Common use of ASSIGNMENT FORM Clause in Contracts

ASSIGNMENT FORM. If you, the Holder, want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ________________________________________________________________________________ (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- )____________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ________________________________________________________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ________________________________________________________________________________ Date: _________________ Your signature: ------------------- -------------------------------- :_________________________________________ (Sign exactly as your name appears on the other side face of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- )___________________________ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ------------------------------------------------------------------------------ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ------------------------------------------------------------------------------ Date: _____________ Your signature: ------------------- -------------------------------- :______________________________________ (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ____________________________________________________________________ (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- )________ ____________________________________________________________________ ____________________________________________________________________ ________________________________________________________________________________ (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ______________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ________________________________________________________________________________ Date: :__________ Your signature: ------------------- -------------------------------- :_____________________________ (Sign exactly as your name appears on the other side of this Security)) Signature Guarantee:___________________________________________

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ________________________________________________________________________________ ________________________________________________________________________________ (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ________________________________________________________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ________________________________________________________________________________ Date: :________________ Your signature: ------------------- -------------------------------- :_____________________________ (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) ---------- and irrevocably appoint: -------------------------------------------------------------------- appoint ------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ----------------- -------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ------------------ -------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ------------------------------------------------------------------------------- Date: Your signatureSignature: ------------------- -------------------------------- ---------------------- ------------------------------ (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you as the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to (Insert assignee's social security or tax ID numberINSERT ASSIGNEE'S SOCIAL SECURITY OR TAX IDENTIFICATION NUMBER) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ======================== -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: -------------------------------------------------------------------------- Your signature: ------------------- -------------------------------- ----------------------------------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, the Holder, you want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- _____________________________________________ _____________________________________________ _____________________________________________ _______________________________________________________________________________ (Insert assignee's Print or type name, address and zip code and social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- (Print or type number of assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ____________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: Your signatureSigned: ------------------- ------------------------------- -------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ________________________________________________________________________________ (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- )_________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ________________________________________________________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ________________________________________________________________________________ Date: Your signature: ------------------- -------------------------------- ------------------------ ---------------------------------- (Sign exactly as your name appears on the other side face of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: ________________ Your signature: ------------------- -------------------------------- ----------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) ---------- and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ---------------- -------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, the Holder, want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- ---------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- _________________ (Print or type assignee's name, address, address and zip code) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- and irrevocably appoint: -------------------------------------------------------------------- appoint _________________________________________________ of __________________________________________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for himsuch agent. ------------------------------------------------------------------- DateDated: Your signature: ------------------- -------------------------------- --------- ----------------------------------------------- (Sign exactly as your name appears on the other side of this Security)) By: -------------------------------------------- NOTICE: To be executed by an executive officer Signature Guarantee: -------------------------

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's ASSIGNEE'S name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ----------------- ----------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, the Holder, want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- ---------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ----------------- (Print or type assignee's name, address, address and zip code) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- and irrevocably appoint: -------------------------------------------------------------------- appoint _________________________________________________ of __________________________________________________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for himsuch agent. ------------------------------------------------------------------- DateDated: Your signature: ------------------- -------------------------------- --------- -------------------------------------- (Sign exactly as your name appears on the other side of this Security)) By: --------------------------------------- NOTICE: To be executed by an executive officer Signature Guarantee: -----------------------

ASSIGNMENT FORM. If you, you as the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to (Insert assignee's social security or tax ID numberINSERT ASSIGNEE'S SOCIAL SECURITY OR TAX IDENTIFICATION NUMBER) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: --------------------------------------------------------------------------- Your signature: ------------------- -------------------------------- ----------------------------------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------- -------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- , ------------------------------------------------------- -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: ---------------------- Your signature: ------------------- -------------------------------- ---------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, the Holder, you want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Insert assignee's Print or type name, address and zip code and social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- (Print or type number of assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint _____________________________________, agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- _____________ Signed:____________________________ (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- --------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: _____________ Your signature: ------------------- -------------------------------- -------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- --------------------------- --------------------------- ------------------------------------------------------------------------ ------------------------------------------------------------------------ ------------------------------------------------------------------------ (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint , ------------------------------------------------ ------------------------------------------------------------------------ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- Date: ---------------------------------- Your signature: ------------------- -------------------------------- --------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: _____________________ Your signature: ------------------- -------------------------------- _________________________ (Sign exactly as your name appears on the other side of this Security)) Signature Guarantee: ___________________________________________________________ EXHIBIT B FORM OF NOTATION ON SECURITY RELATING TO GUARANTEE

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this [name of Security], fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security [name of Security] to: -------------------------------------------------------------------- -------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- (Insert assignee's Print or type name, address and zip code and social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- (Print or type assignee's name, address, and zip codenumber of assignees) and irrevocably appoint: -------------------------------------------------------------------- , ______________________________________ agent to transfer this Security [name of Security] on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- DateDated: Your signatureSigned: ------------------- -------------------------------- ------------------------ ---------------------- ------------------------------- (Sign exactly as your name appears on the other side of this [name of Security])

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to ------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ----------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint ______________________________ agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ------------------------ ------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form below: I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Insert assignee's social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Print or type assignee's name, address, and zip code) ---------- and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------------------------------------------------- agent to transfer this Security on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- -------------------------------------------------------------------------------- Date: Your signature: ------------------- -------------------------------- ---------------- ------------------------------ (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, Holder want to assign this Security, fill in the form belowbelow and have your signature guaranteed: For value received, I or we assign and transfer this Security to: -------------------------------------------------------------------- -------------------------------------------------------------------- to (Insert assignee's social security or tax ID numberINSERT ASSIGNEE'S SOCIAL SECURITY OR TAX IDENTIFICATION NUMBER) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- (Print or type assignee's name, address, address and zip code) and irrevocably appoint: -------------------------------------------------------------------- appoint -------------------------------------- agent to transfer this Security on the books of the ---------------------------- Company. The agent may substitute another to act for him. ------------------------------------------------------------------- ------------------------------------------------------------------------------- Date: -------------------------------------- Your signature: ------------------- -------------------------------- --------------------------------------------- (Sign exactly as your name appears on the other side of this Security)

ASSIGNMENT FORM. If you, you the Holder, holder want to assign this [name of Security], fill in the form belowbelow and have your signature guaranteed: I or we assign and transfer this Security [name of Security] to: -------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- (Insert assignee's Print or type name, address and zip code and social security or tax ID number) -------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------- (Print or type assignee's name, address, and zip codenumber of assignees) and irrevocably appoint: -------------------------------------------------------------------- , ______________________________________ agent to transfer this Security [name of Security] on the books of the Company. The agent may substitute another to act for him. ------------------------------------------------------------------- DateDated: Your signatureSigned: ------------------- -------------------------------- ------------------ ------------------------------- -------------------------------------- (Sign exactly as your name appears on the other side of this [name of Security])