COLLATERAL THERAPEUTICS, INC.
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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SECTION 1: / / New Enrollment 2, 3, 7 AND sign attached
ACTIONS Stock Purchase Agreement
/ / Payroll Deduction Change 2, 4, 7
/ / Terminate Payroll Deductions 2, 5, 7
/ / Leave of Absence 2, 6, 7
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SECTION 2: Name
PERSONNEL --------------------------------------------------------------------------------
DATA Last First MI Dept.
Home Address
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Street
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City State Zip Code
Social Security #: / / / / / / - / / / / - / / / / / / / /
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SECTION 3: Effective with the Purchase
NEW Interval Beginning: Payroll Deduction Amount: _____% of base salary*
ENROLLMENT / / February 1, 199_
/ / August 1, 199_ * Must be a multiple of 1% up to a maximum of 10% of
base salary
/ / Initial Offering Period
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SECTION 4: Effective with the I authorize the following new level of payroll
PAYROLL Pay Period Beginning: ______________________________ deduction: % of base salary*
DEDUCTION Month, Day and Year
CHANGE * Must be a multiple of 1% up to a maximum of 10% of
base salary
NOTE: You may reduce your rate of payroll deductions once per 6-month purchase interval to become effective as
soon as possible following the filing of the change form. You may increase your rate of payroll deductions
to become effective as of the start date of the next 6-month purchase interval (February 1 or August 1).
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SECTION 5: Effective with the Your election to terminate your payroll deductions for the
TERMINATE Pay Period Beginning: __________________________ balance of the offering period cannot be changed, and
PAYROLL Month, Day and Year you may not rejoin the offering period at a later date. You
DEDUCTIONS will not be able to resume participation in the ESPP until the
start of the next offering period.
In connection with my voluntary termination of payroll deductions, I elect
the following action regarding my ESPP payroll deductions to date in the
current purchase interval:
/ / Purchase shares of Collateral Therapeutics, Inc. on next scheduled purchase date
OR
/ / Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your eligibility status changes (less than 20 hrs/wk or less than 5
months/yr), you will immediately cease to participate in the ESPP, and your ESPP payroll deductions collected in
that purchase interval will automatically be refunded to you.
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SECTION 6: In connection with my leave of absence, I elect the following action with respect to my ESPP payroll deductions to
date:
LEAVE OF
ABSENCE
/ / Purchase shares of Collateral Therapeutics, Inc. on next scheduled purchase date
OR
/ / Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll deductions will immediately cease. If you return to active
status within 90 days after the start of your leave, your payroll deductions will at that time automatically resume
at the rate in effect for you when your leave began.
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SECTION 7:
AUTHORIZATION
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Date Signature of Employee
