Special Payment Instructions Sample Clauses

Special Payment Instructions. (If applicable—see item 4 of Instructions) To be completed ONLY if cash payments are to be mailed to a recipient OTHER than the registered holder(s). Stock must be properly assigned and signatures guaranteed. For additional payment instructions, please attach additional sheet. Mail cash payments to (please print): Name: Address: (Zip Code) * The Medallion Signature Guarantee, above, must also be completed if you designate Special Payment Instructions.

Special Payment Instructions. Indicate any particulars, special instructions or references to facilitate payment or identification of payment.

Special Payment Instructions. Provide new payee information in Box C if different than listed on page 2 of this Letter of Transmittal. A Medallion Guarantee is required. Please see Instruction No.

Special Payment Instructions. (If applicable — See Instructions B(2) and B(3)) (If applicable – See Instruction B(4)) Signature Date

Special Payment Instructions. (SEE INSTRUCTIONS 1, 5, 6 AND 7) To be completed ONLY if the check for the purchase price of Shares purchased or certificates for Shares not tendered or not purchased are to be issued in the name of someone other than the undersigned, or if Shares tendered by book-entry transfer that are not purchased are to be returned by credit to an account at one of the Book-Entry Transfer Facilities other than that designated above. Issue check and/or certificates to: Name ___________________________________________________________________________ (Please Print) Address ________________________________________________________________________ ________________________________________________________________________ (Taxpayer Identification No.) (See Substitute Form W-9) / / Credit unpurchased Shares tendered by book-entry transfer to the account set forth below: Name of Account Party __________________________________________________________ Account No. at ____________________________________________________________________ / / The Depository Trust Company / / Midwest Securities Trust Company / / Philadelphia Depository Trust Company SPECIAL DELIVERY INSTRUCTIONS (SEE INSTRUCTIONS 1, 5, 6 AND 7) To be completed ONLY if the check for the purchase price of Shares purchased or certificates for Shares not tendered or not purchased are to be mailed to someone other than the undersigned or to the undersigned at an address other than that shown below the undersigned's signature(s). Mail check and/or certificates to: Name ___________________________________________________________________________ Address ________________________________________________________________________ ________________________________________________________________________ (Taxpayer Identification No.) FORMING PART OF THE TERMS AND CONDITIONS OF THE OFFER

Special Payment Instructions. If checks or certificates representing Oak Hill common stock are to be payable to the order of or registered in other than exactly the name(s) that appear(s) on the certificate(s) representing shares of L▇▇▇▇▇▇▇ common stock being submitted herewith, the certificate(s) submitted herewith must be endorsed, or accompanied by appropriate signed stock power(s), and the signature(s) appearing on such endorsement(s) or stock power(s) and on this Election Form and Letter of Transmittal must be guaranteed by an eligible financial institution or broker who is a member/participant in a Medallion Program approved by the securities transfer association, Inc. Please also check the appropriate box in “Special Payment Instructions” on the Election Form and Letter of Transmittal.

Special Payment Instructions. Complete Box C only if payment is to be issued in the name of someone other than the registered holder of the Shares. If you complete this box you will need a Medallion Signature Guarantee by an eligible institution (see instructions). In addition, depending on the circumstances of the payment (e.g. payment to a party acting in a representative capacity that exceeds $5 million ($5,000,000) or payment to a high risk jurisdiction), you may be requested to provide additional supporting documentation such as a certified copy of a trust agreement, corporate board resolutions, incumbency certificate or articles of association, as applicable. Do you want the net merger consideration to be sent by electronic transfer or check? • If you select “Electronic Transfer”, complete all fields below. If you select “Check”, complete all fields below except for bank account information. IF HANDWRITING, PLEASE PRINT IN CAPITAL LETTERS. Complete Box D only if payment by check in the name of the registered holder is to be sent to an address other than to the address appearing in Box A (above). If you complete this Box D, you will need a Medallion Signature Guarantee by an eligible institution (see instructions). IF HANDWRITING, PLEASE PRINT IN CAPITAL LETTERS. By signing below, the signer certifies that this Letter of Transmittal has not been altered in any way. If you are signing in a representative capacity such as trustee, executor, administrator, guardian, attorney-in-fact, officer of a corporation, or other capacity, under certain circumstances e.g. payment exceeding $25 million ($25,000,000) or payment to a high risk jurisdiction you may be requested to provide additional supporting documentation such as a certified copy of a trust agreement, corporate board resolution, incumbency certificate, or articles of association, as applicable. This Lost Certificate Affidavit and Indemnity Agreement (“Affidavit”) is made and entered into by the undersigned (the “Affiant/Stockholder”) on behalf of the Stockholder (as defined below) in favor of BeneVir Biopharm, Inc. (the “Company”), and JPMorgan Chase Bank, N.A. (the “Paying Agent”). In order to induce the Paying Agent to pay the Merger Consideration [(as defined in the Paying Agent Agreement, dated [•], 2018, by and between ▇▇▇▇▇▇▇ Biotech, Inc. and the Paying Agent)], the Affiant, being duly sworn and under penalties of perjury, deposes and says: The Company issued to the Stockholder a certain certificate number _______ represent...

Special Payment Instructions. If check or certificates representing FirstBank common stock are to be payable to the order of or registered in other than exactly the name(s) that appear(s) on the certificate(s) representing shares of Oregon Trail common stock being submitted herewith, the certificate(s) submitted herewith must be endorsed, or accompanied by appropriate signed stock power(s), and the signature(s) appearing on such endorsement(s) or stock power(s) and on this Election Form and Letter of Transmittal must be guaranteed by an eligible financial institution or broker who is a member/participant in a Medallion Program approved by the Securities Transfer Association, Inc. Please also check the appropriate box in "Special Payment Instructions" on the Election Form and Letter of Transmittal.

Special Payment Instructions. (SEE INSTRUCTIONS 1, 4, 5 AND 6) To be completed ONLY if payment is to be made by wire transfer instead of by check. Wire transfer funds to (Please Type or Print): Bank:__________________________________________ ABA Number:____________________________________ For credit to Account of:______________________ Account Number:________________________________ Ref (if any):__________________________________ EXECUTION VERSION NOTE: SIGNATURES MUST BE PROVIDED BELOW. PLEASE READ CAREFULLY THE INSTRUCTIONS BELOW FORMING PART OF THE TERMS AND CONDITIONS OF A VALID SURRENDER OF SECURITIES