received [check one]:  ] |_| By Hand |_| By Mail Post Marked ----------------------------- Date of Post Xxxx Mark By --------------------------------------------- ----------------------------- Authorized Signature Date of Receipt -------------------------------------------------------------------------------- APPENDIX B TO STOCK OPTION CERTIFICATE PFF BANCORPAGREEMENT HOME BANCORP OF ELGIN, INC. 2006 EQUITY INCENTIVE 1997 STOCK OPTION PLAN Beneficiary Designation FormForm -------------------------------------------------------------------------------- General Information Use this form to designate the Beneficiary(ies) who may exercise Options outstanding to you at the time of your death. Name of Person Making Designation Social Security Number - - -------------- ----- ---- ----- BENEFICIARY Complete sections A and B. If no percentage shares are specified, DESIGNATION each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately A Primary Beneficiary(ies). I hereby designate the following person as my primary Beneficiary under the Plan, reserving the right to change or revoke this designation at any time prior to my death: Name Address Relationship Birthdate Share % ----------------- ------------------ --------- ------- -------- ------------------ % ----------------- --------- ------- -------- ------------------ ------------------ % ----------------- --------- ------- -------- ------------------ Total = 100% ------------------ B Contingent Beneficiary(ies). I hereby designate the following person(s) as my contingent Beneficiary(ies) under the Plan to receive benefits only if all of my primary Beneficiaries should predecease me, reserving the right to change or revoke this designation at any time prior to my death as to all outstanding Options: Name Address Relationship Birthdate Share % ----------------- ------------------ --------- ------- -------- ------------------ % ----------------- --------- ------- -------- ------------------ ------------------ % ----------------- --------- ------- -------- ------------------ ------------------

Appears in 1 contract

Samples: Stock Option Agreement (State Financial Services Corp)

Name of Option Recipient. Option Grant Date: _______________, ______ Exercise Price per share: $ . $__.__ (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price _______________ x $ . $_______._______ = $ $____________________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment [ ] I enclose a certified check, money order, or bank draft payable to the order of PFF Bancorp, Inc. in the Slade's Ferry Bancoxx xx xhe amount of $  $________ [ ] I enclose Shares I have owned for at least six months duly endorsed for transfer to PFF Bancorp, Inc. with Slade's Ferry Bancoxx xxxx all stamps attached and having a fair market value of $ $________ Total Exercise Price $ *$________ * Subject to Committee approval as an acceptable method of payment. ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. of Shares ____________________________________ ______________ - - _______________________ ___-__-____ _____________ ____________________________________ ____________________________________ __________-__-____ - - __________________ _________________________________________________ WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request PFF Bancorp, Inc. Slade's Ferry Bancorp to retain or sell a xxxx x sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: [ ] With a certified or bank check that I will deliver to PFF Bancorp, Inc. on the Slade's Ferry Bancorx xx xxe day after the Effective Date of my Option exercise. [ ] With the proceeds from a sale of Shares that would otherwise be distributed to me. [ ] Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by law. I understand that the withholding elections I have made on this form are not binding on the Committee, and that the Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S H I E G R N E I understand that I must rely on, and consult with, my own tax and legal counsel (and not PFF Bancorp, Inc.) regarding the application of all laws - particularly tax and securities laws - to the transactions to be effected pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I must consult with my own tax advisor regarding how and when such income will be reportable. Signature Date Internal Use Only Received [check one]:  By Hand  By Mail Post Marked Date of Post Xxxx By Authorized Signature Date of Receipt APPENDIX B TO STOCK OPTION CERTIFICATE PFF BANCORP, INC. 2006 EQUITY INCENTIVE PLAN Beneficiary Designation Form.

Appears in 1 contract

Samples: Slades Ferry Bancorp

Name of Option Recipient. Option Grant Date: , Exercise Price per share: $ . ---------------,------- ------ -- (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ --------------- ------------- -- -------------------- (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment [ ] I enclose a certified check, money order, or bank draft payable to hereby request that the order Committee cancel the number of PFF Bancorp, Inc. in Shares covered by my Stock Option Agreement with the amount of $  I enclose Shares I have owned for at least six months duly endorsed for transfer to PFF Bancorp, Inc. with all stamps attached and Company having a fair market value of $ -------- Total Exercise Price $ *Subject to Committee approval as an acceptable method of payment. -------- ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. No of Shares _________________________________________________ - - _________________ _________________________________________________ _________________________________________________ -------------------------------------- ------------------- ------------ -------------------------------------- - - __________________ _________________________________________________ -------------------------------------- ------------------- ------------ -------------------------------------- ------------------------------------------------------------------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries and Outside Directors should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request PFF Bancorp, Inc. the Company to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: [ ] With a certified or bank check that I will deliver to PFF Bancorp, Inc. the Committee on the day after the Effective Date of my Option exercise. [ ] With the proceeds from a sale of Shares that would otherwise be distributed to me. [ ] Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Committee, and that the Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S H I E G R N E SIGN HERE I understand that I must rely on, and consult with, my own tax and legal counsel (and not PFF Bancorp, Inc.the Company) regarding the application of all laws - -- particularly tax and securities laws - -- to the transactions to be effected pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I must consult with my own tax advisor regarding how and when such income will be reportable. ---------------------------------------------- ---------------------- Signature Date ------------------------------------------------------------------------- Address ------------------------------------------------------------------------------- ------------------------------ Internal Use Only ------------------------------ Corporate Secretary Received [check one]: [ ] By Hand [ ] By Mail Post Marked ------------------------- Date of Post Xxxx By ------------------------------------------------ ------------------------- Authorized Signature Date of Receipt ------------------------------------------------------------------------------- APPENDIX B TO STOCK OPTION CERTIFICATE PFF AGREEMENT 1997 STOCK OPTION PLAN FOR OUTSIDE DIRECTORS, OFFICERS AND EMPLOYEES OF FALMOUTH BANCORP, INC. 2006 EQUITY INCENTIVE PLAN Beneficiary Designation FormForm GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who may exercise Options outstanding to you at the time of your death. Name of Person Social Making Designation Security Number - - --------------------------- ---------------- BENEFICIARY DESIGNATION Complete sections A and B. If no percentage shares are specified, each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately. A PRIMARY BENEFICIARY(IES). I hereby designate the following person as my primary Beneficiary under the Plan, reserving the right to change or revoke this designation at any time prior to my death: Name Address Relationship Birthdate Share ------------------------ --------------------------- ---------------------- --------------- -----------% --------------------------- ------------------------ --------------------------- ---------------------- --------------- -----------% --------------------------- ------------------------ --------------------------- ---------------------- --------------- -----------% --------------------------- Total = 100%

Appears in 1 contract

Samples: Stock Option Agreement (Falmouth Bancorp Inc)

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Name of Option Recipient. Option Grant Date: , Exercise Price per share: $ . ---------------------------- ---------------- (Month and Day) (Year) Exercise Price per share: $ _______.___ EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ ------------------- --------- ---- (No. of Shares) (Exercise Price) Price --------------------- Total Exercise Price Method of Payment |_| I enclose a certified check, money order, or bank draft payable to the order of PFF BancorpHome Bancorp of Elgin, Inc. in the amount of $ ---------------- |_| I enclose Shares I have owned for at least six months duly endorsed for transfer to PFF Bancorp, Inc. the Company with all stamps attached and $ having a fair market value of $ ---------------- Total Exercise Price $ *Subject to Committee approval as an acceptable method of payment. ---------------- ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. No of Shares _________________________________________________ ------------------------------- - - _________________ _________________________________________________ _________________________________________________ ----- ----- ----- ------------ ------------------------------- ------------------------------- - - __________________ _________________________________________________ ----- ----- ----- ------------ ------------------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries and Outside Directors should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request PFF Bancorp, Inc. the Company to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: |_| With a certified or bank check that I will deliver to PFF Bancorp, Inc. the Committee on the day after the Effective Date of my Option exercise. |_| With the proceeds from a sale of Shares that would otherwise be distributed to me. |_| Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Committee, and that the Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S H I E G R N E I understand that I must rely on, and consult with, my own tax and legal S H counsel (and not PFF Bancorp, Inc.the Company) regarding the application of all laws - particularly tax and securities laws - to the transactions to be effected I E pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become G R due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I N E must consult with my own tax advisor regarding how and when such income will be reportable. I further understand that if I have elected to have Shares sold to satisfy tax withholding I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. ---------------------------------------------------- ---------------- Signature Date --------------------------------------------------------------------------- Address -------------------------------------------------------------------------------- Internal Use Only -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Corporate Secretary Received [check one]:  ] |_| By Hand |_| By Mail Post Marked ----------------------------- Date of Post Xxxx By Maxx Xy --------------------------------------------- ----------------------------- Authorized Signature Date of Receipt -------------------------------------------------------------------------------- APPENDIX B TO STOCK OPTION CERTIFICATE PFF BANCORPAGREEMENT HOME BANCORP OF ELGIN, INC. 2006 EQUITY INCENTIVE 1997 STOCK OPTION PLAN Beneficiary Designation FormForm -------------------------------------------------------------------------------- General Information Use this form to designate the Beneficiary(ies) who may exercise Options outstanding to you at the time of your death. Name of Person Making Designation Social Security Number - - -------------- ----- ---- ----- BENEFICIARY Complete sections A and B. If no percentage shares are specified, DESIGNATION each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately A Primary Beneficiary(ies). I hereby designate the following person as my primary Beneficiary under the Plan, reserving the right to change or revoke this designation at any time prior to my death: Name Address Relationship Birthdate Share % ----------------- ------------------ --------- ------- -------- ------------------ % ----------------- --------- ------- -------- ------------------ ------------------ % ----------------- --------- ------- -------- ------------------ Total = 100% ------------------ B Contingent Beneficiary(ies). I hereby designate the following person(s) as my contingent Beneficiary(ies) under the Plan to receive benefits only if all of my primary Beneficiaries should predecease me, reserving the right to change or revoke this designation at any time prior to my death as to all outstanding Options: Name Address Relationship Birthdate Share % ----------------- ------------------ --------- ------- -------- ------------------ % ----------------- --------- ------- -------- ------------------ ------------------ % ----------------- --------- ------- -------- ------------------ ------------------

Appears in 1 contract

Samples: Outside Directors (State Financial Services Corp)

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