Common use of For Bearer Securities Clause in Contracts

For Bearer Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be registered in the name of and delivered to the undersigned unless a different name has been indicated below. The address for payment of any such check must be outside the United States. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated: __________________ ___________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] If shares are to be registered in HOLDER the name of and delivered to a Person other than the Holder, please print such Person's name and address: Please print name and address of Holder ___________________________________ ____________________________________ Name Name ___________________________________ ____________________________________ Address Address ___________________________________ ____________________________________ ___________________________________ ____________________________________ ___________________________________ ____________________________________ Social Security or other Taxpayer Social Security or other Taxpayer Identification Number, if any Identification Number, if any Name and address (outside the If only a portion of the Securities is to United States) to where any be converted, please indicate: check referred to in the first paragraph of this Conversion Notice should be mailed: 1. Principal amount to be converted: U.S. $___________________ __________________________ 2. Principal amount and denomination of Name Registered Securities representing unconverted principal amount to be issued: __________________________ Address Amount: U.S.$_________________ Denominations: U.S.$__________ (any integral multiple of U.S. $1,000) C-2

Appears in 1 contract

Samples: Thermo Electron Corp

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For Bearer Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. u.s. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be registered in the name of and delivered to the undersigned unless a different name has been indicated below. The address for payment of any such check must be outside the United States. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated: __________________ ___________________________________ ----------- -------------------------------------- Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] If shares are to be registered in HOLDER the name of and delivered to a Person other than the Holder, please print such Person's name and address: Please print name and address of Holder ------------------------------------- ------------------------------------- Name Name ------------------------------------- ------------------------------------- Address Address ------------------------------------- ------------------------------------- ------------------------------------- ------------------------------------- ------------------------------------- ------------------------------------- Social Security or other Taxpayer Social Security or other Taxpayer Identification Number, if any Identification Number, if any Name and address (outside the United States) to where any check referred to in the first paragraph of this Conversion Notice should be mailed: ___________________________________ ______________________________________________ Name Name ___________________________________ ______________________________________________ Address Address ___________________________________ ____________________________________ ___________________________________ ____________________________________ ___________________________________ ____________________________________ Social Security or other Taxpayer Social Security or other Taxpayer Identification Number, if any Identification Number, if any Name and address (outside the If only a portion of the Securities is to United States) to where any be converted, please indicate: check referred to in the first paragraph of this Conversion Notice should be mailed: 1. Principal amount to be converted: U.S. $___________________ __________________________ 2. Principal amount and denomination of Name Registered Securities representing unconverted principal amount to be issued: __________________________ Address Amount: U.S.$_________________ Denominations: U.S.$__________ (any integral multiple of U.S. $1,000) C-2:

Appears in 1 contract

Samples: Thermo Electron Corp

For Bearer Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) Security into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security and directs that such sharesshares be registered in the name of and delivered, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereofshare, be registered in the name of and delivered to the undersigned unless a different name has been indicated below. The address for payment of any such check must be outside the United States. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. All coupons maturing after the date of conversion are attached. Dated: ___________________ ___________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] If shares are to be registered in HOLDER the name of and delivered to a Person other than the Holder, please print such Person's name and address: ______________________________ Name Please print name and address of Holder Holder: ______________________________ Name ______________________________ Address ______________________________ Address ______________________________ ____________________________________ Name Name _____Social Security or other Taxpayer Identification Number, if any______________________________ ____________________________________ Address Address _____Social Security or other Taxpayer Identification Number, if any Name and address (outside the United States) to where any check referred to in the first paragraph of this Conversion Notice should be mailed: ______________________________ ______Name ______________________________ ___________________________________ ____________________________________ ___________________________________ ______Address ______________________________ Social Security or other Taxpayer Social Security or other Taxpayer Identification Number, if any Identification Number, if any Name and address (outside the If only a portion of the Securities is to United States) to where any be converted, please indicate: check referred to in the first paragraph of this Conversion Notice should be mailed: 1. Principal amount to be converted: U.S. $___________________ __________________________ 2. Principal amount and denomination of Name Registered Securities representing unconverted principal amount to be issued: __________________________ Address Amount: U.S.$_________________ Denominations: U.S.$__________ (any integral multiple of U.S. $1,000) C-2any

Appears in 1 contract

Samples: Indenture (United Waste Systems Inc)

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For Bearer Securities. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of U.S. $1,000 below designated) into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be registered in the name of and delivered to the undersigned unless a different name has been indicated below. The address for payment of any such check must be outside the United States. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Dated: __________________ ___________________________________ Signature [MUST BE GUARANTEED IF STOCK IS TO BE ISSUED IN A NAME OTHER THAN THE REGISTERED HOLDER OF THE SECURITY] If shares are to be registered in HOLDER the name of and delivered to a Person other than the Holder, please print such Person's name and address: Please print name and address of Holder ___________________________________ ____________________________________ Name Name ___________________________________ ____________________________________ Address Address ___________________________________ ____________________________________ ___________________________________ ____________________________________ ___________________________________ ____________________________________ Social Security or other Taxpayer Social Security or other Taxpayer Identification Number, if any Identification Number, if any Name and address (outside the United If only a portion of the Securities is to United States) to where any check referred to be converted, please indicate: check referred to in the first paragraph of this Conversion Notice should be mailed: 1. Principal amount to be converted: U.S. $__________________________ __________________________ 2. Principal amount and denomination Name of Name Registered Securities representing unconverted principal amount to be issued: __________________________ Address Amount: U.S.$______________________ Denominations: U.S.$___________ (any integral multiple of U.S. $1,000) C-2)

Appears in 1 contract

Samples: Thermo Electron Corp

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