SEARS HOMETOWN & OUTLET STORES, INC. - FORM S-1/A - EX-99.5 - FORM OF NOMINEE HOLDER CERTIFICATION - July 19, 2012

Attached files

file filename
EX-3.1 - FORM OF AMENDED AND RESTATED CERTIFICATION OF INCORPORATION - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex31.htm
EX-3.2 - FORM OF BYLAWS - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex32.htm
EX-8.1 - OPINION OF DEBEVOISE & PLIMPTON LLP REGARDING CERTAIN TAX MATTERS - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex81.htm
EX-4.2 - FORM OF RIGHTS CERTIFICATE - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex42.htm
S-1/A - AMENDMENT NO. 3 TO FORM S-1 - SEARS HOMETOWN & OUTLET STORES, INC.d337523ds1a.htm
EX-5.1 - OPINION OF DEBEVOISE & PLIMPTON LLP - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex51.htm
EX-99.3 - FORM OF LETTER TO NOMINEE HOLDERS - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex993.htm
EX-23.2 - CONSENT OF BDO USA, LLP - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex232.htm
EX-99.2 - FORM OF LETTER STOCKHOLDER WHO ARE RECORD HOLDERS - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex992.htm
EX-99.6 - FORM OF BENEFICIAL OWNER ELECTION - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex996.htm
EX-99.1 - FORM OF INSTRUCTION - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex991.htm
EX-99.4 - FOR OF LETTER TO CLIENTS OF NOMINEE HOLDERS - SEARS HOMETOWN & OUTLET STORES, INC.d337523dex994.htm

Exhibit 99.5

FORM OF NOMINEE HOLDER CERTIFICATION

The undersigned, a bank, broker, trustee, depositary or other nominee of transferable subscription rights (the “Rights”) to purchase shares of common stock, par value $0.01 per share (the “Common Stock”) of Sears Hometown and Outlet Stores, Inc. (the “Company”) pursuant to the rights offering described and provided for in the Company’s Prospectus dated [—], 2012 (the “Prospectus”), hereby certifies to the Company, Sears Holdings Corporation and to Computershare Inc., as Subscription Agent for such rights offering, that (1) the undersigned has exercised, on behalf of the beneficial owners thereof (which may include the undersigned), the number of Rights specified below pursuant to the Basic Subscription Right (as defined in the Prospectus) and, on behalf of beneficial owners of Rights who have subscribed for the purchase of additional shares of Common Stock pursuant to the Over-Subscription Privilege (as defined in the Prospectus), the number of shares specified below pursuant to the Over-Subscription Privilege, listing separately below each such exercised Basic Subscription Right and the corresponding Over-Subscription Privilege (without identifying any such beneficial owner), and (2) to the extent a beneficial owner has elected to subscribe for shares pursuant to the Over-Subscription Privilege, each such beneficial owner’s Basic Subscription Right has been exercised in full:

 

     Number of Rights Held    Number of Shares
Subscribed for
Pursuant to Basic
Subscription Right		    Number of Shares
Subscribed for
Pursuant to
Over-Subscription Privilege

1.

         

2.

         

3.

         

4.

         

5.

         

6.

         

7.

         

8.

         

9.

         

Provide the following information if applicable:

Depository Trust Company (“DTC”) Participant Number:

Participant Name:

 

By:    
  Name:
  Title:
DTC Basic Subscription Confirmation Number(s):

SEARS HOMETOWN & OUTLET STORES, INC. Reports