(a)(1)(C)
FORM OF ELECTION
COGNEX CORPORATION
Election Form
To Cognex Corporation:
I am currently employed by or serve as an officer or director of Cognex Corporation (or one of
its subsidiaries). I have received offering materials from Cognex Corporation that were filed with
the Securities and Exchange Commission on Schedule TO on November 16, 2009, describing Cognex
Corporation’s offer to purchase certain underwater stock options in exchange for a cash payment
(the “Offer”). I have read the offering materials and hereby certify that I am the holder of
Eligible Options (as defined in the offering materials) and that I am an Eligible Participant (as
defined in the offering materials). In addition, I have reviewed my Eligible Options and
understand that, by participating in the Offer, I agree to sell certain of these Eligible Options
(as indicated below).
In return for my Eligible Option(s), I understand Cognex Corporation will pay me a total cash
payment, less tax withholdings, which is conditioned on my continued employment or service with
Cognex Corporation or one of its subsidiaries through the scheduled termination date of the Offer,
and subject to certain other conditions described in the offering materials. I agree that Cognex
Corporation is entitled to withhold taxes and social insurance contributions and transfer these
withholdings to my legal employer, who is bound by the legal obligation of withholding.
Furthermore, I am aware that I may be responsible for paying any difference between the actual tax
liability and the amount withheld.
I understand that I may choose to either tender or retain any or all of my options on an
option-by-option basis by checking either “Yes” or “No” in the boxes below, but that I cannot
tender a portion of an option.
For purposes of participating in the Offer, I hereby agree to sell my Eligible Option(s) as
indicated below to Cognex Corporation by my check in the “Yes” box in the “Tender Entire Eligible
Option” column. I understand that these option(s) will be cancelled on the date that the Offer
expires and Eligible Options are accepted for payment by Cognex Corporation.
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Exercise |
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Tender Entire |
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Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
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o Yes, tender Eligible Option |
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o No, retain Eligible Option |
The following is applicable only to non-U.S. employees:
You hereby explicitly and unambiguously consent to the collection, use and transfer, in
electronic or other form, of your personal data as described in the offering materials and this
document by and among Cognex Corporation and its subsidiaries and affiliates for the exclusive
purpose of implementing, administering and managing your participation in the Offer and Cognex
Corporation’s stock option plans (collectively, “Plans”).
You understand that Cognex Corporation may hold certain personal information about you,
including, but not limited to, your name, home address and telephone number, date of birth, social
insurance number or
other identification number, salary, nationality, job title, any shares of
stock or directorships held in Cognex Corporation and its subsidiaries, details of all options or
any other entitlement to shares of stock awarded, canceled, exercised, vested, unvested or
outstanding in your favor, for the purpose of implementing, administering and managing the Plans
(“Data”). You understand that Data may be transferred to any third parties assisting in the
implementation, administration and management of the Plans, that these recipients may be located in
your country or elsewhere, and that the recipients’ country (e.g., the United States) may have
different data privacy laws and protections than your country. You understand that you may request
a list with the names and addresses of any potential recipients of the Data by contacting
Todd Keebaugh at todd.keebaugh@cognex.com. You authorize the recipients to receive, possess, use, retain and transfer the Data, in
electronic or other form, for the sole purpose of implementing, administering and managing your
participation in the Plans, including any requisite transfer of such Data as may be required to a
third party assisting with administration of the Plans. You understand that Data will be held only
as long as is necessary to implement, administer and manage your participation in the Plans. You
understand that you may, at any time, view Data, request additional information about the storage
and processing of Data, require any necessary amendments to Data or refuse or withdraw the consents
herein, in any case without cost, by contacting in writing your local human resources
representative. You understand, however, that refusing or withdrawing your consent may affect your
ability to participate in the Plans. For more information on the consequences of your refusal to
consent or withdrawal of consent, you understand that you may contact
Todd Keebaugh at todd.keebaugh@cognex.com.
I hereby elect to participate in the Offer dated November 16, 2009 with respect to the
option(s) indicated above. I acknowledge that I will be unable to revoke the election described in
this election form after the Offer expires, which is currently scheduled to occur at 5:00 p.m.,
Eastern Time, on December 15, 2009 (unless otherwise extended).
Signature of Holder:
Name (please
print):
Date:
Delivery of your signed and completed election form must be made by one of the following
three methods:
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Scan and email to Treasury@cognex.com |
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Fax to (508) 650-3324 |
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Mail to Cognex Corporation, One Vision Drive, Natick, MA 01760, Attention: Sheila
DiPalma. |
All questions about the program or requests for assistance should be made by email to
Treasury@cognex.com. If you need immediate assistance, you can contact Sheila DiPalma by
email at Sheila.DiPalma@cognex.com or by telephone at (508) 650-3356.
The information contained in this e-mail message is intended only for the use of the
recipient(s) named above. It may include confidential information and/or personal data that should
be kept secure and protected against theft, damage, loss or unauthorized access, and should not be
disclosed to third parties. Any potential breach of this information should be disclosed
immediately to Human Resources.
DELIVERY OF YOUR ELECTION FORM OTHER THAN BY FAX, EMAIL OR MAIL AT THE
ADDRESSES/NUMBERS INDICATED ABOVE WILL NOT CONSTITUTE VALID DELIVERY.
COGNEX CORPORATION MUST RECEIVE YOUR ELECTION FORM NO LATER THAN 5:00 P.M.,
EASTERN TIME, ON DECEMBER 15, 2009 (UNLESS OTHERWISE EXTENDED).
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