DELIVERY OPTIONS FOR SUBSCRIPTION RIGHTS CERTIFICATE
Delivery other than by mail, hand or overnight courier to the address listed below will not constitute valid delivery.
American Stock Transfer & Trust Company, LLC
Operations Center
Attn: Reorganization Department
6201 15th Avenue
Brooklyn, New York 11219
PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY.
FORM1-EXERCISE OF SUBSCRIPTION RIGHTS
To subscribe for shares pursuant to your Subscription Right, please complete line (a) OR (b) and sign under Form 3 below.
EXERCISE OF SUBSCRIPTION RIGHT:
| | | | | | |
(a) I apply for | | shares x $ 13.00 | | = | | $ |
(no. of new shares) | | (subscription price) | | | | (amount enclosed) |
(b) FOR HOLDERS OF GREATER THAN 9.9% OF THE OUTSTANDING NUMBER OF COMMON SHARES:
| | | | | | |
I apply for | | shares x $ 13,000.00 | | = | | $ |
(no. of new shares) | | (subscription price) | | | | (amount enclosed) |
[NOTE: If you are NOT a holder of greater than 9.9% of the outstanding common shares and you apply to purchase shares ofnon-voting Series Y Preferred Stock, you will not receive any, but will instead receive an equivalent number of shares of common stock (on an as-converted basis) in consideration for the same purchase price.]
METHOD OF PAYMENT (CHECK ONE)
☐ | Check or bank draft payable to “American Stock Transfer & Trust Company, LLC as Subscription Agent.” |
☐ | Wire transfer of immediately available funds directly to the account maintained by American Stock Transfer & Trust Company, LLC, as Subscription Agent, for purposes of accepting subscriptions in this Rights Offering at JPMorgan Chase Bank, 55 Water Street, New York, New York 10005, ABA #021000021, Account #530-354616 American Stock Transfer FBO XOMA Corporation, with reference to the rights holder’s name. |
FORM2-DELIVERY TO DIFFERENT ADDRESS
Unless specifically requested, shares of Common Stock will be issued in book entry form. If you wish for the Common Stock underlying your subscription rights, to be delivered to an address different from that shown on the face of this Subscription Rights Certificate, please enter the alternate address below, sign under Form 3 and have your signature guaranteed under Form 4.
FORM3-SIGNATURE
TO SUBSCRIBE: I acknowledge that I have received the Prospectus for this Rights Offering and I hereby irrevocably subscribe for the number of shares indicated above on the terms and conditions specified in the Prospectus. I agree to cooperate with the Company and provide to the Company any and all information requested by the Company in connection with the exercise of the rights granted in the previous sentence.
IMPORTANT: The signature(s) must correspond with the name(s) as printed on the reverse of this Subscription Rights Certificate in every particular, without alteration or enlargement, or any other change whatsoever.
FORM4-SIGNATURE GUARANTEE
This form must be completed if you have completed any portion of Form 2.
| | |
| | (Name of Bank or Firm) |
|
By: |
| | (Signature of Officer) |
IMPORTANT: The signature(s) should be guaranteed by an eligible guarantor institution (bank, stock broker, savings & loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange CommissionRule 17Ad-15.
FOR INSTRUCTIONS ON THE USE OF XOMA CORPORATION SUBSCRIPTION RIGHTS CERTIFICATES, CONSULT D.F. KING & CO., INC., 48 WALL STREET, NEW YORK, NY 10005, THE INFORMATION AGENT, AT212-269-5550 OR866-721-1324