Common use of PARTICIPANT’S ACCEPTANCE Clause in Contracts

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature

Appears in 2 contracts

Samples: Incentive Stock Option Award Agreement (HV Bancorp, Inc.), Non Qualified Stock Option Award Agreement (HV Bancorp, Inc.)

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PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2014 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2014 Equity Incentive Plan. PARTICIPANT Schedule The above form of Stock Option Agreement was signed by Xxxx X. Xxxxxxxxx, Chairman and Chief Executive Officer (400,000 shares), and Xxxxxx X. Xxxxx, President and Chief Operating Officer (278,000 shares). EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Northfield Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Northfield Bancorp, Inc. 2021 2014 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect wish to pay the exercise purchase price by: by (check one or more, as applicable): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. [ ] Withhold a sufficient number of shares to pay minimum required tax withholding)taxes [ ] Calculate minimum required withholding and I will submit payment. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a my broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B EXAMPLE: Assume the employee is granted 500,000 Option Awards on July 1, 2014. The Option Award vests at the rate of 20% per year (i.e., 100,000 shares per year) commencing one year from the date of grant. Also assume each director is granted 100,000 Option Awards on July 1, 2014 and that each director’s awards vest at the rate of 20% per year (i.e., 20,000 shares per year) commencing one year from the date of grant. Further assume that the employee resigns as an employee, effective December 31, 2016, but continues in the service of the Company as a member of the Board. At the time of the employee’s resignation, the employee would have vested in an aggregate of 200,000 Option Awards (on July 1, 2015 and July 1, 2016). The employee’s resignation occurs six months into the third vesting year. Accordingly, on July 1, 2017, the former employee would vest in 60,000 Option Awards, calculated as follows: 100,000 Option Awards (employee grant) x 6/12 (July – December) = 50,000 20,000 Option Awards (director grant) x 6/12 (January through June) = 10,000 Further, the former employee would forfeit 80,000 Option Awards from each of the installments vesting July 1, 2018 and July 1, 2019. The effect of this is that the former employee would vest in a number of Stock Options during the two years in which he performed no services as an employee equal to the same number of Stock Options in which the other non-employee directors vest for such years.

Appears in 2 contracts

Samples: 2014 Equity Incentive Plan (Northfield Bancorp, Inc.), 2014 Equity Incentive Plan (Northfield Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Planthereof. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Amended and Restated 2008 Equity Incentive Plan, as amended to date. PARTICIPANT EXHIBIT A Date: By: [ ] Address: NOTICE OF STOCK OPTION EXERCISE OF OPTION Date: Catabasis Pharmaceuticals, Inc. Xxx Xxxxxxx Xxxxxx, Suite B14202 Cambridge, MA 02139 Attention: Treasurer Dear Sir or Madam: I hereby exercise am the stock option (the “Option”) holder of an Incentive Stock Option granted to me by HV Bancorp, under the Catabasis Pharmaceuticals Inc. (the “Company”) or its affiliate, subject to all the terms Amended and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Restated 2008 Equity Incentive Plan (Plan, as amended to date, on [ ] for the “Plan”) referred to therein, and notify you purchase of [ ] shares of Common Stock of the Company at an exercise price of $[ ] per share. I hereby exercise my desire option to purchase shares of common Common Stock (the “Shares”), for which I have enclosed [insert method of payment] in the amount of . Please register my stock certificate as follows: Name(s): Address: Tax I.D. #: I represent, warrant and covenant as follows: I am purchasing the Shares for my own account for investment only, and not with a view to, or for sale in connection with, any distribution of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check Shares in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) violation of the Securities Act of 19331933 (the “Securities Act”), or any rule or regulation under the Securities Act. I have had such opportunity as I have deemed adequate to obtain from representatives of the Company such information as is necessary to permit me to evaluate the merits and risks of my investment in the Company. I have sufficient experience in business, financial and investment matters to be able to evaluate the risks involved in the purchase of the Shares and to make an informed investment decision with respect to such purchase. I can afford a complete loss of the value of the Shares and am able to bear the economic risk of holding such Shares for an indefinite period. I understand that (i) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would Shares have not violate been registered under the Securities Act and are “restricted securities” within the meaning of 1933 prior Rule 144 under the Securities Act, (ii) the Shares cannot be sold, transferred or otherwise disposed of unless they are subsequently registered under the Securities Act or an exemption from registration is then available; (iii) in any event, the exemption from registration under Rule 144 will not be available for at least six months and even then will not be available unless a public market then exists for the Common Stock, adequate information concerning the Company is then available to your exercise the public, and other terms and conditions of such OptionRule 144 are complied with; and (iv) there is now no registration statement on file with the Securities and Exchange Commission with respect to any stock of the Company and the Company has no obligation or current intention to register the Shares under the Securities Act. Date: Very truly yours, . Participant’s signature(Signature)

Appears in 2 contracts

Samples: Incentive Stock (Catabasis Pharmaceuticals Inc), Incentive Stock (Catabasis Pharmaceuticals Inc)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2010 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2010 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTORS) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Territorial Bancorp Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Territorial Bancorp Inc. 2021 2010 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or Enclosed please find (check one): ¨ Cash, personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ ¨ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A net settlement ¨ My check in the sum of $ and stock of the OptionCompany with a fair market value of $ , using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling purchase price.* ¨ Please sell shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ ¨ investment ___ ¨ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature.

Appears in 1 contract

Samples: Equity Incentive Plan (Territorial Bancorp Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and related prospectus. PARTICIPANT ____________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpDime Community Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpDime Community Bancshares, Inc. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you the Company of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personalPersonal, certified or cashier’s check in the sum of $ , $_______ in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. Withhold a sufficient number of shares to pay minimum required tax withholding)taxes [ ] Calculate minimum required withholding and I will submit payment. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and Stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Dime Community Bancshares, Inc. /NY/)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2014 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2014 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV Georgetown Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Georgetown Bancorp, Inc. 2021 2014 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: by (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Georgetown Bancorp, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Georgetown Bancorp, Inc. 2014 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date:__________________ ___________________

Appears in 1 contract

Samples: 2014 Equity Incentive Plan (Georgetown Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Charter Financial Corporation (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Charter Financial Corporation 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Charter Financial Corporation (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Charter Financial Corporation 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: , . Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (Charter Financial Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2014 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2014 Equity Incentive Plan. PARTICIPANT _________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV Sunnyside Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Sunnyside Bancorp, Inc. 2021 2014 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: by (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: 2014 Equity Incentive Plan (Sunnyside Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Chemung Financial Corporation (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. Chemung Financial Corporation 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Chemung Financial Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT ____________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Melrose Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Melrose Bancorp, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Melrose Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Severn Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Severn Bancorp, Inc. 2021 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (Severn Bancorp Inc)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT __________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV Xxxxxxxx Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Xxxxxxxx Bancorp, Inc. 2021 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Xxxxxxxx Bancorp, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Xxxxxxxx Bancorp, Inc. 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date:________________ ___________________________

Appears in 1 contract

Samples: 2013 Equity Incentive Plan (Hamilton Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2011 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2011 Equity Incentive Plan. PARTICIPANT ______________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpOBA Financial Services, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpOBA Financial Services, Inc. 2021 2011 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of $_______ and stock of the OptionCompany with a fair market value of $______, using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). purchase price.* ___ Selling Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________________ ______________________________________ Participant’s signature * If I elect to exercise by exxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by OBA Financial Services, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the OBA Financial Services, Inc. 2011 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: ____________________ ______________________________________ Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (OBA Financial Services, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2010 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2010 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEES) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Territorial Bancorp Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Territorial Bancorp Inc. 2021 2010 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_________ per share. I elect to pay the exercise price by: am exercising ___________ Cash Incentive Stock Options ___________ Non-qualified Stock Options Enclosed please find (check one or more, as applicable): ¨ Cash, personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ ¨ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ¨ My check in the sum of $_______ A net settlement and stock of the OptionCompany with a fair market value of $ , using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). purchase price.* ¨ Please sell ______ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ ¨ investment ___ ¨ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _________________, ________. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Territorial Bancorp Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Territorial Bancorp Inc. 2010 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: Participant’s signature EXHIBIT TO FORM OF STOCK OPTION AGREEMENT On August 19, 2010, the Compensation Committee awarded the following stock options to our named executive officers: Xx. Xxxxxxxx was granted an option to acquire 205,979 shares; Xx. Xxxxxxxx was granted an option to acquire 19,524 shares; Xx. Xxxxxx was granted an option to acquire 153,930 shares; Xx. Xxxxxxxxx was granted an option to acquire 146,430 shares; and Xx. Xxx was granted an option to acquire 19,524 shares. The exercise price for all of the options is $17.36, which was the closing price of Territorial Bancorp Inc. stock on the grant date. All options expire on August 19, 2020. The awards vest as follows: Date Vested Portion of Award August 19, 2010 0/6 August 19, 2011 1/6 August 19, 2012 2/6 August 19, 2013 3/6 August 19, 2014 4/6 August 19, 2015 5/6

Appears in 1 contract

Samples: Equity Incentive Plan (Territorial Bancorp Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT _______________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpMadison County Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpMadison County Financial, Inc. 2021 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect wish to pay the exercise purchase price by: by (check one or more, as applicable): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a my broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Madison County Financial, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Madison County Financial, Inc. 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date:______________________ __________________________

Appears in 1 contract

Samples: Equity Incentive Plan (Madison County Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2020 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2020 Equity Incentive Plan. PARTICIPANT Date: Name (print): EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTORS) I hereby exercise the stock option (the “Option”) granted to me by HV The Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV The Bancorp, Inc. 2021 2020 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_________ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or Cash, personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. ___ By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, and if applicable, any minimum required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2020 Equity Incentive Plan (Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpWaterstone Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpWaterstone Financial, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: by (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Waterstone Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Kearny Financial Corp. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Kearny Financial Corp. 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $15.35 per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2016 Equity Incentive Plan (Kearny Financial Corp.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpFirst Savings Financial Group, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpFirst Savings Financial Group, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signaturedistribution

