Citizens Independent Bancorp, Inc. - FORM S-1/A - EX-99.6 - EXHIBIT 99.6 - October 22, 2013

Attached files

file filename
S-1/A - FORM S-1/A - Citizens Independent Bancorp, Inc.v357460_s1a.htm
EX-5 - EXHIBIT 5 - Citizens Independent Bancorp, Inc.v357460_ex5.htm
EX-4.3 - EXHIBIT 4.3 - Citizens Independent Bancorp, Inc.v357460_ex4-3.htm
EX-4.2 - EXHIBIT 4.2 - Citizens Independent Bancorp, Inc.v357460_ex4-2.htm
EX-3.1 - EXHIBIT 3.1 - Citizens Independent Bancorp, Inc.v357460_ex3-1.htm
EX-99.4 - EXHIBIT 99.4 - Citizens Independent Bancorp, Inc.v357460_ex99-4.htm
EX-99.3 - EXHIBIT 99.3 - Citizens Independent Bancorp, Inc.v357460_ex99-3.htm
EX-99.5 - EXHIBIT 99.5 - Citizens Independent Bancorp, Inc.v357460_ex99-5.htm
EX-99.8 - EXHIBIT 99.8 - Citizens Independent Bancorp, Inc.v357460_ex99-8.htm
EX-99.7 - EXHIBIT 99.7 - Citizens Independent Bancorp, Inc.v357460_ex99-7.htm
EX-99.2 - EXHIBIT 99.2. - Citizens Independent Bancorp, Inc.v357460_ex99-2.htm
EX-1.1 - SUBSCRIPTION/ESCROW AGENT AGREEMENT - Citizens Independent Bancorp, Inc.v357460_ex1-1.htm
EX-99.1 - EXHIBIT 99.1 - Citizens Independent Bancorp, Inc.v357460_ex99-1.htm
EX-23.1 - CONSENT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM - Citizens Independent Bancorp, Inc.v357460_ex23-1.htm

Exhibit 99.6

 

CITIZENS INDEPENDENT BANCORP, INC.

NOMINEE HOLDER CERTIFICATION

 

The undersigned, a broker, custodian bank, trustee, depository or other nominee holder of subscription rights (the “Subscription Rights”) to purchase common shares, without par value per share (“Common Shares”) of Citizens Independent Bancorp, Inc. (the “Company”) pursuant to the rights offering (the “Rights Offering”) described and provided for in the Company’s registration statement on Form S-1, and final prospectus dated _____________, 2013 (the “Prospectus”), hereby certifies to the Company and Registrar and Transfer Company, as subscription agent of the Rights Offering, that (1) the undersigned has exercised, on behalf of the beneficial owners thereof (which may include the undersigned), the number of Subscription Rights specified below pursuant to the basic subscription privilege and on behalf of beneficial owners of Subscription Rights who have subscribed for the purchase of additional Common Shares pursuant to the over-subscription privilege, listing separately below each such exercised basic subscription privilege and the corresponding over-subscription privilege (without identifying any such beneficial owners), and (2) each such beneficial owner’s basic subscription privilege has been exercised in full if shares are subscribed for pursuant to the over-subscription privilege:

 

Number of
Common Shares Owned on the
Record Date		   Rights Exercised
Pursuant to Basic
Subscription Privilege		   Number of Shares
Subscribed for Pursuant
to the Over-Subscription
Privilege
     
1.        
         
2.        
         
3.        
         
4.        
         
5.        
         
6.        
         
7.        
         
8.        
         
9.        
         
10.        

 

Provide the following information, if applicable:

 

Depository Trust Company (“DTC”) Participant Number  
   
Participant Name  

  

DTC Basic Subscription Confirmation Number(s)  

 

 
 
Name of Broker, Custodian Bank, Trustee, Depository or Other Nominee  

 

By:    
     
Name:    
     
Title:    

 

 

Citizens Independent Bancorp, Inc. Reports