Exhibit (a)(1)(K)
Equity Exchange Program Election Form
This Election Form allows you to elect to participate in the exchange offer from Genworth Financial, Inc. pursuant to the document titled Offer to Exchange Certain Outstanding Stock Options and Stock Appreciation Rights for Replacement Awards, dated July 13, 2009 (the Offering Memorandum). Capitalized terms used but not defined herein have the meaning assigned to them in the Offering Memorandum.
The offering period closes at
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The table below shows your current Eligible Options and SARs based on your employment status on July 9, 2009. Some stock options and SARs might not be eligible for exchange, including, but not limited to, stock options or SARs that expire, terminate or are forfeited before the Expiration Date. Refer to the Offering Memorandum for more information. In order to participate in the exchange offer with respect to your Eligible Options and SARs:
1. | Check the box for each grant to Exchange those Eligible Options or SARs. You also have the option of checking the Exchange All Eligible Options and SARs box instead of selecting individual grants. |
2. | Unchecked grants will not be exchanged. |
Your Election: | ¨ Exchange All Eligible Options and SARs |
|||||||||||
Grant |
Grant Date | Exercise Price |
Eligible Options and SARs |
Exchange Ratio |
I elect to Exchange my Eligible Options and SARs |
Replacement Awards Granted | ||||||
$ | 3.0:1 | ¨ | ||||||||||
$ | 3.0:1 | ¨ | ||||||||||
$ | 3.0:1 | ¨ | ||||||||||
Total: | ||||||||||||
By electing to exchange your Eligible Options and SARs by tendering them in the exchange offer, you are agreeing:
1. To the terms and conditions of the exchange offer as set forth in the Offering Memorandum.
2. To sell, assign and transfer to Genworth all right, title and interest in and to the Eligible Options and SARs tendered as indicated in the table above.
3. To, upon request, promptly execute and deliver any additional documents deemed by Genworth to be necessary to complete the acceptance and payment of the Eligible Options and SARs tendered.
4. That you have read and understand the Offering Memorandum.
Notice: Genworth will collect, use, transfer and share the personal information you submit to the extent necessary to facilitate the acceptance of your tendered Eligible Options and SARs. The information will be stored in the United States.
______________________________________________________ _________________________________
SIGNATURE DATE
Printed Name: ____________________________________________
Telephone Number: ________________________________________
Email address: ____________________________________________
Please complete, sign and return this Election Form to Genworth so that it is received before 5:00 p.m., U.S. Eastern Time, on August 18, 2009, using one of the following means:
Fax to: (866) 878-0212
Or, scan and email to: compensation@genworth.com
Or, mail to:
Genworth Financial, Inc.
6620 West Broad Street, Richmond, VA 23230
Attention: Executive Compensation
Contact Phone #: 866-931-4954
Please keep a copy of your signed Election Form for your records.
Questions
If you have questions regarding this Election Form, please contact the executive compensation team by phone at (866) 931-4954 or by e-mail at compensation@genworth.com, or you may contact your human resources manager.