Common use of Election to Convert Clause in Contracts

Election to Convert. To: Frontier Insurance Group, Inc. The undersigned owner of this Debenture hereby irrevocably exercises the option to convert this Debenture, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. in accordance with the terms of the Indenture referred to in this Debenture, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 or integral multiples thereof): $__________________ ______________________________________________ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ______________________________________________ ______________________________________________ ______________________________________________ Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.

Appears in 1 contract

Samples: Indenture (Frontier Insurance Group Inc)

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Election to Convert. To: Frontier Insurance Group, Inc. HMT Technology Corporation The undersigned owner of this Debenture $________ in principal of HMT Technology Corporation's 5 3/4% Convertible Subordinated Notes due 2004 (the "Convertible Note") hereby irrevocably exercises the option to convert this Debenturethe Convertible Note, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. HMT Technology Corporation in accordance with the terms of the Indenture referred to in this Debenturethe Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holderNoteholder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the DebentureConvertible Note, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the DebenturesConvertible Note. Date: ____________, ____ in whole __ Portions Amount of Debenture Convertible Note to be in part __ converted ($50 1,000 or integral multiples thereof): ); $__________________ _______ Signature (for conversion only) ________________________________________ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ______________________________________________ ______________________________________________ ______________________________________________ Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.Number

Appears in 1 contract

Samples: HMT Technology Corp

Election to Convert. To: Frontier Insurance Group, Inc. Coeur D'Alene Mines Corporation The undersigned owner of this Debenture $________ ix xxxxxxxxx of Coeur D'Alene Mines Corporation's 13-3/8% Convertible Senior Subordinated Xxxxx xxx Xecember 31, 2003 (the "Convertible Note") hereby irrevocably exercises the option to convert this Debenturethe Convertible Note, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. Coeur D'Alene Mines Corporation in accordance with the terms of the Indenture referred Indentxxx xxxxxxxd to in this Debenturethe Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise Date: Amount of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees Convertible Note to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 1,000 or integral multiples thereof): ); $__________________ ______________________________________________ ----------------- Signature (for conversion only) -------------------------------- Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ______________________________________________ ______________________________________________ ______________________________________________ Number: -------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- -------------------------------- Signature Guarantee:* -------- * Guarantee6 --------------- 6 Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc..

Appears in 1 contract

Samples: Coeur D Alene Mines Corp

Election to Convert. To: Frontier Insurance Group, Inc. Coeur d'Xxxxx Xxxxx Corporation The undersigned owner of this Debenture $________ in principal of Coeur d'Xxxxx Xxxxx Corporation's 13 3/8% Convertible Senior Subordinated Notes due December 31, 2003 (the "Convertible Note") hereby irrevocably exercises the option to convert this Debenturethe Convertible Note, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. Coeur d'Xxxxx Xxxxx Corporation in accordance with the terms of the Indenture referred to in this Debenturethe Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise Date: Amount of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees Convertible Note to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 1,000 or integral multiples thereof): ); $__________________ ______________________________________________ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number _________Number: _____________________________________ _____________________________________ _____________________________________ ______________________________________________ Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.Guarantee(2)

Appears in 1 contract

Samples: Coeur D Alene Mines Corp

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Election to Convert. To: Frontier Insurance Group, Inc. Coeur d'Alene Mines Corporation The undersigned owner of this Debenture $________ ix xxxxxxxxx of Coeur d'Alene Mines Corporation's 9.0% Convertible Senior Subordinated Notes dxx Xxxxxxxx 26, 2007 (the "Convertible Note") hereby irrevocably exercises the option to convert this Debenturethe Convertible Note, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. Coeur d'Alene Mines Corporation in accordance with the terms of the Indenture referred to xxxxxxxx xx in this Debenturethe Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise Date: Amount of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees Convertible Note to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 1,000 or integral multiples thereof): ); $__________________ ______________________________________________ Signature (for conversion only) _______________________________ Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number _______________Number: _______________________________ _______________________________ _______________________________ ______________________________________________ Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.

Appears in 1 contract

Samples: First Supplemental Indenture (Coeur D Alene Mines Corp)

Election to Convert. To: Frontier Insurance Group, Inc. Coeur d'Alene Mines Corporation The undersigned owner of this Debenture $________ ix xxxxxxxxx of Coeur d'Alene Mines Corporation's 9.0% Convertible Senior Subordinated Notex xxx Xxxxxary 26, 2007 (the "Convertible Note") hereby irrevocably exercises the option to convert this Debenturethe Convertible Note, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. Coeur d'Alene Mines Corporation in accordance with the terms of the Indenture referred Indentuxx xxxxxxxx to in this Debenturethe Convertible Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise Date: Amount of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees Convertible Note to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 1,000 or integral multiples thereof): $__________________ ______________________________________________ ); $ ------------------------ Signature (for conversion only) ----------------------------------------- Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ______________________________________________ ______________________________________________ ______________________________________________ Number: ----------------------------------------- ----------------------------------------- ----------------------------------------- ----------------------------------------- Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.Guarantee(2)

Appears in 1 contract

Samples: Coeur D Alene Mines Corp

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