Common use of STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE Clause in Contracts

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I hereby sell, assign and transfer unto ____________________________________ (_________) shares of Common Stock, $0.0001 par value per share, of Xilio Therapeutics, Inc. (the “Corporation”) standing in my name on the books of the Corporation represented by Certificate(s) Number __________ herewith, and do hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx and Xxxx LLP attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises. Dated: PARTICIPANT: [Name] Name of Spouse (if any): Instructions to Participant: Please do not fill in any blanks other than the signature line(s). The purpose of the Stock Assignment Separate from Certificate is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouse, if any. The signature(s) to this assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.

Appears in 1 contract

Samples: Restricted Stock Agreement (Xilio Therapeutics, Inc.)

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STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I XXXXXXX X. XXXXXXX hereby sellsells, assign assigns and transfer transfers unto ____________________________________ CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (_________the “Company”), pursuant to the Repurchase Option under that certain Restricted Stock Purchase Agreement, dated March 1, 2006, by and between the undersigned and the Company (the “Agreement”) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(sCertificate No(s) Number __________ herewith, and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx both the Company’s Secretary and Xxxx LLP attorney the Company’s attorney, or either of them, to transfer the said stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the repurchase of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Repurchase Option under the Agreement. Dated: PARTICIPANT: March 1, 2006 /s/ XXXXXXX X. XXXXXXX XXXXXXX X. XXXXXXX [Name] Name of Spouse (if any): Instructions to ParticipantINSTRUCTION: Please do not fill in any blanks other than the signature line(s)line. The purpose of the Stock this Assignment Separate from Certificate is to enable the Company to acquire exercise its repurchase option set forth in the Shares upon exercise of its Right of First Refusal and/or Purchase Option Agreement without requiring additional signatures on the part of Purchaser.] EXHIBIT B JOINT ESCROW INSTRUCTIONS Secretary Catalytic Capital Investment Corporation 000 Xxxxxxxx Xxxxxxxxx, Xxxxx 0000 Xxxxx Xxxxxx, XX 00000 Attention: Xxxxxxx X. Pillar Ladies and Gentlemen: As Escrow Agent for both CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (“Company”) and XXXXXXX X. XXXXXXX, an individual (“Purchaser”), you are hereby authorized and directed to hold the Participant or Participant’s spousedocuments delivered to you pursuant to the terms of that certain Restricted Stock Purchase Agreement dated as of March 1, if any. The signature(s2006 (the “Agreement”) , to this assignment must correspond which a copy of these Joint Escrow Instructions is attached as Exhibit B, in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Purchase Agreement (Catalytic Capital Investment Corp)

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I XXXXXX X. XXXXXXX hereby sellsells, assign assigns and transfer transfers unto ____________________________________ CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (_________the “Company”), pursuant to the Repurchase Option under that certain Restricted Stock Purchase Agreement, dated March 1, 2006, by and between the undersigned and the Company (the “Agreement”) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(sCertificate No(s) Number __________ herewith, and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx both the Company’s Secretary and Xxxx LLP attorney the Company’s attorney, or either of them, to transfer the said stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the repurchase of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Repurchase Option under the Agreement. Dated: PARTICIPANT: March 1, 2006 /s/ XXXXXX X. XXXXXXX XXXXXX X. XXXXXXX [Name] Name of Spouse (if any): Instructions to ParticipantINSTRUCTION: Please do not fill in any blanks other than the signature line(s)line. The purpose of the Stock this Assignment Separate from Certificate is to enable the Company to acquire exercise its repurchase option set forth in the Shares upon exercise of its Right of First Refusal and/or Purchase Option Agreement without requiring additional signatures on the part of Purchaser.] EXHIBIT B JOINT ESCROW INSTRUCTIONS Secretary Catalytic Capital Investment Corporation 000 Xxxxxxxx Xxxxxxxxx, Xxxxx 0000 Xxxxx Xxxxxx, XX 00000 Attention: Xxxxxxx X. Pillar Ladies and Gentlemen: As Escrow Agent for both CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (“Company”) and XXXXXX X. XXXXXXX, an individual (“Purchaser”), you are hereby authorized and directed to hold the Participant or Participant’s spousedocuments delivered to you pursuant to the terms of that certain Restricted Stock Purchase Agreement dated as of March 1, if any. The signature(s2006 (the “Agreement”) , to this assignment must correspond which a copy of these Joint Escrow Instructions is attached as Exhibit B, in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Purchase Agreement (Catalytic Capital Investment Corp)

