EX-99.(A)(1)(IX) 10 dex99a1ix.htm FORM OF REPLACEMENT SIRONA STOCK OPTION EXCHANGE PROGRAM ELECTION FORM Form of Replacement Sirona Stock Option Exchange Program Election Form

EXHIBIT (a)(1)(ix)

********* REPLACEMENT ********

Sirona Stock Option Exchange Program

Election Form

 

Employee Name:

Employee ID:

If you wish to exchange eligible option grants, you must act by 5:00 p.m. U.S. EDT on Wednesday, January 21, 2009. You may change your elections as often as you wish until 5:00 p.m. EDT on Wednesday, January 21, 2009, at which time your option election, if any, in effect at that time will become irrevocable, unless the offer is extended by Sirona Dental Systems, Inc. in its sole discretion.

 

   

Indicate your election for each option grant in the appropriate box (“Exchange” or “Decline”).

 

   

Sign and date the election form and return to Sirona Dental Systems, Inc. by one of the following methods:

 

   

faxing to: (718) 482-2516 or

 

   

mailing to: 30-30 47th Avenue, Suite 500, Long Island City, New York 11101, Attn: Investor Relations or

 

   

scanning and e-mailing to: optionexchangeacceptance@sirona.com

 

   

Election forms SHOULD NOT be returned via inter-office mail.

Questions about the Exchange Program can be directed:

 

   

By phone at (718) 482-2285. You will have the ability to leave a voice message on these extensions.

 

   

By e-mail to optionexchangeacceptance@sirona.com.

 

Eligible Options               
Option
Grant
Date
  Shares
Subject to
Option Grant
  Exercise
Price
(per share)
  Exchange
Ratio
 

Shares Subject

to Replacement
Option

  Exchange*   Decline*
                    ¨   ¨
                    ¨   ¨
                    ¨   ¨

 

Note:

  

The exercise price of the Replacement Options will be equal to the closing price

of the Company’s common stock on NASDAQ on the date the Replacement

Options are granted (currently expected to be January 21, 2009).

 

Signature:  

 

Date:  

 

 

For each grant, if neither Exchange/

Decline box is chosen, you will be

considered to DECLINE the election