EX-99.(A)(1)(N) 3 dex99a1n.htm FORM OF ELECTION AND WITHDRAWL FORM Form of Election and Withdrawl Form

Exhibit (a)(1)(N)

ELECTION AND WITHDRAWAL FORM

Tender Of Eligible Stock Options Pursuant To The Offer To Exchange

Certain Outstanding Options For Restricted Stock Units

Dated January 7, 2010

The Offer Expires At 5:00 p.m. Pacific Standard Time, On February 5, 2010, Unless the Offer Is Extended By Mentor Graphics

Election to Tender. To elect to tender an eligible option, complete the chart and provide employee information, your signature and the date of election where indicated below, and check the box to indicate “Yes” for each eligible option. If you do not complete the requested information and clearly mark the “Yes” box with respect to an Eligible Option, such Eligible Option will not be exchanged.

Election to Withdraw. To elect to withdraw a previous election to tender an eligible option, complete the chart and provide employee information, your signature and the date of election where indicated below, and check the box to indicate “No” for each eligible option.

 

Eligible

Option Grant

  

Eligible

Option

  

Exercise

Price

  

Number of Shares

Subject to Eligible

  

Exchange Eligible

Option?

Date    Number    Per Share    Option    (check the box)
                 

¨ Yes

¨ No 

                   

¨ Yes

¨ No 

                 

¨ Yes

¨ No 

                   

¨ Yes

¨ No 

                   

¨ Yes

¨ No 

Agreement to Terms of Election. By your signature below, you acknowledge that your election is subject to the terms, conditions and restrictions contained in the Offer to Exchange Certain Stock Options for Restricted Stock Units dated January 7, 2010.

 

DATE OF ELECTION:

 

 

  

 

EMPLOYEE INFORMATION: (please print)     MENTOR GRAPHICS CORPORATION
Name:  

 

    8005 SW Boeckman Road   
Address:  

 

    Wilsonville, OR 97070-7777   
 

 

         
Employee #:  

 

    Processed on:   

 

  
Signature:  

 

    Processed by:   

 

  

Valid Signature Is Required

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