Terms of the Repurchase. Number of Preferred Shares repurchased by the Company: Share certificate number (representing the Preferred Shares previously issued to the Investor at the Closing): Per share Liquidation Amount of Preferred Shares: Accrued and unpaid dividends on Preferred Shares: Aggregate purchase price for Repurchased Preferred Shares: Investor wire information for payment of purchase price: ABA Number: Account Number: Annex K (Form of Repurchase Document) [Version to be used by private issuers] Date of Letter Agreement incorporating the Securities Purchase Agreement: Name of the Company: Corporate or other organizational form of the Company: Jurisdiction of organization of the Company: Number and series of preferred stock issued to the Investor at the Closing (Preferred Shares): Number and series of preferred stock underlying the Warrant issued to the Investor at the Closing (Warrant Shares):
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Samples: Assignment and Assumption Agreement (Sunshine Bancorp, Inc.), Securities Purchase Agreement (First Merchants Corp), Securities Purchase Agreement (Citizens South Banking Corp)
Terms of the Repurchase. Number of Preferred Shares repurchased by the Company: Share certificate number (representing the Preferred Shares previously issued to the Investor at the Closing): Per share Liquidation Amount of Preferred Shares: Accrued and unpaid dividends on Preferred Shares: Aggregate purchase price for Repurchased Preferred Shares: Investor wire information for payment of purchase price: ABA Number: Account Number: Annex K (Form of Repurchase Document) [Version to be used by private issuers] Date of Letter Agreement incorporating the Securities Purchase Agreement: Name of the Company: Corporate or other organizational form of the Company: Jurisdiction of organization of the Company: Number and series of preferred stock issued to the Investor at the Closing (Preferred Shares): Number and series of preferred stock underlying the Warrant issued to the Investor at the Closing (Warrant Shares):
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Samples: Securities Purchase Agreement (First Northern Community Bancorp)
Terms of the Repurchase. Number of Preferred Shares repurchased by the Company: Share certificate number (representing the Preferred Shares previously issued to the Investor at the Closing): Per share Liquidation Amount of Preferred Shares: Accrued and unpaid dividends on Preferred Shares: Aggregate purchase price for Repurchased Preferred Shares: Investor wire information for payment of purchase price: ABA Number: Account Number: Annex K (Form of Repurchase Document) [Version to be used by private issuers] Date of Letter Agreement incorporating the Securities Purchase Agreement: Name of the Company: Corporate or other organizational form of the Company: Jurisdiction of organization of the Company: Number and series of preferred stock issued to the Investor at the Closing (Preferred Shares): Number and series of preferred stock underlying the Warrant issued to the Investor at the Closing (Warrant Shares):
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