Stock Option Compensation and Recovery Form
Submit details for stock option compensation or recovery requests. Please complete all relevant fields to ensure timely processing.
Full Name
*
First Name
Last Name
Employee ID
*
Email Address
*
example@example.com
Department
*
Please Select
Finance
Human Resources
Engineering
Sales
Marketing
Other
Stock Option Type
*
Incentive Stock Option (ISO)
Non-Qualified Stock Option (NSO)
Restricted Stock Unit (RSU)
Other
Grant Date of Stock Option
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Shares Involved
*
Vesting Status
*
Fully Vested
Partially Vested
Not Vested
Reason for Compensation or Recovery
*
Please Select
Compensation for Missed Grant
Recovery Due to Ineligibility
Error in Vesting
Voluntary Surrender
Other
Describe the Circumstances or Details
*
Has any prior compensation or recovery action been taken?
*
Yes
No
Upload Supporting Documents (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Submit
Submit
Should be Empty: