STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 3 of the Agreement, please provide us with the following information:
STOCK CERTIFICATE QUESTIONNAIRE. Please provide us with the following information:
STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 2.2(b)(vi) of the Agreement, please provide us with the following information:
STOCK CERTIFICATE QUESTIONNAIRE. Please provide us with the following information and either type or write clearly and legibly:
STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 5(k) of the Agreement, please provide us with the following information:
1. The exact name that the Purchaser's Shares are to be registered in (this is the name that will appear on your stock certificate(s)). A nominee name may be used if appropriate: -----------------------------------------------------------------
2. The relationship between the Purchaser of the Shares and the Registered Holder listed in response to Item 1 above: -----------------------------------------------------------------
3. The mailing address of the Registered Holder listed in response to Item 1 above: ----------------------------------------------------------------- ----------------------------------------------------------------- ----------------------------------------------------------------- -----------------------------------------------------------------
4. The Social Security Number or Tax Identification Number of the Registered Holder listed in response to Item 1 above: -----------------------------------------------------------------
STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 8.2(q) of the Agreement please provide us with the following information:
1. The exact name that the Seller’s Securities are to be registered in (this is the name that will appear on your stock certificate(s)). A nominee name may be used if appropriate:
2. The relationship between the Seller and the Registered Holder listed in response to Item 1 above:
3. The mailing address of the Registered Holder listed in response to Item 1 above:
4. The Social Security Number or Tax Identification Number of the Registered Holder listed in response to Item 1 above:
STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 3 of the Agreement, please allocate the Shares as follows: THIS ESCROW AGREEMENT (“Agreement”) is made and entered into as of the day of February 2004, by and among JPMorgan Chase Bank, a New York banking corporation (the “Escrow Agent”), Genome Therapeutics Corp., a Massachusetts corporation (the “Company”), X.X. Xxxxxx Securities Inc. (“JPMorgan”) and Xxxx Xxxxx Xxxx Xxxxxx, Incorporated (“Xxxx Xxxxx,” and together with JPMorgan, the “Placement Agents”).
STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 4.3 of the Agreement, please provide us with the following information.
1. The exact name that the Shares are to be registered in (this is the name that will appear on the stock certificate(s)). You may use a nominee name if appropriate: --------------------
2. The relationship between the Purchaser of the Share and the Registered Holder listed in response to item 1 above: --------------------
3. The mailing address of the Registered Holder listed in response to item 1 above: -------------------- -------------------- -------------------- -------------------- --------------------
4. The Tax Identification Number of the Registered Holder listed in response to item 1 above: --------------------
STOCK CERTIFICATE QUESTIONNAIRE. Please provide us with the following information:
1. The exact name that the Shares are to be registered in (this is the name that will appear on the stock certificate(s)). You may use a nominee name if appropriate:
2. The relationship between the Purchaser of the Shares and the Registered Holder listed in response to item 1 above:
3. The mailing address of the Registered Holder listed in response to item 1 above:
4. The Tax Identification Number of the Registered Holder listed in response to item 1 above:
STOCK CERTIFICATE QUESTIONNAIRE. To: American Stock Transfer & Trust Company 00 Xxxx Xxxxxx Xxx Xxxx, Xxx Xxxx 00000 Attention: The undersigned, the Purchaser or an officer thereof, or other person duly authorized by the Purchaser, hereby certifies that _________________ (fill in name of Purchaser) institution was the Purchaser of the shares (the "Shares") of common stock, par value $.01 per share, of HemaSure Inc., evidenced by the attached certificate, and as such, proposes to transfer such Shares on or about ________________ (date) either |_| pursuant to a registration statement, in which case the Purchaser certifies that the requirement of a delivering a current prospectus has been complied with or will be complied with in connection with such sale, or |_| pursuant to Rule 144 under the Securities Act of 1933 ("Rule 144"), in which case the Purchaser certifies that it has complied with or will comply with the requirements of Rule 144, or |_| pursuant to an exemption from registration, other than Rule 144, in which case the Purchaser is herewith providing the Company with an opinion of counsel to the effect that the transaction is so exempt. Print or Type: Name of Purchaser: -------------------------------------------------------- Name of Individual representing Purchaser (if an Institution): -------------------------------------------------------- Title of Individual representing Purchaser (if an Institution): ------------------------------------------------------- Signature by: Purchaser or Individual representing Purchaser: ------------------------------------------------------ ANNEX A TO PURCHASE AGREEMENT Form of Legal Opinion of Battle Xxxxxx LLP(1)
1. The Company is a corporation validly existing and in good standing under the laws of the State of Delaware and has all requisite corporate power and authority to conduct its business as presently conducted; and the Company is duly qualified to conduct its business as a foreign corporation in Massachusetts.
2. The authorized capital stock of the Company consists of (a) 35,000,000 shares of common stock, $.01 par value per share, and (b) 1,000,000 shares of undesignated preferred stock, $.01 par value per share.
3. When issued and paid for in accordance with the Agreements, the Shares will be validly issued, fully paid and non-assessable and will not have been issued in violation of any preemptive rights contained in the Company's Certificate of Incorporation or under the Delaware General Corporation Law.
4. The Company has the requi...
