Intel 2005 Annual Report Download - page 162

CONVERSION NOTICE
If you want to convert this Security into Common Stock of the Company, check the box: 3
To convert only part of this Security, state the Principal Amount to be converted (which must be $1,000 or an integral multiple of $1,000):
$
If you want the stock certificate made out in another person’s name, fill in the form below:
Date: Signed:
(Sign exactly as your name appears on the other side of this Security)
Signature Guarantee:
Note: Signatures must be guaranteed by an
“eligible guarantor institution” meeting the requirements of the Security Registrar, which requirements
include membership or participation in the Security Transfer Agent Medallion Program (“ STAMP ”) or such other “signature guarantee program” as
may be determined by the Security Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934,
as amended.
34
(Insert other person
’
s social security or tax ID no.)
(Print or type other person
’
s name, address and zip code)