Common use of To the Rights Agent Clause in Contracts

To the Rights Agent. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Right Certificate to purchase the Preferred Shares, Common Shares or other securities issuable upon the exercise of such Rights and requests that certificates for such Preferred Shares, Common Shares or other securities be issued in the name of: Please insert social security or other identifying number ________________________________________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ Form of Reverse Side of Right Certificate -- continued -------------------------------------------------------------------------------- Dated: _______________, ____ _______________________________ Signature Signature Guaranteed: Form of Reverse Side of Right Certificate -- continued. -------------------------------------------------------------------------------- The undersigned hereby certifies that (1) the Rights evidenced by this Right Certificate are not being exercised by or on behalf of a Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement) and (2) after due inquiry and to the best knowledge of the undersigned, the undersigned did not acquire the Rights evidenced by this Rights Certificate from any Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement).

Appears in 1 contract

Samples: Rights Agreement (Display Technologies Inc)

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To the Rights Agent. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Right Certificate to purchase the Preferred Shares, Common Shares or other securities issuable upon the exercise of such Rights and requests that certificates for such Preferred Shares, Common Shares or other securities be issued in the name of: Please insert social security or other identifying number ________________________________________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ Form of Reverse Side of Right Certificate -- continued -------------------------------------------------------------------------------- --------------------------------------------------------------------------- Dated: _______________, ____ _________________________________ Signature Signature Guaranteed: Form of Reverse Side of Right Certificate -- continued. -------------------------------------------------------------------------------- --------------------------------------------------------------------------- The undersigned hereby certifies that (1) the Rights evidenced by this Right Certificate are not being exercised by or on behalf of a Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement) and (2) after due inquiry and to the best knowledge of the undersigned, the undersigned did not acquire the Rights evidenced by this Rights Certificate from any Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement).

Appears in 1 contract

Samples: Rights Agreement (Salant Corp)

To the Rights Agent. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Right Certificate to purchase the Preferred Shares, Common Shares or other securities issuable upon the exercise of such Rights and requests that certificates for such Preferred Shares, Common Shares or other securities be issued in the name of: Please insert social security or other identifying number _________________________________________________ _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________ _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Form of Reverse Side of Right Certificate -- continued -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Dated: _______________, _____ _________________________________ Signature Signature Guaranteed: Form of Reverse Side of Right Certificate -- continued. -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- The undersigned hereby certifies that (1) the Rights evidenced by this Right Certificate are not being exercised by or on behalf of a Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement) and (2) after due inquiry and to the best knowledge of the undersigned, the undersigned did not acquire the Rights evidenced by this Rights Certificate from any Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement).

Appears in 1 contract

Samples: Rights Agreement (Dennys Corp)

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To the Rights Agent. The undersigned hereby irrevocably elects to exercise ___________________ Rights represented by this Right Certificate to purchase the Preferred Shares, Common Shares or other securities issuable upon the exercise of such Rights and requests that certificates for such Preferred Shares, Common Shares or other securities be issued in the name of: Please insert social security or other identifying number __________________number: ______________________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ ---------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________number: ______________________________ ______________________________________________________________ (Please print name and address) ----------------------------------------------------------------- Dated: ________________ (Please print name and address) _____________________________________________________________________________ Form of Reverse Side of Right Certificate -- continued -------------------------------------------------------------------------------- Dated: _______________, ____ __________________________________ Signature Signature Guaranteed: Form of Reverse Side of Right Certificate -- continued. -------------------------------------------------------------------------------- Signature Guaranteed: Signatures must be guaranteed by a member of the Medallion Signature Guarantee Program. ---------------------------------------------------------------- The undersigned hereby certifies that (1) the Rights evidenced by this Right Certificate are not being exercised by or on behalf of a Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement) and (2) after due inquiry and to the best knowledge of the undersigned, the undersigned did not acquire the Rights evidenced by this Rights Right Certificate from any Person who is or was an Acquiring Person or an Affiliate or Associate thereof (as such terms are defined in the Rights Agreement).

Appears in 1 contract

Samples: Rights Agreement (Maxicare Health Plans Inc)

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