Plan Provisions Control. This Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Certificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Certificate, you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORP, INC. 2007 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Certificate. Option Grant Date: , Exercise Price per $hare: $ . EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ (No. of Shares) (Exercise Price) Total Exercise Price ¨ I enclose a certified check, money order, or bank draft payable to the order of CMS Bancorp, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to CMS Bancorp, Inc. with all stamps attached and having a fair market value of* $ Total Exercise Price $ I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request CMS Bancorp, Inc. to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: ¨ With a certified or bank check that I will deliver to CMS Bancorp, Inc. on the day after the Effective Date of my Option exercise. ¨ With the proceeds from a sale of Shares that would otherwise be distributed to me. ¨ Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by law. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Compensation Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary.
Appears in 1 contract
Plan Provisions Control. This Certificate Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this CertificateAgreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this CertificateAgreement, you acknowledge the Optionee acknowledges receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORP, INC. 2007 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option CertificateAgreement. Name of Option Recipient: Option Grant Date: ________________, __________ Exercise Price per share: $hare: $ . ________________.____ (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price ________________ x $ . $__________.______ = $ $_______________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ I enclose a certified check, money order, or bank draft payable to the order of CMS BancorpDime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to CMS BancorpDime Community Bancshares, Inc. with all stamps attached and having a fair market value of* of $ Total Exercise Price $ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. of Shares - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Outside Directors and Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request CMS BancorpDime Community Bancshares, Inc. Inc., to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: ¨ With a certified or bank check that I will deliver to CMS Bancorp, Inc. the Administrator on the day after the Effective Date of my Option exercise. ¨ With the proceeds from a sale of Shares that would otherwise be distributed to me. ¨ Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Compensation Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary.
Appears in 1 contract
Sources: Non Qualified Stock Option Agreement (Dime Community Bancshares Inc)
Plan Provisions Control. This Certificate Stock Option Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions provisions of this CertificateStock Option Agreement, the terms of the Plan, which are incorporated incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this CertificateStock Option Agreement, you acknowledge receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORPYou acknowledge that you may not and will not rely on any statement of account or other communication or document issued in connection with the Plan other than the Plan, INCthis Stock Option Agreement, and any document signed by an authorized representative of the Company that is designated as an amendment of the Plan or this Stock Option Agreement. 2007 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option CertificateAgreement. Name of Option Recipient:__________________________________________________________ Option Grant Date: :________________, __________ Exercise Price per share: $hare: $ . _________.____ (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price Price________________ x $ . $__________.______ = $ $___________________________ (No. of Shares) (Exercise Price) Total Exercise Price ¨ Method of Payment o I enclose a certified check, money order, or bank draft payable payable to the order of CMS BancorpNorth Central Bancshares, Inc. in the amount of $ ¨ o I enclose Shares I have owned for at least six months duly endorsed for transfer to CMS BancorpNorth Central Bancshares, Inc. with all stamps attached and having a fair market value of* of $ ¨ Return a number of shares from any Option exercised with an aggregate built-in gross [defined as $ fair Market Value on the date of exercise ____the Exercise Price equal to Total Exercise Price $ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 the above instructions be issued to the following person(s) in the amount specified below: - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request CMS BancorpNorth Central Bancshares, Inc. to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: ¨ With a certified or bank check that I will deliver to CMS BancorpNorth Central Bancshares, Inc. on the day after the Effective Date of my Option exercise. ¨ With the proceeds from a sale of Shares that would otherwise be distributed to me. ¨ Retain shares By retaining Shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Compensation Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary. COMPLIANCE WITH TAX AND SECURITIES LAWS S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not North Central Bancshares, Inc.) regarding the application of all laws -- particularly tax and securities laws -- to the transactions to be effected pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become due upon the sale (including a sale pursuant to a “cashless exercise”) or other disposition of Shares issued pursuant to this Notice and that I must consult with my own tax advisor regarding how and when such income will be reportable. ____________________________________________________________________________________ Signature Date Received [check one]: G By Hand G By Mail Post Marked ____________________ Date of Post Mark _____________________________________________ ______________________________ Authorized Signature Date of Receipt GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who will receive vested stock options outstanding to you at the time of your death. Name of Person Making Designation _______________________________ Social Security Number _______C_____C_______ BENEFICIARY DESIGNATION Complete sections A and B. If no percentage shares are specified, each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately.
A. PRIMARY BENEFICIARY(IES). I hereby designate the following person(s) as my primary Beneficiary(ies), reserving the right to change or revoke this designation at any time prior to my death: B. CONTINGENT BENEFICIARY(IES). I hereby designate the following person(s) as my contingent Beneficiary(ies) to receive benefits only if all of my primary Beneficiaries should predecease me, reserving the right to change or revoke this designation at any time prior to my death with respect to all outstanding Stock Options:
Appears in 1 contract
Sources: Stock Option Agreement (North Central Bancshares Inc)
Plan Provisions Control. This Certificate and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this Certificate, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this Certificate, you acknowledge receipt of a copy of the PlanPlan and a copy of the related Prospectus dated May 13, 2004. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORP, INC. 2007 STOCK OPTION SLADE'S FERRY BANCORP 2004 EQUITY ▇▇▇▇▇▇▇VE PLAN NOTICE OF EXERCISE OF STOCK OPTION Use this Notice to inform Slade's Ferry Bancorp that you are ▇▇▇▇▇▇sing your right to purchase shares of common stock ("Shares") of Slade's Ferry Bancorp pursuant to ▇▇ ▇▇▇▇on ("Option") granted under the Slade's Ferry Bancorp 2004 Equity ▇▇▇▇▇▇▇ve Plan ("Plan"). If you are not the person to whom the Option was granted ("Option Recipient"), you must attach to this Notice proof of your right to exercise the Option granted under the Stock Option Certificate entered into between Slade's Ferry Bancorp and the Opti▇▇ ▇▇▇▇pient ("Certificate"). This Notice should be personally delivered or mailed by certified mail, return receipt requested to: Slade's Ferry Bancorp, 100 Slade's ▇▇▇▇▇ Avenue, Somerset, ▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇: Personnel Committee. The effective date of the exercise of the Option shall be the earliest date practicable following the date this Notice is received by Slade's Ferry Bancorp but in no ev▇▇▇ ▇▇▇e than three days after such date ("Effective Date"). Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option Certificate. Option Grant Date: , Exercise Price per $hare: $ . EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price x $ . = $ (No. of Shares) (Exercise Price) Total Exercise Price ¨ I enclose a certified check, money order, or bank draft payable to the order of CMS Bancorp, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to CMS Bancorp, Inc. with all stamps attached and having a fair market value of* $ Total Exercise Price $ I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request CMS Bancorp, Inc. to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: ¨ With a certified or bank check that I will deliver to CMS Bancorp, Inc. on the day after the Effective Date of my Option exercise. ¨ With the proceeds from a sale of Shares that would otherwise be distributed to me. ¨ Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by law. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Compensation Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary.
Appears in 1 contract
Plan Provisions Control. This Certificate Agreement and the rights and obligations created hereunder shall be subject to all of the terms and conditions of the Plan. In the event of any conflict between the provisions of the Plan and the provisions of this CertificateAgreement, the terms of the Plan, which are incorporated herein by reference, shall control. Capitalized terms in this Certificate have the meaning defined in the Plan, as amended from time to time, unless stated otherwise. By signing this CertificateAgreement, you acknowledge the Optionee acknowledges receipt of a copy of the Plan. APPENDIX A TO STOCK OPTION CERTIFICATE CMS BANCORP, INC. 2007 STOCK OPTION PLAN NOTICE OF EXERCISE OF STOCK OPTION OPTION INFORMATION Identify below the Option that you are exercising by providing the following information from the Stock Option CertificateAgreement. Name of Option Recipient: Option Grant Date: ________________, __________ Exercise Price per share: $hare: $ . ________________.____ (Month and Day) (Year) EXERCISE PRICE Compute the Exercise Price below and select a method of payment. Total Exercise Price ________________ x $ . $__________.______ = $ $_______________ (No. of Shares) (Exercise Price) Total Exercise Price Method of Payment ¨ I enclose a certified check, money order, or bank draft payable to the order of CMS BancorpDime Community Bancshares, Inc. in the amount of $ ¨ I enclose Shares I have owned for at least six months duly endorsed for transfer to CMS BancorpDime Community Bancshares, Inc. with all stamps attached and having a fair market value of* of $ Total Exercise Price $ ISSUANCE OF CERTIFICATES I hereby direct that the stock certificates representing the Shares purchased pursuant to section 2 above be issued to the following person(s) in the amount specified below: Name and Address Social Security No. No. of Shares - - - - WITHHOLDING ELECTIONS For Employee Option Recipients with Non-Qualified Stock Options only. Outside Directors and Beneficiaries should not complete. I understand that I am responsible for the amount of federal, state and local taxes required to be withheld with respect to the Shares to be issued to me pursuant to this Notice, but that I may request CMS BancorpDime Community Bancshares, Inc. Inc., to retain or sell a sufficient number of such Shares to cover the amount to be withheld. I hereby request that any taxes required to be withheld be paid in the following manner [check one]: ¨ With a certified or bank check that I will deliver to CMS Bancorp, Inc. the Administrator on the day after the Effective Date of my Option exercise. ¨ With the proceeds from a sale of Shares that would otherwise be distributed to me. ¨ Retain shares that would otherwise be distributed to me and that have a value equal to the minimum amount required to be withheld by lawme. I understand that the withholding elections I have made on this form are not binding on the Compensation Committee, and that the Compensation Committee will decide the amount to be withheld and the method of withholding and advise me of its decision prior to the Effective Date. I further understand that the Compensation Committee may request additional information or assurances regarding the manner and time at which I will report the income attributable to the distribution to be made to me. I further understand that if I have elected to have Shares sold to satisfy tax withholding, I may be asked to pay a minimal amount of such taxes in cash in order to avoid the sale of more Shares than are necessary.. S I G N H E R E I understand that I must rely on, and consult with, my own tax and legal counsel (and not Dime Community Bancshares, Inc.) regarding the application of all laws -- particularly tax and securities laws -- to the transactions to be effected pursuant to my Option and this Notice. I understand that I will be responsible for paying any federal, state and local taxes that may become due upon the sale (including a sale pursuant to a "cashless exercise") or other disposition of Shares issued pursuant to this Notice and that I must consult with my own tax advisor regarding how and when such income will be reportable. Signature Date _______________________________________________________________________________________________ _______________________________________________________________________________________________ Address Received [check one]: ¨ By Hand ¨ By Mail Post Marked Date of Post Mark By ___________________ _______________ Authorized Signature Date of Receipt
Appears in 1 contract
Sources: Stock Option Agreement (Dime Community Bancshares Inc)