Employee Stock Options Termination Acknowledgement Form
Use this form to document an employee’s termination details and confirm understanding of how stock options are affected after termination.
Employee and Termination Details
Employee full name
*
First Name
Last Name
Employee number / internal employee ID
*
Department
*
Please Select
Accounting
Administration
Engineering
Human Resources
Information Technology
Legal
Marketing
Operations
Sales
Other
Job title
*
Manager name
Termination effective date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Termination type
*
Voluntary resignation
Involuntary termination
Retirement
Reduction in force
Other
Stock Option Grant Information
Stock Option Plan Name
*
Grant Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grant Number or Award Reference
*
Number of Options Granted
*
Number of Vested Options as of Termination Date
*
Number of Unvested Options as of Termination Date
*
Acknowledgement and Confirmation
Acknowledgement
*
I understand that, due to termination of my employment, unvested stock options are forfeited, any vested stock options may only be exercised within the remaining exercise window, and I have reviewed the company's stock option terms.
Employee Signature
*
Signature Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: