Document:

Stock Option Agreement

 Exhibit 10.29 
  
 

 
  
 STOCK
OPTION AGREEMENT 
  

									
	 OPTIONEE
 NAME

	 	 NUMBER OF OPTIONS
GRANTED

	 	 OPTION
 PRICE

	 	 GRANT
 DATE

	 	 EXPIRATION
 DATE

	«Full_Name»	 	«Options»	 	«Price»	 	«Grant_Date»	 	«Expiration_Date»

  
 STOCK
OPTION 
 VESTING SCHEDULE 
  

			
	 PERCENTAGE OF OPTION
SHARES EXERCISABLE

	 	 DATE
 EXERCISABLE

	 Up to      % of total
	 	 
	 Up to      % of total
	 	 
	 Up to      % of total
	 	 
	 Up to      % of total
	 	 

  
 I, «Full_Name», Social
Security #«SSN», hereby accept the Options set forth in this Stock Option Agreement, reflecting the grant on «Grant_Date» of «Options» options to purchase the common stock of WMS Industries Inc. at an option price
of «Price» (“Option Agreement”) and agree to comply with the terms and conditions of the Stock Option Agreement and of the Plan referenced in the Stock Option Agreement. 
  
 By signing this cover sheet, you agree to all of the terms and conditions described in
the attached Agreement and the Plan referenced therein. 
  

			
	Grantee:	 	  

	 	 	(Signature)
		
	Company:	 	  
  

	 	 	Brian R. Gamache
	 	 	Chief Executive Officer

  
 PLEASE RETURN A
COPY OF THIS SIGNED AGREEMENT TO: 
 WMS – Legal Department 
 Waukegan Office 
  
 PLEASE RETAIN THE ORIGINALLY SIGNED AGREEMENT FOR YOUR RECORDS 
  
 This document constitutes part of a prospectus covering securities 
 that have been registered under the Securities Act of 1933. 

 

 
  
 STOCK OPTION
AGREEMENT 
  
 This Stock Option Agreement (the
“Option Agreement”) will evidence the grant to you on the Grant Date above by the Compensation Committee of the Board of Directors of WMS Industries Inc. (the “Company”) of an option pursuant to the Company’s 2005 Incentive
Plan (the “Plan”) to purchase shares of the common stock of the Company (the “Option”). Under applicable provisions of the Internal Revenue Code of 1986, as amended, the Option is treated as a non-qualified stock option.

  
 1. Option Subject to Plan. This Option is issued in
accordance with and is subject to and conditioned upon all of the terms and conditions of this Option Agreement and the Plan as amended from time to time, provided, however, that no future amendment or termination of the Plan shall, without your
consent, alter or impair any of your rights or obligations under the Plan, all of which are incorporated by reference in this Option Agreement as if fully set forth herein. 
  
 2. Termination. The Option shall terminate immediately if you cease your service or employment with the Company by
voluntarily terminating your service or employment without the written consent of the Company or if the Company terminates your service or employment for cause. If you voluntarily terminate your service or employment with the Company with the
written consent of the Company (which written consent expressly sets forth a statement to the effect that, to the extent exercisable on the date of such termination the Option shall remain exercisable), or if your service or employment with the
Company is terminated by the Company for reasons other than cause, you may exercise the Option to the extent exercisable at the time of such termination, at any time prior to the expiration of three months after such termination, or for any longer
period of time after such termination as shall be determined by the Committee, but not later than the Expiration Date. Should you die during or following the termination of your service or employment with the Company, the Option shall immediately
terminate, except that, to the extent exercisable by you at the time of your death, the Option may be exercised within one year after the date of your death but not later than the Expiration Date, solely in accordance with all of the terms and
conditions of the Plan by your personal representatives or by the person or persons to whom your rights under the Option shall pass by will or by the applicable laws of descent and distribution. 
  
 3. Additional Forfeiture. The Committee may cancel, suspend, withhold
or otherwise limit or restrict the Option at any time if you (i) are not in compliance with all applicable provisions of the Option or the Plan or (ii) engage in any activity inimical, contrary or harmful to the interests of the Company, including,
but not limited to: (A) 

  

 2 

 
conduct related to your service or employment for which either criminal or civil penalties against you may be sought, (B) violation of any policies of the
Company, including, without limitation, the Company’s insider trading policy or anti-harassment policies or (C) participating in a hostile takeover attempt against the Company. 
  
 4. Restrictive Covenants. As a condition of and consideration for this option grant and in consideration for
«Grant_Reason», you agree with the Company as follows: 
  
 (a) Acknowledgments. You acknowledge that: 
  
 (i) The Company is engaged in the business of designing, developing, manufacturing, selling, leasing and distributing gaming devices (e.g., without limitation, video and reel spinning slot machines, video poker games, video lottery
terminals, local progressives and wide-area progressive systems), related hardware and software, as well as ancillary products associated with such gaming devices, including without limitation marketing materials, chairs, and signage
(“Business”). 
  
 (ii) As an integral part of its
business, the Company develops and maintains proprietary, confidential and trade secret information relating to both specific gaming machines and gaming machines generally, as well as those being developed, its Business, including, but not limited
to, information related to design, product development plans and strategies, techniques for game design and development, knowledge regarding and plans for the integration of hardware and software, product maintenance and operations, game and bonus
concepts, product and marketing strategies, new game concepts, mathematical formulas, license agreements, research regarding players’ behavior and trends in the gaming industry and game themes, licensed and non-licensed themes, and strategic
marketing. 
  
 (iii) The Company undertakes various efforts and
measures to maintain the secrecy and confidentiality of its proprietary, confidential and trade secret information. 
  
 (iv) You have or will have access to and knowledge of such proprietary, confidential and trade secret information. 
  
 (v) The scope of the covenants and restrictions on future employment set
forth below, including with respect to time, territory and industry are reasonable and fair and are necessary for the protection of the Company’s proprietary, confidential and trade secret information. 
  
 (vi) The scope of the covenants and restrictions contained herein in no way
limit you from utilizing in future employment your general skills and abilities as well as the general and non-proprietary, non-confidential and non-trade secret information and knowledge that you have or will obtain, acquire and develop in the
course of employment with the Company. 
  

 3 

 (vii) For a period of one (1) year following termination of your employment with the Company, you would
not be able to work for a competing Business anywhere in the world without using or disclosing the proprietary, confidential or trade secret information of the Company, regardless of any measures taken by you or a future employer to protect and
preserve the Company’s proprietary, confidential or trade secret information. 
  
 (viii) You have both general and specific skills and abilities that are beneficial across many industries outside of the Business and which are located throughout the world, including throughout the United States.
Further, you represent and warrant that you have available sufficient means of support so that observance of and adherence to the covenants contained herein shall not deprive you of the ability to earn a livelihood or support your dependents.

  
 (b) Covenants. You hereby covenant and agree that
during your employment by the Company and for a period of one (1) year following your voluntary termination of employment or any termination of your employment by the Company for cause or without cause: 
  
 (i) You shall not engage or participate in, or assist, advise or otherwise
be connected with (including as an employee, independent contractor, owner, partner, member, shareholder, officer, director, advisor, consultant, lender, supplier, agent or otherwise) a business located anywhere in the world which is engaged in the
design, development, importation, manufacture, leasing, distribution and/or sale of gaming devices, or component parts for gaming devices or related hardware and software, as well as ancillary products associated with such gaming devices, including
without limitation marketing materials, chairs, and signage; provided, however, that nothing in this agreement shall prevent you from acquiring or owning, as a passive investment, up to one percent (1%) of the outstanding voting securities of an
entity engaged in a competing Business which securities are publicly traded in any recognized national securities market; 
  
 (ii) You shall not solicit or attempt to solicit (i) any person, company or entity who is or has been a customer of the Company during the one (1) year
period prior to the termination of your employment at the Company to do business with any person, company or entity other than the Company, or (ii) solicit for employment or employ any employee of the Company or any person who is or was employed by
the Company during the one (1) year period prior to the termination of your employment at the Company, or take any actions which are calculated to persuade any such person to terminate his or her association with the Company. 
  

 4 

 (c) Injunctive Relief. You acknowledge that any violation or threatened violation by you of the
covenants contained in this agreement would cause material and irreparable harm to the Company and that the Company would not have an adequate remedy at law because is will be difficult or impossible to establish the full and precise monetary value
of such damage. The Company agrees that, in addition to any and all other remedies available to it at law or in equity, the Company shall have the right to have your violation or threatened violation of any of the covenants contained herein
restrained by equitable relief, including, but not limited to, a temporary restraining order, a preliminary injunction, a permanent injunction, or such other alternative relief as may be appropriate, without the necessity of the Company posting any
bond. In the event you breach the covenants contained herein, the restricted period applicable to you shall be extended for the period of such breach. 

	

  
 (d)
Indemnification. You agree to indemnify, save and hold harmless the Company from and against any and all claims, damages, losses and expenses (including reasonable attorneys’ and expert witness fees) resulting from or arising out of any
breach by you of this Agreement, or incurred by the Company in enforcing this Agreement against you. 
  
 (e) Other Limitations. The provisions of this Section 4 are in addition to the award forfeiture provisions set forth in Section 10 of the Plan and
in no way modify, amend or change such Plan provisions. 
  
 5.
Severability. Should a court of competent jurisdiction deem any of the provisions in this Option Agreement to be unenforceable in any respect, including a determination that the territorial, temporal and scope limitations (or any absence
thereof) of Section 4 are impermissibly overbroad, it is the intention of the parties to this Option Agreement that this Option Agreement be deemed, without further action on the part of the parties hereto, modified, amended and limited to the
extent necessary to render the same valid and enforceable. It is further the parties’ intent that all provisions not deemed to be overbroad shall be given their full force and effect. You acknowledge that you are freely, knowingly and
voluntarily entering into this Agreement after having an opportunity for consultation with your own independent counsel. 
  
 6. Choice of Law. This Option Agreement shall be governed by and construed and interpreted in accordance with the substantive laws of the State of
Delaware, without giving effect to any conflicts of law rule or principle that might require the application of the laws of another jurisdiction. 
  
 7. Securities Laws. The Company shall not be obligated to issue any shares pursuant to this Option if, in the opinion of counsel to the Company,
the shares to be so issued are required to be registered or otherwise qualified under the Securities Act of 1933, as amended, or under any other applicable statute, regulation or ordinance affecting the sale of securities, unless and until such
shares have been so registered or otherwise qualified. 
  

 5 

 8. Income Taxes. It is understood that the Company may establish, from time to time, appropriate
procedures to provide for payment or withholding of such income or other taxes as may be required by law to be paid or withheld in connection with the exercise of this Option. By the execution hereof, you hereby agree to pay to the Company or your
Employer all such amounts requested by the Company to permit the Company to take any tax deduction available to it resulting from the exercise of this Option. You also agree to comply with any procedures established, from time to time, by the
Company to ensure that the Company receives prompt notice of the occurrence of any event which may create, or affect the timing or amount of, any obligation to pay or withhold any such taxes or which may make available to the Company any tax
deduction resulting from the occurrence of such event. 
  
 9.
Expiration. This Option, to the extent not previously exercised, shall expire on the day preceding the tenth anniversary of the Grant Date. 
  
 10. Exercise. This Option is to be exercised by logging on to www.benefitaccess.com with your User Name, Password and Trading Pin, or such other
method as may be implemented by the Company from time to time upon notice to you. 
  

 6Restricted Stock Agreement

 Exhibit 10.30 
  
 

 
  
 RESTRICTED
STOCK AGREEMENT 
  

							
	 GRANTEE
 NAME

	 	 NUMBER OF
 SHARES

	 	 GRANT
 DATE

	 	 VESTING
 SCHEDULE

	«Full_Name»	 	«Shares»	 	«Grant_Date»	 	«Vesting Schedule»

  
 WMS Industries Inc., a Delaware
corporation (the “Company”), hereby grants to «Name» (the “Grantee”, also referred to herein as “you”) shares of its common stock, par value $.50 per share (the “Stock”), pursuant to the attached
Restricted Stock Agreement and the 2005 Incentive Plan (the “Plan”). 
  
 By signing this cover sheet, you agree to all of the terms and conditions described in the attached Agreement and the Plan referenced therein. 
  

			
	Grantee:	 	  

	 	 	(Signature)
		
	Company:	 	  

	 	 	Brian R. Gamache
	 	 	Chief Executive Officer

  
 PLEASE SIGN
BOTH COPIES OF THIS AGREEMENT AND 
 RETURN (1) ORIGINALLY EXECUTED COPY TO: 
 WMS – Legal Department 
 Waukegan Office 
  
 PLEASE RETAIN THE
OTHER ORIGINALLY EXECUTED COPY FOR YOUR RECORDS. 
  
 This
is not a stock certificate or a negotiable instrument. 
 UPON RECEIPT OF YOUR SIGNED AGREEMENT, 
 A STOCK CERTIFICATE EVIDENCING THE SHARES GRANTED 
 WILL BE SENT TO YOU. 
  
 This document constitutes part of a prospectus covering securities 
 that have been registered under the
Securities Act of 1933. 

 WMS INDUSTRIES, INC. 
 RESTRICTED STOCK AGREEMENT 
  
 1.
Restricted Stock/Nontransferability. This grant is an award of stock in the number of shares set forth on the cover sheet and subject to the vesting conditions described below and the Plan (“Restricted Stock”). To the extent not yet
vested, your Restricted Stock may not be transferred, assigned, pledged or hypothecated, whether by operation of law or otherwise, nor may the Restricted Stock be made subject to execution, attachment or similar process. 
  
 2. Subject to the Plan. This grant is awarded in accordance with, and is subject to
and conditional upon all of the terms and conditions of the Plan which are incorporated by reference in this Restricted Stock Agreement as if fully set forth herein. 
  
 3. Issuance and Vesting. The Company will issue your Restricted Stock in your name as of the Grant Date. Your right to the Restricted
Stock under this Restricted Stock Agreement vests as indicated on the cover sheet of this Agreement. 
  
 4. Accelerated Vesting. Notwithstanding Paragraph 3, your right to the Restricted Stock under this Restricted Stock Agreement shall immediately vest as to 100% of the total number of shares covered by this
grant upon the occurrence of either: 
  

	 	•	 	your termination of employment with or service to the Company due to your death or permanent and total disability, or your involuntary termination of your employment or service
other than by reason of your willful refusal to perform your duties; or 

  

	 	•	 	a “Change in Control” as provided for in Section 9 of the Plan. 

  
 5. Termination. Your right to the Restricted Stock under this Restricted Stock Agreement to the extent the restrictions have not lapsed shall terminate immediately
if you cease your service or employment with the Company by voluntarily terminating your service or employment or if the Company terminates your service or employment by reason of your willful refusal to perform your duties. 
  
 6. Restrictive Covenants. As a condition of and consideration for this grant and in
consideration for <<Grant Reason>>, you agree with the Company as follows: 
  

	 	a.	Acknowledgments. You acknowledge that: 

  

	 	i.	The Company is engaged in the business of designing, developing, manufacturing, selling, leasing and distributing gaming devices (e.g., without limitation, video and reel spinning
slot machines, video poker games, video lottery terminals, local progressives and wide-area progressive systems), related hardware and software, as well as ancillary products associated with such gaming devices, including without limitation
marketing materials, chairs, and signage (“Business”). 

  

	 	ii.	 As an integral part of its business, the Company develops and maintains proprietary, confidential and trade secret information relating to both specific gaming
machines and gaming machines generally, as well as 

  

 2 

	 	 
those being developed, its Business, including, but not limited to, information related to design, product development plans and strategies, techniques for
game design and development, knowledge regarding and plans for the integration of hardware and software, product maintenance and operations, game and bonus concepts, product and marketing strategies, new game concepts, mathematical formulas, license
agreements, research regarding players’ behavior and trends in the gaming industry and game themes, licensed and non-licensed themes, and strategic marketing. 

  

	 	iii.	The Company undertakes various efforts and measures to maintain the secrecy and confidentiality of its proprietary, confidential and trade secret information.

  

	 	iv.	You have or will have access to and knowledge of such proprietary, confidential and trade secret information. 

  

	 	v.	The scope of the covenants and restrictions on future employment set forth below, including with respect to time, territory and industry are reasonable and fair and are necessary
for the protection of the Company’s proprietary, confidential and trade secret information. 

  

	 	vi.	The scope of the covenants and restrictions contained herein in no way limit you from utilizing in future employment your general skills and abilities as well as the general and
non-proprietary, non-confidential and non-trade secret information and knowledge that you have or will obtain, acquire and develop in the course of employment with the Company. 

  

	 	vii.	For a period of one (1) year following termination of your employment with the Company, you would not be able to work for a competing Business anywhere in the world without using or
disclosing the proprietary, confidential or trade secret information of the Company, regardless of any measures taken by you or a future employer to protect and preserve the Company’s proprietary, confidential or trade secret information.

  

	 	viii.	You have both general and specific skills and abilities that are beneficial across many industries outside of the Business and which are located throughout the world, including
throughout the United States. Further, you represent and warrant that you have available sufficient means of support so that observance of and adherence to the covenants contained herein shall not deprive you of the ability to earn a livelihood or
support your dependents. 

  

	 	b.	Covenants. You hereby covenant and agree that during your employment by the Company and for a period of one (1) year following your voluntary termination of employment or any
termination of your employment by the Company for cause or without cause: 

  

 3 

	 	i.	You shall not engage or participate in, or assist, advise or otherwise be connected with (including as an employee, independent contractor, owner, partner, member, shareholder,
officer, director, advisor, consultant, lender, supplier, agent or otherwise) a business located anywhere in the world which is engaged in the design, development, importation, manufacture, leasing, distribution and/or sale of gaming devices, or
component parts for gaming devices or related hardware and software, as well as ancillary products associated with such gaming devices, including without limitation marketing materials, chairs, and signage; provided, however, that nothing in this
agreement shall prevent you from acquiring or owning, as a passive investment, up to one percent (1%) of the outstanding voting securities of an entity engaged in a competing Business which securities are publicly traded in any recognized national
securities market; 

  

	 	ii.	You shall not solicit or attempt to solicit (i) any person, company or entity who is or has been a customer of the Company during the one (1) year period prior to the termination of
your employment at the Company to do business with any person, company or entity other than the Company, or (ii) solicit for employment or employ any employee of the Company or any person who is or was employed by the Company during the one (1) year
period prior to the termination of your employment at the Company, or take any actions which are calculated to persuade any such person to terminate his or her association with the Company. 

  

	 	c.	Injunctive Relief. You acknowledge that any violation or threatened violation by you of the covenants contained in this agreement would cause material and irreparable harm to
the Company and that the Company would not have an adequate remedy at law because is will be difficult or impossible to establish the full and precise monetary value of such damage. The Company agrees that, in addition to any and all other remedies
available to it at law or in equity, the Company shall have the right to have your violation or threatened violation of any of the covenants contained herein restrained by equitable relief, including, but not limited to, a temporary restraining
order, a preliminary injunction, a permanent injunction, or such other alternative relief as may be appropriate, without the necessity of the Company posting any bond. In the event you breach the covenants contained herein, the restricted period
applicable to you shall be extended for the period of such breach. 

  

	 	d.	Indemnification. You agree to indemnify, save and hold harmless the Company from and against any and all claims, damages, losses and expenses (including reasonable
attorneys’ and expert witness fees) resulting from or arising out of any breach by you of this Agreement, or incurred by the Company in enforcing this Agreement against you. 

  

 4 

	 	e.	Other Limitations. The provisions of this Section 6 are in addition to the award forfeiture provisions set forth in Section 10 of the Plan and in no way modify, amend or
change such Plan provisions. 

  
 7. Additional Forfeiture.
The Committee may cancel, suspend, withhold or otherwise limit or restrict your right to the Restricted Stock under this Restricted Stock Agreement at any time if you (i) are not in compliance with all applicable provisions of this Restricted Stock
Agreement or the Plan or (ii) engage in any activity inimical, contrary or harmful to the interests of the Company, including, but not limited to: (A) conduct related to the your service or employment for which either criminal or civil penalties
against you may be sought, (B) violation of any policies of the Company, including, without limitation, the Company’s insider trading policy or anti-harassment policies or (C) participating in a hostile takeover attempt against the Company.

  
 8. Return of Shares. If the Restricted Stock does not become vested in
accordance with the foregoing provisions or as otherwise provided for in the Plan, you will return the certificate representing the Restricted Stock and the Restricted Stock shall be deemed no longer outstanding. 
  
 9. Income Taxes; Section 83(b) Election. Under Section 83 of the Internal
Revenue Code of 1986, as amended (the “Code”), the difference between the purchase price, if any, paid for the shares of Restricted Stock and their fair market value on the date any forfeiture restrictions applicable to such shares lapse
will be reportable as ordinary income at that time. You may elect to be taxed at the time the shares are acquired rather than when such shares cease to be subject to such forfeiture restrictions by filing an election under Section 83(b) of the Code
with the Internal Revenue Service within thirty (30) days after the Grant Date. You will have to make a tax payment to the extent the purchase price is less than the fair market value of the shares on the Grant Date. No tax payment will have to be
made to the extent the purchase price is at least equal to the fair market value of the shares on the Grant Date. The form for making this election is attached as Exhibit A hereto. Failure to make this filing within the thirty (30) day period will
result in the recognition of ordinary income by you (in the event the fair market value of the shares increases after the date of purchase) as the forfeiture restrictions lapse. 
  
 10. Shareholder Rights. You have the right to vote the Restricted Stock and to receive any dividends declared or paid on such stock.
Any distributions you receive as a result of any stock split, stock dividend, combination of shares or other similar transaction shall be deemed to be a part of the Restricted Stock and subject to the same conditions and restrictions applicable
thereto. 
  
 11. Adjustments. In the event of a stock split, a stock
dividend or a similar change in the Company stock, the number of shares covered by this grant shall be adjusted (and rounded down to the nearest whole number). 
  

12. Compliance with Law. The issuance of this Restricted Stock shall be subject to compliance with the rules and policies of the New York Stock Exchange.

  
 13. Legends. All certificates representing the Restricted Stock issued
in connection with this grant shall, where applicable, have endorsed thereon the following legends: 
  
 “THE SHARES REPRESENTED BY THIS CERTIFICATE ARE SUBJECT TO CERTAIN 

  

 5 

 
RESTRICTIONS SET FORTH IN AN AGREEMENT BETWEEN THE COMPANY AND THE REGISTERED HOLDER, OR HIS OR HER PREDECESSOR IN INTEREST. A COPY OF SUCH AGREEMENT IS ON
FILE AT THE PRINCIPAL OFFICE OF THE COMPANY AND WILL BE FURNISHED UPON WRITTEN REQUEST TO THE SECRETARY OF THE COMPANY BY THE HOLDER OF RECORD OF THE SHARES REPRESENTED BY THIS CERTIFICATE.” 
  
 14. Severability. Should a court of competent jurisdiction deem any of the provisions
in this Restricted Stock Agreement to be unenforceable in any respect, including a determination that the territorial, temporal and scope limitations (or any absence thereof) of Section 6 are impermissibly overbroad, it is the intention of the
parties to this Restricted Stock Agreement that this Restricted Stock Agreement be deemed, without further action on the part of the parties hereto, modified, amended and limited to the extent necessary to render the same valid and enforceable. It
is further the parties’ intent that all provisions not deemed to be overbroad shall be given their full force and effect. You acknowledge that you are freely, knowingly and voluntarily entering into the Agreement after having an opportunity for
consultation with your own independent counsel. 
  
 15. Choice of Law. This
Restricted Stock Agreement shall be governed by and construed and interpreted in accordance with the substantive laws of the State of Delaware, without giving effect to any conflicts of law rule or principle that might require the application of the
laws of another jurisdiction. 
  
 16. Securities Laws. The Company shall
not be obligated to issue any shares pursuant to this Restricted Stock Agreement if, in the opinion of counsel to the Company, the shares to be so issued are required to be registered or otherwise qualified under the Securities Act of 1933, as
amended, or under any other applicable statute, regulation or ordinance affecting the sale of securities, unless and until such shares have been so registered or otherwise qualified. 
  

 6 

 EXHIBIT A 
  

ELECTION UNDER SECTION 83(b) OF 
 THE INTERNAL REVENUE CODE 
  
 The undersigned hereby makes an
election pursuant to Section 83(b) of the Internal Revenue Code with respect to the property described below and supplies the following information in accordance with the regulations promulgated thereunder: 
  
 1. The name, address and social security number of the undersigned:

  
 Name:                                     
                                        
                             
 Address:                                     
                                        
                        
 Social Security
No.                                       
                                        
     
  
 2. Description of property with
respect to which the election is being made: 
  
              shares of common stock, par value $.50 per share, WMS Industries Inc., a Delaware corporation, (the “Company”). 
  
 3. The date on which the property was transferred is
                    ,         . 
  
 4. The taxable year to which this election relates is calendar year
                    . 
  
 5. Nature of restrictions to which the property is subject: 
  
 The shares of stock are subject to the provisions of a Restricted Stock Agreement between the undersigned and the Company. The shares of stock are subject to forfeiture
under the terms of the Agreement. 
  
 6. The fair market value of
the property at the time of transfer (determined without regard to any lapse restriction) was $             per share, for a total of
$            . 
  
 7. The amount paid by taxpayer for the property was $            . 
  
 8. A copy of this statement has been furnished to the Company. 
  
 Dated:
                    ,          
  

	
	  

	 Taxpayer’s Signature

	
	  

	 Taxpayer’s Printed Name

  

 7 

 PROCEDURES FOR MAKING ELECTION 
 UNDER INTERNAL REVENUE CODE SECTION 83(b) 
  
 The following procedures must be followed with respect to the attached form for making an election under Internal Revenue Code section 83(b) in order for the election to be effective: 
  
 1. You must file one copy of the completed election form with the IRS
Service Center where you file your federal income tax returns within thirty (30) days after the Grant Date of your Restricted Stock. 
  
 2. At the same time you file the election form with the IRS, you must also give a copy of the election form to the Secretary of the Company. 

 
 3. You must file another copy of the election form with your federal
income tax return (generally, Form 1040) for the taxable year in which the stock is transferred to you. 
  

 8

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