Certification and Required Signatures Sample Clauses

Certification and Required Signatures. See Instruction 9 I/we, the undersigned, surrender to you for exchange the Certificate(s) representing Axxxxxxx common shares identified in Section 1 above. I/we agree, upon request, to execute and deliver any additional documents which Park or the Exchange Agent tells me/us are necessary or desirable to complete the exchange of my Axxxxxxx common shares. I/we understand and acknowledge that delivery will be effected, and risk of loss and title to my Certificate(s) for Axxxxxxx common shares will pass, only upon proper delivery of those Certificates to you, as Exchange Agent. I/we certify that I/we have reviewed the accompanying Instructions and have complied with all requirements stated therein. I/we acknowledge that any election made in Section 2 above in connection with the Merger may be subject to allocation and proration, as provided in the Merger Agreement and as described in the Prospectus/Proxy Statement. Therefore, I/we acknowledge that I/we may receive a different form of consideration than I/we elected as a result of such allocation and proration. I/we hereby authorize the Exchange Agent to rely upon all representations, certifications and instructions accompanying this Election Form/Letter of Transmittal. Required Signatures — all shareholders must sign below. x x Signature of Shareholder Date Signature of Shareholder (if joint account) Date Daytime Phone Number Title, if required 5 Special Payment or Issuance Instructions — See Instruction 10 Any Park common shares and/or any check you receive in exchange for your Axxxxxxx common shares in the Merger will be issued in the name(s) printed in Section 1 above unless you indicate a different name(s) below. If you indicate a different name(s), your signature(s) and a Medallion Signature Guarantee are required, and the Substitute Form W-9 attached to this Election Form/Letter of Transmittal MUST be completed by the new shareholder or payee. Please refer to Instruction 10. Name Name (if joint account) Address City State Zip x x Authorized signature(s) Place Medallion Signature Guarantee here 4 6 Special Delivery Instructions — See Instruction 11 Park common shares and/or a check will be mailed to the person and address shown in Section 1 (or the person and address in Section 5, if completed) unless you indicate a different mailing address below: Name Address City State Zip