Form of Deferred Stock Unit Grant Notice and Agreement under the 2021 Equity Incentive
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Human Resources
- Bonus & Incentive Agreements
EX-10.19 3 orc10K20211231x1019.htm EXHIBIT 10.19 orc10K20211231x1019 3305 Flamingo Drive Vero Beach, Florida 32963 If to the Participant, to the address for the Participant indicated on the signature Any new signed DSU Election Form must be received by the Company no later ( (a) The default time specified in the Agreement. (b) The date I incur a separation from service with the Company, (c) The anniversary of the date of I incur a separation from (d) As soon as administratively feasible following ________________ Name: ( (a) The date I incur a separation from service with the Company, (b) The anniversary of the date of I incur a separation from (c) As soon as administratively feasible following ________________ Name:
Exhibit 10.19
ORCHID ISLAND CAPITAL, INC.
2021 EQUITY INCENTIVE PLAN
DEFERRED STOCK UNIT GRANT NOTICE
Pursuant to the terms and conditions of the Orchid Island Capital, Inc. 2021 Equity
Incentive Plan, as amended from time to time (the “
Plan
”), Orchid Island Capital, Inc.
(the “
Company
”) hereby grants to the individual listed below (“
you
” or the “
Participant
”) the
number of Deferred Stock Units (the “
DSUs
”) set forth below in this Deferred Stock Unit Grant
Notice (this “
Grant Notice
”). This award of DSUs (this “
Award
”) is subject to the terms and
conditions set forth herein, in the Deferred Stock Unit Agreement attached hereto as Exhibit A
(the “
Agreement
”) and the Plan, each of which is incorporated herein by reference. Capitalized
terms used but not defined herein shall have the meanings set forth in the Plan.
Participant:
Date of Grant:
Award Type and
Description:
Other Equity-Based Award granted pursuant to Article X of the Plan.
Total Number of
Deferred Stock Units:
By signing below, you agree to be bound by the terms and conditions of the Plan, the
Agreement and this Grant Notice. You acknowledge that you have reviewed the Agreement, the
Plan and this Grant Notice in their entirety and fully understand all provisions of the Agreement,
the Plan and this Grant Notice. You hereby agree to accept as binding, conclusive and final all
decisions or interpretations of the Committee regarding any questions or determinations arising
under the Agreement, the Plan or this Grant Notice. This Grant Notice may be executed in one or
more counterparts (including portable document format (.pdf) and facsimile counterparts), each of
which shall be deemed to be an original, but all of which together shall constitute one and the same
agreement.
[Signature Page Follows]
IN WITNESS WHEREOF
, the Company has caused this Grant Notice to be executed
by an officer thereunto duly authorized, and the Participant has executed this Grant Notice,
effective for all purposes as provided above.
COMPANY
Orchid Island Capital, Inc.
By:
Name:
Title:
PARTICIPANT
Name:
Address:
EXHIBIT A
DEFERRED STOCK UNIT AGREEMENT
This Deferred Stock Unit Agreement (together with the Grant Notice to which this
Agreement is attached, this “
Agreement
”) is made as of the Date of Grant set forth in the Grant
Notice (the “
Date of Grant
”) by and between Orchid Island Capital, Inc., a Maryland corporation
(the “
Company
”), and _________ (the “
Participant
”). Capitalized terms used but not specifically
defined herein shall have the meanings specified in the Plan or the Grant Notice.
1.
Award
. In consideration of the Participant’s past and/or continued service to the
Company or its Affiliates and for other good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, effective as of the Date of Grant, the Company
hereby grants to the Participant the number of DSUs set forth in the Grant Notice on the terms and
conditions set forth in the Grant Notice, this Agreement and the Plan, which is incorporated herein
by reference as a part of this Agreement. In the event of any inconsistency between the Plan and
this Agreement, the terms of the Plan shall control. Each DSU represents the right to receive one
share of Common Stock, subject to the terms and conditions set forth in the Grant Notice, this
Agreement and the Plan. Unless and until the DSUs are delivered in accordance with Section 4,
the Participant will have no right to receive any Common Stock or other payments in respect of
the DSUs. The DSUs shall be credited to a separate account maintained for the Participant on the
books and records of the Company (the “
Account
”). Prior to settlement of this Award, the DSUs
and this Award represent an unsecured obligation of the Company, payable only from the general
assets of the Company.
2.
Vesting of DSUs
. The DSUs shall be 100% vested on the Date of Grant.
3.
Dividend Equivalent Rights
.
(a)
In the event that the Company declares and pays a dividend in respect of its
outstanding shares of Common Stock and, on the record date for such dividend, the Participant
holds DSUs granted pursuant to this Agreement that have not been settled, the Company shall pay
to the Participant an amount equal to the dividends the Participant would have received if the
Participant was the holder of record, as of such record date, of the number of shares of Common
Stock relating to the portion of the Participant’s DSUs that have not been settled as of such record
date (the “
Dividend Equivalents
”), unless payment is deferred pursuant to Section 3(b).
(b)
Notwithstanding Section 3(a), the Participant may elect to defer the
payment of any Dividend Equivalents pursuant to the Dividend Equivalents Deferral Election
Form attached hereto as Exhibit C. Any such deferral election must be made in compliance with
such rules and procedures as the Committee prescribes. If any Dividend Equivalents are deferred,
the Company shall credit the amount of such Dividend Equivalents to the Account in the form of
additional DSUs based on the Fair Market Value of a share of Common Stock on the date such
Dividend Equivalent would be paid pursuant to Section 3(a). Any such additional DSUs shall be
considered DSUs under this Agreement and shall be entitled to receive Dividend Equivalents
pursuant to this Section 3; provided, however, that any such additional DSUs shall be settled in
accordance with the deferral election made pursuant to this Section 3(b), rather than pursuant to
Section 4.
4.
Settlement of DSUs
.
(a)
As soon as administratively practicable following the vesting of DSUs
pursuant to Section 2, but in no event later than 30 days after such vesting date, the Company shall
deliver to the Participant a number of shares of Common Stock equal to the number of DSUs
subject to this Award, unless delivery is deferred pursuant to Section 4(b). All shares of Common
Stock issued hereunder shall be delivered either by delivering one or more certificates for such
shares to the Participant or by entering such shares in book-entry form, as determined by the
Committee in its sole discretion. The value of shares of Common Stock shall not bear any interest
owing to the passage of time. Neither this Section 3 nor any action taken pursuant to or in
accordance with this Agreement shall be construed to create a trust or a funded or secured
obligation of any kind.
(b)
Notwithstanding Section 4(a), the Participant may elect to defer the delivery
of the DSUs pursuant to the Deferred Stock Units Deferral Election Form attached hereto as
Exhibit B. Any such deferral election must be made in compliance with such rules and procedures
as the Committee prescribes.
5.
Tax Withholding
. To the extent that the receipt, vesting or settlement of this
Award results in compensation income or wages to the Participant for federal, state, local and/or
foreign tax purposes, the Participant shall make arrangements satisfactory to the Company for the
satisfaction of obligations for the payment of withholding taxes and other tax obligations relating
to this Award, which arrangements include the delivery of cash or cash equivalents, Common
Stock (including previously owned Common Stock, net settlement, a broker-assisted sale, or other
cashless withholding or reduction of the amount of shares otherwise issuable or delivered pursuant
to this Award), other property, or any other legal consideration the Committee deems appropriate.
If such tax obligations are satisfied through net settlement or the surrender of previously owned
Common Stock, the maximum number of shares of Common Stock that may be so withheld (or
surrendered) shall be the number of shares of Common Stock that have an aggregate Fair Market
Value on the date of withholding or surrender equal to the aggregate amount of such tax liabilities
determined based on the greatest withholding rates for federal, state, local and/or foreign tax
purposes, including payroll taxes, that may be utilized without creating adverse accounting
treatment for the Company with respect to this Award, as determined by the Committee. The
Participant acknowledges that there may be adverse tax consequences upon the receipt, vesting or
settlement of this Award or disposition of the underlying shares and that the Participant has been
advised, and hereby is advised, to consult a tax advisor. The Participant represents that the
Participant is in no manner relying on the Board, the Committee, the Company or any of its
Affiliates or any of their respective managers, directors, officers, employees or authorized
representatives (including, without limitation, attorneys, accountants, consultants, bankers,
lenders, prospective lenders and financial representatives) for tax advice or an assessment of such
tax consequences.
6.
Non-Transferability
. None of the DSUs, the Dividend Equivalents or any interest
or right therein may be sold, pledged, assigned or transferred in any manner other than by will or
the laws of descent and distribution, unless and until the shares of Common Stock underlying the
DSUs have been issued, and all restrictions applicable to such shares have lapsed. Neither the
DSUs nor any interest or right therein shall be liable for the debts, contracts or engagements of the
Participant or his or her successors in interest or shall be subject to disposition by transfer,
alienation, anticipation, pledge, encumbrance, assignment or any other means, whether such
disposition be voluntary or involuntary or by operation of law by judgment, levy, attachment,
garnishment or any other legal or equitable proceedings (including bankruptcy), and any attempted
disposition thereof shall be null and void and of no effect, except to the extent that such disposition
is expressly permitted by the preceding sentence.
7.
Compliance with Applicable Law
. Notwithstanding any provision of this
Agreement to the contrary, the issuance of shares of Common Stock hereunder will be subject to
compliance with all requirements of applicable law with respect to such securities and with the
requirements of any stock exchange or market system upon which the Common Stock may then
be listed. No shares of Common Stock will be issued hereunder if such issuance would constitute
a violation of any applicable law or regulation or the requirements of any stock exchange or market
system upon which the Common Stock may then be listed. In addition, shares of Common Stock
will not be issued hereunder unless (a) a registration statement under the Securities Act is in effect
at the time of such issuance with respect to the shares to be issued or (b) in the opinion of legal
counsel to the Company, the shares to be issued are permitted to be issued in accordance with the
terms of an applicable exemption from the registration requirements of the Securities Act. The
inability of the Company to obtain from any regulatory body having jurisdiction the authority, if
any, deemed by the Company’s legal counsel to be necessary for the lawful issuance and sale of
any shares of Common Stock hereunder will relieve the Company of any liability in respect of the
failure to issue such shares as to which such requisite authority has not been obtained. As a
condition to any issuance of Common Stock hereunder, the Company may require the Participant
to satisfy any requirements that may be necessary or appropriate to evidence compliance with any
applicable law or regulation and to make any representation or warranty with respect to such
compliance as may be requested by the Company.
8.
Legends
. If a stock certificate is issued with respect to shares of Common Stock
delivered hereunder, such certificate shall bear such legend or legends as the Committee deems
appropriate in order to reflect the restrictions set forth in this Agreement and to ensure compliance
with the terms and provisions of this Agreement, the rules, regulations and other requirements of
the Securities and Exchange Commission, any applicable laws or the requirements of any stock
exchange on which the Common Stock is then listed. If the shares of Common Stock issued
hereunder are held in book-entry form, then such entry will reflect that the shares are subject to
the restrictions set forth in this Agreement.
9.
Rights as a Stockholder
. The Participant shall have no rights as a stockholder of
the Company with respect to any shares of Common Stock that may become deliverable hereunder
unless and until the Participant has become the holder of record of such shares of Common Stock,
and no adjustments shall be made for dividends in cash or other property, distributions or other
rights in respect of any such shares of Common Stock, except as otherwise specifically provided
for in the Plan or this Agreement.
10.
Execution of Receipts and Releases
. Any issuance or transfer of shares of
Common Stock or other property to the Participant or the Participant’s legal representative, heir,
legatee or distributee, in accordance with this Agreement shall be in full satisfaction of all claims
of such person hereunder. As a condition precedent to such payment or issuance, the Company
may require the Participant or the Participant’s legal representative, heir, legatee or distributee to
execute (and not revoke within any time provided to do so) a release and receipt therefor in such
form as it shall determine appropriate; provided, however, that any review period under such
release will not modify the date of settlement with respect to vested DSUs.
11.
No Right to Continued Service or Awards
. Nothing in the adoption of the Plan,
nor the award of the DSUs thereunder pursuant to the Grant Notice and this Agreement, shall
confer upon the Participant the right to a continued service relationship with the Company or any
Affiliate, or any other entity, or affect in any way the right of the Company or any such Affiliate,
or any other entity to terminate such service relationship at any time. The grant of the DSUs is a
one-time benefit and does not create any contractual or other right to receive a grant of Awards or
benefits in lieu of Awards in the future. Any future Awards will be granted at the sole discretion
of the Company.
12.
Notices
. All notices and other communications under this Agreement shall be in
writing and shall be delivered to the parties at the following addresses (or at such other address for
a party as shall be specified by like notice):
If to the Company, unless otherwise designated by the Company in a written notice
to the Participant (or other holder):
Orchid Island Capital, Inc.
Attn: Bob Cauley
page to the Grant Notice (as such address may be updated by the Participant providing written
notice to such effect to the Company).
Any notice that is delivered personally or by overnight courier or telecopier in the manner provided
herein shall be deemed to have been duly given to the Participant when it is mailed by the Company
or, if such notice is not mailed to the Participant, upon receipt by the Participant. Any notice that
is addressed and mailed in the manner herein provided shall be conclusively presumed to have
been given to the party to whom it is addressed at the close of business, local time of the recipient,
on the fourth day after the day it is so placed in the mail.
13.
Consent to Electronic Delivery; Electronic Signature
. In lieu of receiving
documents in paper format, the Participant agrees, to the fullest extent permitted by law, to accept
electronic delivery of any documents that the Company may be required to deliver (including, but
not limited to, prospectuses, prospectus supplements, grant or award notifications and agreements,
account statements, annual and quarterly reports and all other forms of communications) in
connection with this and any other Award made or offered by the Company. The Participant hereby
consents to any and all procedures the Company has established or may establish for an electronic
signature system for delivery and acceptance of any such documents that the Company may be
required to deliver, and agrees that his or her electronic signature is the same as, and shall have the
same force and effect as, his or her manual signature.
14.
Agreement to Furnish Information
. The Participant agrees to furnish to the
Company all information requested by the Company to enable it to comply with any reporting or
other requirement imposed upon the Company by or under any applicable statute or regulation.
15.
Entire Agreement; Amendment
. This Agreement, the Grant Notice and the Plan
constitute the entire agreement of the parties with regard to the subject matter hereof, and contains
all the covenants, promises, representations, warranties and agreements between the parties with
respect to the DSUs granted hereby; provided, however, that the terms of this Agreement shall not
modify and shall be subject to the terms and conditions of any consulting and/or severance
agreement between the Company (or an Affiliate or other entity) and the Participant in effect as of
the date a determination is to be made under this Agreement. Without limiting the scope of the
preceding sentence, except as provided therein, all prior understandings and agreements, if any,
among the parties hereto relating to the subject matter hereof are hereby null and void and of no
further force and effect. The Committee may, in its sole discretion, amend this Agreement from
time to time in any manner that is not inconsistent with the Plan; provided, however, that except
as otherwise provided in the Plan or this Agreement, any such amendment that materially reduces
the rights of the Participant shall be effective only if it is in writing and signed by both the
Participant and an authorized officer of the Company.
16.
Severability and Waiver
. If a court of competent jurisdiction determines that any
provision of this Agreement is invalid or unenforceable, then the invalidity or unenforceability of
such provision shall not affect the validity or enforceability of any other provision of this
Agreement, and all other provisions shall remain in full force and effect. Waiver by any party of
any breach of this Agreement or failure to exercise any right hereunder shall not be deemed to be
a waiver of any other breach or right. The failure of any party to take action by reason of such
breach or to exercise any such right shall not deprive the party of the right to take action at any
time while or after such breach or condition giving rise to such rights continues.
17.
Clawback
. Notwithstanding any provision in the Grant Notice, this Agreement or
the Plan to the contrary, to the extent required by (a) applicable law, including, without limitation,
the requirements of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010,
any Securities and Exchange Commission rule or any applicable securities exchange listing
standards and/or (b) any policy that may be adopted or amended by the Board from time to time,
all shares of Common Stock issued hereunder shall be subject to forfeiture, repurchase,
recoupment and/or cancellation to the extent necessary to comply with such law(s) and/or policy.
18.
Governing Law
. THIS AGREEMENT SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF MARYLAND
APPLICABLE TO CONTRACTS MADE AND TO BE PERFORMED THEREIN, EXCLUSIVE
OF THE CONFLICT OF LAWS PROVISIONS OF MARYLAND LAW.
19.
Successors and Assigns
. The Company may assign any of its rights under this
Agreement without the Participant’s consent. This Agreement will be binding upon and inure to
the benefit of the successors and assigns of the Company. Subject to the restrictions on transfer
set forth herein and in the Plan, this Agreement will be binding upon the Participant and the
Participant's beneficiaries, executors, administrators and the person(s) to whom the DSUs may be
transferred by will or the laws of descent or distribution.
20.
Headings
. Headings are for convenience only and are not deemed to be part of this
Agreement.
21.
Counterparts
. The Grant Notice may be executed in one or more counterparts,
each of which shall be deemed an original and all of which together shall constitute one instrument.
Delivery of an executed counterpart of the Grant Notice by facsimile or portable document format
(.pdf) attachment to electronic mail shall be effective as delivery of a manually executed
counterpart of the Grant Notice.
22.
Section 409A
. Notwithstanding anything herein or in the Plan to the contrary, the
DSUs granted pursuant to this Agreement are intended to comply with the applicable requirements
of Section 409A, as amended from time to time, and the guidance and regulations promulgated
thereunder and successor provisions, guidance and regulations thereto (the “
Nonqualified
Deferred Compensation Rules
”) and shall be construed and interpreted in accordance with such
intent. If the Participant is deemed to be a “specified employee” within the meaning of the
Nonqualified Deferred Compensation Rules, as determined by the Committee, at a time when the
Participant becomes eligible for settlement of the DSUs upon the Participant’s “separation from
service” within the meaning of the Nonqualified Deferred Compensation Rules, then to the extent
necessary to prevent any accelerated or additional tax under the Nonqualified Deferred
Compensation Rules, such settlement will be delayed until the earlier of: (a) the date that is six
months following the Participant’s separation from service and (b) the Participant’s death.
Notwithstanding the foregoing, the Company and its Affiliates make no representations that the
DSUs provided under this Agreement are compliant with the Nonqualified Deferred Compensation
Rules and in no event shall the Company or any Affiliate be liable for all or any portion of any
taxes, penalties, interest or other expenses that may be incurred by the Participant on account of
non-compliance with the Nonqualified Deferred Compensation Rules.
EXHIBIT B
DEFERRED STOCK UNITS
DEFERRAL ELECTION FORM
Please complete this Deferred Stock Units Deferral Election Form (the “
DSU Election Form
”)
and return a signed copy to Bob Cauley no later than 5:00pm EST on December 31, 2021 (the
“
Election Deadline
”).
Name: ______________________________________
NOTE: This DSU Election Form will apply to all grants of Deferred Stock Units (the
“
DSUs
”) you may receive from Orchid Island Capital, Inc. (the “
Company
”) on and after
January 1, 2022 until such time as a new signed DSU Election Form is received by the
Company.
than December 31 of the calendar year preceding the calendar in which it is intended to
apply.
1.
Settlement of DSUs
In making this election, the following rules apply:
●
Unless otherwise specified, capitalized terms used but not defined in this DSU Election
Form shall have the meaning attributed to them in the Deferred Stock Unit Grant Notice
(the “
Grant Notice
”), the Deferred Stock Unit Agreement (the “
Agreement
”) or the Orchid
Island Capital, Inc. 2021 Equity Incentive Plan, as amended from time to time (the “
Plan
”),
as applicable.
●
You must complete this DSU Election Form by the Election Deadline and select a payment
date on which you will receive the shares of Common Stock underlying the DSUs. You
must complete this DSU Election Form even if you want the shares of Common Stock
underlying your DSUs to be paid to you at the default time specified in the Agreement.
●
Notwithstanding the foregoing, if you fail to complete and timely submit this DSU Election
Form, the shares of Common Stock underlying your DSUs will be paid to you at the default
time specified in the Agreement.
2.
Deferral Election
I hereby irrevocably elect to receive the shares of Common Stock issuable pursuant
to any DSUs granted to me under the Plan or any successor plan thereto in 2022 and any
future calendar years, until such time as a new signed DER Election Form is received by
the Company, upon the earlier to occur of my death, disability (as defined in Treasury
Regulation Section 1.409A-3(i)(4)), a Change in Control, or
select only one of the following
):
☐
☐
determined in accordance with the Company’s written and generally applicable
policies.
☐
service with the Company, determined in accordance with the Company’s written
and generally applicable policies.
☐
___, _____ (
insert applicable date
).
3.
Signature
I understand that my rights to the shares of Common Stock underlying the DSUs are
subject to the rights of the general creditors of the Company in the event of its insolvency.
I further understand that this DSU Election Form will become effective and irrevocable as of
5:00pm EST on December 31, 2021, which is the Election Deadline.
Once I have elected the
time of settlement of my DSUs by filing this completed DSU Election Form, I understand
that (a) the settlement election will be irrevocable and (b) the settlement election will
control over any contrary payment time or event specified in Section 4 of the Agreement.
I
acknowledge that, if I do not complete and timely submit this DSU Election Form, the shares of
Common Stock underlying my DSUs will be paid to me at the default time specified in the
Agreement.
By executing this DSU Election Form, I hereby acknowledge my understanding of, and
agreement with, the terms and provisions set forth in this DSU Election Form, the Grant Notice,
the Agreement and the Plan.
PARTICIPANT
Date:
EXHIBIT C
DIVIDEND EQUIVALENTS
DEFERRAL ELECTION FORM
Please complete this Dividend Equivalents Deferral Election Form (the “
DER Election Form
”)
and return a signed copy to Bob Cauley no later than 5:00pm EST on December 31, 2021 (the
“
Election Deadline
”).
Name: ______________________________________
NOTE: This DER Election Form will apply to all Dividend Equivalents you may receive
from Orchid Island Capital, Inc. (the “
Company
”) pursuant to an award of Deferred Stock
Units on and after January 1, 2022 until such time as a new signed DER Election Form is
received by the Company. Any new signed DSU Election Form must be received by the
Company no later than December 31 of the calendar year preceding the calendar in which
it is intended to apply.
1.
Settlement of Dividend Equivalents
In making this election, the following rules apply:
●
Unless otherwise specified, capitalized terms used but not defined in this DER Election
Form shall have the meaning attributed to them in the Deferred Stock Unit Grant Notice
(the “
Grant Notice
”), the Deferred Stock Unit Agreement (the “
Agreement
”) or the Orchid
Island Capital, Inc. 2021 Equity Incentive Plan, as amended from time to time (the “
Plan
”),
as applicable.
●
You must complete this DER Election Form by the Election Deadline and select a payment
date on which you will receive the Dividend Equivalents (or the shares of Common Stock
underlying any reinvested Dividend Equivalents). You must complete this DER Election
Form even if you want the Dividend Equivalents to be paid to you at the default time
specified in the Agreement.
●
Notwithstanding the foregoing, if you fail to complete and timely submit this DER Election
Form, the Dividend Equivalents will be paid to you at the default time specified in the
Agreement.
2.
Deferral Election
I hereby irrevocably elect to receive _____% of the Dividend Equivalents (or the
shares of Common Stock underlying any reinvested Dividend Equivalents)
issuable
pursuant to any Deferred Stock Units granted to me under the Plan or any successor plan
thereto in 2022 and any future calendar years (the “Deferred Dividend Equivalents”), until
such time as a new signed DER Election Form is received by the Company, upon the
earlier to occur of my death, disability (as defined in Treasury Regulation Section 1.409A-
3(i)(4)), a Change in Control, or
select only one of the following
):
☐
determined in accordance with the Company’s written and generally applicable
policies.
☐
service with the Company, determined in accordance with the Company’s written
and generally applicable policies.
☐
___, _____ (
insert applicable date
).
For the avoidance of doubt, if less than 100% of the Dividend Equivalents (or the
shares of Common Stock underlying any reinvested Dividend Equivalents) are Deferred
Dividend Equivalents pursuant to this Section 2 of the DER Election Form, then any
Dividend Equivalents (or the shares of Common Stock underlying any reinvested Dividend
Equivalents) that are not Deferred Dividend Equivalents will be paid at the default time
specified in the Agreement.
3.
Signature
I understand that my rights to the Deferred Dividend Equivalents are subject to the rights
of the general creditors of the Company in the event of its insolvency.
I further understand
that this DER Election Form will become effective and irrevocable as of 5:00pm EST on
December 31, 2021, which is the Election Deadline.
Once I have elected the time of settlement
of my Deferred Dividend Equivalents by filing this completed DER Election Form, I
understand that (a) the settlement election will be irrevocable and (b) the settlement
election will control over any contrary payment time or event specified in Section 3 of the
Agreement for the Deferred Dividend Equivalents.
I acknowledge that, if I do not complete
and timely submit this DER Election Form, none of the Dividend Equivalents (or the shares of
Common Stock underlying any reinvested Dividend Equivalents) will become Deferred
Dividend Equivalents and all Dividend Equivalents (or the shares of Common Stock underlying
any reinvested Dividend Equivalents) will be paid to me at the default time specified in the
Agreement.
By executing this DER Election Form, I hereby acknowledge my understanding of, and
agreement with, the terms and provisions set forth in this DER Election Form, the Grant Notice,
the Agreement and the Plan.
PARTICIPANT
Date: