Social Security No. This beneficiary designation relates to any and all of Recipient’s rights under the following Award or Awards: o any Award that Recipient has received under the Plan. o the Award that Recipient received pursuant to an award agreement dated , between Recipient and the Company. The Recipient understands that this designation operates to entitle the above-named beneficiary to the rights conferred by an Award from the date this form is delivered to the Company until such date as this designation is revoked in writing by the Recipient, including by delivery to the Company of a written designation of beneficiary executed by the Recipient on a later date. Date: By: [Recipient Name] Sworn to before me this day of , 200 Notary Public County of State of
Social Security No. (or TAX ID NO.)
Social Security No. You understand that this designation operates to entitle the above-named beneficiary to the rights conferred by the Award Agreement from the date this form is delivered to the Company until such date as this designation is revoked in writing by you, including by delivery to the Company of a written designation of beneficiary executed by you on a later date. Date: By: [Participant Name] Sworn to before me this ____ day of ____________, 200_ ___________________________ Notary Public County of __________________ State of __________________
Social Security No. Phone No. (My)/(our) employer's company name and address is:
Social Security No. 2. Description of property with respect to which the election is being made: _________ shares of common stock of Healthsport, Inc. (the “Company”).
Social Security No. The Optionee acknowledges receipt of a copy of the Plan, represents that he or she is familiar with the terms and provisions thereof, and hereby rejects this grant. REJECTED: Dated: Signed:
Social Security No. This beneficiary designation relates to any and all of Recipient’s rights under the following Award or Awards: o any Award that Recipient has received under the Plan. o the Award that Recipient received pursuant to an award agreement dated , between Recipient and the Company. The Recipient understands that this designation operates to entitle the above-named beneficiary to the rights conferred by an Award from the date this form is delivered to the Company until such date as this designation is revoked in writing by the Recipient, including by delivery to the Company of a written designation of beneficiary executed by the Recipient on a later date. Date: By: [Recipient Name] Sworn to before me this day of , 200 Notary Public County of State of Exhibit B FORM OF RESTRICTED SHARE AWARD AGREEMENT COMMERCE ENERGY GROUP, INC. FALLQUIST INCENTIVE PLAN Restricted Share Award Agreement MXXXXXX X. XXXXXXXXX Award No. Date: March , 2008
Social Security No. 2. Description of property with respect to which the election is being made: shares of common stock, par value $.01 per share, Cytyc Corporation, a Delaware corporation, (the “Company”).
Social Security No. 2. A description of the property with respect to which the election is being made: [ ] shares of common stock of Accretive Health, Inc., par value $0.01.
Social Security No. This beneficiary designation relates to any and all of my rights under the following Award or Awards: ¨ any Award that I have received or ever receive under the 2007 Plan. ¨ the _________________ Award that I received pursuant to an award agreement dated _________ __, ____ between myself and the Company. I understand that this designation operates to entitle the above named beneficiary, in the event of my death, to any and all of my rights under the Award(s) designated above from the date this form is delivered to the Company until such date as this designation is revoked in writing by me, including by delivery to the Company of a written designation of beneficiary executed by me on a later date. Date: By: Name of Participant Sworn to before me this ____day of ____________, 200_ ___________________________ Notary Public County of _________________ State of __________________ EXHIBIT 4.3 Form of Restricted Share Units Award Agreement under the Centerline Holding Company 2007 Incentive Share Plan CENTERLINE HOLDING COMPANY 2007 INCENTIVE SHARE PLAN _________________________________ Restricted Share Unit Award Agreement __________________________________
