Form of Election to Convert Sample Clauses
The 'Form of Election to Convert' clause defines the process and requirements for a party to formally notify the other party of its decision to convert a security or instrument, such as a convertible note or preferred shares, into another form, typically common stock. This clause usually specifies the format and content of the conversion notice, the method of delivery, and any supporting documentation that must accompany the election. By standardizing the conversion procedure, the clause ensures clarity and consistency, reducing the risk of disputes or delays related to the conversion process.
Form of Election to Convert. The notice of conversion to be delivered by a Holder to the Conversion Agent in connection with the conversion of Securities of any series that are convertible into Parent Shares shall be in substantially the following form, with such appropriate insertions, omissions, substitutions and other variations as are deemed necessary or appropriate by the Guarantor or the Trustee: NOTICE OF CONVERSION The undersigned Holder of the Securities specified below hereby irrevocably exercises the option to convert such Securities, or the aggregate principal amount thereof specified below, into Common Shares of the Guarantor ("Parent Common Shares") or American Depositary Shares evidencing such Parent Common Shares ("Parent ADSs" and, together with such Parent Common Shares, the "Parent Shares"), as indicated below, in accordance with the terms of the Securities and the Indenture dated as of _______, (the "Indenture") among Ahold Finance U.S.A., Inc., as Issuer, Koninklijke Ahold N.V., as Guarantor, and The Bank of New York, as Trustee, and directs that (i) if such Holder is electing to receive Parent Common Shares, the Parent Common Shares issuable and deliverable upon conversion be delivered to such Holder through Nederlands Centraal Instituut voor Giraal Effectenverkeer and (ii) if such Holder elects to receive Parent ADSs, the Parent American Depositary Receipts evidencing such Parent ADSs issuable and deliverable on conversion be issued in the name of and delivered to the undersigned unless otherwise indicated below and, in either case, any check in payment for fractional Parent Shares be issued in the name of and delivered to the undersigned unless a different name has been indicated below. If Parent ADSs are to be issued in the name of a person other than the undersigned, the undersigned has paid all transfer taxes payable with respect thereto. All capitalized terms used herein and not defined herein shall have the meanings specified in the Indenture. Dated: ___________________________ Signature (for Conversion only) Title of Securities: Certificate Number(s) (if applicable):
(1) Principal Amount to be Converted:(2)
(1) Unless otherwise specified a Holder will deemed to be converting the entire principal amount of the Securities delivered.
(2) Certificate registered in the name of the Holder will be issued in the prncipal amount of the Securities not converted, unless otherwise provided Indicate Parent Shares to be issued: |_| Parent Common Shares |_| Parent Ameri...
Form of Election to Convert. The notice of conversion to be delivered by a Holder to the conversion agent in connection with the conversion of Securities of any series that are convertible into shares of Common Stock shall be in substantially the following form, with such appropriate insertions, omissions, substitutions and other variations as are deemed necessary or appropriate by the Issuer or the Trustee: Notice of Conversion The undersigned Holder of the Securities specified below hereby irrevocably exercises the option to convert such Securities, or the aggregate principal amount thereof specified below, into shares of Common Stock of the Issuer, in accordance with the terms of the Securities and the Indenture dated as of ___________, (the "Indenture") among Newmont Mining Corporation, as issuer, Newmont USA Limited, as guarantor, and Citibank, N.A. as Trustee, and directs that if such Holder is electing to receive Common Stock, the Common Stock issuable and deliverable upon conversion be delivered to such Holder unless otherwise indicated below and any check in payment for fractional shares be issued in the name of and delivered to the undersigned unless a different name has been indicated below. All capitalized terms used herein and not defined herein shall have the meanings specified in the Indenture. Dated: --------------------------- Signature (for Conversion only) Title of Securities: Certificate Number(s) (if applicable):
(1) Principal Amount to be Converted:(2) If check for fractional Shares to be issued otherwise than to Holder: -------------------------- Print name and address Please print name and address of Holder -------------------------- -------------------------- Signature Guarantee: -------------------------- --------------------------
Form of Election to Convert. [To Be Executed Upon Conversion of Warrant] The undersigned holder hereby represents that he or it is the registered holder of this Warrant Certificate, and hereby irrevocably elects to exercise the right, represented by this Warrant Certificate, to convert the Warrants evidenced by this Warrant Certificate into____________ shares of Class A Common Stock, par value $.01 per share (the "Class A Common Stock"), of BRUNSWICK BIOMEDICAL CORPORATION (the "Company") and herewith tenders payment for such shares to the order of the Company in the amount of $___________ in accordance with the terms hereof. The undersigned requests that a certificate for such shares be registered in the name of the undersigned or his/its nominee hereinafter set forth, and further that such certificate be delivered to the undersigned at the address hereinafter set forth or to such other person or entity as is hereinafter set forth. If said number of shares is less than all of the shares of Class A Common Stock convertible hereunder, the undersigned requests that a new Warrant Certificate representing the remaining balance of such shares be registered in the name of the undersigned or his/its nominee hereinafter set forth, and further that such Warrant Certificate be delivered to the undersigned at the address hereinafter set forth or to such other person or entity as is hereinafter set forth. Certificate to be registered as follows: Name: Internationale Nederlanden (U.S.) Capital Corporation Address: 135 ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇ Attn: Chief Credit Officer Certificate to be delivered as follows: Name: Internationale Nederlanden (U.S.) Capital Corporation Address: 135 ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇ Attn: Chief Credit Officer Date: --------------------------- ---------------------------------------- (Signature must conform in all respects to the name of the holder as specified on the fact of the Warrant Certificate, unless Form of Assignment has been executed)
Form of Election to Convert. To: The Bank of New York The undersigned Holder of this Convertible Debenture hereby irrevocably exercises the option to convert this Convertible Debenture, or the portion below designated, into Steel Stock of USX CORPORATION ("USX"), or any other class of common stock of USX, as permitted by the Restated Certificate of Incorporation of USX, in accordance with the terms of the Indenture referred to in this Convertible Debenture, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: in whole in part Portion of principal amount of the Convertible Debenture to be converted (the Principal Amount of One Convertible Debenture or integral multiples thereof): $ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number Signature Guarantee:/(1)/
Form of Election to Convert. To Ferrellgas Partners, L.P.
Form of Election to Convert. To FACT Corporation:
Form of Election to Convert. The notice of conversion to be delivered by a Holder to the Conversion Agent in connection with the conversion of Convertible Securities of any series that are convertible into Common Shares shall be in substantially the following form, with such appropriate insertions, omissions, substitutions and other variations as are deemed necessary or appropriate by AEGON N.V. or the Trustee: Notice of Conversion The undersigned Holder of the Convertible Securities specified below hereby irrevocably exercises the option to convert such Convertible Securities, or the aggregate principal amount thereof specified below, into Common Shares of AEGON N.V., as indicated below, in accordance with the terms of the Convertible Securities and the Indenture dated as of October 11, 2001 (the "Indenture") between AEGON N.V., AEGON Funding Corp., AEGON Funding Corp. II and [.], as Trustee, and directs that (i) the Common Shares issuable and deliverable upon conversion be issued in the name of and delivered to the undersigned unless a different name has been indicated below or (ii) the Cash Option Amount be delivered if AEGON N.V. elects to exercise its Cash Option. AEGON N.V. shall cause any amounts due to the Holder to be paid as promptly as practicable. If Common Shares are to be issued in the name of a Person other than the undersigned, the undersigned has paid all transfer taxes payable with respect thereto. All capitalized terms used herein and not defined herein shall have the meanings specified in the Indenture. Dated:
Form of Election to Convert. The notice of conversion to be delivered by a Holder to the Conversion Agent in connection with the conversion of Convertible Securities of any series that are convertible into other securities shall be in substantially the following form, with such appropriate insertions, omissions, substitutions and other variations as are deemed necessary or appropriate by the Company or the Trustee: Notice of Conversion The undersigned Holder of the Convertible Securities specified below hereby irrevocably exercises the option to convert such Convertible Securities, or the aggregate principal amount thereof specified below, into [ • ] of TPG N.V., as indicated below, in accordance with the terms of the Convertible Securities and the Indenture dated as of May 28, 2004 (the "Indenture") between TPG N.V. and Citibank, N.A., as Trustee, and directs that (i) the [Conversion Securities] issuable and deliverable upon conversion be issued in the name of and delivered to the undersigned unless a different name has been indicated below [or (ii) the cash option amount be delivered if the Company elects to exercise any cash option]. TPG N.V. shall cause any amounts due to the Holder to be paid as promptly as practicable. If [Conversion Securities] are to be issued in the name of a Person other than the undersigned, the undersigned has paid all transfer taxes payable with respect thereto. All capitalized terms used herein and not defined herein shall have the meanings specified in the Indenture. Signature (for Conversion only) Title of Convertible Securities: Certificate Number(s) (if applicable): Aggregate Principal Amount Represented: (1) Principal Amount to be Converted: (2)
(1) Unless otherwise specified, a Holder will be deemed to be converting the entire principal amount of the Convertible Securities delivered.
(2) Certificate registered in the name of the Holder will be issued in the principal amount of the Convertible Securities not converted, unless otherwise provided. Please print name and address [If check for fractional [Conversion Securities] to be issued otherwise than to Holder: Please print name and address] [If TPG N.V. elects a cash option, payment should be made in accordance with the following instructions: Payment to: Please print name and address For Account: ] Please print name and address of Holder
Form of Election to Convert. I (we) hereby irrevocably exercise the option to convert this Note, or the portion below designated, into shares of Common Stock in accordance with the terms of the Indenture referred to in this Note, and direct that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned registered Holder hereof, unless a different name has been indicated below. If shares are to be issued in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Portion of this Note to be converted (if partial conversion, $1,000 or an integral multiple thereof): $______________ Signature:___________________________________ (exactly as your name appears on the face of this Note) Name:_______________________________________ Title:______________________________________ Address:____________________________________ Phone No.:__________________________________ Date:_______________________________________ If shares are to be issued and registered in the name of a Person other than the undersigned, please print the name and address, including zip code, and social security or other taxpayer identification number of such Person below. Name: ________________________________________ Address:______________________________________ TIN/Social Security No:_______________________ Signature Guaranteed (if Common Stock to be issued to other than registered holders):
Form of Election to Convert. To: The Bank of New York The undersigned Holder of this Convertible Debenture hereby irrevocably exercises the option to convert this Convertible Debenture, or the portion below designated, into Steel Stock of USX CORPORATION ("USX"), or any other class of common stock of USX, as permitted by the Restated Certificate of Incorporation of USX, in accordance with the terms of the Indenture referred to in this Convertible Debenture, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: in whole in part Portion of principal amount of the Convertible Debenture to be converted (the Principal Amount of One Convertible Debenture or integral multiples thereof): $ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number Signature Guarantee:/1/ /1/ Signature must be guaranteed by an "eligible guarantor institution" that is a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Conversion Agent, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("STAMP") or such other "signature guarantee program" as may be determined by the Conversion Agent in addition to, or in substitution for, STAMP, all in accordance with the Securities and Exchange Act of 1934, as amended.