Stock Power and Assignment Separate from Stock Certificate for Gas and Oil Technologies, Inc.
This document allows a shareholder of Gas and Oil Technologies, Inc. to transfer ownership of specified shares of common stock to another party, as authorized by a Stock Option Exercise Agreement. By signing, the shareholder appoints the company's Secretary to handle the transfer on their behalf. The assignment is only valid as permitted by the related Exercise Agreement, typically to enable the company to repurchase the shares or exercise a right of first refusal. The document must be signed and dated by the shareholder (and spouse, if applicable).
STOCK POWER AND ASSIGNMENT
SEPARATE FROM STOCK CERTIFICATE
Stock Power and Assignment
Separate from Stock Certificate
FOR VALUE RECEIVED and pursuant to that certain Stock Option Exercise Agreement No. ___ dated as of _______________, 19___, (the "Agreement"), the undersigned hereby sells, assigns and transfers unto _______________________________, shares of the Common Stock, $1.00 par value per share, of Gas and Oil Technologies, Inc., a Delaware corporation (the "Company"), standing in the undersigned's name on the books of the Company represented by Certificate No(s). ______ delivered herewith, and does hereby irrevocably constitute and appoint the Secretary of the Company as the undersigned's attorney-in-fact, with full power of substitution, to transfer said stock on the books of the Company. THIS ASSIGNMENT MAY ONLY BE USED AS AUTHORIZED BY THIS EXERCISE AGREEMENT AND ANY EXHIBITS THERETO.
Dated: _______________, 19____
PURCHASER
(Please Print Name)
(Spouse's Signature, if any)
(Please Print Spouse's Name)
Instructions: Please do not fill in any blanks other than the signature line. The purpose of this Stock Power and Assignment is to enable the Company to acquire the shares upon exercise of its "Repurchase Option" or "Right of First Refusal" set forth in this Exercise Agreement.
