Shutterfly 2011 Annual Report Download - page 108
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RECEIPT AND CONSENT
The undersigned Participant hereby acknowledges receipt of a photocopy of Certificate No. -________
for ________________ shares
of Common Stock of Shutterfly, Inc. (the “Company”)
The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to
the Restricted Shares Agreement that Participant has previously entered into with the Company. As escrow holder, the Secretary of the
Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’
s name.To facilitate any transfer
of Shares to the Company pursuant to the Restricted Shares Agreement, Participant has executed the attached Assignment Separate from
Certificate.
Dated:
, 20
Signature
Please Print Name