SEC Filings

S-1/A
AVEXIS, INC. filed this Form S-1/A on 02/01/2016
Entire Document
 

 

ATTACHMENT III

 

NOTICE OF EXERCISE

 

AveXis, Inc.

 

[Address]

Date of Exercise:

 

 

This constitutes notice to AveXis, Inc. (the “Company”) under my stock option that I elect to purchase the below number of shares of Common Stock of the Company (the “Shares”) for the price set forth below.

 

Type of option (check one):

 

Incentive ¨

 

Nonstatutory ¨

 

 

 

 

 

Stock option dated:

 

 

 

 

 

 

 

 

 

Number of Shares as to which option is exercised:

 

 

 

 

 

 

 

 

 

Certificates to be issued in name of:

 

 

 

 

 

 

 

 

 

Total exercise price:

 

$              

 

$              

 

 

 

 

 

Cash payment delivered herewith:

 

$              

 

$              

 

 

 

 

 

[Value of          Shares delivered herewith(1):

 

$              

 

$              ]

 

 

 

 

 

[Value of          Shares pursuant to net exercise(2):

 

$              

 

$              ]

 

 

 

 

 

[Regulation T Program (cashless exercise(3)):

 

$              

 

$              ]

 


(1)                                 Shares must meet the public trading requirements set forth in the option.  Shares must be valued in accordance with the terms of the option being exercised, and must be owned free and clear of any liens, claims, encumbrances or security interests.  Certificates must be endorsed or accompanied by an executed assignment separate from certificate.

(2)                                 The option must be a Nonstatutory Stock Option, and the Company must have established net exercise procedures at the time of exercise, in order to utilize this payment method.

(3)                                 Shares must meet the public trading requirements set forth in the option.

 

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