Common use of FORM OF ELECTION TO EXERCISE Clause in Contracts

FORM OF ELECTION TO EXERCISE. The undersigned hereby irrevocably elects to exercise _________________________ whole Rights represented by this Rights Certificate to purchase the Shares issuable upon the exercise of such Rights and requests that certificates for such Shares be issued in the name of and delivered to: Address City and Province Social Insurance No. 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: Address City and Province Social Insurance No. or other taxpayer identification number Signature (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever) Signature must be Signature Guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company or a member of a recognized Medallion Guarantee program. The undersigned hereby certifies and represents, for the benefit of the Corporation and 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 by an Affiliate or Associate of an Acquiring Person or any other Person acting jointly or in concert with any of the foregoing (as such terms are defined in the Rights Agreement). Signature (Please print name below signature)

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Gildan Activewear Inc.)

FORM OF ELECTION TO EXERCISE. The undersigned hereby irrevocably elects to exercise _________________________ whole Rights represented by this Rights Certificate to purchase the Shares or other securities, if applicable, issuable upon the exercise of such Rights and requests that certificates for such Shares securities be issued in the name of and delivered to: Name Address City and Province Social Insurance No. 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 No. or other taxpayer identification number Signature (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever) Signature Guaranteed Signature must be Signature Guaranteed signature guaranteed by a Schedule 1 Canadian chartered bank, a Canadian major Canadian trust company or a member firm of a recognized Medallion Signature Guarantee programProgram. The undersigned hereby certifies and represents, for the benefit of the Corporation and 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 by an Affiliate or Associate of an Acquiring Person or any other Person acting jointly or in concert with any of the foregoing (as such terms are defined in the Rights Agreement). Signature (Please print name below signature)

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Aeterna Zentaris Inc.)

FORM OF ELECTION TO EXERCISE. The undersigned hereby irrevocably elects to exercise _________________________ whole Rights represented by this Rights Certificate to purchase the Shares issuable upon the exercise of such Rights and requests that certificates for such Shares be issued in the name of and delivered to: Address City and Province Social Insurance No. 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: Address City and Province Social Insurance No. or other taxpayer identification number Signature (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever) Signature Guaranteed Signature must be Signature Guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company or a member of a recognized Medallion Guarantee program. The undersigned hereby certifies and represents, for the benefit of the Corporation and 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 by an Affiliate or Associate of an Acquiring Person or any other Person acting jointly or in concert with any of the foregoing (as such terms are defined in the Rights Agreement). Signature (Please print name below signature)

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Gildan Activewear Inc.)

FORM OF ELECTION TO EXERCISE. The undersigned hereby irrevocably elects to exercise _________________________ whole Rights represented by this Rights Certificate to purchase the Common Shares issuable upon the exercise of such Rights and requests that certificates for such Common Shares be issued in the name of and delivered to: Name Address City and Province Social Insurance No. 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 No. or other taxpayer identification number Date: Signature Guaranteed (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever) Signature must be Signature Guaranteed guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company company, a member firm of a recognized stock exchange in Canada, a member of a registered national securities exchange in the United States, or a member of a recognized the Securities Transfer Association Medallion Guarantee program(STAMP) Program. The undersigned hereby certifies and represents, for the benefit of the Corporation and 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 by an Affiliate or Associate of an Acquiring Person or any other Person acting jointly or in concert with any of the foregoing (as such terms are defined in the Rights Agreement). Signature (Please print name below signature)Signature

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Nortel Networks Corp)

FORM OF ELECTION TO EXERCISE. (To be exercised by the registered holder if such holder desires to exercise the Rights Certificate.) TO: LEADING BRANDS, INC. and COMPUTERSHARE TRUST COMPANY OF CANADA The undersigned hereby irrevocably elects to exercise _________________________ _____whole Rights represented by this 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 Shares securities be issued in In the name of and delivered toof: Address (Name) (Address) (City and Province Province) Social Insurance No. 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: Address (Name) (Address) (City and Province Province) Social Insurance No. Number or other taxpayer identification number number. Signature Signature Guaranteed: (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever.) Signature *The signature of the person executing this form of election to exercise must be Signature Guaranteed guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company bank or a member of a recognized Medallion Guarantee an eligible guarantor institution with membership in an approved signature guarantee medallion program. The undersigned party exercising Rights hereunder, hereby certifies and represents, for the benefit of the Corporation and all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not not, and, to the knowledge of the undersigned, have never been, Beneficially Owned owned by an Acquiring Person or by an Affiliate or Associate of an Acquiring Person thereof or any other a Person acting jointly or in concert with any of an Acquiring Person or an Affiliate or Associate thereof. Capitalized terms shall have the foregoing (as such terms are defined meaning ascribed thereto in the Rights Plan Agreement). Signature (Please print name below signature)Signature

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Leading Brands Inc)

FORM OF ELECTION TO EXERCISE. TO: NOVAGOLD RESOURCES INC. The undersigned hereby irrevocably elects to exercise _________________________ whole Rights represented by this the attached Rights Certificate to purchase the Common Shares issuable upon the exercise of such Rights and requests that certificates for such Shares be issued in the name of and delivered to: Address City and Province Social Insurance No. or other taxpayer identification number (NAME) (ADDRESS) (CITY AND STATE OR PROVINCE) 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: Address City and Province Social Insurance No. or other taxpayer identification number (NAME) (ADDRESS) (CITY AND STATE OR PROVINCE) SOCIAL INSURANCE, SOCIAL SECURITY OR OTHER TAXPAYER NUMBER Dated Signature Guaranteed Signature (Signature must correspond to name as written upon the face of this Rights Certificate in Signature Guaranteed every particular, without alteration or enlargement or any change whatsoever) Signature must be Signature Guaranteed guaranteed by a Schedule 1 Canadian chartered bank, a major Canadian trust company or a member of a recognized stock exchange or a member of a recognized Medallion Guarantee programProgram. The undersigned hereby certifies and represents, for the benefit of the Corporation and all holders of Rights and Common Shares, that the Rights evidenced by this Rights Certificate are not not, and, to the knowledge of the undersigned, have never been, Beneficially Owned by an Acquiring Person or by an Affiliate or Associate of an Acquiring Person thereof or any other Person acting jointly or in concert consent with any of the foregoing or any Affiliate or Associate of such Person (as such terms are defined in the Rights Agreement). Signature (Please print name below signature)Signature

Appears in 1 contract

Sources: Shareholder Rights Plan Agreement (Novagold Resources Inc)