Election to Convert. To: Chemed Corporation The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Stock of CHEMED CORPORATION in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: , in whole __ Portions of Security to be converted ($27 or integral multiples thereof): $_________________ ----------------------------------- Signature (for conversion only) Plese Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- Signature Guarantee:(5) ----------------------------------- -------- (5)(Signature must be guaranteed by an "eligible guarantor institution" that is, a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("STAMP") or such other "signature guarantee program" as may be determined by the Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934.)
Election to Convert. To NTL Incorporated The undersigned owner of this Note hereby irrevocably exercises the option to convert this Note, or the portion below designated, into Common Stock of NTL Incorporated in accordance with the terms of the Indenture referred to in this Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If the shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder of Notes, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Note, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Notes. Date: in whole ___ Portions of Note to be converted ($1,000 or integral multiples thereof): $______________ Signature ______________________________________ Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ________________________________________________ ________________________________________________ ________________________________________________ Signature Guarantee: * ________________________ * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange. [TO BE ATTACHED TO GLOBAL NOTES] SCHEDULE A SCHEDULE OF PRINCIPAL AMOUNT The initial principal amount of this Global Note shall be $__________________. The following increases or decreases in the principal amount of this Global Note have been made: Amount of decrease in Amount of increase Principal amount of Signature of Date of exchange principal amount of in principal amount this Global Note authorized officer following such this Global Note of this Global Note of Trustee or Notes decrease or increase Custodian -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- --...
Election to Convert. (a) Holder hereby elects to convert the debt owed by GWSO in the amount of $350,095 into 155,885 shares of Common Stock.
Election to Convert. To: Frontier Insurance Group, Inc. The undersigned owner of this Debenture hereby irrevocably exercises the option to convert this Debenture, or the portion below designated, into Common Stock of Frontier Insurance Group, Inc. in accordance with the terms of the Indenture referred to in this Debenture, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Debenture, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Debentures. Date: ____________, ____ in whole __ Portions of Debenture to be in part __ converted ($50 or integral multiples thereof): $__________________ ______________________________________________ Signature (for conversion only) Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ______________________________________________ ______________________________________________ ______________________________________________ Signature Guarantee:* -------- * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange, Inc.
Election to Convert. To: Intevac, Inc. The undersigned owner of this Note hereby irrevocably exercises the option to convert this Note, or the portion below designated, into Common Stock of Intevac, Inc. in accordance with the terms of the Indenture referred to in this Note, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. The undersigned agrees to be bound by the terms of the Registration Agreement relating to the Common Stock issuable upon conversion of the Notes. Date: In whole or Portion of Note to be converted ($1,000 or any integral multiple thereof): $ Your Signature: (Sign exactly as your name appears on the other side of this Note) Please print or typewrite name and address, including zip code, and Social Security or other identifying number Signature Guarantee:* * Signature must be guaranteed by a commercial bank, trust company or member firm of the New York Stock Exchange.
Election to Convert. At any time prior to the Maturity Date, the Investor may elect by written notice to the Company and the surrender of this Note to convert this Note (including accrued but unpaid interest), at the Conversion Price, into shares of Series B-1 Participating Convertible Preferred Stock of the Company, par value $.001 per share.
Election to Convert. Notwithstanding the provisions set forth above, Investor may at any time, at its option, by written notice (the "Conversion Notice") to the Company, elect to convert all or any part of the entire outstanding principal amount of the Note plus a pro rata share of the accrued interest on the then outstanding balance into common stock of the Company at a price per share equal to Two Dollars and No Cents ($2.00) per share.
Election to Convert. At any time prior to the Maturity Date, the Investor may elect by written notice to the Company and the surrender of this Note to convert this Note (including accrued but unpaid interest) into such number of shares of Series C Preferred Stock as equals the number of shares of Common Stock that the Investor would have received if this Note (including accrued but unpaid interest) had been converted as of the same date, at the Conversion Price, into shares of Series B-2 Preferred Stock, and such shares of Series B-2 Preferred Stock had been immediately thereafter converted, in accordance with the then-current terms thereof, into shares of Common Stock.”
Election to Convert a. Holder hereby elects to convert 70,000 shares of Preferred Shares held by Holder into 70 million shares of Common Stock in accordance with Securities Purchase Agreement.
Election to Convert. Holder may, at its option exercisable by written notice (the “Conversion Notice”) to the Company at any time prior to payment in full hereof, elect to convert all or any part of the entire outstanding principal amount of this Note plus a pro rata share of the accrued interest on the then outstanding balance (i) into shares of Common Stock at a conversion price equal to $1.00 per share (subject to adjustment in the event of any stock splits, stock dividends or other recapitalization of Common Stock). Conversion of this Note shall be conditioned on Holder’s execution of an investment representation statement in a form reasonably required by the Company.
