Exhibit (a)(1)(H)
| ¨ Personnel Grant Status | IRIDEX CORPORATION ID: 77-0210467 1212 TERRA BELLA AVENUE MOUNTAIN VIEW, CA 94043 | |
| AS OF 7/30/2009 | ||
| [Name] | ID: | |
| [Address] | ||
STOCK OPTIONS
| Number |
Grant Date |
Plan | Type | Granted | Price | Exercised | Vested | Cancelled | Unvested | Outstanding | Exercisable | ||||||||||||
| [Number] | [Date] | [Plan] | [Type] | [Shares] | $ | [Price] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | |||||||||||
| [Number] | [Date] | [Plan] | [Type] | [Shares] | $ | [Price] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | |||||||||||
| [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | [Shares] | |||||||||||||||||
Information Currently on File
| Tax |
Rate % |
Option Broker |
Registration |
Alternate Address | |||||
| Federal |
[ | %] | |||||||
| Social Security |
[ | %] | |||||||
| Medicare |
[ | %] |