STOCK CERTIFICATE QUESTIONNAIRE Sample Clauses

STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 3 of the Agreement, please provide us with the following information:
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STOCK CERTIFICATE QUESTIONNAIRE. Please provide us with the following information:
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STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 2.2(b)(vi) of the Agreement, please provide us with the following information:
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STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 8.2(q) of the Agreement please provide us with the following information:
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STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 2 of the Securities Purchase Agreement, please provide us with the following information:
Sample 1
STOCK CERTIFICATE QUESTIONNAIRE. To: American Stock Transfer & Trust Company 00 Xxxx Xxxxxx Xxx Xxxx, Xxx Xxxx 00000 Attention: The undersigned, the Purchaser or an officer thereof, or other person duly authorized by the Purchaser, hereby certifies that _________________ (fill in name of Purchaser) institution was the Purchaser of the shares (the "Shares") of common stock, par value $.01 per share, of HemaSure Inc., evidenced by the attached certificate, and as such, proposes to transfer such Shares on or about ________________ (date) either |_| pursuant to a registration statement, in which case the Purchaser certifies that the requirement of a delivering a current prospectus has been complied with or will be complied with in connection with such sale, or |_| pursuant to Rule 144 under the Securities Act of 1933 ("Rule 144"), in which case the Purchaser certifies that it has complied with or will comply with the requirements of Rule 144, or |_| pursuant to an exemption from registration, other than Rule 144, in which case the Purchaser is herewith providing the Company with an opinion of counsel to the effect that the transaction is so exempt. Print or Type: Name of Purchaser: -------------------------------------------------------- Name of Individual representing Purchaser (if an Institution): -------------------------------------------------------- Title of Individual representing Purchaser (if an Institution): ------------------------------------------------------- Signature by: Purchaser or Individual representing Purchaser: ------------------------------------------------------ ANNEX A TO PURCHASE AGREEMENT Form of Legal Opinion of Battle Xxxxxx LLP(1)
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STOCK CERTIFICATE QUESTIONNAIRE. Please provide us with the following information and either type or write clearly and legibly:
Sample 1
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STOCK CERTIFICATE QUESTIONNAIRE. Pursuant to Section 3 of the Agreement, please allocate the Shares as follows: Exhibit B Form of Escrow Agreement ESCROW AGREEMENT THIS ESCROW AGREEMENT (“Agreement”) is made and entered into as of the day of February 2004, by and among JPMorgan Chase Bank, a New York banking corporation (the “Escrow Agent”), Genome Therapeutics Corp., a Massachusetts corporation (the “Company”), X.X. Xxxxxx Securities Inc. (“JPMorgan”) and Xxxx Xxxxx Xxxx Xxxxxx, Incorporated (“Xxxx Xxxxx,” and together with JPMorgan, the “Placement Agents”).
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Related to STOCK CERTIFICATE QUESTIONNAIRE

  • REGISTRATION STATEMENT QUESTIONNAIRE In connection with the preparation of the Registration Statement, please provide us with the following information:

  • Underwriters’ Questionnaire Your acceptance of the Invitation Wire for an Offering or your participation in an Offering as an Underwriter will confirm that you have no exceptions to the Underwriters’ Questionnaire attached as Exhibit A hereto (or to any other questions addressed to you in any Wires relating to the Offering previously sent to you), other than exceptions noted by you In Writing in connection with the Offering and received from you by us before the time specified in the Invitation Wire or any subsequent Wire.

  • QUESTIONNAIRE (1) (a) Full Legal Name of Selling Securityholder:

  • Investor Questionnaire The undersigned represents and warrants to the Company that all information that the undersigned has provided to the Company, including, without limitation, the information in the Investor Questionnaire attached hereto or previously provided to the Company (the “Investor Questionnaire”), is correct and complete as of the date hereof.

  • Administrative Questionnaire An Administrative Questionnaire in a form supplied by the Administrative Agent.

  • Stock Certificate Please issue a certificate or certificates representing the shares in the name of: ¨ The undersigned ¨ Other—Name: Address:

  • D&O Questionnaires To the Company’s knowledge, all information contained in the questionnaires (the “Questionnaires”) completed by each of the Company’s directors and officers immediately prior to the Offering (the “Insiders”) as supplemented by all information concerning the Company’s directors, officers and principal shareholders as described in the Registration Statement, the Pricing Disclosure Package and the Prospectus, as well as in the Lock-Up Agreement (as defined in Section 2.24 below), provided to the Underwriters, is true and correct in all material respects and the Company has not become aware of any information which would cause the information disclosed in the Questionnaires to become materially inaccurate and incorrect.

  • FORM OF ASSIGNMENT AND ACCEPTANCE This Assignment and Acceptance (this “Assignment and Acceptance”) is dated as of the Effective Date set forth below and is entered into by and between [Insert name of Assignor] (the “Assignor”) and [Insert name of Assignee] (the “Assignee”). Capitalized terms used but not defined herein shall have the meanings given to them in the Credit Agreement identified below (as amended, the “Credit Agreement”), receipt of a copy of which is hereby acknowledged by the Assignee. The Standard Terms and Conditions set forth in Annex 1 attached hereto are hereby agreed to and incorporated herein by reference and made a part of this Assignment and Acceptance as if set forth herein in full. For an agreed consideration, the Assignor hereby irrevocably sells and assigns to the Assignee, and the Assignee hereby irrevocably purchases and assumes from the Assignor, subject to and in accordance with the Standard Terms and Conditions and the Credit Agreement, as of the Effective Date inserted by the Administrative Agent as contemplated below (i) all of the Assignor’s rights and obligations as a Lender under the Credit Agreement and any other documents or instruments delivered pursuant thereto in the amount[s] and equal to the percentage interest[s] identified below of all the outstanding rights and obligations under the respective facilities identified below (including, without limitation, included in such facilities) and (ii) to the extent permitted to be assigned under applicable law, all claims, suits, causes of action and any other right of the Assignor (in its capacity as a Lender) against any Person, whether known or unknown, arising under or in connection with the Credit Agreement, any other documents or instruments delivered pursuant thereto or the loan transactions governed thereby or in any way based on or related to any of the foregoing, including, but not limited to, contract claims, tort claims, malpractice claims, statutory claims and all other claims at law or in equity related to the rights and obligations sold and assigned pursuant to clause (i) above (the rights and obligations sold and assigned pursuant to clauses (i) and (ii) above being referred to herein collectively as, the “Assigned Interest”). Such sale and assignment is without recourse to the Assignor and, except as expressly provided in this Assignment and Acceptance, without representation or warranty by the Assignor.

  • Conflict of Interest Questionnaire Chapter 176 of the Texas Local Government Code requires contractors contracting or seeking to contract with H-GAC to file a conflict of interest questionnaire (CIQ) if they have an employment or other business relationship with an H-GAC officer or an officer’s close family member. The required questionnaire and instructions are located on the H-GAC website or at the Texas Ethics Commission website xxxxx://xxx.xxxxxx.xxxxx.xx.xx/forms/CIQ.pdf. H-GAC officers include its Board of Directors and Executive Director, who are listed on this website. Respondent must complete and file a CIQ with the Texas Ethics Commission if an employment or business relationship with H-GAC office or an officer’s close family member as defined in the law exists.

  • ACCREDITED INVESTOR QUESTIONNAIRE In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.

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