Tesla 2016 Annual Report Download - page 95

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EXHIBIT B
TESLA MOTORS, INC.
2010 EMPLOYEE STOCK PURCHASE PLAN
NOTICE OF WITHDRAWAL
The undersigned Participant in the Offering Period of the Tesla Motors, Inc. 2010 Employee Stock Purchase Plan that began on ____________,
______(the“OfferingDate”)herebynotifiestheCompanythatheorsheherebywithdrawsfromtheOfferingPeriod.HeorsheherebydirectstheCompanyto
paytotheundersignedaspromptlyaspracticableallthepayrolldeductionscreditedtohisorheraccountwithrespecttosuchOfferingPeriod.Theundersigned
understandsandagreesthathisorheroptionforsuchOfferingPeriodwillbeautomaticallyterminated.Theundersignedunderstandsfurtherthatnofurtherpayroll
deductionswillbemadeforthepurchaseofsharesinthecurrentOfferingPeriodandtheundersignedwillbeeligibletoparticipateinsucceedingOfferingPeriods
onlybydeliveringtotheCompanyanewSubscriptionAgreement.
NameandAddressofParticipant:
Signature: 
Date: