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Print Name. Designation ......................................... Dated this .. day of ........................ 20..........
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Print Name. By: ------------------------------------------ Signature Title: --------------------------------------- (required for any purchaser that is a corporation, partnership, trust or other entity) EXHIBIT C AMYLIN PHARMACEUTICALS, INC. CERTIFICATE OF SUBSEQUENT SALE ChaseMellon Shareholder Services RE: Sale of Shares of Common Stock of Amylin Pharmaceuticals, Inc. (the "Company") pursuant to the Company's Prospectus dated _______________, 2000 (the "Prospectus") Dear Sir/Madam: The undersigned hereby certifies, in connection with the sale of shares of Common Stock of the Company included in the table of Selling Shareholders in the Prospectus, that the undersigned has sold the Shares pursuant to the Prospectus and in a manner described under the caption "Plan of Distribution" in the Prospectus and that such sale complies with all applicable securities laws, including, without limitation, the Prospectus delivery requirements of the Securities Act of 1933, as amended. Selling Shareholder (the beneficial owner): ----------------------------- Record Holder (e.g., if held in name of nominee): ----------------------- Restricted Stock Certificate No.(s): ------------------------------------ Number of Shares Sold: -------------------------------------------------- Date of Sale: ----------------------------------------------------------- In the event that you receive a stock certificate(s) representing more shares of Common Stock than have been sold by the undersigned, then you should return to the undersigned a newly issued certificate for such excess shares in the name of the Record Holder and BEARING A RESTRICTIVE LEGEND. Further, you should place a stop transfer on your records with regard to such certificate. Very truly yours, By: ------------------------------------- Print Name: ----------------------------- Title: ---------------------------------- Dated: -------------------
Print Name. (Instruction: Please do not fill in any blanks other than the signature line. The purpose of the assignment is to enable the Corporation to exercise its sale/purchase option set forth in the Restricted Stock Award Agreement without requiring additional signatures on the part of the Individual.)
Print Name. Date: .......................................................................... Signed: .......................................................................
Print Name. BYRON H. RUBIN --------------------------------------------- By: BYRON H. RUBIN /S/ --------------------------------------------- Name: --------------------------------------------- Title: --------------------------------------------- Address: 5310 HARVEST HILL ROAD --------------------------------------------- XXXXX 000 XXXXXX, XXXXX 00000 Xxxxxxxxx: --------------------------------------------- Facsimile: --------------------------------------------- E-Mail: --------------------------------------------- SOC/EIN#: --------------------------------------------- Number of Shares of Series A Preferred Stock Purchased at Closing 7 ---------------------------------------------------- Number of Warrants Purchased at Closing 14,000 -------------------------------------------------- Aggregate Purchase Price $126,630.00 ------------------------------------ OMNIBUS SIGNATURE PAGE TO NATIONAL COAL CORP. PREFERRED STOCK AND WARRANT PURCHASE AGREEMENT The undersigned hereby executes and delivers the Preferred Stock and Warrant Purchase Agreement to which this signature page is attached, which, together with all counterparts of the Agreement and signature pages of the other parties named in said Agreement, shall constitute one and the same document in accordance with the terms of the Agreement. Print Name: GERALD J. RUBIN --------------------------------------------- By: GERALD J. RUBIN /S/ --------------------------------------------- Name: --------------------------------------------- Title: ---------------------------------------------
Print Name. The full name of the 1st party should be printed as clarification of his or her identity. Second Party’s Signature (11) 2nd Party’s Signature. The binding signature of the individual or Business Entity defined as the 2nd Party or Party B must be delivered. (12)
Print Name. Number of shares owned subject to warrants, options or convertible securities: Certificate numbers: EXHIBIT D FORM OF WAIVER [Letterhead of [ ]] Advanced Disposal Services, Inc. Public Offering of Common Stock [Date] [Name and Address of Officer or Director Requesting Waiver] Dear Mr./Ms. [Name]: This letter is being delivered to you in connection with the offering by Advanced Disposal Services, Inc. (the “Company”) of [ ] shares of common stock, $0.01 par value (the “Common Stock”), of the Company and the lock-up letter dated [ ], 2017 (the “Lock-up Letter”), executed by you in connection with such offering, and your request for a [waiver] [release] dated [ ], 2017, with respect to [ ] shares of Common Stock (the “Shares”). The Underwriters hereby agree to [waive] [release] the transfer restrictions set forth in the Lock-up Letter, but only with respect to the Shares, effective [ ], 2017; provided, however, that such [waiver] [release] is conditioned on the Company announcing the impending [waiver] [release] by press release through a major news service at least two business days before effectiveness of such [waiver] [release]. This letter will serve as notice to the Company of the impending [waiver] [release]. Except as expressly [waived] [released] hereby, the Lock-up Letter shall remain in full force and effect. Yours very truly, [ · ] By: Name: Title: [ · ] By: Name: Title: [ · ] By: Name: Title: cc: Company EXHIBIT E FORM OF PRESS RELEASE Advanced Disposal Services, Inc. [Date] Advanced Disposal Services, Inc. (“Company”) announced today that Credit Suisse Securities (USA) LLC, the book-running manager in the Company’s recent public sale of shares of common stock, is [waiving] [releasing] a lock-up restriction with respect to shares of the Company’s common stock held by [certain officers or directors] [an officer or director] of the Company. The [waiver] [release] will take effect on , 2017 , and the shares may be sold on or after such date. This press release is not an offer for sale of the securities in the United States or in any other jurisdiction where such offer is prohibited, and such securities may not be offered or sold in the United States absent registration or an exemption from registration under the United States Securities Act of 1933, as amended.
