Number of Warrants Exercised. (Total number of Warrants being exercised – may be expressed as a percentage)
Number of Warrants Exercised. (Total number Direct Registration Warrant being exercised – may be expressed as a percentage) The undersigned requests that the Warrant Exercise Shares be issued in the name of the undersigned Holder or as otherwise indicated below: Name Social Security or Other Taxpayer Identification Number Address If said number of Warrant Exercise Shares shall not be all the Warrant Exercise Shares issuable upon exercise of the Warrant, the undersigned requests that a new Warrant representing the balance of such Warrant shall be issued in the name of the undersigned Holder or as otherwise indicated below and that a Warrant Statement reflecting such balance be delivered to the address indicated below: Name Social Security or Other Taxpayer Identification Number Address Dated: , 20 Signature: Name: EXHIBIT C EXERCISE FORM FOR BENEFICIAL HOLDERS HOLDING WARRANTS THROUGH THE DEPOSITORY TRUST COMPANY TO BE COMPLETED BY DIRECT PARTICIPANT IN THE DEPOSITORY TRUST COMPANY (To be executed upon exercise of Warrants) NOTE: THIS EXERCISE NOTICE MUST BE DELIVERED TO THE WARRANT AGENT, PRIOR TO 5:00 P.M., EASTERN TIME, ON OCTOBER 12, 2026. The undersigned, being the beneficial holder of Book-Entry Warrants issued pursuant to that certain Warrant Agreement, as dated October 12, 2016 (the “Warrant Agreement”), by and among Xxxxxxxx Petroleum Corporation (the “Company”), and American Stock Transfer & Trust Company, LLC (the “Warrant Agent”) and held for its benefit through the book-entry facilities of The Depository Trust Company (the “Depositary”), hereby irrevocably elects to exercise the number of Book-Entry Warrants indicated below, to acquire the number of shares of Common Stock indicated below, pursuant to the exercise provisions of Section 4.3 of the Warrant Agreement. All capitalized terms used in this Exercise Form that are not defined herein but are defined in the Warrant Agreement shall have the meanings given to them in the Warrant Agreement.
Number of Warrants Exercised. (Total number of Warrants being exercised – may be expressed as a percentage) Method of Exercise: ☐ Check Box for All Cash Exercise. The undersigned shall pay the applicable Aggregate Exercise Price in the sum of $ in accordance with the terms of the Warrant Agreement. ☐ Check Box for All Cashless Exercise (by way of Net Issue). Upon confirmation by the Company of the number of Ordinary Shares to be issued, the undersigned hereby instructs the Company to withhold a number of Ordinary Shares issuable upon exercise of the Warrants being exercised with an aggregate Fair Market Value as of the Exercise Date equal to the Aggregate Exercise Price in return for the issue of the relevant number of Ordinary Shares net of such withholding (as indicated below) and in accordance with the terms of the Warrant Agreement. The undersigned requests that the Ordinary Shares be issued by the Company in the name of the undersigned Warrantholder as indicated below: Name Social Security or Other Taxpayer Identification Number Address If the Warrants are represented by a Warrant Certificate and said number of Ordinary Shares shall not be all the Ordinary Shares issuable upon exercise of the Warrants represented by said Warrant Certificate, the undersigned requests that a new Warrant Certificate representing the balance of such Warrants shall be issued in the name of the undersigned Warrantholder as indicated below: Name Social Security or Other Taxpayer Identification Number Address Dated: , 20
Number of Warrants Exercised. If the Corporation selects a cashless exercise of the Warrants (as provided below), the Common Shares (or other securities or property) are to be issued as follows: Name: Address in full: Social Security Number:
Number of Warrants Exercised. Any capitalized term in this Warrant Certificate that is not otherwise defined herein, shall have the meaning ascribed thereto in the Warrant Indenture. If the Corporation selects a cashless exercise of the Warrants (as provided below), the Common Shares (or other securities or property) are to be issued as follows: Name: Address in full: Social Security Number:
Number of Warrants Exercised. The holder is exercising [•] Warrants, for [•] Warrant Shares* to be issued out of the Company’s conditional share capital according to article 5 of the Company’s articles of association at an exercise price per Warrant Share of USD 4.69.
Number of Warrants Exercised. (Total number of Warrants being exercised – may be expressed as a percentage) The undersigned requests that the Warrant Shares be issued in the name of the undersigned Registered Holder or as otherwise indicated below: Name Social Security or Other Taxpayer Identification Number Address If such Warrants shall not constitute all of the Warrants represented hereby, the undersigned requests that a new Warrant Certificate of like tenor and date for the balance of the Warrants represented hereby be issued and delivered in the name of the undersigned Holder or as otherwise indicated as follows: Name Social Security or Other Taxpayer Identification Number Address Dated: , 20 Signature: Name: In addition, this form is accompanied by the transferee certification required by Section 6.2.
Number of Warrants Exercised. (Total number of Warrants being exercised – may be expressed as a percentage) The undersigned requests that the Warrant Shares be issued in the name of the undersigned Registered Holder or as otherwise indicated below: Name Social Security or Other Taxpayer Identification Number
Number of Warrants Exercised. The Common Shares (or other securities or property) are to be issued as follows: Name: Address in full: Social Insurance Number:
Number of Warrants Exercised. (Total number of Warrants being exercised – may be expressed as a percentage) The undersigned requests that the Warrant Shares be issued in the name of the undersigned Registered Holder or as otherwise indicated below: Name Social Security or Other Taxpayer Identification Number Address If said number of Warrant Shares shall not be all the Warrant Shares issuable upon exercise of the Warrant, the undersigned requests that a new Warrant representing the balance of such Warrant shall be issued in the name of the undersigned Registered Holder or as otherwise indicated below and that a Warrant Statement reflecting such balance be delivered to the address indicated below: Name Social Security or Other Taxpayer Identification Number Address Dated: , 20 Signature: Name: In addition, this form is accompanied by the transferee certification required by Section 6.2 of the Warrant Agreement.
