Common use of For Registered Securities Clause in Contracts

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: _______________________________ Name _______________________________ Address _______________________________ Social security or other Taxpayer Identification Number, if any If only a portion of the Securities is to be converted, please indicate:

Appears in 2 contracts

Samples: Thermo Electron Corp, Thermo Electron Corp

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For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 U.S.$1,000, provided that the unconverted portion of such principal amount is U.S.$1,000 or any integral multiple of U.S.$1,000 in excess thereof) below designated) , into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares of Common Stock or Securities are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated:_________: _____________________ ________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: _______________________________ Name _______________________________ Address _______________________________ Social security Security or other Taxpayer Identification Number, if any If only a portion of the Securities is to be converted, please indicate:

Appears in 1 contract

Samples: Indenture (United Waste Systems Inc)

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ : --------------------------------- ---------------------------------- Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ --------------------------------------- Name ____________________________________ --------------------------------------- Address ____________________________________ --------------------------------------- Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: _______________________________ Name _______________________________ Address _______________________________ Social security or other Taxpayer Identification Number, if any :If only a portion of the Securities is to be converted, please indicate:

Appears in 1 contract

Samples: Thermo Electron Corp

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ : ---------------------- ---------------------- Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ ----------------------------------- Name ____________________________________ ----------------------------------- Address ____________________________________ ----------------------------------- Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are If only a portion of the Securities to be registered in the name of a is to be converted, please indicate: Person other than the Holder, please print such Person's name and address: _____________________1. Principal amount to be converted: U.S. $ ------------------ -------------------------- 2. Principal amount and Name denomination of Registered Securities representing uncoverted principal -------------------------- amount to be issued. Address Amount: U.S.$ ---------------------- -------------------------- Social security or other Taxpayer Denominations: Identification Number, if any U.S.$ ------------ (any integral multiple of U.S. $1,000) C-4 EXHIBIT D --------- Form of Certificate of Beneficial Ownership for Bearer Securities to be Provided to the Euroclear Operator or to Cedel Bank, societe anonyme CERTIFICATION ------------- U.S. $__________ Name _______________________________ Address _______________________________ Social security or other Taxpayer Identification Number, if any If only a portion THERMO INSTRUMENT SYSTEMS INC. [Title of Securities] (the Securities is to be converted, please indicate:"Securities")

Appears in 1 contract

Samples: Thermo Electron Corp

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 U.S.$1,000, PROVIDED that the unconverted portion of such principal amount is U.S.$5,000 or any integral multiple of U.S.$1,000 in excess thereof) below designated) , into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares of Common Stock or Securities are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated:: _____________________ If shares or Registered If only a portion of the Securities are to be Securities is to be registered in the name of a converted, please indicate: Person other than the Holder, please print such Person's name and address: 1. Principal amount to be converted: _________________________ U.S.$___________ Name 2. Principal amount and denomination of Registered Securities representing uncon _________________________ verted principal amount Address to be issued: _________________________ Amount: U.S.$________ Social Security or other Taxpayer Identification Denominations: Number, if any U.S.$______ (any integral multiple of U.S.$1,000, PROVIDED that the unconverted portion of such principal amount is U.S.$5,000 or any integral multiple of U.S.$1,000 in excess thereof) ___________________________ ________________________________ [Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: _______________________________ Name _______________________________ Address _______________________________ Social security or other Taxpayer Identification Number, if any If only a portion of the Securities is to be converted, please indicate:Guaranteed]

Appears in 1 contract

Samples: Staples Inc

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be If only a portion of the Securities is to be registered in the name of a Person other converted, please indicate: than the Holder, please print such Person's name and address: 1. Principal amount to be converted: U.S. $___________________ _______________________________ 2. Principal amount and denomination of Name Registered Securities representing unconverted principal amount to be issued. _______________________________ Address Amount: U.S.$_________________ _______________________________ Social security or other Taxpayer Denominations: Identification Number, if any If only a portion U.S.$__________ (any integral multiple of the U.S. $1,000) EXHIBIT D Form of Certificate of Beneficial Ownership for Bearer Securities is to be convertedProvided to the Euroclear Operator or to Cedel Bank, please indicate:societe anonyme CERTIFICATION U.S. $____________ THERMEDICS INC. [Title of Securities] (the "Securities")

Appears in 1 contract

Samples: Thermo Electron Corp

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For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ : --------------------------------- ------------------------------------ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ --------------------------------------- Name ____________________________________ --------------------------------------- Address ____________________________________ --------------------------------------- Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: _______________________________ Name _______________________________ Address _______________________________ Social security or other Taxpayer Identification Number, if any :If only a portion of the Securities is to be converted, please indicate:

Appears in 1 contract

Samples: Indenture (Thermo Electron Corp)

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares or Securities are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ Signature [MUST BE GUARANTEED IF STOCK IS OR SECURITIES ARE TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered If only a portion of the Securities is to be Securities are to be converted, please indicate: registered in the name of a Person other than the Holder, please print such Person's name and address: 1. Principal amount to be converted: U.S. $___________________ __________________________ 2. Principal amount and denomination of Name _____Registered Securities representing unconverted principal amount to be issued. __________________________ Address Amount: U.S. $_________________ __________________________ Social security or other Denominations: Taxpayer Identification U.S. $__________ Number, if any If only a portion (any integral multiple of the U.S. $1,000) C-4 EXHIBIT D --------- Form of Certificate of Beneficial Ownership for Bearer Securities is to be convertedProvided to the Euroclear Operator or to Cedel Bank, please indicate:societe anonyme CERTIFICATION ------------- U.S. $____________ THERMOTREX CORPORATION [Title of Securities] (the "Securities")

Appears in 1 contract

Samples: Indenture (Thermotrex Corp)

For Registered Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares or Securities are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated:______________________________ ________________________________ Signature [MUST BE GUARANTEED IF STOCK IS OR SECURITIES ARE TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] ____________________________________ Name ____________________________________ Address ____________________________________ Social Security or other Taxpayer Identification Number, if any If shares or Registered Securities are to be If only a portion of the Securities is to be converted, please registered in the name of a Person person other than indicate: the Holder, please print such Person's name and address: 1. Principal amount to be converted: U.S. $___________________ _______________________________________ Name 2. Principal amount and denomination of Registered Securities representing unconverted principal amount to be issued. _______________________________________ Address Amount: U.S.$_________________ _______________________________________ Denominations: Social security or other Taxpayer Identification U.S.$__________ Number, if any If only a portion (any integral multiple of the U.S. $1,000) C-4 EXHIBIT D --------- Form of Certificate of Beneficial Ownership for Bearer Securities is to be convertedProvided to the Euroclear Operator or to Cedel Bank, please indicate:societe anonyme CERTIFICATION ------------- U.S. $____________ THERMO INSTRUMENT SYSTEMS INC. [Title of Securities] (the "Securities")

Appears in 1 contract

Samples: Indenture (Thermo Instrument Systems Inc)

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