NEITHER THE SECURITIES REPRESENTED BY THIS AGREEMENT NOR THE SECURITIES OBTAINABLE UPON EXERCISE HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD, TRANSFERRED, ASSIGNED OR HYPOTHECATED, OR...
Exhibit 10.2
NEITHER THE SECURITIES REPRESENTED BY THIS AGREEMENT NOR THE SECURITIES OBTAINABLE UPON EXERCISE
HAVE BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE
OFFERED, SOLD, TRANSFERRED, ASSIGNED OR HYPOTHECATED, OR EXERCISED BY OR ON BEHALF OF A U.S.
PERSON, UNLESS THERE IS AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT COVERING SUCH SECURITIES,
OR THE COMPANY RECEIVES AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT AN EXEMPTION FROM
SUCH REGISTRATION IS AVAILABLE UNDER REGULATION S PROMULGATED BY THE SECURITIES AND EXCHANGE
COMMISSION UNDER THE ACT OR PURSUANT TO ANOTHER EXEMPTION FROM REGISTRATION. HEDGING TRANSACTIONS
INVOLVING THE SECURITIES REPRESENTED BY THIS AGREEMENT MAY NOT BE CONDUCTED UNLESS IN COMPLIANCE
WITH THE ACT.
PHANTOM STOCK UNITS AGREEMENT
| Date of Issuance: May , 2008 | Certificate No. PSU- |
This Phantom Stock Units Agreement (this “Agreement”), dated May , 2008 (the
“Effective Date”), is made and entered into by and among Trico Marine Services, Inc., a
Delaware corporation (the “Company”) and (“Unitholder”).
W I T N E S S E T H :
WHEREAS, the Company, Unitholder and Trico Shipping AS, a subsidiary of the Company
(“Buyer”), entered into that certain Share Purchase Agreement dated May 15, 2008 (the
“Purchase Agreement”), pursuant to which Buyer agreed to purchase from Unitholder, and
Unitholder agreed to sell to Buyer all of Unitholder’s shares of common stock of DeepOcean ASA, a
Norwegian public limited company (“DeepOcean”);
WHEREAS, pursuant to the Purchase Agreement, the Company agreed to pay Unitholder cash and
issue Phantom Stock Units (as defined below) of the Company; and
WHEREAS, the Company and Unitholder desire to enter into this Agreement to provide for the
terms and conditions of the Phantom Stock Units;
NOW THEREFORE, in consideration of the foregoing and the mutual representations, warranties,
covenants, agreements, terms and conditions contained herein, the parties to this Agreement agree
as follows:
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ARTICLE 1
PHANTOM STOCK UNITS
PHANTOM STOCK UNITS
1.1 Grant. For value received, the Company hereby grants to Unitholder
( ) phantom stock units of the Company (the “Phantom Stock Units”),
which shall be evidenced by this Agreement, representing the right to receive
( ) shares of the Company’s Common Stock, $0.01 par value per share (the
“Trico Common Shares”), or, at the option of the Company, the Cash Equivalent (as defined
below) on the terms and conditions set forth in this Agreement. The number of Trico Common Shares
(and the amount and kind of other securities) for which the Phantom Stock Units are exercisable
shall be subject to adjustment as provided in this Agreement.
1.2 Vesting Schedule. A Phantom Stock Unit may be exercised only after vesting in
accordance with the following schedule:
(a) Time Vesting. Subject to earlier vesting set forth in Section 1.2(b) or Section 1.2(c),
the Phantom Stock Units shall be subject to vesting as follows:
(i) fifty percent (50%) of the Phantom Stock Units shall vest and be exercisable upon the
first anniversary of the Closing Date; and
(ii) the remaining fifty percent (50%) of the Phantom Stock Units shall vest and be
exercisable upon the second anniversary of the Closing Date1.
(b) Performance Vesting. If DeepOcean’s earnings before interest, taxes, depreciation and
amortization (EBITDA) for its fiscal year ended December 31, 2008 is greater than NOK 489,000,000,
then one hundred percent (100%) of the Phantom Stock Units shall vest and be exercisable upon the
first anniversary of the Closing Date. For purposes of this Agreement, “Closing Date”
shall mean the date of the completion and settlement of Buyer’s mandatory offer to purchase all of
the issued and outstanding shares of DeepOcean for NOK 32 in cash.
(c) Change of Control. One hundred percent (100%) of the Phantom Stock Units shall vest and
be exercisable immediately prior to a Change of Control. For purposes of this Agreement,
“Change of Control” means (i) a merger, consolidation or business combination in which the
Company is not the surviving entity or the Company’s shareholders immediately prior to such event
do not own at least a majority of the outstanding equity interests of the surviving company, (ii)
the sale of all or substantially all of the assets of the Company and its subsidiaries in one or
more related transactions, (iii) the acquisition of beneficial ownership or voting control of a
majority of the outstanding equity interests of the Company by any person (as such term is used in
Section 3(a)(9) and Section 13(d) of the U.S. Securities Exchange Act) or a “group” (as defined by
or under Section 13(d)(3) of the U.S. Securities Exchange Act), or (iv) the dissolution or
liquidation of the Company.2
| 1 | With respect to certain members of DeepOcean’s management (each a “Management Member”), all of the Phantom Stock Units granted to those Management Members (74,402 total Phantom Stock Units) will vest 181 days after the Closing Date. | |
| 2 | The Phantom Stock Units granted to certain Management Members will vest in connection with the termination of their employment. All 74,402 Phantom Stock Units granted to certain of these Management Members will vest if, prior to the first anniversary of the Closing Date, their employment with DeepOcean is terminated due to retirement |
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1.3 Exercise Period. The Unitholder may exercise vested Phantom Stock Units, in
whole but not in part, at any time after vesting in accordance with Section 1.2, and from time to
time thereafter until the fifth anniversary of the Closing Date or, if such day is not a business
day, on the next succeeding business day (the “Exercise Period”)3. The Company
will give the Unitholder of the Phantom Stock Units written notice of the expiration of the
Exercise Period at least 30 days (but no more than 45 days) prior to the date of such expiration.
1.4 Exercise Procedure. Vested Phantom Stock Units shall be deemed to have been
exercised when all of the following items have been delivered to the Company (the “Exercise
Time”):
(a) a completed Exercise Certificate, in the form attached as Exhibit 1, executed by the
Unitholder; and
(b) the original of this Agreement executed by the Unitholder.
1.5 Issuance or Payment by the Company. Upon delivery of the items set forth in
Section 1.4, the Company shall deliver either the number of Trico Common Shares set forth in
Section 1.5(a) or the amount set forth Section 1.5(b) below:
(a) a certificate or certificates representing the number of Trico Common Shares underlying
the vested Phantom Stock Units exercised, together with any cash payable in lieu of a fraction of a
share pursuant to Section 1.5(c) of this Agreement; or
(b) an amount in cash equal to the Weighted Average Trading Price on the Nasdaq Global Market
(or such other securities exchange or automated quotation system on which the Trico Common Shares
are then listed or quoted) during the last three days on which the Trico Common Shares were traded
prior to the Exercise Time multiplied by the number of Trico Common Shares underlying the vested
Phantom Stock Units exercised (the “Cash Equivalent”), where the “Weighted Average
Trading Price” for the three days shall mean (x) the sum for all three days of the average of
the high and low sales prices for one Trico Common Share for each of the three days times the
number of Trico Common Shares traded on each such day, all as is reported by the Nasdaq Global
Market (or such other securities exchange or automated quotation system), divided by (y) the total
number of Trico Common Shares traded during such three days, as is reported by the Nasdaq Global
Market (or such other securities exchange or automated quotation system). The Weighted Average
Trading Price shall be converted from USD into NOK based on the USD/NOK exchange rate as quoted by
the Federal Reserve Bank of New York at the end of each of the same three trading days as the
Weighted Average Trading Price of the Trico Common Shares are calculated, using the same weighted
average method of calculation as used with respect to sales prices of the Trico Common Shares.
| (“Retirement”). All 151,707 Phantom Stock Units granted to another Management Member will vest if, prior to the first anniversary of the Closing Date, his employment with DeepOcean is terminated due to Retirement or he steps down (“Step Down”) from his current position (provided he agrees to remain as an employee of the Company until December 31, 2008). | ||
| 3 | With respect to all of the Phantom Stock Units held by Management Members described in footnote 2 above, upon such Retirement or Step Down, their Phantom Stock Units will be exercisable for the lesser of (i) three month period after Retirement or Step Down or (ii) the remaining term of the Exercise Period. |
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(c) In no event shall the Company issue any fractional Trico Common Shares to the Unitholder
pursuant to this Section 1.5. In lieu of any such fractional shares, the Company shall pay the
Unitholder the cash value of such fractional share as determined based on the calculation set forth
in Section 1.5(b).
(d) Any cash amount that may be paid to the Unitholder pursuant to Section 1.5(b) or Section
1.5(c) shall be payable within three (3) business days after the Exercise Time by wire transfer or
delivery of other immediately available funds to Unitholder.
(e) Any Trico Common Shares issued upon exercise of the vested Phantom Stock Units shall be
delivered by the Company to Unitholder within three (3) business days after the date of the
Exercise Time by delivery of a stock certificate or certificates representing such Trico Common
Shares or, at the Unitholder’s option, by crediting its account with such shares through delivery
by electronic book-entry at the Depository Trust Company. Unless the Phantom Stock Units have
expired or been exercised in their entirety, the Company shall prepare a new Phantom Stock Units
Agreement, substantially identical hereto and executed by the Company, representing the rights
formerly represented by the Phantom Stock Units which have not expired or been exercised and shall
deliver such new Phantom Stock Units Agreement to the Unitholder concurrently with the delivery of
certificates for Trico Common Shares.
1.6 Record Holder of Shares. The Trico Common Shares issuable upon the exercise of
the Phantom Stock Units shall be deemed to have been issued to the Unitholder at the Exercise Time,
and the Unitholder shall be deemed for all purposes to have become the record holder of such Trico
Common Shares at the Exercise Time.
1.7 Reserved Shares. The Company shall at all times reserve and keep available out of
its authorized but unissued capital stock, solely for the purpose of issuance upon the exercise of
the Phantom Stock Units, the maximum number of Trico Common Shares issuable upon the exercise of
the Phantom Stock Units. All Trico Common Shares which are so issuable shall, when issued, be duly
and validly issued, fully paid and nonassessable and free from all taxes, liens and charges.
1.8 Replacement. Upon receipt of evidence reasonably satisfactory to the Company (an
affidavit of the Unitholder shall be satisfactory) of the ownership and the loss, theft,
destruction or mutilation of any certificate evidencing the Phantom Stock Units, and in the case of
any such loss, theft or destruction, upon receipt of indemnity reasonably satisfactory to the
Company (provided that if the holder is a financial institution or other institutional investor its
own agreement shall be satisfactory), or, in the case of any such mutilation upon surrender of such
certificate, the Company shall (at its expense) execute and deliver in lieu of such certificate a
new certificate of like kind representing the same rights represented by such lost, stolen,
destroyed or mutilated certificate and dated the date of such lost, stolen, destroyed or mutilated
certificate.
ARTICLE 2
ADJUSTMENT
ADJUSTMENT
2.1 Adjustment of Number of Trico Common Shares. In order to prevent dilution of the
rights granted under the Phantom Stock Units, the number of Trico Common Shares or other
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securities
obtainable upon exercise of the Phantom Stock Units shall be subject to adjustment from time to
time as provided in this Article 2.
2.2 Adjustment for Stock Splits and Combinations. If the Company at any time after
the Date of Issuance (as set forth on the first page of this Agreement) effects a subdivision of
the outstanding Trico Common Shares, the aggregate number of Trico Common Shares for which the
Phantom Stock Units are exercisable shall be proportionately increased. If the Company any time
after the Date of Issuance combines the outstanding Trico Common Shares into a smaller number of
shares, the aggregate number of Trico Common Shares for which the Phantom Stock Units are
exercisable shall be proportionately reduced. Any adjustment under this Section 2.2 shall become
effective at the close of business on the date the subdivision or combination becomes effective.
2.3 Adjustment for Stock Dividends and Distributions. If the Company at any time
after the Date of Issuance makes, or fixes a record date for the determination of holders of Trico
Common Shares entitled to receive, a dividend or other distribution payable in additional Trico
Common Shares, in each such event the aggregate number of Trico Common Shares for which the Phantom
Stock Units are exercisable shall be proportionately increased as of the time of such issuance.
