Exhibit 99.1 |
SUBSCRIPTION I.D. NO. | RIGHTS OFFERING GENESYS S.A. ADS RIGHTS CERTIFICATE AND SUBSCRIPTION FORM FOR NEW ADSs | NO. OF ADS RIGHTS |
By Mail | By Hand, Express Mail or Overnight Courier |
The Bank of New York Tender and Exchange Department P.O. Box 11248 Church Street Station New York, NY 10286-1248 | The Bank of New York Tender and Exchange Department 101 Barclay Street Receive and Delivery Window Street Level New York, New York 10286 |
For Telephone Assistance (800) 507 9357 |
THE REGISTERED OWNER OF THIS SUBSCRIPTION FORM IS THE HOLDER OF THE NUMBER OF ADS RIGHTS SHOWN IN THE UPPER RIGHT HAND CORNER OF THE OTHER SIDE OF THIS FORM UPON THE TERMS AND CONDITIONS SPECIFIED IN THE PROSPECTUS RELATING THERETO, WHICH ARE INCORPORATED HEREIN BY REFERENCE
PLEASE FILL IN ALL APPLICABLE INFORMATION:
1. The undersigned hereby notifies the ADS Rights Agent of its subscription for New ADSs in the following amount: | ||
[ ] New ADSs to be subscribed for pursuant to the exercise of ADS Rights | ||
I hereby irrevocably subscribe for the number of New ADSs indicated above upon the terms and conditions specified in the Prospectus relating hereto. Receipt of the Prospectus is hereby acknowledged. | ||
Signature of Subscriber: | ||
Name: | ||
Phone No: | ||
Fax No: | ||
e-mail address: | ||
(Joint owners should each sign. If signing as executor, administrator, attorney, trustee, or guardian, give title as such. If a corporation, sign in full corporate name by authorized of offer. If a partnership, sign in the name of authorized person.) |
2. Method of Payment Check (A) or (B): | ||
A) Multiply number of ADSs Subscribed for by US $1.35 enclose money order or certified check in this amount payable to “The Bank of New York” | ||
or | ||
B) Wire Transfer (contact the ADS Rights Agent for wire transactions) | ||
TO BE EXECUTED ONLY BY NON-UNITED STATES RESIDENTS: | |||
I hereby certify that the foregoing purchase of New ADSs has been effected in accordance with the applicable laws of the jurisdiction in which I reside. | |||
Dated: | , 2003 | ||
Substitute Form W-9 | ||
PART 1 – PLEASE PROVIDE YOUR TAXPAYER IDENTIFICATION NUMBER (TIN) IN THE BOX AT THE RIGHT AND CERTIFY BY SIGNING AND DATING BELOW | Social Security No. OR taxpayer ID No. | |
CERTIFICATION – UNDER THE PENALTIES OF PERJURY, I CERTIFY: (1) THE NUMBER SHOWN ON THIS FORM IS MY CORRECT TAXPAYER IDENTIFICATION NUMBER (OR I AM WAITING FOR A NUMBER TO BE ISSUED TO ME), (2) I AM NOT SUBJECT TO BACKUP WITHHOLDING BECAUSE: (A) I AM EXEMPT FROM BACKUP WITHHOLDING, OR (B) I HAVE NOT BEEN NOTIFIED BY THE INTERNAL REVENUE SERVICE (IRS) THAT I AM SUBJECT TO BACKUP WITHHOLDING AS A RESULT OF A FAILURE TO REPORT ALL INTEREST OR DIVIDENDS, OR (C) THE IRS HAS NOTIFIED ME THAT I AM NO LONGER SUBJECT TO BACKUP WITHHOLDING AND (3) I AM A U.S. PERSON (INCLUDING A U.S. RESIDENT ALIEN) (YOU MUST CROSS OUT ITEM (2) ABOVE IF YOU HAVE BEEN NOTIFIED BY THE IRS THAT YOU ARE SUBJECT TO BACKUP WITHHOLDING BECAUSE OF UNDER REPORTING INTEREST OR DIVIDENDS ON YOUR TAX RETURN) | PART 2 - TIN applied for (or intended to apply for in near future) CHECK BOX OF APPLICABLE PART 3 - EXEMPT PAYEE Attach Certificate of Foreign Status |
Signature | Department of the Treasury, Internal Revenue Services Payer’s Request for Taxpayer Identification Number (TIN) | ||
Name | |||
Address | |||
Date | |||
CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER | |||
I certify under penalties of perjury that a taxpayer identification number has not been issued to me and that I mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administrative Office (or I intend to mail or deliver an application in the near future). I understand that if I do not provide a taxpayer identification number to the payer by the time of payment, the payer is required to withhold the applicable rate from all cash payments made to me until I provide a number. | |||
Signature: | |||
Date: | |||
NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN BACKUP WITHHOLDING FROM ANY GROSS PROCEEDS. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. |
Genesys S.A.
Instructions as to the Exercise
of
ADS Rights
1. | Subscription. |
By Mail | By Hand, Express Mail or Overnight Courier |
The Bank of New York Tender and Exchange Department P.O. Box 11248 Church Street Station New York, NY 10286-1248 | The Bank of New York Tender and Exchange Department 101 Barclay Street Receive and Delivery Window Street Level New York, New York 10286 |
For Telephone Assistance (800) 507 9357 |
account for the Deposit Amount for the ADSs and to deliver such amount to the ADS Rights Agent. DTC must receive the subscription instructions and the payment of the Deposit Amount for the ADSs by the Expiration Date.
2. | Your Method of Delivery. |
3. | Deliveries from the ADS Rights Agent. |
4. | Partial Subscriptions. |
5. | Signatures on ADS Rights Certificate/Subscription Form. |
when signing, and proper evidence satisfactory to Genesys S.A. and the ADS Rights Agent of their authority to act must be submitted.
6. | Substitute Form W-9. |
7. | Backup Withholding. |