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVEDFor Value Received, I the undersigned hereby sellsells, assign assigns and transfer transfers unto _______________Hot Topic, Inc., a California corporation (the “Company”), pursuant to the Reacquisition Right under that certain Restricted Stock Bonus Agreement, dated as of October 8, 2010 by and between the undersigned and the Company (the “Agreement”), _____________________ (_________) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(s) Number Certificate No(s). _______________ herewith(or uncertificated and recorded at the office of the Company’s transfer agent, if applicable) and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx and Xxxx LLP the Company’s Secretary as attorney to transfer the said stock Common Stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the reacquisition of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Reacquisition Right under the Agreement. Dated: PARTICIPANT: [_______________ /s/ Xxxxxx X. Xxxxxx (Signature) Xxxxxx X. Xxxxxx (Print Name] Name of Spouse ) (if any): Instructions to ParticipantInstruction: Please do not fill in any blanks other than the signature line(s“Signature” line and the “Print Name” line.) [Note: Director agrees to re-execute documentation as necessary in the event of required notarization or medallion guarantee] 504505 v3/SD Exhibit B Joint Escrow Instructions 504505 v3/SD JOINT ESCROW INSTRUCTIONS Secretary Hot Topic, Inc. 00000 X. Xxx Xxxx Xxxxxx City of Industry, CA 91748 Ladies and Gentlemen: As Escrow Agent for both Hot Topic, Inc., a California corporation (“Company”) and the undersigned Director (“Director”). The purpose , you are hereby authorized and directed to hold the documents delivered to you pursuant to the terms of the that certain Restricted Stock Assignment Separate from Certificate Bonus Agreement dated as of October 8, 2010 (“Agreement”), to which a copy of these Joint Escrow Instructions is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouseattached as Exhibit B, if any. The signature(s) to this assignment must correspond in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Bonus Agreement (Becker Drapkin Management, L.P.)

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVEDFor Value Received, I the undersigned hereby sellsells, assign assigns and transfer transfers unto _______________Hot Topic, Inc., a California corporation (the “Company”), pursuant to the Reacquisition Right under that certain Restricted Stock Bonus Agreement, dated as of October 8, 2010 by and between the undersigned and the Company (the “Agreement”), _____________________ (_________) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(s) Number Certificate No(s). _______________ herewith(or uncertificated and recorded at the office of the Company’s transfer agent, if applicable) and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx and Xxxx LLP the Company’s Secretary as attorney to transfer the said stock Common Stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the reacquisition of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Reacquisition Right under the Agreement. Dated: PARTICIPANT: [_______________ /s/ Xxxxxxx X. Xxxxxxx (Signature) Xxxxxxx X. Xxxxxxx (Print Name] Name of Spouse ) (if any): Instructions to ParticipantInstruction: Please do not fill in any blanks other than the signature line(s“Signature” line and the “Print Name” line.) [Note: Director agrees to re-execute documentation as necessary in the event of required notarization or medallion guarantee] 504505 v3/SD Exhibit B Joint Escrow Instructions 504505 v3/SD JOINT ESCROW INSTRUCTIONS Secretary Hot Topic, Inc. 00000 X. Xxx Xxxx Xxxxxx City of Industry, CA 91748 Ladies and Gentlemen: As Escrow Agent for both Hot Topic, Inc., a California corporation (“Company”) and the undersigned Director (“Director”). The purpose , you are hereby authorized and directed to hold the documents delivered to you pursuant to the terms of the that certain Restricted Stock Assignment Separate from Certificate Bonus Agreement dated as of October 8, 2010 (“Agreement”), to which a copy of these Joint Escrow Instructions is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouseattached as Exhibit B, if any. The signature(s) to this assignment must correspond in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Bonus Agreement (Becker Drapkin Management, L.P.)

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STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVEDFor Value Received, I the undersigned hereby sellsells, assign assigns and transfers unto Hot Topic, Inc., a California corporation (the “Company”), pursuant to the Reacquisition Right under that certain Restricted Stock Bonus Agreement, dated as of ____________ by and between the undersigned and the Company (the “Agreement”), _____________________ shares of Common Stock of the Company standing in the undersigned’s name on the books of the Company represented by Certificate No(s). _______________ (or uncertificated and recorded at the office of the Company’s transfer unto agent, if applicable) and does hereby irrevocably constitute and appoint the Company’s Secretary as attorney to transfer said Common Stock on the books of the Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the reacquisition of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Reacquisition Right under the Agreement. Dated: _______________ __________________________________________ (Signature) _________) shares of Common Stock, $0.0001 par value per share, of Xilio Therapeutics, Inc. (the “Corporation”) standing in my name on the books of the Corporation represented by Certificate(s) Number __________________________________ herewith, and do hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx and Xxxx LLP attorney to transfer the said stock on the books of the Corporation with full power of substitution in the premises. Dated: PARTICIPANT: [(Print Name] Name of Spouse ) (if any): Instructions to ParticipantInstruction: Please do not fill in any blanks other than the signature line(s“Signature” line and the “Print Name” line.) [Note: Director agrees to re-execute documentation as necessary in the event of required notarization or medallion guarantee] Exhibit B Joint Escrow Instructions JOINT ESCROW INSTRUCTIONS Secretary Hot Topic, Inc. 00000 X. Xxx Xxxx Xxxxxx City of Industry, CA 91748 Ladies and Gentlemen: As Escrow Agent for both Hot Topic, Inc., a California corporation (“Company”) and the undersigned Director (“Director”). The purpose , you are hereby authorized and directed to hold the documents delivered to you pursuant to the terms of the that certain Restricted Stock Assignment Separate from Certificate Bonus Agreement dated as of _____________ (“Agreement”), to which a copy of these Joint Escrow Instructions is to enable the Company to acquire the Shares upon exercise of its Right of First Refusal and/or Purchase Option without requiring additional signatures on the part of the Participant or Participant’s spouseattached as Exhibit B, if any. The signature(s) to this assignment must correspond in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Bonus Agreement (Hot Topic Inc /Ca/)

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I XXXXXX X. XXXXXXXXXXX hereby sellsells, assign assigns and transfer transfers unto ____________________________________ CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (_________the “Company”), pursuant to the Repurchase Option under that certain Restricted Stock Purchase Agreement, dated March 1, 2006, by and between the undersigned and the Company (the “Agreement”) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(sCertificate No(s) Number __________ herewith, and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx both the Company’s Secretary and Xxxx LLP attorney the Company’s attorney, or either of them, to transfer the said stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the repurchase of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Repurchase Option under the Agreement. Dated: PARTICIPANT: March 1, 2006 /s/ XXXXXX X. XXXXXXXXXXX XXXXXX X. XXXXXXXXXXX [Name] Name of Spouse (if any): Instructions to ParticipantINSTRUCTION: Please do not fill in any blanks other than the signature line(s)line. The purpose of the Stock this Assignment Separate from Certificate is to enable the Company to acquire exercise its repurchase option set forth in the Shares upon exercise of its Right of First Refusal and/or Purchase Option Agreement without requiring additional signatures on the part of Purchaser.] EXHIBIT B JOINT ESCROW INSTRUCTIONS Secretary Catalytic Capital Investment Corporation 000 Xxxxxxxx Xxxxxxxxx, Xxxxx 0000 Xxxxx Xxxxxx, XX 00000 Attention: Xxxxxxx X. Pillar Ladies and Gentlemen: As Escrow Agent for both CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (“Company”) and XXXXXX X. XXXXXXXXXXX, an individual (“Purchaser”), you are hereby authorized and directed to hold the Participant or Participant’s spousedocuments delivered to you pursuant to the terms of that certain Restricted Stock Purchase Agreement dated as of March 1, if any. The signature(s2006 (the “Agreement”) , to this assignment must correspond which a copy of these Joint Escrow Instructions is attached as Exhibit B, in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Purchase Agreement (Catalytic Capital Investment Corp)

STOCK ASSIGNMENT SEPARATE FROM CERTIFICATE. FOR VALUE RECEIVED, I XXXXXXX X. XXXXX hereby sellsells, assign assigns and transfer transfers unto ____________________________________ CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (_________the “Company”), pursuant to the Repurchase Option under that certain Restricted Stock Purchase Agreement, dated March 1, 2006, by and between the undersigned and the Company (the “Agreement”) shares of Common Stock, $0.0001 par value per share, Stock of Xilio Therapeutics, Inc. (the “Corporation”) Company standing in my the undersigned’s name on the books of the Corporation Company represented by Certificate(sCertificate No(s) Number __________ herewith, and do does hereby irrevocably constitute and appoint Xxxxxx Xxxxxx Xxxxxxxxx Xxxx both the Company’s Secretary and Xxxx LLP attorney the Company’s attorney, or either of them, to transfer the said stock on the books of the Corporation Company with full power of substitution in the premises. This Assignment may be used only in accordance with and subject to the terms and conditions of the Agreement, in connection with the repurchase of shares of Common Stock issued to the undersigned pursuant to the Agreement, and only to the extent that such shares remain subject to the Company’s Repurchase Option under the Agreement. Dated: PARTICIPANT: March 1, 2006 /s/ XXXXXXX X. XXXXX XXXXXXX X. XXXXX [Name] Name of Spouse (if any): Instructions to ParticipantINSTRUCTION: Please do not fill in any blanks other than the signature line(s)line. The purpose of the Stock this Assignment Separate from Certificate is to enable the Company to acquire exercise its repurchase option set forth in the Shares upon exercise of its Right of First Refusal and/or Purchase Option Agreement without requiring additional signatures on the part of Purchaser.] EXHIBIT B JOINT ESCROW INSTRUCTIONS Secretary Catalytic Capital Investment Corporation 000 Xxxxxxxx Xxxxxxxxx, Xxxxx 0000 Xxxxx Xxxxxx, XX 00000 Attention: Xxxxxxx X. Pillar Ladies and Gentlemen: As Escrow Agent for both CATALYTIC CAPITAL INVESTMENT CORPORATION, a Delaware corporation (“Company”) and XXXXXXX X. XXXXX, an individual (“Purchaser”), you are hereby authorized and directed to hold the Participant or Participant’s spousedocuments delivered to you pursuant to the terms of that certain Restricted Stock Purchase Agreement dated as of March 1, if any. The signature(s) 2006 (the “Agreement”), to this assignment must correspond which a copy of these Joint Escrow Instructions is attached as Exhibit B, in accordance with the name as written upon the face of the certificate, in every particular, without alteration, enlargement, or any change whatever. Notice on 83(b) Elections IF YOU WISH TO MAKE A SECTION 83(B) ELECTION, THE FILING OF SUCH ELECTION IS YOUR RESPONSIBILITY. THE FORM FOR MAKING THIS SECTION 83(B) ELECTION IS ATTACHED TO THIS AGREEMENT. YOU MUST FILE THIS FORM WITHIN 30 DAYS OF THE GRANT DATE. YOU (AND NOT THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON) SHALL BE SOLELY RESPONSIBLE FOR FILING SUCH FORM WITH THE IRS, EVEN IF YOU REQUEST THE COMPANY, ITS AGENTS OR ANY OTHER PERSON TO MAKE THIS FILING ON YOUR BEHALF AND EVEN IF THE COMPANY, ANY OF ITS AGENTS OR ANY OTHER PERSON HAS PREVIOUSLY MADE THIS FILING ON YOUR BEHALF. The 83(b) election should be filed by mailing a signed election form by certified mail, return receipt requested to the IRS Service Center where you file your tax returns. See xxx.xxx.xxx.following instructions:

Appears in 1 contract

Samples: Restricted Stock Purchase Agreement (Catalytic Capital Investment Corp)

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