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (First Savings Financial Group Inc)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2018 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 's 2018 Equity Incentive Plan. PARTICIPANT ________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the "Option") granted to me by HV Eagle Financial Bancorp, Inc. (the "Company") or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the "Agreement") and the HV Eagle Financial Bancorp, Inc. 2021 2018 Equity Incentive Plan (the "Plan") referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company ("Common Stock") for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s 's check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s 's signature

Appears in 1 contract

Samples: Non Qualified Stock (Eagle Financial Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and related prospectus have been provided or made available to the Participant. ​ ​ ​ PARTICIPANT ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Eureka Homestead Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Eureka Homestead Bancorp, Inc. 2021 2020 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect wish to pay the exercise price by: by (check one or more): ​ ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value Fair Market Value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using whereby I direct the Company to withhold a portion sufficient number of shares to satisfy the shares exercise price obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ _investment ___ _resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, . _____._________________________________________ Participant’s signaturesignature ​ ​ ​ ​

Appears in 1 contract

Samples: Non Qualified Stock Option Agreement (Eureka Homestead Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive 2015 Stock Option Plan. The undersigned hereby acknowledges receipt of a copy of the CompanyBank’s 2021 Equity Incentive 2015 Stock Option Plan. PARTICIPANT [Name] EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTORS) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. 1st Manatee Bank (the “CompanyBank) or its affiliate), subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive 1st Manatee Bank 2015 Stock Option Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company Bank (“Common Stock”) for a purchase price of $ $_________ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or Cash, personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company Bank with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). $_______ Selling shares from my Option shares through and stock of the Bank with a broker fair market value of $______, in full/partial payment of the purchase price. .* I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company Bank or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Bank with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2015 Stock Option Plan (National Commerce Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV WCF Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV WCF Bancorp, Inc. 2021 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (WCF Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Texas Community Bancshares, Inc. 2022 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Texas Community Bancshares, Inc. 2022 Equity Incentive PlanPlan and related prospectus. PARTICIPANT ____________________________________ Name: _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I I, ______________________________, hereby exercise the stock option (the “Option”) granted to me by HV BancorpTexas Community Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Incentive Stock Option Agreement (the “Agreement”) and the HV BancorpTexas Community Bancshares, Inc. 2021 2022 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $________ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) , as amended (the "Securities Act"), the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _______________, . 20___ _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Texas Community Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT ___________________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV SSB Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV SSB Bancorp, Inc. 2021 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Non Qualified Stock (SSB Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT _________________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Metropolitan Bank Holding Corp. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Metropolitan Bank Holding Corp. 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2019 Equity Incentive Plan (Metropolitan Bank Holding Corp.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV WCF Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV WCF Bancorp, Inc. 2021 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (WCF Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The As of the date of grant of this Option set forth above, the undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT By: EXHIBIT A NOTICE OF EXERCISE OF INCENTIVE STOCK OPTION (ISO) I hereby exercise exercise, all or part of, the incentive stock option (the “Option” or “ISO”) granted to me by HV CBM Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV CBM Bancorp, Inc. 2021 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $________, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $_______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling _______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ____________, 20___. _________________________________________ investment ___ resale or distribution Please note: if your intention is Date of Exercise Participant’s signature * If I elect to resell (or distribute within exercise an Option by exchanging shares I already own, I will constructively return shares that I already own to purchase the meaning of Section 2(11) new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the Securities Act of 1933) shares I am treating as having exchanged. If the shares you acquire through this Option exerciseare held in “street name” by a registered broker, I must provide the Company or transfer agent may require an opinion with a statement attesting to the number of counsel shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. I certify that either (i) I have held the shares I am tendering for at least one year after acquiring such resale or distribution would not violate shares through the Securities Act of 1933 prior to your exercise of an ISO, or (ii) I have not obtained such Optionshares through the exercise of an ISO. Date: Further, I acknowledges that if I am exercising ISO options, failure to retain such shares for a minimum of one year from the date of exercise will result in a disqualified disposition and immediate taxation at ordinary income tax rates. Participant’s signatureBY THE COMPANY

Appears in 1 contract

Samples: Form of Incentive Stock Option Award Agreement (CBM Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Blue Foundry Bancorp 2022 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Blue Foundry Bancorp 2022 Equity Incentive PlanPlan and related prospectus. PARTICIPANT __________________________ Name: _____________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I I, ______________________________, hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Blue Foundry Bancorp (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Incentive Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Blue Foundry Bancorp 2022 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $________ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) , as amended (the "Securities Act"), the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _______________, . 20___ _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Blue Foundry Bancorp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2020 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2020 Equity Incentive Plan. PARTICIPANT __________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp1895 Bancorp of Wisconsin, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp1895 Bancorp of Wisconsin, Inc. 2021 2020 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option (1895 Bancorp of Wisconsin, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Univest Financial Corporation 2023 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Univest Financial Corporation 2023 Equity Incentive PlanPlan and related prospectus. PARTICIPANT ____________________________________ Name:_______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I I, ______________________________, hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Univest Financial Corporation (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Incentive Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Univest Financial Corporation 2023 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $________ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $____________, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $____________ in full/partial payment of the purchase price.* ___ My check in the sum of $___________ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ___________ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, _____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) , as amended (the "Securities Act"), the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _______________, . 20___ _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (UNIVEST FINANCIAL Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2011 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2011 Equity Incentive Plan. PARTICIPANT Participant EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTORS) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpNorthwest Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpNorthwest Bancshares, Inc. 2021 2011 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_________ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or Cash, personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of $_______ and stock of the OptionCompany with a fair market value of $______, using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). purchase price.* ___ Selling Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature.

Appears in 1 contract

Samples: 2011 Equity Incentive Plan (Northwest Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 PB Bankshares, Inc. 2022 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 PB Bankshares, Inc. 2022 Equity Incentive PlanPlan and related prospectus. PARTICIPANT _____________________________________ Name: ________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I I, ______________________________, hereby exercise the stock option (the “Option”) granted to me by HV BancorpPB Bankshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Non-Qualified Stock Option Agreement (the “Agreement”) and the HV BancorpPB Bankshares, Inc. 2021 2022 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933, as amended (the "Securities Act") the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _______________, 20___. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (PB Bankshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV PB Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV PB Bancorp, Inc. 2021 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (PB Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Company’s 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpFirst Savings Financial Group, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpFirst Savings Financial Group, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signaturedistribution

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (First Savings Financial Group Inc)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Chemung Financial Corporation (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. Chemung Financial Corporation 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Chemung Financial Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and related prospectus. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpFirst Savings Financial Group, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Incentive Stock Option Agreement (the “Agreement”) and the HV BancorpFirst Savings Financial Group, Inc. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (First Savings Financial Group, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2011 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2011 Equity Incentive Plan. PARTICIPANT Participant EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEES) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpNorthwest Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpNorthwest Bancshares, Inc. 2021 2011 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_________ per share. I elect to pay the exercise price by: am exercising _________ Cash Incentive Stock Options _________ Non-qualified Stock Options Enclosed please find (check one or more, as applicable): ___ Cash, personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of $_______ and stock of the OptionCompany with a fair market value of $______, using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). purchase price.* ___ Selling Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Northwest Bancshares, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Northwest Bancshares, Inc. 2011 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: Participant’s signature

Appears in 1 contract

Samples: 2011 Equity Incentive Plan (Northwest Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT _____________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpMadison County Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpMadison County Financial, Inc. 2021 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Madison County Financial, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Madison County Financial, Inc. 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date:_____________ __________________

Appears in 1 contract

Samples: Equity Incentive Plan (Madison County Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT ___________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpMadison County Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpMadison County Financial, Inc. 2021 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_____________ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. OUTSIDE DIRECTOR EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Madison County Financial, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Madison County Financial, Inc. 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date:__________________ _______________________

Appears in 1 contract

Samples: Equity Incentive Plan (Madison County Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The As of the date of grant of this Option set forth above, the undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF NON-QUALIFIED STOCK OPTION I hereby exercise the stock option (the “Option”) granted to me by HV CBM Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV CBM Bancorp, Inc. 2021 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a an aggregate purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). Selling ______ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ____________, 20___. _________________________________________________ investment ___ resale or distribution Please note: if your intention is Date Participant’s signature * If I elect to resell (or distribute within exercise an Option by exchanging shares I already own, I will constructively return shares that I already own to purchase the meaning of Section 2(11) new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the Securities Act of 1933) shares I am treating as having exchanged. If the shares you acquire through this Option exerciseare held in “street name” by a registered broker, I must provide the Company or transfer agent may require an opinion with a statement attesting to the number of counsel shares owned that such resale or distribution would not violate will be treated as having been exchanged. I will keep the Securities Act of 1933 prior shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to your exercise of such Optionthe difference between the shares I constructively exchange and the total new option shares that I acquire. Date: , . Participant’s signatureBY THE COMPANY

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (CBM Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT ________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Cincinnati Bancorp (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Cincinnati Bancorp 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (Cincinnati Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpBen Franklin Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpBen Franklin Financial, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Ben Franklin Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 's 2017 Equity Incentive Plan. PARTICIPANT ___________________________________________ Date: ___________________________ Name (print) _________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the "Option") granted to me by HV BancorpBancorp 34, Inc. (the "Company") or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the "Agreement") and the HV BancorpBancorp 34, Inc. 2021 2017 Equity Incentive Plan (the "Plan") referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company ("Common Stock") for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personalPersonal, certified or cashier’s 's check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s 's signature

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Bancorp 34, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT __________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV SSB Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV SSB Bancorp, Inc. 2021 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: 2019 Equity Incentive Plan (SSB Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2020 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2020 Equity Incentive Plan. PARTICIPANT Date: Name (print): EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV The Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV The Bancorp, Inc. 2021 2020 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or Cash, personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. ___ By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, and if applicable, any minimum required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Charter Financial Corporation (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Charter Financial Corporation 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect wish to pay the exercise purchase price by: by (check one or more, as applicable): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a my broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Charter Financial Corporation (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Charter Financial Corporation 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: , . Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (Charter Financial Corp)

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PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Provident Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Provident Bancorp, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Provident Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpWaterstone Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpWaterstone Financial, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: by (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Waterstone Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpBen Franklin Financial, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpBen Franklin Financial, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Ben Franklin Financial, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT ____________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Provident Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Provident Bancorp, Inc. 2021 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Provident Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 VWF Bancorp, Inc. 2023 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 VWF Bancorp, Inc. 2023 Equity Incentive PlanPlan and related prospectus. ​ ​ ​ ​ PARTICIPANT ​ ​ ​ ​ ​ ​ ​ Name: ​ ​ ​ ​ EXHIBIT A NOTICE OF EXERCISE OF OPTION I ​ I, , hereby exercise the stock option (the “Option”) granted to me by HV VWF Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Incentive Stock Option Agreement (the “Agreement”) and the HV VWF Bancorp, Inc. 2021 2023 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ My check in the sum of $ and stock of the Company with a fair market value of $ , in full/partial payment of the purchase price.* ​ ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ _investment ___ _resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) , as amended (the "Securities Act"), the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . 20 ​ ​ Participant’s signaturesignature ​ *If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (VWF Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT ______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpPilgrim Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpPilgrim Bancshares, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Pilgrim Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT ________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpPilgrim Bancshares, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpPilgrim Bancshares, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Pilgrim Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned I, , hereby accepts accept the foregoing Option option award agreement and agrees agree to the terms and conditions hereofthereof. Furthermore, including the terms I hereby acknowledge having received and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of read a copy of the Company’s 2021 Equity 2010 Stock Incentive PlanPlan and agree to comply with it and all applicable laws and regulations. PARTICIPANT EXHIBIT PARTICIPANT: Address: Exhibit A NOTICE OF STOCK OPTION EXERCISE OF OPTION Date: 1 Zipcar, Inc. 00 Xxxxx Xxxxxx, Xxxxxx Xxxxx Xxxxxxxxx, XX 00000 Attention: Treasurer Dear Sir or Madam: I hereby exercise am the stock option (the “Option”) holder of 2 Stock Option granted to me by HV Bancorpunder the Zipcar, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the 2010 Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive Plan (on 3 for the “Plan”) referred to therein, and notify you purchase of my desire to purchase 4 shares of common stock Common Stock of the Company (“Common Stock”) for at a purchase price of $ 5 per share. I elect hereby exercise my option to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, 6 shares of Common Stock remain subject to (the Option“Shares”), subject to all terms and provisions set forth for which I have enclosed 7 in the Agreement and amount of 8. Please register my stock certificate as follows: Name(s): 9 Address: Tax I.D. #: 10 1 Enter the Plandate of exercise. I hereby represent that it is my intention 2 Enter either “an Incentive” or “a Nonstatutory”. 3 Enter the date of grant. 4 Enter the total number of shares of Common Stock for which the option was granted. 5 Enter the option exercise price per share of Common Stock. 6 Enter the number of shares of Common Stock to acquire these shares for the following purpose: ___ investment ___ resale be purchased upon exercise of all or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) part of the Securities Act option. 7 Enter “cash”, “personal check” or if permitted by the option or Plan, “stock certificates No. XXXX and XXXX”. 8 Enter the dollar amount (price per share of 1933) Common Stock times the number of shares of Common Stock to be purchased), or the number of shares tendered. Fair market value of shares tendered, together with cash or check, must cover the purchase price of the shares issued upon exercise. 9 Enter name(s) to appear on stock certificate: (a) Your name only; (b) Your name and other name (i.e., Xxxx Xxx and Xxxx Xxx, Joint Tenants With Right of Survivorship); or (c) In the case of a Nonstatutory option only, a Child’s name, with you acquire through this Option exerciseas custodian (i.e., the Company or transfer agent Xxxx Xxx, Custodian for Xxxxx Xxx). Note: There may require an opinion be income and/or gift tax consequences of counsel that such resale or distribution would not violate the Securities Act registering shares in a Child’s name. 10 Social Security Number of 1933 prior to your exercise of such Option. Date: , . Participant’s signatureHolder(s).

Appears in 1 contract

Samples: Nonstatutory Stock Option Agreement (Zipcar Inc)

PARTICIPANT’S ACCEPTANCE. The As of the date of grant of this Option set forth above, the undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF NON-QUALIFIED STOCK OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpMAINSTREET BANCSHARES, Inc. INC. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpMAINSTREET BANCSHARES, Inc. 2021 INC. 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a an aggregate purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). — Selling ______ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. ____________, 20___. _________________________________________ Date Participant’s signature * If I hereby represent elect to exercise an Option by exchanging shares I already own, I will constructively return shares that it is I already own to purchase the new option shares. If my intention shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a statement attesting to acquire these the number of shares for owned that will be treated as having been exchanged. I will keep the following purposeshares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. BY THE COMPANY Date Received: ___ investment __________________ resale or distribution Please noteCompany Representative: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signature__________________

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (MainStreet Bancshares, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV PB Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV PB Bancorp, Inc. 2021 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (PB Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 's 2017 Equity Incentive Plan. PARTICIPANT ___________________________________________ Date: ___________________________ Name (print) _________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the "Option") granted to me by HV BancorpBancorp 34, Inc. (the "Company") or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the "Agreement") and the HV BancorpBancorp 34, Inc. 2021 2017 Equity Incentive Plan (the "Plan") referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company ("Common Stock") for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personalPersonal, certified or cashier’s 's check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s 's signature

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Bancorp 34, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive Plan. PARTICIPANT ___________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Bogota Financial Corp. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. Bogota Financial Corp. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling shares from my Option ______ shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Non Qualified (Bogota Financial Corp.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2019 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2019 Equity Incentive Plan. PARTICIPANT __________________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Metropolitan Bank Holding Corp. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Metropolitan Bank Holding Corp. 2019 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock (Metropolitan Bank Holding Corp.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT ______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Melrose Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Melrose Bancorp, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (Melrose Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEES) I hereby exercise the stock option (the “Option”) granted to me by HV Meridian Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Meridian Bancorp, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash am exercising Incentive Stock Options Non-qualified Stock Options Enclosed please find (check one or more, as applicable): Cash, personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A My check in the sum of $ and stock of the Company with a fair market value of $ , in full/partial payment of the purchase price.* Please sell shares from my Option shares through a broker in full/partial payment of the purchase price. By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, and if applicable, any minimum required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Meridian Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and related prospectus. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpFirst Savings Financial Group, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Non-Qualified Stock Option Agreement (the “Agreement”) and the HV BancorpFirst Savings Financial Group, Inc. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _____________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (First Savings Financial Group, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and Plan Prospectus. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTOR) I hereby exercise the stock option (the “Option”) granted to me by HV Northfield Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect wish to pay the exercise purchase price by: by (check one or more): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Northfield Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2013 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2013 Equity Incentive Plan. PARTICIPANT _______________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Xxxxxxxx Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Xxxxxxxx Bancorp, Inc. 2021 2013 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect wish to pay the exercise purchase price by: by (check one or more, as applicable): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any required tax withholding)whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a my broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Xxxxxxxx Bancorp, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Xxxxxxxx Bancorp, Inc. 2013 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: __________________________ ________________________________

Appears in 1 contract

Samples: 2013 Equity Incentive Plan (Hamilton Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2016 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2016 Equity Incentive Plan. PARTICIPANT _________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Kearny Financial Corp. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Kearny Financial Corp. 2016 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2016 Equity Incentive Plan (Kearny Financial Corp.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 's 2017 Equity Incentive Plan. PARTICIPANT _____________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the "Option") granted to me by HV Best Hometown Bancorp, Inc. (the "Company") or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the "Agreement") and the HV Best Hometown Bancorp, Inc. 2021 2017 Equity Incentive Plan (the "Plan") referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company ("Common Stock") for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s 's check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s 's signature

Appears in 1 contract

Samples: Non Qualified Stock (Best Hometown Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Bank’s 2015 Stock Option Plan. The undersigned hereby acknowledges receipt of a copy of the CompanyBank’s 2021 Equity Incentive 2015 Stock Option Plan. PARTICIPANT [Name] EMPLOYEE EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. 1st Manatee Bank (the “CompanyBank) or its affiliate), subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive 1st Manatee Bank 2015 Stock Option Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company Bank (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company Bank with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). $_______ Selling shares from my Option shares through and stock of the Bank with a broker fair market value of $______, in full/partial payment of the purchase price. .* I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company Bank or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Bank with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: 2015 Stock Option Plan (National Commerce Corp)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2014 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2014 Equity Incentive Plan. PARTICIPANT ___________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Georgetown Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Georgetown Bancorp, Inc. 2021 2014 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: by (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by Georgetown Bancorp, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the Georgetown Bancorp, Inc. 2014 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: ____________________ _______________________ Participant’s signature

Appears in 1 contract

Samples: 2014 Equity Incentive Plan (Georgetown Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2014 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2014 Equity Incentive Plan. PARTICIPANT Schedule The above form of Stock Option Agreement was signed by Xxxx X. Xxxxxxxxx, Chairman and Chief Executive Officer (225,000 shares), and Xxxxxx X. Xxxxx, President and Chief Operating Officer (135,000 shares). EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV Northfield Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Northfield Bancorp, Inc. 2021 2014 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect wish to pay the exercise purchase price by: by (check one or more, as applicable): [Any payment to be delivered must accompany this Notice of Exercise of Option] ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price settlement” of the Option (and, if applicable, any whereby I direct the Company to withhold a sufficient number of shares to satisfy the purchase price. [ ] Withhold a sufficient number of shares to pay minimum required tax withholding)taxes [ ] Calculate minimum required withholding and I will submit payment. ___ Selling A check (personal, certified or cashier’s) in the sum of $_______ and stock of the Company with a fair market value of $______, in full payment of the purchase price.* ___ Please sell ______ shares from my Option shares through a my broker in full/partial payment of the purchase price. If my broker requires additional forms in order to consummate this “broker cashless exercise,” I have included them with this election. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having been exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B EXAMPLE: Assume the employee is granted 500,000 Option Awards on July 1, 2014. The Option Award vests at the rate of 20% per year (i.e., 100,000 shares per year) commencing one year from the date of grant. Also assume each director is granted 100,000 Option Awards on July 1, 2014 and that each director’s awards vest at the rate of 20% per year (i.e., 20,000 shares per year) commencing one year from the date of grant. Further assume that the employee resigns as an employee, effective December 31, 2016, but continues in the service of the Company as a member of the Board. At the time of the employee’s resignation, the employee would have vested in an aggregate of 200,000 Option Awards (on July 1, 2015 and July 1, 2016). The employee’s resignation occurs six months into the third vesting year. Accordingly, on July 1, 2017, the former employee would vest in 60,000 Option Awards, calculated as follows: 100,000 Option Awards (employee grant) x 6/12 (July – December) = 50,000 20,000 Option Awards (director grant) x 6/12 (January through June) = 10,000 Further, the former employee would forfeit 80,000 Option Awards from each of the installments vesting July 1, 2018 and July 1, 2019. The effect of this is that the former employee would vest in a number of Stock Options during the two years in which he performed no services as an employee equal to the same number of Stock Options in which the other non-employee directors vest for such years.

Appears in 1 contract

Samples: 2014 Equity Incentive Plan (Northfield Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Cullman Bancorp, Inc. 2023 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Cullman Bancorp, Inc. 2023 Equity Incentive PlanPlan and related prospectus. PARTICIPANT ________________________________ Name:___________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I I, ______________________________, hereby exercise the stock option (the “Option”) granted to me by HV Cullman Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Non-Qualified Stock Option Agreement (the “Agreement”) and the HV Cullman Bancorp, Inc. 2021 2023 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ My check in the sum of $_______ and stock of the Company with a fair market value of $______, in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933, as amended (the "Securities Act") the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: _______________, 20___. _________________________________________ Participant’s signaturesignature * If I elect to exercise by xxxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Non Qualified Stock Option Award Agreement (Cullman Bancorp, Inc. /MD/)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 Equity Incentive PlanPlan and related prospectus have been provided or made available to the Participant. PARTICIPANT ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Eureka Homestead Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Eureka Homestead Bancorp, Inc. 2021 2020 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect wish to pay the exercise price by: by (check on or more): ​ ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value Fair Market Value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using whereby I direct the Company to withhold a portion sufficient number of shares to satisfy the shares exercise price obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. ​ ​ Participant’s signaturesignature ​ ​ ​ * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Agreement (Eureka Homestead Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY OUTSIDE DIRECTORS) I hereby exercise the stock option (the “Option”) granted to me by HV Meridian Bancorp, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Meridian Bancorp, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase shares of common stock of the Company (“Common Stock”) for a purchase price of $ per share. I elect to pay the exercise price by: ___ Cash or Enclosed please find (check one): Cash, personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A My check in the sum of $ and stock of the Company with a fair market value of $ , in full/partial payment of the purchase price.* Please sell shares from my Option shares through a broker in full/partial payment of the purchase price. By a net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, and if applicable, any minimum required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Equity Incentive Plan (Meridian Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 's 2017 Equity Incentive Plan. PARTICIPANT ____________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the "Option") granted to me by HV New Bancorp, Inc. (the "Company") or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the "Agreement") and the HV New Bancorp, Inc. 2021 2017 Equity Incentive Plan (the "Plan") referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company ("Common Stock") for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s 's check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s 's signature

Appears in 1 contract

Samples: Equity Incentive Plan (New Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2015 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2015 Equity Incentive Plan. PARTICIPANT _______________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV BancorpCB Financial Services, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpCB Financial Services, Inc. 2021 2015 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any minimum required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signaturesignature * If I elect to exercise by exchanging shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire.

Appears in 1 contract

Samples: Incentive Stock Option Award Agreement (CB Financial Services, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2017 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2017 Equity Incentive Plan. PARTICIPANT _________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION I hereby exercise the stock option (the “Option”) granted to me by HV Bancorp, Inc. Cincinnati Bancorp (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Cincinnati Bancorp 2017 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $______ per share. I elect to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________, _____. _________________________________________ Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (Cincinnati Bancorp, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned hereby accepts the foregoing Option and agrees to the terms and conditions hereof, including the terms and provisions of the 2021 2011 Equity Incentive Plan. The undersigned hereby acknowledges receipt of a copy of the Company’s 2021 2011 Equity Incentive Plan. PARTICIPANT ______________________________________ EXHIBIT A NOTICE OF EXERCISE OF OPTION (BY EMPLOYEE) I hereby exercise the stock option (the “Option”) granted to me by HV BancorpOBA Financial Services, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the Stock Option Agreement (the “Agreement”) and the HV BancorpOBA Financial Services, Inc. 2021 2011 Equity Incentive Plan (the “Plan”) referred to therein, and notify you of my desire to purchase __________________ shares of common stock of the Company (“Common Stock”) for a purchase price of $ $_______ per share. I elect to pay the exercise price by: Enclosed please find (check one): ___ Cash or personal, certified or cashier’s check in the sum of $ $_______, in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ $______ in full/partial payment of the purchase price.* ___ A net settlement My check in the sum of $_______ and stock of the OptionCompany with a fair market value of $______, using a portion of the shares obtained on exercise in full/partial payment of the exercise price of the Option (and, if applicable, any required tax withholding). purchase price.* ___ Selling Please sell ______ shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, ____________ shares of Common Stock remain subject to the Option, subject to all terms and provisions set forth in the Agreement and the Plan. I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exercise, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: ____________________ ______________________________________ Participant’s signature * If I elect to exercise by exxxxxxxxx shares I already own, I will constructively return shares that I already own to purchase the new option shares. If my shares are in certificate form, I must attach a separate statement indicating the certificate number of the shares I am treating as having exchanged. If the shares are held in “street name” by a registered broker, I must provide the Company with a notarized statement attesting to the number of shares owned that will be treated as having been exchanged. I will keep the shares that I already own and treat them as if they are shares acquired by the option exercise. In addition, I will receive additional shares equal to the difference between the shares I constructively exchange and the total new option shares that I acquire. EXHIBIT B ACKNOWLEDGMENT OF RECEIPT OF SHARES I hereby acknowledge the delivery to me by OBA Financial Services, Inc. (the “Company”) or its affiliate on _____________________________, of stock certificates for ____________________ shares of common stock of the Company purchased by me pursuant to the terms and conditions of the Stock Option Agreement and the OBA Financial Services, Inc. 2011 Equity Incentive Plan, as applicable, which shares were transferred to me on the Company’s stock record books on ____________________. Date: ____________________ ______________________________________ Participant’s signature

Appears in 1 contract

Samples: Equity Incentive Plan (OBA Financial Services, Inc.)

PARTICIPANT’S ACCEPTANCE. The undersigned I, , hereby accepts accept the foregoing Option option award agreement and agrees agree to the terms and conditions hereofthereof. Furthermore, including the terms I hereby acknowledge having received and provisions of the 2021 Equity Incentive Plan. The undersigned hereby acknowledges receipt of read a copy of the Company’s 2021 Equity 2010 Stock Incentive PlanPlan and agree to comply with it and all applicable laws and regulations. PARTICIPANT EXHIBIT PARTICIPANT: Address: Exhibit A NOTICE OF STOCK OPTION EXERCISE OF OPTION Date: 1 Zipcar, Inc. 00 Xxxxx Xxxxxx, Xxxxxx Xxxxx Xxxxxxxxx, XX 00000 Attention: Treasurer Dear Sir or Madam: I hereby exercise am the stock option (the “Option”) holder of 2 Stock Option granted to me by HV Bancorpunder the Zipcar, Inc. (the “Company”) or its affiliate, subject to all the terms and provisions set forth in the 2010 Stock Option Agreement (the “Agreement”) and the HV Bancorp, Inc. 2021 Equity Incentive Plan (on 3 for the “Plan”) referred to therein, and notify you purchase of my desire to purchase 4 shares of common stock Common Stock of the Company (“Common Stock”) for at a purchase price of $ 5 per share. I elect hereby exercise my option to pay the exercise price by: ___ Cash or personal, certified or cashier’s check in the sum of $ , in full/partial payment of the purchase price. ___ Stock of the Company with a fair market value of $ in full/partial payment of the purchase price.* ___ A net settlement of the Option, using a portion of the shares obtained on exercise in payment of the exercise price of the Option (and, if applicable, any required tax withholding). ___ Selling shares from my Option shares through a broker in full/partial payment of the purchase price. I understand that after this exercise, 6 shares of Common Stock remain subject to (the Option“Shares”), subject to all terms and provisions set forth for which I have enclosed 7 in the Agreement amount of 8. Please register my stock certificate as follows: Name(s): 9 Address: Tax I.D. #: 10 1 Enter the date of exercise. 2 Enter either “an Incentive” or “a Nonstatutory”. 3 Enter the date of grant. 4 Enter the total number of shares of Common Stock for which the option was granted. 5 Enter the option exercise price per share of Common Stock. 6 Enter the number of shares of Common Stock to be purchased upon exercise of all or part of the option. 7 Enter “cash”, “personal check” or if permitted by the option or Plan, “stock certificates No. XXXX and XXXX”. 8 Enter the Plandollar amount (price per share of Common Stock times the number of shares of Common Stock to be purchased), or the number of shares tendered. Fair market value of shares tendered, together with cash or check, must cover the purchase price of the shares issued upon exercise. 9 Enter name(s) to appear on stock certificate: (a) Your name only; (b) Your name and other name (i.e., Xxxx Xxx and Xxxx Xxx, Joint Tenants With Right of Survivorship); or (c) In the case of a Nonstatutory option only, a Child’s name, with you as custodian (i.e., Xxxx Xxx, Custodian for Xxxxx Xxx). Note: There may be income and/or gift tax consequences of registering shares in a Child’s name. 10 Social Security Number of Holder(s). I hereby represent that it is my intention to acquire these shares for the following purpose: ___ investment ___ resale or distribution Please note: if your intention is to resell (or distribute within the meaning of Section 2(11) of the Securities Act of 1933) the shares you acquire through this Option exerciserepresent, the Company or transfer agent may require an opinion of counsel that such resale or distribution would not violate the Securities Act of 1933 prior to your exercise of such Option. Date: , . Participant’s signaturewarrant and covenant as follows:

Appears in 1 contract

Samples: Incentive Stock Option Agreement (Zipcar Inc)

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