Common use of ASSIGNMENT FORM Clause in Contracts

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the Company, with full power of substitution in the premises. In connection with the transfer of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended.

Appears in 7 contracts

Samples: Convertible Loan Note, Convertible Loan Note, Convertible Loan Note

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ASSIGNMENT FORM. For value received FOR VALUE RECEIVED, the undersigned hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE PLEASE PRINT OR TYPE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE the within NoteSecurity and all rights thereunder, and hereby irrevocably constitutes constituting and appoints appointing attorney to transfer the said Note Security on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the transfer of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) Signature: NOTICE: THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE WITHIN INSTRUMENT IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER. Signature Guarantee: SIGNATURE GUARANTEE Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended.. Maple Escrow Subsidiary, Inc. c/o Keurig Green Mountain, Inc. 00 Xxxxxx Xxxx Xxxxxxxxx, Xxxxxxx 00000 Attention: General Counsel Email: Xxxxx-Xxxxxxxxx@xxxx.xxx Xxxxx Fargo Bank, N.A. Corporate Trust-DAPS Reorg 000 Xxxxxx Xxxxxx Xxxxx, 0xx Floor MAC X0000-000 Xxxxxxxxxxx, XX 00000 Phone: 0-000-000-0000 Fax: 0-000-000-0000 Email: xxxxxxxxx@xxxxxxxxxx.xxx CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFER RESTRICTED NOTES This certificate relates to $ principal amount of Notes held in (check applicable space) book entry or definitive form by the undersigned. The undersigned (check one box below): o has requested the Trustee by written order to deliver in exchange for its beneficial interest in the Global Note held by the Depository a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above); o has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate under the Securities Act, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 6 contracts

Samples: Second Supplemental Indenture (Keurig Dr Pepper Inc.), First Supplemental Indenture (Keurig Dr Pepper Inc.), Fourth Supplemental Indenture (Keurig Dr Pepper Inc.)

ASSIGNMENT FORM. For value received hereby sell(s)If you the Holder want to assign this Note, assign(s)fill in the form below and have your signature guaranteed: I or we assign and transfer this Note to: (Print or type name, address and transfer(s) unto (Please insert zip code and social security or other Taxpayer Identification Number tax ID number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in . The agent may substitute another to act for him. Dated: Signed: (Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note) Signature Guarantee: EXHIBIT C-1 FORM OF PRIVATE PLACEMENT LEGEND THIS SECURITY HAS NOT BEEN REGISTERED UNDER SECTION 5 OF THE SECURITIES ACT OF 1933, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof AS AMENDED (the THE Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transferSECURITIES ACT”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: OR ANY STATE SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE REOFFERED, SOLD, ASSIGNED, TRANSFERRED, PLEDGED, ENCUMBERED OR OTHERWISE DISPOSED OF IN THE ABSENCE OF SUCH REGISTRATION OR UNLESS SUCH TRANSACTION IS EXEMPT FROM, OR NOT SUBJECT TO, SUCH REGISTRATION. THE HOLDER OF THIS SECURITY, BY ITS ACCEPTANCE HEREOF, (1) REPRESENTS THAT (X) IT IS A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule “QUALIFIED INSTITUTIONAL BUYER” (AS DEFINED IN RULE 144A under the UNDER THE SECURITIES ACT), (Y) IT IS A NON-U.S. Securities Act of 1933PURCHASER AND IS ACQUIRING THIS SECURITY IN AN OFFSHORE TRANSACTION WITHIN THE MEANING OF REGULATION S UNDER THE SECURITIES ACT, as amended OR (the Z) IT IS AN INSTITUTIONAL Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1ACCREDITED INVESTOR” WITHIN THE MEANING OF SUBPARAGRAPH (a)(1), (2), (3) or OR (7) OF RULE 501 UNDER THE SECURITIES ACT, AND (2) AGREES TO OFFER, SELL, PLEDGE OR OTHERWISE TRANSFER SUCH SECURITY OR ANY INTEREST OR PARTICIPATION HEREIN, PRIOR TO THE DATE WHICH IS TWO YEARS (OR SUCH SHORTER PERIOD THAT MAY BE HEREINAFTER PROVIDED UNDER RULE 144(K) UNDER THE SECURITIES ACT PERMITTING RESALES OF RESTRICTED SECURITIES BY NON-AFFILIATES WITHOUT RESTRICTION) (THE “RESALE RESTRICTION TERMINATION DATE”) AFTER THE LATER OF THE ORIGINAL ISSUE DATE HEREOF AND THE LAST DATE ON WHICH MCLEODUSA INCORPORATED OR ANY AFFILIATE OF MCLEODUSA INCORPORATED WAS THE OWNER OF THIS SECURITY (OR ANY PREDECESSOR OF SUCH SECURITY), ONLY (A) TO MCLEODUSA INCORPORATED OR ANY OF ITS SUBSIDIARIES, (B) PURSUANT TO A REGISTRATION STATEMENT WHICH HAS BEEN DECLARED EFFECTIVE UNDER THE SECURITIES ACT, (C) FOR SO LONG AS THE SECURITIES ARE ELIGIBLE FOR RESALE PURSUANT TO RULE 144A UNDER THE SECURITIES ACT, TO A PERSON IT REASONABLY BELIEVES IS A “QUALIFIED INSTITUTIONAL BUYER” AS DEFINED IN RULE 144A UNDER THE SECURITIES ACT THAT PURCHASES FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF A QUALIFIED INSTITUTIONAL BUYER TO WHOM NOTICE IS GIVEN THAT THE TRANSFER IS BEING MADE IN RELIANCE ON RULE 144A, (D) PURSUANT TO OFFERS AND SALES TO NON-U.S. PERSONS THAT OCCUR OUTSIDE THE UNITED STATES WITHIN THE MEANING OF REGULATION S UNDER THE SECURITIES ACT, (E) TO AN INSTITUTIONAL “ACCREDITED INVESTOR” WITHIN THE MEANING OF SUBPARAGRAPH (A)(1), (2), (3) OR (7) OF RULE 501 UNDER THE SECURITIES ACT THAT IS ACQUIRING THE SECURITY FOR ITS OWN ACCOUNT, OR FOR THE ACCOUNT OF SUCH AN INSTITUTIONAL ACCREDITED INVESTOR, FOR INVESTMENT PURPOSES AND NOT WITH A VIEW TO, OR FOR OFFER OR SALE IN CONNECTION WITH, ANY DISTRIBUTION IN VIOLATION OF THE SECURITIES ACT, (F) PURSUANT TO ANOTHER AVAILABLE EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT, SUBJECT TO THE RIGHT OF MCLEODUSA INCORPORATED AND THE TRUSTEE, OR OF THE TRANSFER AGENT, AS APPLICABLE, PRIOR TO ANY SUCH OFFER, SALE OR TRANSFER PURSUANT TO CLAUSE (D), (E) OR (F) TO REQUIRE THE DELIVERY OF AN OPINION OF COUNSEL, CERTIFICATION AND/OR OTHER INFORMATION SATISFACTORY TO EACH OF THEM, AND IN EACH OF THE FOREGOING CASES, IN ACCORDANCE WITH ANY APPLICABLE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES OR ANY APPLICABLE JURISDICTION. IN EACH OF THE FOREGOING CASES, A CERTIFICATE OF TRANSFER IN THE FORM APPEARING ON THE OTHER SIDE OF THIS SECURITY SHALL BE COMPLETED AND DELIVERED BY THE TRANSFEROR TO THE TRUSTEE. THIS LEGEND WILL BE REMOVED UPON THE REQUEST OF THE HOLDER AFTER THE RESALE RESTRICTION TERMINATION DATE. EXHIBIT C-2 FORM OF LEGEND FOR GLOBAL NOTES Any Global Note authenticated and delivered hereunder shall bear a legend (which would be in addition to any other legends required in the case of Rule 501 under a Restricted Security) in substantially the Securities Act; or The transfer following form: [If a Regulation S Temporary Global Note, insert: THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES GOVERNING ITS EXCHANGE FOR CERTIFICATES NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF THIS REGULATION S TEMPORARY GLOBAL NOTE SHALL BE ENTITLED TO RECEIVE PAYMENT OF INTEREST HEREON.] THIS NOTE IS A GLOBAL NOTE WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITORY OR A NOMINEE OF A DEPOSITORY OR A SUCCESSOR DEPOSITORY. THIS NOTE IS NOT EXCHANGEABLE FOR NOTES REGISTERED IN THE NAME OF A PERSON OTHER THAN THE DEPOSITORY OR ITS NOMINEE EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE, AND NO TRANSFER OF THIS NOTE (OTHER THAN A TRANSFER OF THIS NOTE AS A WHOLE BY THE DEPOSITORY TO A NOMINEE OF THE DEPOSITORY OR BY A NOMINEE OF THE DEPOSITORY TO THE DEPOSITORY OR ANOTHER NOMINEE OF THE DEPOSITORY) MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. EXHIBIT D Form of Certificate To Be Delivered in Connection with Transfers to Non-QIB Accredited Investors , U.S. Bank National Association 00 Xxxxxxxxxx Xxxxxx EP-MN-WS3C St. Xxxx, MN 55107-2292 Attn: Xxxx Xxxxxxxx Re: 10½% Senior Second Secured Notes due 2011 (the “Notes”) of McLeodUSA Incorporated (the “Company”) Ladies and Gentlemen: In connection with our proposed purchase of $ aggregate principal amount of the Surrendered Note is pursuant to an effective registration statement under the Securities ActNotes, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms we confirm that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended.:

Appears in 2 contracts

Samples: McLeodUSA Holdings Inc, McLeodusa Inc

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the any transfer of this a Restricted Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Restricted Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Restricted Note is made to the Companybeing transferred: ☐ To Jazz Investments I Limited, Jazz Pharmaceuticals Public Limited Company or a respective subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ☐ Pursuant to a registration statement which has become effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies ☐ To a qualified institutional buyer in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities Act; or The transfer of the Surrendered Note is pursuant ☐ Pursuant to an effective exemption from registration statement provided by Rule 144 under the Securities Act, or The transfer of the Surrendered Note is pursuant to another any other available exemption from the registration requirement requirements of the Securities Act, . TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and unless warrants that it is purchasing this Restricted Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the box below meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Issuer as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the undersigned confirms thatTrustee will refuse to register any of the Restricted Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, to provided that if the undersigned’s knowledgefourth box is checked, the Surrendered Issuer, the Guarantor or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Issuer, the Guarantor or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Indenture shall have been satisfied. If this Note is not being transferred a Restricted Note, the Trustee or Registrar shall not be obligated to an “affiliate” register such Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the CompanyIndenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 2 contracts

Samples: Indenture (Jazz Pharmaceuticals PLC), Indenture (Jazz Pharmaceuticals PLC)

ASSIGNMENT FORM. For value received FOR VALUE RECEIVED, the undersigned hereby sell(s), assign(s), ) and transfer(s) unto _____________________________________ (Please insert social security Print or other Taxpayer Identification Number Typewrite Name and Address of assigneeAssignee) the within Note, instrument of COLORADO INTERSTATE GAS COMPANY and does hereby irrevocably constitutes constitute and appoints attorney appoint ________________________ Attorney to transfer the said Note instrument on the books of the within-named Company, with full power of substitution in the premises. Please Insert Social Security or Other Identifying Number of Assignee: Dated: (Signature) Signature Guarantee: ____________________________________________________________________________ (Participant in a Recognized Signature Guaranty Medallion Program) NOTICE: The signature to this assignment must correspond with the name as written upon the face of the within instrument in every particular, without alteration or enlargement or any change whatever. EXCHANGE/TRANSFER CERTIFICATE Re: 5.95% Senior Notes due 2015 of Colorado Interstate Gas Company (the “Notes”). This Exchange/Transfer Certificate relates to $____ principal amount of Notes held by _____________________ (the “Transferor”). The Transferor has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with such request and in respect of each such Note, the Transferor does hereby certify that the Transferor is familiar with the Indenture relating to the above-captioned Notes and that the transfer of this Note, Note does not require registration under the undersigned registered owner of this Securities Act (as defined below) because:** ‪ Such Note hereby certifies with respect is being acquired for the Transferor’s own account without transfer. ‪ Such Note is being transferred (i) to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with qualified institutional buyer” (as defined in Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); ), in accordance with Rule 144A under the Securities Act or The transfer (ii) pursuant to an exemption from registration in accordance with Rule 904 of Regulation S under the Securities Act (and in the case of clause (ii), based upon an opinion of counsel if the Company or the Trustee so requests, together with a certification in substantially the form of the Surrendered Regulation S Certificate included in such Note). ‪ Such Note complies is being transferred (i) pursuant to an exemption from registration in accordance with Rule 501(a)(1), 144 under the Securities Act (2), (3and based upon an opinion of counsel if the Company or the Trustee so requests) or (7ii) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered . ‪ Such Note is pursuant to being transferred in reliance on and in compliance with another available exemption from the registration requirement requirements of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (and based upon an opinion of counsel if the Company or the Trustee so requests). [INSERT NAME OF TRANSFEROR] By: ________________________________________________ Name: Title: Address: Date: **Check appropriate box. REGULATION S CERTIFICATE _________________, _____ The Bank of New York Trust Company, N.A., as Registrar 000 Xxxxx Xxxxx Xxxxxx, Xxxxx 000 Xxxxxx, XX 00000 Attention: Corporate Trust Administration Ladies and Gentlemen: In connection with our proposed sale of $_______________ principal amount of 5.95% Senior Notes due 2015 (the AffiliateNotes”) of Colorado Interstate Gas Company (the “Company”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or we confirm that such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all sale has been effected pursuant to and in accordance with Regulation S under the United States Securities Exchange Act of 19341933, as amended.amended (the “Securities Act”), and, accordingly, we represent that:

Appears in 2 contracts

Samples: Indenture (Colorado Interstate Gas Co), Indenture (Colorado Interstate Gas Co)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within To assign this Note, fill in the form below: I or we assign and hereby transfer this Note to (Print or type assignee’s name, address and zip code) (Insert assignee’s soc. sec. or tax I.D. No.) and irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in Issuer. The agent may substitute another to act for her. Date: Your Signature: Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to . Signature Signature Guarantee: Signature must be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) guaranteed Signature Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the United States Securities Exchange Act of 1934, as amended.. CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFERS OF TRANSFER RESTRICTED NOTES2 This certificate relates to $ principal amount of Notes held in (check applicable space) book-entry or definitive form by the undersigned. The undersigned (check one box below): ☐ has requested the Trustee by written order to deliver in exchange for its beneficial interest in a Global Note held by the Depositary a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above) in accordance with the Indenture; or ☐ has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 1 contract

Samples: First Supplemental Indenture (General Electric Co)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: ¨ To Oclaro Luxembourg S.A. or Oclaro, Inc. or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ¨ Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies ¨ Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant ¨ Pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the fourth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amendedregistered Holder.

Appears in 1 contract

Samples: Indenture (Oclaro, Inc.)

ASSIGNMENT FORM. For value received FOR VALUE RECEIVED, the undersigned hereby sell(s), assign(s), ) and transfer(s) unto _____________________________________ (Please insert social security Print or other Taxpayer Identification Number Typewrite Name and Address of assigneeAssignee) the within Note, instrument of COLORADO INTERSTATE GAS COMPANY and does hereby irrevocably constitutes constitute and appoints attorney appoint ________________________ Attorney to transfer the said Note instrument on the books of the within-named Company, with full power of substitution in the premises. Please Insert Social Security or Other Identifying Number of Assignee: Dated: (Signature) Signature Guarantee: ____________________________________________________________________________ (Participant in a Recognized Signature Guaranty Medallion Program) NOTICE: The signature to this assignment must correspond with the name as written upon the face of the within instrument in every particular, without alteration or enlargement or any change whatever. EXCHANGE/TRANSFER CERTIFICATE Re: 6.80% Senior Notes due 2015 of Colorado Interstate Gas Company (the “Notes”). This Exchange/Transfer Certificate relates to $____ principal amount of Notes held by _____________________ (the “Transferor”). The Transferor has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with such request and in respect of each such Note, the Transferor does hereby certify that the Transferor is familiar with the Indenture relating to the above-captioned Notes and that the transfer of this Note, Note does not require registration under the undersigned registered owner of this Securities Act (as defined below) because:** ‪ Such Note hereby certifies with respect is being acquired for the Transferor’s own account without transfer. ‪ Such Note is being transferred (i) to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with qualified institutional buyer” (as defined in Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); ), in accordance with Rule 144A under the Securities Act or The transfer (ii) pursuant to an exemption from registration in accordance with Rule 904 of Regulation S under the Securities Act (and in the case of clause (ii), based upon an opinion of counsel if the Company or the Trustee so requests, together with a certification in substantially the form of the Surrendered Regulation S Certificate included in such Note). ‪ Such Note complies is being transferred (i) pursuant to an exemption from registration in accordance with Rule 501(a)(1), 144 under the Securities Act (2), (3and based upon an opinion of counsel if the Company or the Trustee so requests) or (7ii) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered . ‪ Such Note is pursuant to being transferred in reliance on and in compliance with another available exemption from the registration requirement requirements of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (and based upon an opinion of counsel if the Company or the Trustee so requests). [INSERT NAME OF TRANSFEROR] By: Name: Title: Address: Date: **Check appropriate box. REGULATION S CERTIFICATE _________________, _____ The Bank of New York Trust Company, N.A., as Registrar 000 Xxxxx Xxxxx Xxxxxx, Xxxxx 000 Xxxxxx, XX 00000 Attention: Corporate Trust Administration Ladies and Gentlemen: In connection with our proposed sale of $_______________ principal amount of 6.80% Senior Notes due 2015 (the AffiliateNotes”) of Colorado Interstate Gas Company (the “Company”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or we confirm that such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all sale has been effected pursuant to and in accordance with Regulation S under the United States Securities Exchange Act of 19341933, as amended.amended (the “Securities Act”), and, accordingly, we represent that:

Appears in 1 contract

Samples: Registration Rights Agreement (Colorado Interstate Gas Co)

ASSIGNMENT FORM. For value received _________________________ hereby sell(s), assign(s), ) and transfer(s) unto _________________________________ (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints ___________________________ attorney to transfer the said Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: □To Endeavour International Corporation or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A □Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies □Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant □Pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date:Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the third or fourth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Indenture (Endeavour International Corp)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within To assign this Note, fill in the form below: I or we assign and hereby transfer this Note to (Print or type assignee’s name, address and zip code) (Insert assignee’s soc. sec. or tax I.D. No.) and irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in Issuer. The agent may substitute another to act for her. Date: Your Signature: Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to . Signature Signature Guarantee: Signature must be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) guaranteed Signature Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the United States Securities Exchange Act of 1934, as amended.. CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFERS OF TRANSFER RESTRICTED NOTES1 This certificate relates to $ principal amount of Notes held in (check applicable space) book-entry or definitive form by the undersigned. The undersigned (check one box below): ☐ has requested the Trustee by written order to deliver in exchange for its beneficial interest in a Global Note held by the Depositary a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above) in accordance with the Indenture; or ☐ has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 1 contract

Samples: First Supplemental Indenture (General Electric Co)

ASSIGNMENT FORM. For value received hereby sell(s)If you the Holder want to assign this Security, assign(s), fill in the form below: I or we assign and transfer(s) unto transfer this Security to (Please insert Insert assignee’s social security or other Taxpayer Identification Number of tax ID number) (Print or type assignee) the within Note’s name, address, and hereby zip code) and irrevocably constitutes and appoints attorney appoint agent to transfer the said Note this Security on the books of the Company, with full power of substitution in . The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”Security) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked belowSignature Guarantee: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) Signature must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation participant in the Security Transfer Agent a recognized Signature Guarantee Medallion Program (or other signature guarantee program reasonably acceptable to the Trustee) [FORM OF NOTATION ON SECURITY RELATING TO GUARANTEE] NOTATION OF GUARANTEE The undersigned (the STAMPSubsidiary Guarantors”) have unconditionally guaranteed, jointly and severally (such guarantee by each Subsidiary Guarantor being referred to herein as the “Guarantee”), (i) the due and punctual payment of the principal of and premium, if any, and interest on the Notes, whether at maturity, by acceleration or otherwise, the due and punctual payment of interest on the overdue principal and interest, if any, on the Notes, to the extent lawful, and the due and punctual performance of all other obligations of the Company to the Holders or the Trustee all in accordance with, and subject to the limitations of, the terms set forth in Article X of the Indenture and (ii) in case of any extension of time of payment or renewal of any Notes or any of such other “signature guarantee program” as may obligations, that the same will be determined by the Notes registrar promptly paid in addition to, full when due or in substitution for, STAMP, all performed in accordance with the Securities Exchange Act terms of 1934the extension or renewal, whether at stated maturity, by acceleration or otherwise. No past, present or future stockholder, officer, director, member, manager, partner, employee or incorporator, as amended.such, of any of the Subsidiary Guarantors shall have any liability under the Guarantee by reason of such person’s status as stockholder, officer, director, member, manager, partner, employee or incorporator. Each Holder of a Note by accepting a Note waives and releases all such liability. This waiver and release are part of the consideration for the issuance of the Guarantees. Each Holder of a Note by accepting a Note agrees that any Subsidiary Guarantor named below shall have no further liability with respect to its Guarantee if such Subsidiary Guarantor otherwise ceases to be liable in respect of its Guarantee in accordance with the terms of the Indenture. The Guarantee shall not be valid or obligatory for any purpose until the certificate of authentication on the Notes upon which the Guarantee is noted shall have been executed by the Trustee under the Indenture by the manual signature of one of its authorized officers. Geismar Holdings, Inc. GVGP, Inc. Westlake Chemical Investments, Inc. Westlake Development Corporation Westlake Ethylene Pipeline Corporation Westlake Geismar Power Company LLC By Westlake Vinyls Company LP, its Manager By GVGP, Inc., its General Partner Westlake Longview Corporation Westlake Management Services, Inc. Westlake NG I Corporation Westlake NG IV Corporation Westlake NG V Corporation Westlake Olefins Corporation Westlake Petrochemicals LLC, By Westlake Chemical Investments, Inc., its Manager Westlake Pipeline Investments LLC, By Westlake Chemical Investments, Inc., its Manager Westlake Polymers LLC, By Westlake Chemical Investments, Inc., its Manager Westlake PVC Corporation Westlake Resources Corporation Westlake Styrene LLC, By Westlake Chemical Investments, Inc., its Manager Westlake Supply and Trading Company Westlake Vinyl Corporation Westlake Vinyls Company LP, By GVGP, Inc., its General Partner Westlake Vinyls, Inc. WPT LLC, By Westlake Chemical Investments, Inc. its Manager By: Name: Xxxxxx Xxxx Title: President North American Pipe Corporation Westech Building Products, Inc. By: Name: Xxxxxx X. Xxxxxxxxx Title: President

Appears in 1 contract

Samples: Sixth Supplemental Indenture (Westlake Chemical Corp)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney as agent to transfer the said this Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: ☐ To Gevo, Inc. or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ☐ Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies ☐ Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant ☐ Pursuant to an effective registration statement and in compliance with Regulation S under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant ☐ Pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the third, fourth or fifth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Indenture (Gevo, Inc.)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the any transfer of this a Restricted Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Restricted Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Restricted Note is made to the Companybeing transferred: ¨ To Horizon Pharma Investment Limited, Horizon Pharma Public Limited Company or a respective subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ¨ Pursuant to a registration statement which has become effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies ¨ To a qualified institutional buyer in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities Act; or The transfer of the Surrendered Note is pursuant ¨ Pursuant to an effective exemption from registration statement provided by Rule 144 under the Securities Act, or The transfer of the Surrendered Note is pursuant to another any other available exemption from the registration requirement requirements of the Securities Act, . TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and unless warrants that it is purchasing this Restricted Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the box below meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Issuer as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the undersigned confirms thatTrustee will refuse to register any of the Restricted Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, to provided that if the undersigned’s knowledgefourth box is checked, the Surrendered Issuer, the Guarantor or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Issuer, the Guarantor or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Indenture shall have been satisfied. If this Note is not being transferred a Restricted Note, the Trustee or Registrar shall not be obligated to an “affiliate” register such Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the CompanyIndenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Horizon Pharma PLC

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within To assign this Note, fill in the form below: I or we assign and hereby transfer this Note to (Print or type assignee’s name, address and zip code) (Insert assignee’s soc. sec. or tax I.D. No.) and irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in Issuer. The agent may substitute another to act for her. Date: Your Signature: Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to . Signature Signature Guarantee: Signature must be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) guaranteed Signature Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the United States Securities Exchange Act of 1934, as amended.. CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFERS OF TRANSFER RESTRICTED NOTES4 This certificate relates to $ principal amount of Notes held in (check applicable space) book-entry or definitive form by the undersigned. The undersigned (check one box below): ☐ has requested the Trustee by written order to deliver in exchange for its beneficial interest in a Global Note held by the Depositary a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above) in accordance with the Indenture; or ☐ has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 1 contract

Samples: First Supplemental Indenture (General Electric Co)

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ASSIGNMENT FORM. For value received _________________________ hereby sell(s), assign(s), ) and transfer(s) unto _______________________ (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints ___________________________ attorney to transfer the said Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: o To Endeavour International Corporation or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A o Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies o Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant o Pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the third or fourth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Indenture (Endeavour International Corp)

ASSIGNMENT FORM. For value received _________________________ hereby sell(s), assign(s), ) and transfer(s) unto _________________________________ (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney ___________________________ as agent to transfer the said this Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: □ To Gevo, Inc. or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A □ Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies □ Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant □ Pursuant to an effective registration statement and in compliance with Regulation S under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant □ Pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the third, fourth or fifth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Warrant Agreement (Gevo, Inc.)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within To assign this Note, fill in the form below: I or we assign and hereby transfer this Note to (Print or type assignee’s name, address and zip code) (Insert assignee’s soc. sec. or tax I.D. No.) and irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in Issuer. The agent may substitute another to act for her. Date: Your Signature: Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to . Signature Signature Guarantee: Signature must be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) guaranteed Signature Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the United States Securities Exchange Act of 1934, as amended.. CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFERS OF TRANSFER RESTRICTED NOTES3 This certificate relates to $ principal amount of Notes held in (check applicable space) book-entry or definitive form by the undersigned. The undersigned (check one box below): ☐ has requested the Trustee by written order to deliver in exchange for its beneficial interest in a Global Note held by the Depositary a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above) in accordance with the Indenture; or ☐ has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 1 contract

Samples: First Supplemental Indenture (General Electric Co)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within To assign this Note, fill in the form below: I or we assign and hereby transfer this Note to (Print or type assignee’s name, address and zip code) (Insert assignee’s soc. sec. or tax I.D. No.) and irrevocably constitutes and appoints attorney appoint agent to transfer the said this Note on the books of the Company, with full power of substitution in Issuer. The agent may substitute another to act for her. Date: Your Signature: Sign exactly as your name appears on the premises. In connection with the transfer other side of this Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to . Signature Signature Guarantee: Signature must be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Company; or The transfer of the Surrendered Note complies with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the Company. Dated: Signature(s) Signature(s) guaranteed Signature Signatures must be guaranteed by an “eligible guarantor institution” meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar Registrar in addition to, or in substitution for, STAMP, all in accordance with the United States Securities Exchange Act of 1934, as amended.. CERTIFICATE TO BE DELIVERED UPON EXCHANGE OR REGISTRATION OF TRANSFERS OF TRANSFER RESTRICTED NOTES5 This certificate relates to $ principal amount of Notes held in (check applicable space) book-entry or definitive form by the undersigned. The undersigned (check one box below): ☐ has requested the Trustee by written order to deliver in exchange for its beneficial interest in a Global Note held by the Depositary a Note or Notes in definitive, registered form of authorized denominations and an aggregate principal amount equal to its beneficial interest in such Global Note (or the portion thereof indicated above) in accordance with the Indenture; or ☐ has requested the Trustee by written order to exchange or register the transfer of a Note or Notes. In connection with any transfer of any of the Notes evidenced by this certificate, the undersigned confirms that such Notes are being transferred in accordance with its terms: CHECK ONE BOX BELOW

Appears in 1 contract

Samples: First Supplemental Indenture (General Electric Co)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the any transfer of this a Restricted Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Restricted Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Restricted Note is made to the Companybeing transferred: ¨ To Jazz Investments I Limited, Jazz Pharmaceuticals Public Limited Company or a respective subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ¨ Pursuant to a registration statement which has become effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies ¨ To a qualified institutional buyer in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities Act; or The transfer of the Surrendered Note is pursuant ¨ Pursuant to an effective exemption from registration statement provided by Rule 144 under the Securities Act, or The transfer of the Surrendered Note is pursuant to another any other available exemption from the registration requirement requirements of the Securities Act, . TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and unless warrants that it is purchasing this Restricted Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the box below meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Issuer as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the undersigned confirms thatTrustee will refuse to register any of the Restricted Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, to provided that if the undersigned’s knowledgefourth box is checked, the Surrendered Issuer, the Guarantor or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Issuer, the Guarantor or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Indenture shall have been satisfied. If this Note is not being transferred a Restricted Note, the Trustee or Registrar shall not be obligated to an “affiliate” register such Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the CompanyIndenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Indenture (Jazz Pharmaceuticals PLC)

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the any transfer of this a Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Restricted Note is made to the Companybeing transferred: ☐ To Seaspan Corporation or a subsidiary thereof; or The transfer of the Surrendered Note complies ☐ To a qualified institutional buyer in compliance with Rule 144A under the U.S. Securities Act of 1933, as amended (the “Securities Act”); . TO BE COMPLETED BY PURCHASER IF THE SECOND BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Restricted Note for its own account or The transfer of an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the Surrendered Note complies with Rule 501(a)(1), (2), (3) or (7) meaning of Rule 501 144A under the Securities Act; Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Issuer as the undersigned has requested pursuant to Rule 144A or The transfer has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the Surrendered Note is pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below above boxes is checked, the undersigned confirms that, Trustee will refuse to register any of the undersigned’s knowledgeRestricted Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof. If none of the foregoing boxes is checked, the Surrendered Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Indenture shall have been satisfied. If this Note is not being transferred a Restricted Note, the Trustee or Registrar shall not be obligated to an “affiliate” register such Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.10 of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the CompanyIndenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Atlas Corp.

ASSIGNMENT FORM. For value received hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security or other Taxpayer Identification Number of assignee) the within Note, and hereby irrevocably constitutes and appoints attorney to transfer the said Note on the books of the Company, with full power of substitution in the premises. In connection with the any transfer of this the within Note occurring prior to the Resale Restriction Termination Date, as defined in the Indenture governing such Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Note is made to the Companybeing transferred: · To Callidus Software Inc. or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A · Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”)amended; or The transfer of the Surrendered Note complies · Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 144A under the Securities ActAct of 1933, as amended; or The transfer of the Surrendered Note is pursuant · Pursuant to an effective registration statement under the Securities Act, or The transfer of the Surrendered Note is pursuant to another available exemption from the registration requirement of the Securities Act, and unless the box below is checked, the undersigned confirms that, to the undersigned’s knowledge, the Surrendered Note is not being transferred to an “affiliate” of the Company as defined in compliance with Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of 1933, as amended, or any other available exemption from the registration requirements of the CompanySecurities Act of 1933, as amended. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “qualified institutional buyer” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Date: Signed: Unless one of the above boxes is checked, the Trustee will refuse to register any of the Notes evidenced by this certificate in the name of any Person other than the registered Holder thereof, provided that if the fourth box is checked, the Company or the Trustee may require, prior to registering any such transfer of the Notes, in its sole discretion, such legal opinions, certifications and other information as the Company or the Trustee may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities Act. If none of the foregoing boxes is checked, the Trustee or Registrar shall not be obligated to register this Note in the name of any Person other than the Holder hereof unless and until the conditions to any such transfer of registration set forth herein and in Section 3.11 of the Indenture shall have been satisfied. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an eligible guarantor institution” meeting Guarantor Institution (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Callidus Software Inc

ASSIGNMENT FORM. For value received (Please insert legal name of registered Holder) hereby sell(s), assign(s), ) and transfer(s) unto (Please insert social security legal name of assignee), (Please insert Social Security or other Taxpayer Identification Number of assignee) ), the within Note, and hereby irrevocably constitutes and appoints attorney agent to transfer the said Note on the books of the CompanyIssuer, with full power of substitution in the premises. In connection with the any transfer of this a Restricted Note occurring prior to the Resale Restriction Termination Date, as defined such Restricted Note, the undersigned registered owner of this Note hereby certifies with respect to US$ principal amount of this Note presented or surrendered on the date hereof (the “Surrendered Note”) for registration of transfer, or for exchange where the Notes issuable upon such transfer or exchange are to be registered in a name other than that of the undersigned registered owner (each such transaction being a “transfer”), confirms that such transfer complies with the restrictive legend set forth on the face of the Surrendered Note for the reason checked below: A transfer of the Surrendered Restricted Note is made to the Companybeing transferred: ¨ To Amarin Corporation plc or a subsidiary thereof; or The transfer of the Surrendered Note complies with Rule 144A ¨ Pursuant to a registration statement that has become or been declared effective under the U.S. Securities Act of 1933, as amended (the “Securities Act”); or The transfer of the Surrendered Note complies ¨ Pursuant to and in compliance with Rule 501(a)(1), (2), (3) or (7) of Rule 501 under the Securities Act; or The transfer of the Surrendered Note is pursuant to an effective registration statement 144 under the Securities Act, or The transfer of the Surrendered Note is pursuant to another any other available exemption from the registration requirement requirements of the Securities Act. TO BE COMPLETED BY PURCHASER IF THE THIRD BOX ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Restricted Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a “Accredited Investor” within the meaning of the Securities Act of 1933 and is aware that the sale to it is being made in reliance on an exemption from registration of the Securities Act of 1933. Date: ______________________ Signed: If none of the foregoing boxes is checked, or if this Note is not a Restricted Note, the Registrar shall not be obligated to register any of the Restricted Notes in the name of any Person other than the registered Holder thereof unless and unless until the conditions to any such transfer of registration set forth herein and in Section 3 of the Note shall have been satisfied; provided, that if the fourth box below above is checked, the undersigned confirms thatIssuer may require, prior to registering any such transfer of the undersigned’s knowledgeNotes, in its sole discretion, such legal opinions, certifications and other information as the Issuer may reasonably request to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the Surrendered Note is not being transferred to an “affiliate” registration requirements of the Company as defined in Rule 144 under the Securities Act (an “Affiliate”). The transferee is an Affiliate of the CompanyAct. Dated: Signature(s) Signature Guarantee Signature(s) must be guaranteed by an “eligible guarantor institution” meeting (banks, stock brokers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if Notes are to be delivered, other than to and in the requirements name of the Registrar, which requirements include membership or participation in registered holder. NOTICE: The signature on the Security Transfer Agent Medallion Program (“STAMP”) or such other “signature guarantee program” as may be determined by the Notes registrar in addition to, or in substitution for, STAMP, all in accordance assignment must correspond with the Securities Exchange Act name as written upon the face of 1934, as amendedthe Note in every particular without alteration or enlargement or any change whatever.

Appears in 1 contract

Samples: Amarin Corp Plc\uk

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