2.4 Adjustments for Other Dividends and Distributions. If the Company at any time
after the Date of Issuance makes, or fixes a record date for the determination of holders of Trico
Common Shares entitled to receive a dividend or other distribution (other than a dividend or
distribution payable solely in Trico Common Shares), in each such event provision shall be made so
that the holder of the Phantom Stock Units shall receive upon exercise hereof, in addition to the
number of Trico Common Shares receivable thereupon, the dividend or distribution which such holder
would have received had such exercise occurred immediately prior to such event. Any such dividends
paid shall be subject to withholding by the Company for taxes.
2.5 Adjustment for Reclassification, Exchange and Substitution. If at any time after
the Date of Issuance the Trico Common Shares issuable upon exercise of the Phantom Stock Units are
changed into the same or a different number of shares of any class or classes of stock, whether by
recapitalization, reclassification or otherwise (other than a subdivision or combination of shares
or stock dividend, a reorganization, merger or consolidation provided for elsewhere in this Article
2), in any such event the Phantom Stock Units shall thereafter represent the right to receive upon
exercise hereof the kind and amount of stock and other securities and property receivable in
connection with such recapitalization, reclassification or other change with respect to the maximum
number of Trico Common Shares issuable upon exercise of the Phantom Stock Units immediately prior
to such recapitalization, reclassification or change, all subject to further adjustments as
provided herein or with respect to such other securities or property by the terms thereof.
2.6 Reorganizations, Mergers or Consolidations. If, at any time after the Date of
Issuance, the Trico Common Shares are converted into other securities or property, whether pursuant
to a reorganization, merger, consolidation or otherwise (other than a recapitalization,
subdivision, combination, reclassification, exchange or substitution of shares provided for
elsewhere in this Article 2 or any such transaction pursuant to which the Company exercises its
right to require exercise pursuant to Section 2.7), then, as a part of such transaction, provision shall be made so that
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the Phantom Stock Units shall thereafter represent the right to receive upon exercise hereof the
number of shares of stock or other securities or property to which a holder of the maximum number
of Trico Common Shares issuable upon exercise of the Phantom Stock Units immediately prior to such
transaction would have been entitled in connection with such transaction, subject to further
adjustments as provided herein or with respect to such other securities or property by the terms
thereof. In any such case, appropriate adjustment shall be made in the application of the
provisions of this Article 2 with respect to the rights of the Unitholder after such transaction to
the end that the provisions of this Article 2 (including adjustment of the number of Trico Common
Shares issuable upon exercise of the Phantom Stock Units) shall be applicable after that event and
be as nearly equivalent as practicable.
2.7 Change of Control. If any transaction is contemplated that would constitute a
Change of Control and that would involve the holders of Trico Common Shares receiving or having the
right to receive securities or other property in exchange for Trico Common Shares (whether by
merger, consolidation, exchange offer or otherwise), then, notwithstanding anything in this
Agreement to the contrary, (a) the Company shall have the right to require that the Unitholder
exercise all Phantom Stock Units immediately prior to the consummation of such Change of Control in
exchange for the Trico Common Shares underlying such Phantom Stock Units, (b) upon such exercise
the Phantom Stock Units and this Phantom Stock Units Agreement shall be null and void and of no
further force and effect and (c) thereafter, Unitholder shall be entitled to receive the number of
shares of stock or other securities or property to which any other holder of such number of Trico
Common Shares immediately prior to the consummation of such transaction would be entitled to in
connection with such transaction.
2.8 Certificate of Adjustment. In each case of an adjustment or readjustment under
this Article 2, the Company, at its expense, shall compute such adjustment or readjustment in
accordance with the provisions hereof and prepare a certificate showing such adjustment or
readjustment, and shall mail such certificate, by first class mail, postage prepaid, to the
Unitholder. The certificate shall set forth such adjustment or readjustment, showing in detail the
facts upon which such adjustment or readjustment is based.
2.9 Notices. The Company shall give written notice to the Unitholder at least 15
days prior to the date on which the Company closes its books or takes a record with respect to any
dividend or distribution upon the Trico Common Shares.
ARTICLE 3
NO ASSIGNMENT
NO ASSIGNMENT
The Phantom Stock Units are not transferable and Unitholder may not sell, transfer, assign,
pledge, encumber or otherwise dispose of any of the Phantom Stock Units or any legal or equitable
interest therein other than by will (testament) or the laws of descent and distribution upon death.
Upon any such permitted assignment, assignee shall assume Unitholder’s rights and obligations
under this Agreement.
ARTICLE 4
MISCELLANEOUS
MISCELLANEOUS
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4.1 Notices. All notices and other communications provided for herein (including the
Exercise Certificate and Assignment Certificate) shall be in writing and shall be deemed to have
been duly given when delivered personally or sent by facsimile or email (provided a confirmation
copy is later sent by other method) or three (3) business days after being mailed by registered or
certified mail, return receipt requested, postage prepaid, to the party to whom it is directed or
one (1) business day after being sent via an internationally recognized courier service for next
business day delivery, to the party to whom it is directed:
If to the Company, to:
0000 Xxxxxxxxx Xxxxxxx, Xxxxx 0000
Xxxxxxx, Xxxxx 00000
Attention: Xxxxx X. Xxxxx
Telephone: (000) 000-0000
Facsimile: (000) 000-0000
E-Mail: xxxxxx@xxxxxxxxxxx.xxx
Xxxxxxx, Xxxxx 00000
Attention: Xxxxx X. Xxxxx
Telephone: (000) 000-0000
Facsimile: (000) 000-0000
E-Mail: xxxxxx@xxxxxxxxxxx.xxx
With a copy to:
Bartlit Xxxx Xxxxxx Xxxxxxxxx & Xxxxx LLP
0000 Xxxxxxx Xxxxxx, Xxxxx 000
Xxxxxx, Xxxxxxxx 00000
Attention: Xxxxx X. Xxxxxxxxx
Telephone: 000-000-0000
Facsimile: 303-592-3140
E-Mail: xxxxx.xxxxxxxxx@xxxxxxx-xxxx.xxx
0000 Xxxxxxx Xxxxxx, Xxxxx 000
Xxxxxx, Xxxxxxxx 00000
Attention: Xxxxx X. Xxxxxxxxx
Telephone: 000-000-0000
Facsimile: 303-592-3140
E-Mail: xxxxx.xxxxxxxxx@xxxxxxx-xxxx.xxx
and:
Xxxxx, Xxxxxx-Xxxxxx & Xxxxxxxxx
X.X. Xxx 0000 Xxxx
X-0000
Xxxx, Xxxxxx
Attention: Bjørn Xxxxxxx Xxxx
Telephone: x00 00 00 00 00
Facsimile: x00 00 00 00 00
E-Mail: xxx@xxxx.xx
X.X. Xxx 0000 Xxxx
X-0000
Xxxx, Xxxxxx
Attention: Bjørn Xxxxxxx Xxxx
Telephone: x00 00 00 00 00
Facsimile: x00 00 00 00 00
E-Mail: xxx@xxxx.xx
If to Unitholder to:
[Name]
[Address]
Telephone:
Facsimile:
E-Mail:
[Address]
Telephone:
Facsimile:
E-Mail:
With a copy to:
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Attention:
Telephone:
Facsimile:
E-Mail:
Telephone:
Facsimile:
E-Mail:
or for any party, at such other address as such party shall have specified in writing to each of
the other parties in accordance with this Section 4.1.
4.2 Amendments. Any provision of this Agreement may be waived or amended if, and only
if, such amendment or waiver is in writing and signed by the Company and Unitholder.
4.3 Entire Agreement. This Agreement (including the Exhibit), together with the
Purchase Agreement (a) constitutes the entire agreement and understandings of the parties hereto
and supersedes all prior agreements and understandings, both written and oral, among the parties
hereto with respect to the subject matter hereof, and (b) is not intended to confer upon any other
Person any rights or remedies hereunder.
4.4 Governing Law. This Agreement shall be governed by and construed in accordance
with the Laws of Norway (without regard to the choice of law provisions thereof).
4.5 Dispute Resolution. The parties shall attempt to resolve disputes that arise out
of or in relation to this Agreement amicably. If the parties in dispute fail to resolve the
dispute, the dispute shall be referred to arbitration pursuant to the Norwegian Arbitration Act
(2004). Each party shall appoint one arbitrator and the two arbitrators shall appoint the third
arbitrator who shall be the chairman of the arbitration tribunal. The chairman shall be a
Norwegian legal professional. If one party fails to appoint an arbitrator within one month from
being requested to do so or if the two arbitrators cannot agree on who shall be appointed chairman
within one month from the last appointment, the Chief Justice of Oslo District Court shall appoint
such arbitrator. The venue of the arbitral proceedings shall be in Oslo and the language shall be
English. The arbitration is deemed to be commenced when request for arbitration is sent from the
party requesting arbitration. The parties agree to conclude a separate agreement on
confidentiality of both the arbitral proceedings and the award immediately after arbitration has
been requested. In the event of any dispute arising out of or related to this Agreement, the
prevailing party shall be entitled to recover from the losing party all of its costs and expenses
incurred in connection with such dispute, including costs of the arbitration and reasonable
attorneys’ fees.
4.6 Severability. If any term or other provision of this Agreement is invalid,
illegal or incapable of being enforced by any law or public policy, all other terms and provisions
of this Agreement shall nevertheless remain in full force and effect. Upon such determination that
any term or other provision is invalid, illegal or incapable of being enforced, the parties hereto
shall negotiate in good faith to modify this Agreement so as to effect the original intent of the
parties as closely as possible in an acceptable manner in order that the transactions contemplated
hereby are consummated as originally contemplated to the greatest extent possible.
4.7 Specific Performance. Each of the parties hereto acknowledges and agrees that the
Company and the Unitholder would be irreparably damaged if each covenant in this
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Agreement is not performed in accordance with its specific terms and that any breach of such provision of this
Agreement by any party to this Agreement could not be adequately compensated in all cases by
monetary damages alone. Accordingly, in addition to any other right or remedy to which either the
Company or the Unitholder may be entitled under this Agreement, the Company and the Unitholder
shall be entitled to enforce such provision of this Agreement by a decree of specific performance
and to temporary, preliminary and permanent injunctive relief to prevent breaches or threatened
breaches of any of such provision of this Agreement, without posting any bond or other undertaking.
4.8 No Rights as a Shareholder. Until Trico Common Shares are issued to the
Unitholder hereunder, the Unitholder shall not possess any rights of a stockholder of the Company
with respect to the Trico Common Shares underlying the Phantom Stock Units, including, without
limitation, the right to vote such Trico Common Shares or receive dividends (except as provided
above).
4.9 Taxes. Unitholder shall bear and pay any taxes payable arising out of or
otherwise in connection with the Phantom Stock Units and the transactions contemplated by this
Phantom Stock Units Agreement, including, without limitation, any taxes arising in connection with
exercising any of the Phantom Stock Units.
4.10 Counterparts. This Agreement may be executed in separate counterparts, each of
which is deemed to be an original and all of which taken together constitute one and the same
agreement.
[REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]
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IN WITNESS WHEREOF, the Company has caused this Phantom Stock Units Agreement to be duly
executed and attested by its duly authorized officers under its corporate seal and to be dated as
of the date first above written.
| COMPANY: | ||||||
| TRICO MARINE SERVICES, INC. | ||||||
| By: | Xxxxx X. Xxxxx | |||||
| Its: | Chief Administrative Officer, | |||||
| Vice President and General Counsel | ||||||
AGREED AND ACKNOWLEDGED:
UNITHOLDER:
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EXHIBIT 1
EXERCISE CERTIFICATE
| To: | Dated: |
The undersigned, pursuant to the provisions set forth in the attached Phantom Stock Units
Agreement (Certificate No. PSU- ), hereby exercises its Phantom Stock Units for Trico
Common Shares covered by such Phantom Stock Units.
The undersigned requests that a certificate for such Trico Common Shares be registered in the
name of whose address is
and whose [identifying
number] is
, and that such
certificate be delivered to
whose address is
.
If said number of Trico Common Shares is less than all of the Trico Common Shares issuable under
the Phantom Stock Units, the undersigned requests that a new Phantom Stock Units Agreement
evidencing the right to the remaining balance of Trico Common Shares for which the Phantom Stock
Units are exercisable be registered in the name of whose address is
and whose [identifying number] is
,
and that such certificate be
delivered to
whose address is
.
| Signature |
|
|||||
| Address |
|
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