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Orrick's Emerging Companies Group Start-Up Forms Library: OHS East:160454226.2

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This 3 sentence summary provides the key details from the Notice of Issuance of Securities Pursuant to Subdivision (o) of Section 25102 of the Corporations Code document: [Company Name] filed this notice with the California Department of Corporations to issue restricted stock and common stock options to employees under a flexible purchase/option plan, with the aggregate current market value of securities sought to be sold being $__________. The company is incorporated in Delaware and has its principal place of business at ____________________ in __________, __________ ______. [Officer 3], Secretary, signed the notice on behalf of the issuer [Company Name].

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Orrick's Emerging Companies Group Start-Up Forms Library: OHS East:160454226.2

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52 views2 pages
This 3 sentence summary provides the key details from the Notice of Issuance of Securities Pursuant to Subdivision (o) of Section 25102 of the Corporations Code document: [Company Name] filed this notice with the California Department of Corporations to issue restricted stock and common stock options to employees under a flexible purchase/option plan, with the aggregate current market value of securities sought to be sold being $__________. The company is incorporated in Delaware and has its principal place of business at ____________________ in __________, __________ ______. [Officer 3], Secretary, signed the notice on behalf of the issuer [Company Name].

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This 3 sentence summary provides the key details from the Notice of Issuance of Securities Pursuant to Subdivision (o) of Section 25102 of the Corporations Code document: [Company Name] filed this notice with the California Department of Corporations to issue restricted stock and common stock options to employees under a flexible purchase/option plan, with the aggregate current market value of securities sought to be sold being $__________. The company is incorporated in Delaware and has its principal place of business at ____________________ in __________, __________ ______. [Officer 3], Secretary, signed the notice on behalf of the issuer [Company Name].

Copyright:

Attribution Non-Commercial (BY-NC)
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
52 views2 pages

Orrick's Emerging Companies Group Start-Up Forms Library: OHS East:160454226.2

Uploaded by

api-26365036
This 3 sentence summary provides the key details from the Notice of Issuance of Securities Pursuant to Subdivision (o) of Section 25102 of the Corporations Code document: [Company Name] filed this notice with the California Department of Corporations to issue restricted stock and common stock options to employees under a flexible purchase/option plan, with the aggregate current market value of securities sought to be sold being $__________. The company is incorporated in Delaware and has its principal place of business at ____________________ in __________, __________ ______. [Officer 3], Secretary, signed the notice on behalf of the issuer [Company Name].

Copyright:

Attribution Non-Commercial (BY-NC)
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Orrick's Emerging Companies Group

Start-Up Forms Library


The attached document is part of the Start-Up Forms Library provided by Orrick's Emerging
Companies Group. By using/viewing the attached document, you agree to the Terms of Use
Agreement for the Start-Up Forms Library, which can be viewed at:
http://www.orrick.com/practices/corporate/emergingCompanies/startup/forms_disclaimer.asp.

OHS East:160454226.2
(Department of Corporations Use Only) DEPARTMENT OF CORPORATIONS
Fee Paid $ FILE No., if any:

Receipt No. ____________________ (Insert File Number(s) of Previous Filings Before the
Department, if any)
FEE: $__________
(See Corporations Code Section 25608(y) and Section 25608(e).
The fee is based on the current market value of the securities,
or in the case of options, the underlying securities.)
COMMISSIONER OF CORPORATIONS
STATE OF CALIFORNIA
Notice of Issuance of Securities Pursuant to Subdivision (o) of
Section 25102 of the Corporations Code
1. Name of Issuer: [Company Name]
2. State of Incorporation or Organization: Delaware
3. Address of Principal Place of Business:
____________________ __________, __________ ______
Number and Street City State Zip Code
4. The security is issued pursuant to a: (Check One)
[ ] Purchase Plan or Agreement.
Name of Security:
Number of Securities:
Price per Security: $
[ ] Option Plan or Agreement.
Name and Number of Options:
Name and Number of the Underlying Securities:
Exercise Price Per Security: $
[X] “Flexible” Purchase/Option Plan or Agreement.
Name of Security/Option: Restricted Stock/Common Stock Option
Number of Securities/Options: __________
Name and Number of the Underlying Securities: Common Stock
Price Per Security: $__________
5. Aggregate current market value of securities sought to be
sold: $ __________
6. Date of Notice: [Date]
() Check if Issuer [Company Name]
has a consent to service Name of Issuer
of process on file with
the Commissioner.
Authorized Signature on
Behalf of Issuer

[Officer 3], Secretary


Print Name and Title of
Signatory
Name, Address and Phone Number of Contact Person:
[Name] c/o Orrick, Herrington & Sutcliffe LLP
____________________, __________, __ ______
Phone: ____________________
Instructions: Each issuer (other than a California corporation) filing a notice under Section 25102(o) must file a consent
to service of process (Form 260.165), unless it already has a consent to service on file with the Commissioner.

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