Blueprint





 







Exhibit 4.1



 


AMENDMENT
#1 TO WARRANT AGREEMENT


 


BETWEEN


 


OXBRIDGE
RE HOLDINGS LIMITED


 


AND


 


BROADRIDGE
CORPORATE ISSUER SOLUTIONS, INC., AS WARRANT AGENT


 


THIS
AMENDMENT #1, dated November 16, 2018 (“Amendment
#1”), to the Warrant Agreement, dated as of March 26,
2014, (the “Warrant
Agreement”), by and between Oxbridge Re Holdings
Limited, a Cayman Islands exempted company (the “Company”), and
Broadridge Corporate Issuer Solutions, Inc., a Pennsylvania
corporation, as Warrant Agent (the “Warrant
Agent”).


 


WHEREAS, the
Company and the Warrant Agent entered into that certain Warrant
Agreement relating to, among other things, the issuance of warrants
to purchase shares of the Company’s common stock at an
exercise price of $7.50 per share (the “Warrants”);
and


 


WHEREAS, pursuant
to Section 3.2 of the Warrant Agreement, the Company has elected to
extend the duration of the Warrants by delaying the Expiration Date
(as defined in the Warrant Agreement) as further set forth herein,
and the Company and the Warrant Agent desire to hereby amend the
Warrant Agreement accordingly.


 


NOW,
THEREFORE, in consideration of the mutual agreements herein
contained, the Company and the Warrant Agent agree as
follows:


 



1.


Amendments.






 



a.


Section
3.2 of the Warrant Agreement is amended and restated as
follows:






 



“3.2



Duration of Warrants . A Warrant may be exercised only
during the period (the “Exercise Period”) commencing on
March 26, 2014 and terminating at 5:00 p.m., Philadelphia time on
the earlier to occur of (i) March 26, 2024 and (ii) the day prior
to the date fixed for cancellation of the Warrants as provided in
Section 6 of this Agreement (“Expiration Date”). Each Warrant
not exercised on or before the Expiration Date shall become null
and void, and all rights thereunder and all rights in respect
thereof under this Agreement shall cease at the close of business
on the Expiration Date. The Company in its sole discretion may
extend the duration of the Warrants by delaying the Expiration Date
and will provide written notification of the delayed Expiration
Date to the Warrant Agent.






 



b.


The
Form of Warrant Certificate attached as Exhibit A to the Warrant
Agreement is amended and restated as set forth on Exhibit A to this
Amendment #1.






 



2.


Counterparts.
This Amendment may be executed in any number of original or
facsimile counterparts and each of such counterparts shall for all
purposes be deemed to be an original, and all such counterparts
shall together constitute but one and the same
instrument.





 



3.


Miscellaneous:
This Amendment #1 shall be made a party of the Warrant Agreement
and shall be subject to the terms and provisions of the Warrant
Agreement. In the event of any conflict or inconsistency between
the Warrant Agreement and this Amendment #1, this Amendment #1
shall supersede and prevail. Capitalized terms not otherwise
defined shall have the meaning set forth in the Warrant Agreement.
Except as specifically modified hereby, the terms and conditions of
the Warrant Agreement shall continue in full force and
effect.






 


[Signature page follows]


 


 


 




 








 






 

 


IN
WITNESS WHEREOF, the parties hereto have caused this Amendment #1
to be duly executed as of the date first above
written.


 


	
 

	

COMPANY:


	
 

	
 


	
 

	


oxbridge re holdings
limited


	
 

	
 

	
 


	
 

	

By:

	

/s/
Wrendon Timothy


	
 

	
 

	

Name:

	

Wrendon
Timothy


	
 

	
 

	

Title:

	

Chief
Financial Officer


	
 

	
 


	
 

	

WARRANT
AGENT:


	
 

	
 


	
 

	


broadridge corporate issuer solutions,
inc.


	
 

	
 

	
 


	
 

	

By:

	

/s/
John Dunn


	
 

	
 

	

Name:

	

 John
Dunn


	
 

	
 

	

Title:

	

Vice
President







 




 








 






 



EXHIBIT A

 



FORM OF WARRANT CERTIFICATE

 



(as amended and restated on November 16, 2018)

 



THIS WARRANT CERTIFICATE CANNOT BE TRANSFERRED OR EXCHANGED UNTIL
THE DATE (THE “DETACHMENT DATE”) ESTABLISHED FOR
SEPARATION FROM THE ORDINARY SHARES TO WHICH THIS WARRANT IS
ATTACHED EXCEPT AS PART OF A UNIT OF OXBRIDGE RE HOLDINGS
LIMITED.


 


EXERCISABLE
ONLY IF COUNTERSIGNED BY THE WARRANT


AGENT
AS PROVIDED HEREIN


 


Warrant
Certificate evidencing Warrants to Purchase


Ordinary
Shares, $0.001 (USD) par value per share, as described
herein


 


Oxbridge
Re Holdings Limited


 



No._____________                                                                                                            

CUSIP No.
G6856M
114






 



VOID AFTER 5:00 P.M., PHILADELPHIA TIME,



ON MARCH 26, 2024, OR UPON EARLIER CANCELLATION


 


This
certifies that ______________________ is the registered holder of
the above indicated number of warrants to purchase certain
securities (each a “Warrant”). 
Each Warrant entitles the holder thereof, subject to the provisions
contained herein and in the Warrant Agreement (as defined below),
to purchase from Oxbridge Re Holdings Limited, a Cayman Islands
exempted company (the “Company”),
one of the Company’s Ordinary Shares (each, a
“Share”)
at the Exercise Price set forth below.  The exercise price of
each Warrant (the “Exercise
Price”) shall be $7.50 initially, subject to
adjustments as set forth in the Warrant Agreement (as defined
below).


 


Subject
to the terms of the Warrant Agreement, each Warrant evidenced
hereby may be exercised at any time, as specified herein, on any
Business Day (as defined below) occurring during the period (the
“Exercise
Period”) commencing on March 26, 2014 and ending at
5:00 p.m., Philadelphia time, on the earlier to occur of (i)
March 26, 2024 and (ii) the day prior to the date fixed for
cancellation of the Warrants as provided in Section 6 of the
Warrant Agreement (the “Expiration
Date”).  Each Warrant remaining unexercised after
5:00 p.m., Philadelphia time on the Expiration Date shall
become void, and all rights of the holder of this Warrant
Certificate evidencing such Warrant shall cease.


 




 








 






 

 


 


The
holder of the Warrants represented by this Warrant Certificate may
exercise any Warrant by delivering, not later than 5:00 p.m.,
Philadelphia time, on any Business Day during the Exercise Period
(the “Exercise
Date”) to Broadridge Corporate Issuer Solutions, Inc.
(the “Warrant
Agent,” which term includes any successor warrant
agent under the Warrant Agreement described below) at its corporate
trust department (i) this Warrant Certificate evidencing the
Warrants to be exercised, or, in the case of a Book-Entry Warrant
Certificate (as defined in the Warrant Agreement), the Warrants to
be exercised (the “Book-Entry
Warrants”) as shown on the records of The Depository
Trust Company (the “Depository”)
to an account of the Warrant Agent at the Depository designated for
such purpose in writing by the Warrant Agent to the Depository,
(ii) an election to purchase (“Election to
Purchase”), properly completed and executed (A) by the
holder hereof on the reverse of this Warrant Certificate or (B) in
the case of a Book-Entry Warrant Certificate, by the institution in
whose account the Warrant is recorded on the records of the
Depository (the “Participant”)
substantially in the form included on the reverse hereof, as
applicable and (iii) unless the holder of the Warrants has
elected a Cashless Exercise (as defined below), the Exercise Price
for each Warrant to be exercised in lawful money of the United
States of America by certified or official bank check or by bank
wire transfer in immediately available funds, in each case payable
to the order of the Company. 


 


If an
effective registration statement is not available for the issuance
of the Shares, the holder of the Warrants may exercise the Warrants
through a cashless exercise (a “Cashless
Exercise”). The number of Shares to be issued in
connection with a Cashless Exercise shall be determined as
follows:


 


X =
Y x ((A-B)/A)


 


where:


 


X =
the number of Shares to be issued to the registered
holder;


 


Y =
the number of Shares with respect to which the Warrant Certificates
or Book-Entry Warrant Certificates are being
exercised;


 


A =
the average of the Closing Sale Prices of the Company’s
ordinary shares (as reported by Bloomberg) for the five (5)
consecutive trading days ending on the date immediately preceding
the Exercise Date; and


 


B =
the Exercise Price.


 


“Closing Sale
Price” means, for any security as of any date, the
last trade price for such security on the principal securities
exchange or trading market for such security, as reported by
Bloomberg, or, if such exchange or trading market begins to operate
on an extended hours basis and does not designate the last trade
price, then the last trade price of such security prior to 4:00
p.m., Philadelphia time, as reported by Bloomberg, or if the
foregoing do not apply, the last trade price of such security in
the over-the-counter market for such security as reported by
Bloomberg, or, if no last trade price is reported for such security
by Bloomberg, the average of the bid prices, or the ask prices,
respectively, of any market makers for such security as reported by
OTC Markets Group Inc. If the Closing Sale Price cannot be
calculated for a security on a particular date on any of the
foregoing bases, the Closing Sale Price of such security on such
date shall be the fair market value as mutually determined by the
Company and the registered holder. If the Company and the
registered holder are unable to agree upon the fair market value of
such security, then the Board of Directors of the Company shall use
its good faith judgment to determine the fair market value. The
Board of Directors’ determination shall be binding upon all
parties absent demonstrable error. All such determinations shall be
appropriately adjusted for any stock dividend, stock split, stock
combination or other similar transaction during the applicable
calculation period.


 




 








 






 

 


 


If any
of (a) the Warrant Certificate or the Book-Entry Warrants, (b) the
Election to Purchase, or (c) the Exercise Price therefor (if
applicable), is received by the Warrant Agent after 5:00 p.m.,
Philadelphia time, on the specified Exercise Date, the Warrants
shall be deemed to be received and exercised on the Business Day
next succeeding the Exercise Date. If the date specified as the
Exercise Date is not a Business Day, the Warrants shall be deemed
to be received and exercised on the next succeeding day that is a
Business Day. If the Warrants are received or deemed to be received
after the Expiration Date, the exercise thereof shall be null and
void and any funds delivered to the Warrant Agent will be returned
to the registered holder or the Participant, as the case may be, as
soon as practicable. In no event will interest accrue on funds
deposited with the Warrant Agent in respect of an exercise or
attempted exercise of Warrants. The validity of any exercise of
Warrants shall be determined by the Company, in its sole
discretion, and such determination shall be final and binding upon
the registered holder or the Participant, as applicable, and the
Warrant Agent. Neither the Company nor the Warrant Agent shall have
any obligation to inform a registered holder or the Participant, as
applicable, of the invalidity of any exercise of
Warrants.


 


As used
herein, the term “Business
Day” means any day that is not a Saturday or Sunday
and is not a United States federal holiday or a day on which
banking institutions generally are authorized or obligated by law
or regulation to close in New York City.


 


No
fractional Ordinary Shares are to be issued upon the exercise of
any Warrant and no payment will be made with respect to any
fractional Ordinary Shares to which any holder of Warrants might
otherwise be entitled upon exercise of Warrants. 


 


If
fewer than all of the Warrants evidenced by this Warrant
Certificate are exercised, a new Warrant Certificate for the number
of unexercised Warrants remaining shall be executed by the Company
and countersigned by the Warrant Agent as provided in Section 2 of
the Warrant Agreement, and delivered to the holder of the Warrant
Certificate at the address specified on the books of the Warrant
Agent or as otherwise specified by such registered holder. If fewer
than all the Warrants evidenced by a Book-Entry Warrant Certificate
are exercised, a notation shall be made to the records maintained
by the Depository, its nominee for each Book-Entry Warrant
Certificate, or a Participant, as appropriate, evidencing the
balance of the Warrants remaining after such exercise.


 


This
Warrant Certificate is issued under and in accordance with the
Warrant Agreement, dated as of March 26, 2014 (as amended, the
“Warrant
Agreement”), between the Company and the Warrant Agent
and is subject to the terms and provisions contained in the Warrant
Agreement, to all of which terms and provisions the holder of this
Warrant Certificate and the beneficial owners of the Warrants
represented by this Warrant Certificate consent by acceptance
hereof.  Copies of the Warrant Agreement are on file and can
be inspected at the above-mentioned office of the Warrant Agent and
at the office of the Company at Harbour Place, Ground Floor, 103
South Church Street, P.O. Box 469, Grand Cayman, KY1-9006, Cayman
Islands.


 


After
September 26, 2014, the Company may, at its option, cancel the then
outstanding Warrants upon giving notice in accordance with the
terms of the Warrant Agreement (the “Cancellation
Notice”), provided, that the closing
price per share of the Company’s Ordinary Shares has exceeded
$9.38 for at least ten (10) trading days within any period of
twenty (20) consecutive trading days, including the last trading
day of the period. In the event that the Company shall elect to
cancel all or a portion of the then outstanding Warrants, the
Company shall fix a date for the cancellation (the
“Cancellation
Date”). The Warrants may be exercised in accordance
with the terms of this Agreement at any time after a Cancellation
Notice shall have been given by the Company; provided, however, that no Warrants may
be exercised subsequent to the expiration of the Exercise Period;
provided,
further, that all
rights whatsoever with respect to the Warrants shall cease on the
Cancellation Date.


 




 








 






 

 


 


 


The
accrual of dividends, if any, on the Shares issued upon the valid
exercise of any Warrant will be governed by the terms generally
applicable to such Shares.  From and after the issuance of
such Shares, the former holder of the Warrants exercised will be
entitled to the benefits generally available to other holders of
Shares and such former holder’s right to receive payments of
dividends and any other amounts payable in respect of the Shares
shall be governed by, and shall be subject to, the terms and
provisions generally applicable to such Shares.


 


The
Exercise Price and the number of Shares purchasable upon the
exercise of each Warrant shall be subject to adjustment as provided
pursuant to Section 4 of the Warrant Agreement.


 


Prior
to the Detachment Date, the Warrants represented by this Warrant
Certificate may be exchanged or transferred only together with the
Shares to which such Warrant is attached (together, a
“Unit”),
and only for the purpose of effecting, or in conjunction with, an
exchange or transfer of such Unit.  Additionally, prior to the
Detachment Date, each transfer of such Unit on the register of the
Units shall operate also to transfer the Warrants included in such
Units.  From and after the Detachment Date, the two
immediately preceding sentences shall be of no further force and
effect. 


 


Warrants may be
surrendered to the Warrant Agent, together with a written request
for exchange or transfer reasonably acceptable to the Warrant
Agent, duly executed by the registered holder thereof, or by a duly
authorized attorney, and thereupon the Warrant Agent shall issue in
exchange therefor one or more new Warrants as requested by the
registered holder of the Warrants so surrendered, representing an
equal aggregate number of Warrants; provided, however, that except
as otherwise provided herein or in any Book-Entry Warrant
Certificate, each Book-Entry Warrant Certificate may be transferred
only in whole and only to the Depository, to another nominee of the
Depository, to a successor depository, or to a nominee of a
successor depository; and provided, further, that in the event that
a Warrant surrendered for transfer bears a restrictive legend, the
Warrant Agent shall not cancel such Warrant and issue new Warrants
in exchange therefor until the Warrant Agent has received an
opinion of counsel for the Company stating that such transfer may
be made and indicating whether the new Warrants must also bear a
restrictive legend. Upon any such registration of transfer, the
Company shall execute, and the Warrant Agent shall countersign and
deliver, in the name of the designated transferee, a new Warrant
Certificate or Warrant Certificates of any authorized denomination
evidencing in the aggregate a like number of unexercised
Warrants.


 


Neither
this Warrant Certificate nor the Warrants evidenced hereby shall
entitle the holder hereof or thereof to any of the rights of a
holder of the Shares, including, without limitation, the right to
receive dividends, if any, or payments upon the liquidation,
dissolution or winding up of the Company or to exercise voting
rights, if any.


 


The
Warrant Agreement and this Warrant Certificate may be amended as
provided in the Warrant Agreement including, under certain
circumstances described therein, without the consent of the holder
of this Warrant Certificate or the Warrants evidenced
thereby.


 


 


THIS
WARRANT CERTIFICATE AND ALL RIGHTS HEREUNDER AND UNDER THE WARRANT
AGREEMENT SHALL BE GOVERNED BY AND INTERPRETED AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF THE CAYMAN ISLANDS APPLICABLE TO
CONTRACTS FORMED AND TO BE PERFORMED ENTIRELY WITHIN THE CAYMAN
ISLANDS, WITHOUT REGARD TO THE CONFLICTS OF LAW PROVISIONS THEREOF
TO THE EXTENT SUCH PRINCIPLES OR RULES WOULD REQUIRE OR PERMIT THE
APPLICATION OF THE LAWS OF ANOTHER JURISDICTION.


 


This
Warrant Certificate shall not be entitled to any benefit under the
Warrant Agreement or be valid or obligatory for any purpose, and no
Warrant evidenced hereby may be exercised, unless this Warrant
Certificate has been countersigned by the manual signature of the
Warrant Agent.


 


 




 








 






IN WITNESS WHEREOF, the Company has
caused this instrument to be duly executed.


 


Dated
as of November 16, 2018


 


OXBRIDGE
RE HOLDINGS LIMITED


 


 



By: /s/ Sanjay Madhu      
             
   








Name: Sanjay Madhu      
              
  








Title: Chief Executive
Officer







 


 



BROADRIDGE CORPORATE ISSUER



SOLUTIONS, INC., AS WARRANT AGENT 


 


 

By: 
/s/ John
Dunn                          





Name: John
Dunn                           







Title: 
Vice President  
                 
   



 


 


 


 


 

 


 




 








 







 [REVERSE]


The
Corporation will furnish without charge to each shareholder who so
requests the powers, designations, preferences and relative,
participating, optional, or other special rights of each class of
stock or series thereof and the qualifications, limitations or
restrictions of such preferences and/or rights.


 



Instructions for Exercise of Warrant


 


To
exercise the Warrants evidenced hereby, the holder or Participant
must, by 5:00 p.m., Philadelphia time, on the specified
Exercise Date, deliver to the Warrant Agent at its stock transfer
division, a certified or official bank check or a wire transfer in
immediately available funds, in each case payable to the Company,
in an amount equal to the Exercise Price in full for the Warrants
exercised (unless the holder has elected a Cashless Exercise, in
which case no such payment must be made). The Warrant holder or
Participant must also provide the information required below and
deliver this Warrant Certificate to the Warrant Agent at the
address set forth below and the Book-Entry Warrants to the Warrant
Agent in its account with the Depository designated for such
purpose.  The Warrant Certificate and this Election to
Purchase must be received by the Warrant Agent by 5:00 p.m.,
Philadelphia time, on the specified Exercise Date.


 


ELECTION
TO PURCHASE


TO BE
EXECUTED IF WARRANT HOLDER DESIRES


TO
EXERCISE THE WARRANTS EVIDENCED HEREBY


 


The
undersigned hereby irrevocably elects to exercise, on
_______________, _____ (the “Exercise Date”), ___________
Warrants, evidenced by this Warrant Certificate, to purchase,
_______________ Ordinary Shares (each a “Share”) of Oxbridge Re Holdings
Limited, a Cayman Islands exempted company (the “Company”), and represents
that:


 


_____  this
exercise is intended to be a Cash Exercise and that such holder
has, on or before the Exercise Date, tendered payment for such
Shares by certified or official bank check or bank wire transfer in
immediately available funds to the order of the Company c/o
Broadridge Corporate Issuer Solutions, Inc., in the amount of
$ ___________ in accordance with the terms hereof;
or


 


_____
this exercise is intended to be a Cashless Exercise.


 


The
undersigned requests that said number of Shares be in fully
registered form, registered in such names and delivered, all as
specified in accordance with the instructions set forth
below.


 


If said
number of Shares is less than all of the Shares purchasable
hereunder, the undersigned requests that a new Warrant Certificate
evidencing the remaining balance of the Warrants evidenced hereby
be issued and delivered to the holder of the Warrant Certificate
unless otherwise specified in the instructions below.


 




 








 






Dated: 
                                 ,
        


 



Name:                                                                

(Please
Print)






 


 


(Insert
Social Security or Other Identifying


Number
of Holder)


 



Address:                                                                









                                                          
   


 







                                                             












 



Signature:                                                                           






 


This
Warrant may only be exercised by presentation to the Warrant
Agent.


 


The
method of delivery of this Warrant Certificate is at the option and
risk of the exercising holder and the delivery of this Warrant
Certificate will be deemed to be made only when actually received
by the Warrant Agent.  If delivery is by mail, registered mail
with return receipt requested, properly insured, is
recommended.  In all cases, sufficient time should be allowed
to assure timely delivery.


 


(Instructions as to
form and delivery of Shares and/or Warrant
Certificates)


 


	

Name in
which Shares

	
 

	
 


	

are to
be registered if other than

	
 

	
 


	

in the
name of the registered holder

	
 

	
 


	

of this
Warrant Certificate:

	
 

	
 


	
 

	
 

	
 


	

Address
to which Shares

	
 

	
 


	

are to
be mailed if other than to the

	
 

	
 


	

address
of the registered holder of

	
 

	
 


	

this
Warrant Certificate as shown on

	
 

	
 


	

the
books of the Warrant Agent:

	
 

	
 


	
 

	
 

	

(Street
Address)


	
 

	
 

	
 


	
 

	
 

	
 


	
 

	
 

	

(City
and State) (Zip Code)


	
 

	
 

	
 


	
 

	
 

	
 


	

Name in
which Warrant Certificate

	
 

	
 


	

evidencing
unexercised Warrants, if any,

	
 

	
 


	

are to
be registered if other than in the

	
 

	
 


	

name of
the registered holder of this

	
 

	
 


	

Warrant
Certificate:

	
 

	
 


	
 

	
 

	
 


	

Address
to which certificate representing

	
 

	
 


	

unexercised
Warrants, if any, are to be

	
 

	
 


	

mailed
if other than to the address of

	
 

	
 


	

the
registered holder of this Warrant

	
 

	
 


	

Certificate
as shown on the books of

	
 

	
 


	

the
Warrant Agent:

	
 

	
 


	
 

	
 

	

(Street
Address)


	
 

	
 

	
 


	
 

	
 

	
 


	
 

	
 

	

(City
and State) (Zip Code)







 


	
 

	
 

	

Dated:


	
 

	
 

	
 


	
 

	
 

	
 

	
 


	
 

	
 

	

Signature


	
 

	
 

	
 


	
 

	
 

	


Signature must conform in all respects to the name of the holder as
specified on the face of this Warrant Certificate. If Shares, or a
Warrant Certificate evidencing unexercised Warrants, are to be
issued in a name other than that of the registered holder hereof or
are to be delivered to an address other than the address of such
holder as shown on the books of the Warrant Agent, the above
signature must be guaranteed by an Eligible Guarantor Institution
(Banks, Stockbrokers, Savings and Loan Associations and Credit
Unions with membership in an approved Signature Guarantee Medallion
Program), pursuant to S.E.C. Rule 17Ad-15.







 




 








 







SIGNATURE GUARANTEE


 


	

Name of
Firm:

	
 

	
 

	
 


	

Address:

	
 

	
 

	
 


	

Area
Code

	
 

	
 


	

and
Number:

	
 

	
 

	
 


	

Authorized

	
 

	
 


	

Signature:

	
 

	
 

	
 


	

Name:

	
 

	
 

	
 


	

Title:

	
 

	
 

	
 


	

Dated:

	
 

	
 

	
 


	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 

	
 







 


 




 








 







ASSIGNMENT


 


(FORM
OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER


DESIRES
TO TRANSFER WARRANTS EVIDENCED HEREBY)


 


FOR
VALUE RECEIVED, ______________________ HEREBY SELL(S), ASSIGN(S)
AND TRANSFER(S) UNTO:
           
                                                                                                     


 


	
 

	
 

	
 

	
 


	
 

	
 

	
 

	
 


	

(Please
print name and address

	
 

	

(Please
insert social security or

	
 


	

including
zip code of assignee)

	
 

	

other
identifying number of assignee)

	
 







 


the
rights represented by the within Warrant Certificate and does
hereby irrevocably constitute and appoint _______________________
Attorney to transfer said Warrant Certificate on the books of the
Warrant Agent with full power of substitution in the
premises.


 


	

Dated:


	
 

	
 

	
 


	
 

	

Signature

	
 


	
 

	
 


	
 

	


(Signature must conform in all respects to the name of the holder
as specified on the face of this Warrant Certificate and must bear
a signature guarantee by an Eligible Guarantor Institution (Banks,
Stockbrokers, Savings and Loan Associations and Credit Unions with
membership in an approved Signature Guarantee Medallion Program),
pursuant to S.E.C. Rule 17Ad-15.







 



SIGNATURE GUARANTEE


 


	

Name of
Firm:

	
 

	
 

	
 


	

Address:

	
 

	
 

	
 


	

Area
Code

	
 

	
 


	

and
Number:

	
 

	
 

	
 


	

Authorized

	
 

	
 


	

Signature:

	
 

	
 

	
 


	

Name:

	
 

	
 

	
 


	

Title:

	
 

	
 

	
 


	

Dated: