FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. Dated: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members of the Stamp Medallion Program.
Appears in 2 contracts
Sources: Successor Rights Plan Agreement (West Fraser Timber Co., LTD), Shareholder Rights Plan Agreement (Norbord Inc.)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and ProvinceProvince or State) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and ProvinceProvince or State) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or trust company, a member firm of a recognized stock exchange in Canada, a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in Canada or the United States or a member of an acceptable the Securities Transfer Association Medallion Signature Guarantee Program (STAMP, SEMP, MSP)Stamp) Program. The guarantor must affix undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a stamp bearing Person acting jointly or in concert with any of the actual words “Signature Guaranteed”foregoing. In Capitalized terms shall have the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” onlymeaning ascribed thereto in the Shareholder Rights Agreement. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members (Please print name of the Stamp Medallion Program.Signatory)
Appears in 2 contracts
Sources: Shareholder Rights Plan Agreement (Dirtt Environmental Solutions LTD), Shareholder Rights Plan Agreement (Dirtt Environmental Solutions LTD)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights represented by this Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) AND TO: Computershare Investor Services Inc. The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) Dated: Signature Signature: Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature signature(s) on this election to exercise form must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must also be guaranteed by one of the following methods: In Canada and the US: a major Canadian Schedule I chartered bank or Medallion Guarantee obtained from a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, ,SEMP or MSP). Many banks, credit unions and broker dealers are members of a Medallion Guarantee Program. The guarantor must affix a stamp in the space above bearing the actual words “Medallion Guaranteed”. In Canada: a Signature Guarantee obtained from a major Canadian Schedule I bank that is not a member of a Medallion Guarantee Program. The guarantor must affix a stamp in the space above bearing the actual words “Signature Guaranteed”. In Outside Canada and the USA, signature guarantees US: holders must be done by members obtain a guarantee from a local financial institution that has a corresponding affiliate in Canada or the US that is a member of a “an acceptable Medallion Signature Guarantee Program” only. The corresponding affiliate must over guarantee the guarantee provided by the local financial institution. CERTIFICATE The undersigned party exercising Rights hereunder hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members (please print name of the Stamp Medallion Program.signatory)
Appears in 2 contracts
Sources: Shareholder Rights Plan Agreement (Caledonia Mining Corp), Shareholder Rights Plan Agreement (Caledonia Mining Corp)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTDTAHOE RESOURCES INC. and AST TRUST COMPANY (CANADA) COMPUTERSHARE INVESTOR SERVICES INC. The undersigned hereby irrevocably Irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. number If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: number Signature Signature Guaranteed: (Signature must correspond to name as written Signature Guaranteed: upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) *The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and person executing this form of transfer must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature guarantee medallion program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Common Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. Signature
Appears in 2 contracts
Sources: Shareholder Rights Plan Agreement (Tahoe Resources Inc.), Shareholder Rights Plan Agreement (Tahoe Resources Inc.)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER COATS CORPORATION and COMPUTERSHARE INVESTOR SERVICES INC. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. Dated: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The guarantor Guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members of the Stamp Medallion Program.. The undersigned Person exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms in this Certificate shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. Signature
Appears in 2 contracts
Sources: Shareholder Rights Plan Agreement (ATS Corp /ATS), Shareholder Rights Plan Agreement (ATS Corp /ATS)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER COLOMIKO METALS INC. LTD. and AST AND TO: COMPUTERSHARE TRUST COMPANY (CANADA) OF CANADA The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated) DATED: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature medallion guarantee program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Common Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Programundersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement of LOMIKO METALS INC.
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a Canadian chartered bank or trust company, a member firm of a recognized stock exchange in Canada a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in Canada or the United States or a member of the Securities Transfer Association Medallion (Stamp) Program. major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature medallion guarantee program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with any of the foregoing. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. (Please print name of Signatory)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _________________________________________ The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or an eligible guarantor institution with membership in an approved signature medallion guarantee program. CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a member Person acting jointly or in concert with any of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)the foregoing. The guarantor must affix a stamp bearing Capitalized terms shall have the actual words “Signature Guaranteed”. In meaning ascribed thereto in the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” onlyShareholder Rights Agreement. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members (Please print name of the Stamp Medallion Program.Signatory)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Asanko Gold Inc.)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or trust company, a member firm of a recognized stock exchange in Canada a registered national securities exchange in the United States, a member of the Investment Dealers Association of Canada or National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in Canada or the United States or a member of the Securities Transfer Association Medallion (Stamp) Programan eligible guarantor institution with membership in an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)approved signature medallion guarantee program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with any of the foregoing. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Agreement. (Please print name of Signatory)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) GEN III OIL CORPORATION The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares (or other securities, if applicable, securities or property) issuable upon the exercise of such Rights and requests that certificates for such Shares (or other securities or title to such property) be issued in the name of: (Name) (AddressStreet) (City and State or Province) Social Insurance Number(Country, Social Security NumberPostal Code or Zip Code) SOCIAL INSURANCE, or other taxpayer identification number. SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (AddressStreet) (City and State or Province) Social Insurance Number(Country, Social Security NumberPostal Code or Zip Code) SOCIAL INSURANCE, or other taxpayer identification number. Dated: Signature SOCIAL SECURITY OR OTHER TAXPAYER IDENTIFICATION NUMBER Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election If the Form of Election to exercise must correspond with Exercise indicates that either Shares (or other securities or title to such property) or the name as written upon balance of Rights not being exercised are to be issued to a person or persons other than the face registered holder of the Right Certificate(s)Rights Certificate, in every particular, without alteration or enlargement, or any change whatsoever and the signature of such holder on the Form of Election to Exercise must be guaranteed by a major Canadian Schedule I chartered bank bank, a Canadian trust company, a member of a recognized stock exchange or a member of an acceptable the Securities Transfer Association Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members of the Stamp Medallion ) Program.
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER COSILVERCREST MINES INC. LTD. and AST AND TO: PACIFIC CORPORATE TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) Dated: Signature _______________________ Signature Guaranteed: Signature (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature medallion guarantee program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Common Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement of SilverCrest Mines Inc.
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Silvercrest Mines Inc)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise ________________________________________ The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or an eligible guarantor institution with membership in an approved signature medallion guarantee program. CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a member Person acting jointly or in concert with any of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)the foregoing. The guarantor must affix a stamp bearing Capitalized terms shall have the actual words “Signature Guaranteed”. In meaning ascribed thereto in the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” onlyShareholder Rights Agreement. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members (Please print name of the Stamp Medallion Program.Signatory)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Taseko Mines LTD)
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER COPROMIS NEUROSCIENCES INC. LTD. and AST AND TO: COMPUTERSHARE TRUST COMPANY (CANADA) OF CANADA The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City City, Province and ProvincePostal Code) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) Dated: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature medallion guarantee program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Common Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement dated as of January 22, 2016 between ProMIS Neurosciences Inc. and Computershare Trust Company of Canada
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement
FORM OF ELECTION TO EXERCISE. (To be exercised executed by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise :________________________________________ The undersigned hereby irrevocably elects to exercise _____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Signature (Please print name of Signatory) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature (Please print name of Signatory) Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and Signature must be guaranteed by a major Canadian Schedule I chartered bank or an eligible guarantor institution with membership in an approved signature medallion guarantee program. CERTIFICATE (To be completed if true.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a member Person acting jointly or in concert with any of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)the foregoing. The guarantor must affix a stamp bearing Capitalized terms shall have the actual words “Signature Guaranteed”. In meaning ascribed thereto in the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” onlyShareholder Rights Agreement. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members (Please print name of the Stamp Medallion Program.Signatory)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Northern Dynasty Minerals LTD)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTDLEADING BRANDS, INC. and AST COMPUTERSHARE TRUST COMPANY (CANADA) OF CANADA The undersigned hereby irrevocably elects to exercise _____________________________ _whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in In the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) *The signature on of the person executing this form of election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must be guaranteed by a major Schedule 1 Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP)eligible guarantor institution with membership in an approved signature guarantee medallion program. The guarantor must affix a stamp bearing undersigned party exercising Rights hereunder, hereby represents, for the actual words “Signature Guaranteed”. In benefit of all holders of Rights and Common Shares, that the USARights evidenced by this Rights Certificate are not, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branchesand, Credit Unions or Caisses Populaires unless they are members to the knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Rights Plan Agreement. Signature
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Leading Brands Inc)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) COMPUTERSHARE INVESTOR SERVICES INC. The undersigned hereby irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, or other taxpayer identification number. Dated: Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must be guaranteed by a major Canadian Schedule I chartered bank or a member of an acceptable Medallion Signature Guarantee Program (STAMP, SEMP, MSP). The guarantor must affix a stamp bearing the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members of the Stamp Medallion Program. The undersigned party exercising Rights hereunder, hereby represents, for the benefit of all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not, and, to the knowledge of the undersigned, have never been, Beneficially owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. (To be attached to each Rights Certificate.)
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (West Fraser Timber Co., LTD)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. and AST TRUST COMPANY (CANADA) The undersigned hereby irrevocably elects to exercise _____________________________________ The undersigned hereby irrevocably elects to exercise ____________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of: (Name) (Address) (City and Province) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. ) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) (Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: Signature ) Dated Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) The signature on this election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and (Signature must be guaranteed by a major Canadian member firm of a recognized stock exchange in Canada who is a member of the Stock Transfer Association Medallion Program (medallion guarantee), or a Schedule I Canadian chartered bank or a member major Canadian trust company.) The undersigned party exercising Rights hereunder, hereby represents, for the benefit of an acceptable Medallion Signature Guarantee Program (STAMPall holders of Rights and Common Shares, SEMPthat the Rights evidenced by this Rights Certificate are not, MSP). The guarantor must affix a stamp bearing and, to the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. Signature
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Alberta Star Development Corp)
FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: ▇▇▇▇ ▇▇▇▇▇▇ TIMBER CO. LTD. Silvercorp Metals Inc. and AST TRUST COMPANY (CANADA) Computershare Investor Services Inc. The undersigned hereby irrevocably Irrevocably elects to exercise _____________________________ whole Rights represented by the attached Rights Certificate to purchase the Common Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such securities be issued in In the name of: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Name) (Address) (City and Province) Social Insurance Number, Social Security Number, Number or other taxpayer identification number. Dated: _____________________________ ____________________________________________ Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever.) *The signature on of the person executing this form of election to exercise must correspond with the name as written upon the face of the Right Certificate(s), in every particular, without alteration or enlargement, or any change whatsoever and must be guaranteed by a major Canadian Schedule I chartered bank or a member an eligible guarantor institution with membership in an approved signature guarantee medallion program. Silvercorp\Shareholder rights plan The undersigned party exercising Rights hereunder, hereby represents, for the benefit of an acceptable Medallion Signature Guarantee Program (STAMPall holders of Rights and Common Shares, SEMPthat the Rights evidenced by this Rights Certificate are not, MSP). The guarantor must affix a stamp bearing and, to the actual words “Signature Guaranteed”. In the USA, signature guarantees must be done by members of a “Medallion Signature Guarantee Program” only. Signature guarantees are not accepted from Treasury Branches, Credit Unions or Caisses Populaires unless they are members knowledge of the Stamp Medallion Program.undersigned, have never been, Beneficially owned by an Acquiring Person or an Affiliate or Associate thereof or a Person acting jointly or in concert with an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the meaning ascribed thereto in the Shareholder Rights Plan Agreement. Dated: _____________________________ ____________________________________________ Signature
Appears in 1 contract
Sources: Shareholder Rights Plan Agreement (Silvercorp Metals Inc)