Exhibit 4.5
ACN 009 232 026 | REGISTERED OFFICE Level 12, BGC Centre 28 The Esplanade Perth WA 6000 |
[NAME] | Certificate Number | |
[ADDRESS] | ||
Security Number | ||
C0000000825 |
JURISDICTION OF INCORPORATION: WESTERN AUSTRALIA
OPTION CERTIFICATE
OPTIONS EXPIRING AT 5:00 PM (AWST) ON 22 FEBRUARY 2011
EXERCISABLE IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF ISSUE AT AN
EXERCISABLE PRICE OF $0.23 PER OPTION
Date | Transaction Type | Quantity | ||
21 February 2007 | Allotment |
THIS IS TO CERTIFY THAT THE ABOVE NAMED IS THE REGISTERED HOLDER OF OPTIONS OVER FULLY PAID SHARES IN PSIVIDA LIMITED ISSUED SUBJECT TO THE ATTACHED TERMS AND CONDITIONS AND THE CONSTITUTION OF THE COMPANY.
Signed in accordance with the constitution of the Company
Director | Company Secretary |
Share Registry: Computershare Investor Services Pty Limited
GPO Box D182
PERTH WA 6840
Enquiries (within Australia) 1300 557 010
(outside Australia) 61 8 9323 2000
Facsimile 61 8 9323 2033
THIS CERTIFICATE MUST BE SURRENDED TO THE COMPANY ON TRANSFER OF ANY OF THE ABOVE OPTIONS.
Application Form on Exercise of Unlisted Options Expiring 22 February 2011
To the Directors, pSivida Limited
I/We hereby exercise | option(s) and hand you herewith my/our cheque for |
being 0.23 cents per share on application for | ordinary shares in the capital of the Company. |
I/We request that you allot me that number of shares and I/We agree to accept that number of shares on the terms below and the Constitution of the Company, and I/We authorise you to place my/our name on the register.
My/Our Holder Number (as shown on my/our Certificate) is |
Sign Here—This sectionmust be signed for your instructions to be executed
I/We authorise you to act in accordance with my/our instructions set out above.
Individual or Securityholder 1
| Securityholder 2
| Securityholder 3
| ||||||
Director | Director/Company Secretary | Sole Director and Sole Company Secretary |
Note: when signed under Power of Attorney, the attorney states that they have not received a notice of revocation. Computershare Investor Services Pty Limited needs to sight a certified copy of the Power of Attorney. | Day/Date | Month | Year | |||
Terms and
Conditions of
Options Attached