Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges receipt of a copy of the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Stock Option Agreement (Dime Community Bancshares Inc)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan that would apply if this stock option had been granted under the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this agreement have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the PlanPlan and a copy of the Prospectus for this stock option dated November 9, 2001. APPENDIX A TO STOCK OPTION AGREEMENT HUDSON CITY BANCORP, INC. DEXXX X. SALAMONE STOCK OPTIXX XXXX NOTICE OF EXERCISE OF STOCK OPTION USE THIS NOTICE TO INFORM HUDSON CITY BANCORP, INC. THXX XXX ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF HUDSON CITY BANCORP, INC. PUX XXXXT TO AN OPTION ("OPTION") GRANTED UNDER THE STOCK OPTION AGREEMENT BETWEEN HUDSON CITY BANOCORP, INC. AXX XXXIS J. SALAMONE DATED OCTOXXX 00, 0000 (XXX "OPTION AGREEMENT"). IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT . THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: HUDSON CITY BANCORP, INC, WEXX 00 CENTURY ROAD, PARAMUS, NEX XXXXXX 00000-0000, XXXXXXXXX: XXXXXXXXX XXXXXTARY. THE EFFECTIVE DATE OF THE EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY HUDSON CITY BANCORP, INC. BUX XX XO EVENT MORE THAN THREE DAYS AFTER SUCH DATE ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE HUDSON CITY BANCORP, INC. 2000 XXXCK OPTION PLAN (THE "PLAN"). OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementIDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION AGREEMENT. Name of Option Recipient: Option Grant DateNAME OF OPTION RECIPIENT: ____________________________________________ OPTION GRANT DATE: ______________, __________ Exercise Price per share: $___________EXERCISE PRICE PER SHARE:$_____.____ (Month and DayMONTH AND DAY) (YearYEAR) EXERCISE PRICE Compute the Exercise Price below and select a method of paymentCOMPUTE THE EXERCISE PRICE BELOW AND SELECT A METHOD OF PAYMENT. Total Exercise Price TOTAL EXERCISE PRICE ________________ x $__________.______ = $_______________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank $_______ draft payable to the order of Dime Community BancsharesHudson City Bancorp, Inc. in the amount of $ ¨ |_| I enclose Shares duly endorsed for transfer to Dime Community Bancshares$_______ Hudson City Bancorp, Inc. with all wixx xxx stamps attached and having a fair market value of $ Total Exercise Price $ $_______ 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 NoNAME AND ADDRESS SOCIAL SECURITY NO. NoNO. of Shares - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 OF SHARES _________________________________ ______-___-______ _______________________________ _________________________________ _________________________________ ______-___-______ _______________________________ _________________________________ Address Received 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 Hudson City Bancorp, Inc., tx xxxxin 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]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt:
Appears in 1 contract
Plan Provisions Control. This Agreement Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this AgreementCertificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this AgreementCertificate, the Optionee acknowledges you acknowledge receipt of a copy of the Plan and a copy of the related Prospectus dated July 29, 2003. APPENDIX A TO STOCK OPTION CERTIFICATE BRIDGE STREET FINANCIAL, INC. 2003 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION -------------------------------------------------------------------------------- Use this Notice to inform Bridge Street Financial, Inc. that you are exercising your right to purchase shares of common stock ("Shares") of Bridge Street Financial, Inc. pursuant to an option ("Option") granted under the Bridge Street Financial, Inc. 2003 Stock Option Plan ("Plan"). If you are not the person to whom the Option was granted ("Option Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Certificate entered into between Bridge Street Financial, Inc. and the Option Recipient ("Certificate"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Bridge Street Financial, Inc., 44 East Bridge Street, Oswego, New Xxxx, 00000, Xxxxxxxxx: Xxxxxxxxx Xxxxxxxxx. Xhe effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by Bridge Street Financial, Inc. but in no event more than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementCertificate. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 :_______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Stock Option Agreement (Bridge Street Financial Inc)
Plan Provisions Control. This Agreement Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this AgreementCertificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this AgreementCertificate, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORP, INC. 2007 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementCertificate. Name of Option Recipient: Option Grant Date: ________________, __________ Exercise Price per share$hare: $________________.____ (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 Dime Community BancsharesCMS Bancorp, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to Dime Community BancsharesCMS Bancorp, Inc. with all stamps attached and having a fair market value of of* $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community BancsharesCMS Bancorp, Inc., 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 the Administrator CMS 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 meme 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 Compensation Committee, and that the Compensation 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 Compensation 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt.
Appears in 1 contract
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges receipt of a copy of the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt.
Appears in 1 contract
Samples: Non Qualified Stock Option Agreement (Dime Community Bancshares Inc)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. Appendix A to Stock Option Agreement 1997 Stock Option Plan for Outside Directors, Officers and Employees of Falmouth Bancorp, Inc. Notice of Exercise of Stock Option ------------------------------------------------------------------------------- Use this Notice to inform the Committee administering the 1997 Stock Option Plan for Outside Directors, Officers and Employees of Falmouth Bancorp, Inc. ("Plan") that you are exercising your right to purchase shares of common stock ("Shares") of Falmouth Bancorp, Inc. (the "Company") pursuant to an option ("Option") granted under the Plan. If you are not the person to whom the Option was granted ("Option Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Agreement entered into between the Company and the Option Recipient ("Agreement"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Falmouth Bancorp, Inc., 20 Davis Straits, Falmouth, Massacxxxxxxx 00000 Attention: Corporate Secretary. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by the Company, but in no event more than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan that would apply if this stock option had been granted under the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this agreement have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the PlanPlan and a copy of the Prospectus for this stock option dated April 16, 2004. APPENDIX A TO STOCK OPTION AGREEMENT FOR RONALD J. BUTKOVICH XXXXCE OF EXERCISE OF STOCK OPTION -------------------------------------------------------------------------------- USE THIS NOTICE TO INFORM HUDSON CITY BANCORP, INC. THXX XXX ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF HUDSON CITY BANCORP, INC. PUXXXXXX TO AN OPTION ("OPTION") GRANTED UNDER THE STOCK OPTION AGREEMENT BETWEEN HUDSON CITY BANCORP, INC. ANX XXXXLD J. BUTKOVICH DATED APXXX 00, 0000 (XXX "OPTION AGREEMENT"). IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT. THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: HUDSON CITY BANCORP, INC., WXXX 00 CENTURY ROAD, PARAMUS, NEX XXXXXX 00000, XXXXXXXXX: XXXXXXXXX SECRETARY. THE EFFECTIVE DATE OF THE EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY HUDSON CITY BANCORP, INC. BUX XX XO EVENT MORE THAN THREE DAYS AFTER SUCH DATE ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE HUDSON CITY BANCORP, INC. 2000 XXXCK OPTION PLAN (THE "PLAN"). OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementIDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION AGREEMENT. Name of Option RecipientNAME OF OPTION RECIPIENT: Option Grant DateRonald J. Butkovich -------------------------------------------- OPTION GRANT DATE: ________________, __________ Exercise Price per share(MONTH AND DAY) (YEAR) EXERCISE PRICE PER SHARE: $________________.____ (Month and Day) (Year) TOTAL EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price ________________ x $__________.______ = $____________________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank draft payable to the order of Dime Community Bancshares$____________________ Hudson City Bancorp, Inc. in the amount xxx xmount of $ ¨ |_| I enclose Shares duly endorsed for transfer to Dime Community BancsharesHudson City Bancorp, Inc. with all wixx xxx $____________________ _______________ stamps attached and having a fair market value of $ Total Exercise Price $ $____________________ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 the above instructions be issued to the following person(s) in the amount specified below: Name and Address Social Security NoNAME AND ADDRESS SOCIAL SECURITY NO. NoNO. of Shares OF SHARES ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with NonFOR EMPLOYEE OPTION RECIPIENTS WITH NON-Qualified Stock Options onlyQUALIFIED STOCK OPTIONS ONLY. Outside Directors and Beneficiaries should not completeBENEFICIARIES 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 Dime Community BancsharesHudson City Bancorp, Inc., Inc. to retain xxxxxn 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt:
Appears in 1 contract
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan that would apply if this stock option had been granted under the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this agreement have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the PlanPlan and a copy of the Prospectus for this stock option dated November 9, 2001. APPENDIX A TO STOCK OPTION AGREEMENT HUDSON CITY BANCORP, INC. DENIS J. SALAMONE STOCK OPTION PLAN NOTICE OF XXXXXXXX XX XXXXK OPTION -------------------------------------------------------------------------------- USE THIS NOTICE TO INFORM HUDSON CITY BANCORP, INC. THAT YOU ARE EXERCISING YOUR RIGHT TO PURCXXXX XHARES OF COMMON STOCK ("SHARES") OF HUDSON CITY BANCORP, INC. PURSUANT TO AN OPTION ("OPTION") GRANTED UXXXX XHE STOCK OPTION AGREEMENT BETWEEN HUDSON CITY BANOCORP, INC. AND DENIS J. SALAMONE DATED OCTOBER 29, 2000 (XHE "OPTION AGREEMENT"). IX XXX XXX XXX XXX PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT . THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: HUDSON CITY BANCORP, INC, WEST 80 CENTURY ROAD, PARAMUS, NEW JERSEY 00000-1473, ATTENTION: CORPORATX XXXXXXXXX. XXX XXXXXXXXX XXXX XX XXX XXXXXXXX OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY HUDSON CITY BANCORP, INC. BUT IN NO EVENT MORE THAN THREE DAYS AFTER XXXX DATE ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE HUDSON CITY BANCORP, INC. 2001 STOCK OPTION PLAN (THE "PLAN"). OPTIXX XXXORMATION IDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementFROM THE STOCK OPTION AGREEMENT. Name of Option RecipientNAME OF OPTION RECIPIENT: Option Grant Date---------------------------------------------- OPTION GRANT DATE: ________________, __________ Exercise Price per shareEXERCISE PRICE PER SHARE: $________________.____ $ . -------------- ------ ---- -- (Month and DayMONTH AND DAY) (YearYEAR) EXERCISE PRICE Compute the Exercise Price below and select a method of paymentCOMPUTE THE EXERCISE PRICE BELOW AND SELECT A METHOD OF PAYMENT. Total Exercise Price ________________ TOTAL EXERCISE PRIC x $__________.______ $ . = $_______________ $ -------------- ----------- -- ------------------- (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank draft payable to the order of Dime Community BancsharesHudson City Bancorp, Inc. in the amount of $ ¨ the order ox $_______ |_| I enclose Shares duly endorsed for transfer to Dime Community BancsharesHudson City Bancorp, Inc. with all stamps attached and having xxxxxg a fair market value of $ $_______ Total Exercise Price $ $_______ 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 NoNAME AND ADDRESS SOCIAL SECURITY NO. NoNO. of Shares OF SHARES --------------------------------------- - - ------- ---- --------- ------------- --------------------------------------- --------------------------------------- - - ------- ---- --------- ------------- --------------------------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with NonFOR EMPLOYEE OPTION RECIPIENTS WITH NON-Qualified Stock Options onlyQUALIFIED STOCK OPTIONS ONLY. Outside Directors and Beneficiaries should not completeBENEFICIARIES 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 Dime Community BancsharesHudson City Bancorp, Inc., to retain or sell a sufficient number of such Shares xxxx Xhares 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt:
Appears in 1 contract
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan that would apply if this stock option had been granted under the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this agreement have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the PlanPlan and a copy of the Prospectus for this stock option dated April 16, 2004. APPENDIX A TO STOCK OPTION AGREEMENT FOR J. CHRISTOPHER NETTLETON XXXXCE OF EXERCISE OF STOCK OPTION -------------------------------------------------------------------------------- USE THIS NOTICE TO INFORM HUDSON CITY BANCORP, INC. THXX XXX ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF HUDSON CITY BANCORP, INC. PUXXXXXX TO AN OPTION ("OPTION") GRANTED UNDER THE STOCK OPTION AGREEMENT BETWEEN HUDSON CITY BANCORP, INC. ANX X. XHRISTOPHER NETTLETON DATED XXXXX 00, 0000 (XXX "OPTION AGREEMENT"). IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT. THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: HUDSON CITY BANCORP, INC., WXXX 00 CENTURY ROAD, PARAMUS, NEX XXXXXX 00000, XXXXXXXXX: XXXXXXXXX XXXXXTARY. THE EFFECTIVE DATE OF THE EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY HUDSON CITY BANCORP, INC. BUX XX XO EVENT MORE THAN THREE DAYS AFTER SUCH DATE ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE HUDSON CITY BANCORP, INC. 2000 XXXCK OPTION PLAN (THE "PLAN"). OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementIDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION AGREEMENT. Name of Option RecipientNAME OF OPTION RECIPIENT: Option Grant DateJ. Christopher Nettleton -------------------------------------------- OPTION GRANT DATE: ________________, __________ Exercise Price per share(MONTH AND DAY) (YEAR) EXERCISE PRICE PER SHARE: $________________.____ (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of paymentCOMPUTE THE EXERCISE PRICE BELOW AND SELECT A METHOD OF PAYMENT. Total Exercise Price TOTAL EXERCISE PRICE ________________ x $__________.______ = $____________________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank draft payable to the order of Dime Community Bancshares$____________________ Hudson City Bancorp, Inc. in the amount xxx xmount of $ ¨ |_| I enclose Shares duly endorsed for transfer to Dime Community BancsharesHudson City Bancorp, Inc. with all wixx xxx $____________________ _______________ stamps attached and having a fair market value of $ Total Exercise Price $ $____________________ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 the above instructions be issued to the following person(s) in the amount specified below: Name and Address Social Security NoNAME AND ADDRESS SOCIAL SECURITY NO. NoNO. of Shares OF SHARES ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with NonFOR EMPLOYEE OPTION RECIPIENTS WITH NON-Qualified Stock Options onlyQUALIFIED STOCK OPTIONS ONLY. Outside Directors and Beneficiaries should not completeBENEFICIARIES 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 Dime Community BancsharesHudson City Bancorp, Inc., Inc. to retain xxxxxn 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt:
Appears in 1 contract
Plan Provisions Control. This Agreement Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this AgreementCertificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this AgreementCertificate, the Optionee acknowledges you acknowledge receipt of a copy of the PlanPlan and a copy of the related Prospectus dated October 29, 2004. APPENDIX A TO STOCK OPTION CERTIFICATE PFF BANCORP, INC. 2004 EQUITY INCENTIVE PLAN NOTICE OF EXERCISE OF STOCK OPTION -------------------------------------------------------------------------------- USE THIS NOTICE TO INFORM PFF BANCORP, INC. THAT YOU ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF PFF BANCORP, INC. PURSUANT TO AN OPTION ("OPTION") GRANTED UNDER THE PFF BANCORP, INC. 2004 EQUITY INCENTIVE PLAN ("PLAN"). IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION CERTIFICATE ENTERED INTO BETWEEN PFF BANCORP, INC. AND THE OPTION RECIPIENT ("CERTIFICATE"). THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: PFF BANCORP, INC., 350 SOUTH GAREY AVENUE, POMONA, CA 00000, XXXXXXXXX: EMPLOYEE COMPENSATION AND BENEFITS COMMITTEE. THE EFFECTIVE DATE OF THE EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY PFF BANCORP, INC. ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE PLAN. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementIDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION CERTIFICATES. Name of Option RecipientNAME OF OPTION RECIPIENT: Option Grant Date____________________________________________ OPTION GRANT DATE: ________________, __________ Exercise Price per share(MONTH AND DAY) (YEAR) EXERCISE PRICE PER SHARE: $________________.____ (Month and Day) (Year) TOTAL 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 ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank draft payable to the order of Dime Community BancsharesPFF Bancorp, Inc. Inc, in the amount of $ ¨ $____________________ |_| I enclose Shares I have owned for at least six months duly endorsed for transfer to Dime Community BancsharesPFF 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 NoNAME AND ADDRESS SOCIAL SECURITY NO. NoNO. of Shares OF SHARES ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- ------------------------------------------------------------------------------ - - ------------------------------------------------------------------------------ --------- ----------- --------- --------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with NonFOR EMPLOYEE OPTION RECIPIENTS WITH NON-Qualified Stock Options onlyQUALIFIED STOCK OPTIONS ONLY. Outside Directors and Beneficiaries should not completeBENEFICIARIES 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 Dime Community BancsharesPFF Bancorp, Inc., 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 the Administrator 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 meme 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. S I G N H E R E COMPLIANCE WITH TAX AND SECURITIES LAWS I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community BancsharesPFF Bancorp, Inc.) regarding the application S H of all laws -- particularly tax and securities laws -- to the I E transactions to be effected pursuant to my Option and this Notice. G R I understand that I will be responsible for paying any federal, N E 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 _______________________________________ ___________________ Signature DATE --------------------------------------------------------- INTERNAL USE ONLY -------------------------------------------------------- Received [CHECK ONE]: |_| By Hand |_| By Mail Post Marked ________________________________ DATE OF POST MARK By ___________________________________________________________________ _______________________________________________________________________ AUTHORIZED SIGNATURE DATE OF RECEIPT APPENDIX B TO STOCK OPTION CERTIFICATE PFF BANCORP, INC. 2004 EQUITY INCENTIVE PLAN BENEFICIARY DESIGNATION FORM -------------------------------------------------------------------------------- GENERAL INFORMATION USE THIS FORM TO DESIGNATE THE BENEFICIARY(IES) WHO WILL RECEIVE VESTED STOCK OPTIONS OUTSTANDING TO YOU AT THE TIME OF YOUR DEATH. Name of Award Recipient _________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By Social Security Number _______________-__-____ _______________ Authorized Signature Date BENEFICIARY COMPLETE SECTIONS A AND B. IF NO PERCENTAGE SHARES ARE DESIGNATION 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(s) as my primary Beneficiary(ies) under the Plan, reserving the right to change or revoke this designation at any time prior to my death: NAME ADDRESS RELATIONSHIP BIRTH DATE 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 Receiptmy primary Beneficiaries should predecease me, reserving the right to change or revoke this designation at any time prior to my death:
Appears in 1 contract
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee Recipient acknowledges receipt of a copy of the Plan. The Recipient acknowledges that he or she may not and will not rely on any statement of account or other communication or document issued in connection with the Plan other than the Plan, this Agreement, and any document signed by an authorized representative of the Company that is designated as an amendment of the Plan or this Agreement. APPENDIX A TO STOCK OPTION AGREEMENT PROVIDENT BANCORP, INC. 2004 STOCK INCENTIVE PLAN Notice of Exercise of Stock Option ------------------------------------------------------------------------------ Use this Notice to inform the Committee administering the Provident Bancorp, Inc. 2004 Stock Incentive Plan ("Plan") that you are exercising your right to purchase shares of common stock ("Shares") of Provident Bancorp, Inc. ("Provident") pursuant to an option ("Option") granted under the Plan. If you are not the person to whom the Option was granted ("Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Agreement entered into between Provident and the Recipient ("Agreement"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Provident Bancorp, Inc., c/o Provident Bank, 400 Rella Boulevaxx, Xxxxxxxxxx, New York, Attention: Corporate Secretary. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by Provident ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Stock Option Agreement (Provident New York Bancorp)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION AGREEMENT HOME BANCORP OF ELGIN, INC. 1997 STOCK OPTION PLAN Notice of Exercise of Stock Option -------------------------------------------------------------------------------- Use this notice to inform the Committee administering the Home Bancorp of Elgin, Inc. 1997 Stock Option Plan ("Plan") that you are exercising your right to purchase shares of common stock ("Shares") of Home Bancorp of Elgin, Inc. (the "Company") pursuant to an option ("Option") granted under the Plan. If you are not the person to whom the Option was granted ("Option Recipient") you must attach to this notice proof of your right to exercise the Option granted under the Stock Option Agreement entered into between the Company and the Option Recipient ("Agreement"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Home Bancorp of Elgin, Inc., c/o Home Federal Savings and Loan Association of Elgin, 16 North Spring Street, Elgin, Illinois 60120 Attention: Corporate Sxxxxxxxx. Xxx xxxxxxxxx xxxx xx xxx xxxxxxxx xf the Option shall be the earliest date practicable following the date this Notice is received by the Company, but in no event more than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Stock Option Agreement (State Financial Services Corp)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges receipt of a copy of the Plan. APPENDIX A U.S.B. HOLDING CO., INC., 2005 EMPLOYEE STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION USE THIS NOTICE TO INFORM THE COMMITTEE ADMINISTERING THE U.S.B. HOLDING CO., INC., 2005 EMPLOYEE STOCK OPTION PLAN ("PLAN") THAT YOU ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF U.S.B. HOLDING CO., INC. ("USB") PURSUANT TO AN OPTION ("OPTION") GRANTED UNDER THE PLAN. IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT ENTERED INTO BETWEEN USB AND THE OPTION RECIPIENT ("AGREEMENT"). THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: U.S.B. HOLDING CO., INC., 100 DUTCH HILL ROAD, ORANGEBURG, NEX XXXX 00000, XXXXXXXXX: XXXXX XXXXXXXXX XXXXXXR - STOCK OPTION PLANS. THE EFFECTIVE DATE OF THE EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE REASONABLY PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY USB ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE PLAN. THIS NOTICE IS SUBJECT TO ALL OF THE TERMS AND CONDITIONS OF THE PLAN AND THE AGREEMENT. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement- IDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION AGREEMENT. Name of Option Recipient: Option Grant DateNAME OF OPTIONEE: ______________________________________________ OPTION GRANT DATE:_______________, __________ Exercise Price per shareEXERCISE PRICE PER SHARE: $________________.____ (Month and DayMONTH AND DAY) (YearYEAR) TOTAL 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 ¨ METHOD OF PAYMENT |_| I enclose a certified check, money order, or bank $____________ draft payable to the order of Dime Community BancsharesU.S.B. Holding Co., Inc. in the amount of $ ¨ |_| I enclose Shares Shares* duly endorsed for transfer to Dime Community Bancshares$____________ U.S.B. Holding Co., Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ |_| I authorize the transfer of ______________ shares* $____________ of U.S.B. Holding Co., Inc. from my account at ____________, account number ____________ to pay for this exercise with a fair market value of * - Shares must be owned for a period of at least six months. 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 NoNAME AND ADDRESS SOCIAL SECURITY NO. No. of Shares NO OF SHARES - - -------------------------------------------- ------- ---- ------- ------------ -------------------------------------------- - - -------------------------------------------- ------- ---- ------- ------------ -------------------------------------------- WITHHOLDING ELECTIONS For Employee Option Recipients with Non- FOR EMPLOYEE OPTION RECIPIENTS WITH NON-Qualified Stock Options onlyQUALIFIED STOCK OPTIONS ONLY. Outside Directors and Beneficiaries should not completeBENEFICIARIES 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 Dime Community Bancshares, Inc., USB 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 the Administrator on the day after the Effective Date of my Option exercise. ¨ exercise |_| With the proceeds from shares, previously owned for a sale period of Shares that would otherwise be distributed at least six months, duly endorsed for transfer to me. ¨ U.S.B. Holding Co., Inc. |_| Retain shares that would otherwise be distributed to me. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt.
Appears in 1 contract
Plan Provisions Control. This Stock Option Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions provisions of this Stock Option Agreement, the terms of the Plan, which are incorporated incorporated herein by reference, shall control. By signing this Stock Option Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. You acknowledge that you may not and will not rely on any statement of account or other communication or document issued in connection with the Plan other than the Plan, this Stock Option Agreement, and any document signed by an authorized representative of the Company that is designated as an amendment of the Plan or this Stock Option Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Price________________ x $__________.______ = $___________________________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ o I enclose a certified check, money order, or bank draft payable payable to the order of Dime Community North Central Bancshares, Inc. in the amount of $ ¨ o I enclose Shares duly endorsed for transfer to Dime Community North Central Bancshares, Inc. with all stamps attached and having a fair market value of $ ¨ Return a number of shares from any Option exercised with an aggregate built-in gross [defined as $ fair Market Value on the date of exercise ____the Exercise Price equal to Total Exercise Price $ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 the above instructions 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. Outside Directors and 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 Dime Community North Central Bancshares, Inc., 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 the Administrator North Central Bancshares, 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 By retaining Shares that would otherwise be distributed to me. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation 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 Compensation 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 I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community North Central Bancshares, 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 _______________________________________________________________________________________________ Signature Date Received [check one]: G By Hand G By Mail Post Marked ___________________________________________________ Date of Post Mark _____________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ______________________________ Authorized Signature Date of Receipt GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who will receive vested stock options outstanding to you at the time of your death. Name of Person Making Designation _______________________________ Authorized Signature Date Social Security Number _______C_____C_______ 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 Receipteach remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately.
A. PRIMARY BENEFICIARY(IES). I hereby designate the following person(s) as my primary Beneficiary(ies), reserving the right to change or revoke this designation at any time prior to my death: B. CONTINGENT BENEFICIARY(IES). I hereby designate the following person(s) as my contingent Beneficiary(ies) 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 with respect to all outstanding Stock Options:
Appears in 1 contract
Samples: Stock Option Agreement (North Central Bancshares Inc)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION AGREEMENT 1997 STOCK OPTION PLAN FOR OUTSIDE DIRECTORS, OFFICERS AND EMPLOYEES OF FALMOUTH BANCORP, INC. Notice of Exercise of Stock Option Use this Notice to inform the Committee administering the 1997 Stock Option Plan for Outside Directors, Officers and Employees of Falmouth Bancorp, Inc. ("Plan") that you are exercising your right to purchase shares of common stock ("Shares") of Falmouth Bancorp, Inc. (the "Company") pursuant to an option ("Option") granted under the Plan. If you are not the person to whom the Option was granted ("Option Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Agreement entered into between the Company and the Option Recipient ("Agreement"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Falmouth Bancorp, Inc., 00 Xxxxx Xxxxxxx, Falmouth, Massachusetts 02340 Attention: Corporate Secretary. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by the Company, but in no event more than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Non Qualified Stock Option Agreement (Falmouth Bancorp Inc)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION AGREEMENT HOME BANCORP OF ELGIN, INC. 1997 STOCK OPTION PLAN Notice of Exercise of Stock Option -------------------------------------------------------------------------------- Use this notice to inform the Committee administering the Home Bancorp of Elgin, Inc. 1997 Stock Option Plan ("Plan") that you are exercising your right to purchase shares of common stock ("Shares") of Home Bancorp of Elgin, Inc. (the "Company") pursuant to an option ("Option") granted under the Plan. If you are not the person to whom the Option was granted ("Option Recipient") you must attach to this notice proof of your right to exercise the Option granted under the Stock Option Agreement entered into between the Company and the Option Recipient ("Agreement"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Home Bancorp of Elgin, Inc., c/o Home Federal Savings and Loan Association of Elgin, 16 Xxxxx Xxxxxx Xxxxxx, Xxxxx, Xxxxxxxx 00000 Xttention: Corporate Secretary. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by the Company, but in no event more than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. 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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Samples: Non Qualified Stock Option Agreement (State Financial Services Corp)
Plan Provisions Control. This Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Agreement, the terms of the Plan, which are incorporated herein by reference, shall control. By signing this Agreement, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION AGREEMENT BIG FOOT FINANCIAL CORP. 1997 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION ------------------------------------------------------------------------------------------------------------------------------------ USE THIS NOTICE TO INFORM THE COMMITTEE ADMINISTERING THE BIG FOOT FINANCIAL CORP. 1997 STOCK OPTION PLAN("PLAN") THAT YOU ARE EXERCISING YOUR RIGHT TO PURCHASE SHARES OF COMMON STOCK ("SHARES") OF BIG FOOT FINANCIAL CORP. (THE "COMPANY") PURSUANT TO AN OPTION ("OPTION") GRANTED UNDER THE PLAN. IF YOU ARE NOT THE PERSON TO WHOM THE OPTION WAS GRANTED ("OPTION RECIPIENT"), YOU MUST ATTACH TO THIS NOTICE PROOF OF YOUR RIGHT TO EXERCISE THE OPTION GRANTED UNDER THE STOCK OPTION AGREEMENT ENTERED INTO BETWEEN THE COMPANY AND THE OPTION RECIPIENT ("AGREEMENT"). THIS NOTICE SHOULD BE PERSONALLY DELIVERED OR MAILED BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED TO: BIG FOOT FINANCIAL CORP., C/O FAIRFIELD SAVINGS BANK, 1190 RFD, LONG GROVE, ILLINOIS 60047 ATTENTION: CORPORATE SXXXXXXXX. XXX XXXXXXXXX XXXX XX XXX EXERCISE OF THE OPTION SHALL BE THE EARLIEST DATE PRACTICABLE FOLLOWING THE DATE THIS NOTICE IS RECEIVED BY THE COMPANY, BUT IN NO EVENT MORE THAN THREE DAYS AFTER SUCH DATE ("EFFECTIVE DATE"). EXCEPT AS SPECIFICALLY PROVIDED TO THE CONTRARY HEREIN, CAPITALIZED TERMS SHALL HAVE THE MEANINGS ASSIGNED TO THEM UNDER THE PLAN. THIS NOTICE IS SUBJECT TO ALL OF THE TERMS AND CONDITIONS OF THE PLAN AND THE AGREEMENT. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementIDENTIFY BELOW THE OPTION THAT YOU ARE EXERCISING BY PROVIDING THE FOLLOWING INFORMATION FROM THE STOCK OPTION AGREEMENT. Name of Option RecipientNAME OF OPTION RECIPIENT: Option Grant Date__________________________________________________________________ OPTION GRANT DATE: ____________________, __________ Exercise Price per shareEXERCISE PRICE PER SHARE: $________________.____ (Month and DayMONTH AND DAY) (YearYEAR) EXERCISE PRICE Compute the Exercise Price below and select a method of paymentCOMPUTE THE EXERCISE PRICE BELOW AND SELECT A METHOD OF PAYMENT. Total Exercise Price TOTAL EXERCISE PRICE ________________ x $__________.______ = $______________________ (No. of Shares) (Exercise Price) (Total Exercise Price Method of Payment ¨ Price) METHOD OF PAYMENT /_/ I enclose a certified check, money order, or bank draft payable to the order of Dime Community Bancshares, Inc. Big Foot Financial Corp. in the amount of $ ¨ $______________ /_/ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. the Company with all stamps attached and having a fair market value of $ $______________ Total Exercise Price $ $______________ 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 NoNAME AND ADDRESS SOCIAL SECURITY NO. No. of Shares - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 NO OF SHARES __________________________________________________________________________ ________-________-________ ______________________ __________________________________________________________________________ __________________________________________________________________________ ______________-________-________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ______________________ __________________________________________________________________________ Authorized Signature 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 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 the Committee on the day after the Effective Date of Receiptmy 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. 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.
Appears in 1 contract
Plan Provisions Control. This Agreement Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this AgreementCertificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this AgreementCertificate, the Optionee acknowledges you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE LAKE SHORE BANCORP, INC. 2006 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION Use this Notice to inform Lake Shore Bancorp, Inc. that you are exercising your right to purchase shares of common stock (“Shares”) of Lake Shore Bancorp, Inc. pursuant to an option (“Option”) granted under the Lake Shore Bancorp, Inc. 2006 Stock Option Plan (“Plan”). If you are not the person to whom the Option was granted (“Option Recipient”), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Certificate entered into between Lake Shore Bancorp, Inc. and the Option Recipient (“Certificate”). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Lake Shore Bancorp, Inc., 000 Xxxx 0xx Xxxxxx, Xxxxxxx, XX 00000, Attention: Compensation Committee. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by Lake Shore Bancorp, Inc. (“Effective Date”). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option AgreementCertificate. 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 Dime Community BancsharesLake Shore Bancorp, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to Dime Community BancsharesLake Shore Bancorp, Inc. with all stamps attached and having a fair market value of of* $ Total Exercise Price $ ISSUANCE OF CERTIFICATES * Subject to Committee approval as an acceptable method of payment. 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. Outside Directors and 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 Dime Community BancsharesLake Shore Bancorp, Inc., 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 the Administrator Lake Shore 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 meme 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt.
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Plan Provisions Control. This Agreement Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this AgreementCertificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this AgreementCertificate, the Optionee acknowledges you acknowledge receipt of a copy of the Plan and a copy of the related Prospectus dated May 13, 2004. APPENDIX A TO STOCK OPTION CERTIFICATE SLADE'S FERRY BANCORP 2004 EQUITY XXXXXXXVE PLAN NOTICE OF EXERCISE OF STOCK OPTION Use this Notice to inform Slade's Ferry Bancorp that you are xxxxxxsing your right to purchase shares of common stock ("Shares") of Slade's Ferry Bancorp pursuant to xx xxxxon ("Option") granted under the Slade's Ferry Bancorp 2004 Equity Xxxxxxxve Plan ("Plan"). If you are not the person to whom the Option was granted ("Option Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Certificate entered into between Slade's Ferry Bancorp and the Optixx Xxxxpient ("Certificate"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Slade's Ferry Bancorp, 100 Slade's Xxxxx Avenue, Somerset, XX 00000, Xxxxxxxxx: Personnel Committee. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by Slade's Ferry Bancorp but in no evxxx xxxe than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Agreement. Name of Option Recipient: Option Grant Date: ________________, __________ Exercise Price per share: $________________Certificate.____ (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 Dime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares duly endorsed for transfer to Dime Community Bancshares, Inc. with all stamps attached and having a fair market value of $ Total Exercise Price $ 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. Outside Directors and 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 Dime Community Bancshares, 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 the Administrator 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. 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. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, 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 _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
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