STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I hereby sell, assign and transfer unto ____________________________________ (_________) shares of Common Stock, $0.0001 par value per share, of Xilio Therapeutics, Inc. (the “Corporation”) standing in my name on the books of the Corporation represented by Certificate(s) Number __________ herewith, and do hereby irrevocably constitute and appoint ▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇ and ▇▇▇▇ LLP attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises. Dated: PARTICIPANT: [Name] Name of Spouse (if any): Instructions to Participant: Please do not fill in any blanks other than the signature line(s). The purpose of the Stock Assignment Separate from Certificate is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouse, if any. The signature(s) to this assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See ▇▇▇.▇▇▇.▇▇▇.
Appears in 1 contract
Sources: Restricted Stock Agreement (Xilio Therapeutics, Inc.)
STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I hereby sell, assign and transfer unto ____________________________________ (_________( ) shares of Common Stock, $0.0001 0.001 par value per share, of Xilio Tvardi Therapeutics, Inc. (the “Corporation”) standing in my name on the books of the Corporation represented by Certificate(s) Number __________ herewith, and do hereby irrevocably constitute and appoint ▇W▇▇▇▇▇ ▇▇▇▇▇▇ ▇P▇▇▇▇▇▇▇▇ ▇▇▇▇ and ▇D▇▇▇ LLP attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises. Dated: PARTICIPANT: [Name] Name of Spouse (if any): Instructions to Participant: Please do not fill in any blanks other than the signature line(s). The purpose of the Stock Assignment Separate from Certificate is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouse, if any. The signature(s) to this assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See ▇w▇▇.▇▇▇.▇▇▇.
Appears in 1 contract
Sources: Restricted Stock Agreement (Cara Therapeutics, Inc.)