Attached files
| file | filename |
|---|---|
| S-1/A - AMENDMENT #1 TO FORM S-1 - Carroll Bancorp, Inc. | d648640ds1a.htm |
| EX-5 - EXHIBIT 5 - Carroll Bancorp, Inc. | d648640dex5.htm |
| EX-4.2 - EXHBIT 4.2 - Carroll Bancorp, Inc. | d648640dex42.htm |
| EX-4.3 - EXHIBIT 4.3 - Carroll Bancorp, Inc. | d648640dex43.htm |
| EX-99.5 - EXHIBIT 99.5 - Carroll Bancorp, Inc. | d648640dex995.htm |
| EX-23.2 - EXHIBT 23.2 - Carroll Bancorp, Inc. | d648640dex232.htm |
| EX-99.4 - EXHIBIT 99.4 - Carroll Bancorp, Inc. | d648640dex994.htm |
| EX-99.3 - EXHIBIT 99.3 - Carroll Bancorp, Inc. | d648640dex993.htm |
| EX-99.1 - EXHIBIT 99.1 - Carroll Bancorp, Inc. | d648640dex991.htm |
| EX-99.2 - EXHIBIT 99.2 - Carroll Bancorp, Inc. | d648640dex992.htm |
Exhibit 99.6
FORM OF BENEFICIAL OWNER ELECTION FORM
The undersigned acknowledge(s) receipt of your letter and the enclosed materials relating to the grant of non-transferable subscription rights (“Subscription Rights”) to purchase units (the “Units”) consisting of one share of common stock, $0.01 par value per share (“Common Stock”), of Carroll Bancorp, Inc. (the “Company”) and a warrant to purchase one-half of a share of Common Stock, including the Company’s prospectus dated [—] (the “Prospectus”).
I (we) instruct you as follows:
(CHECK THE APPLICABLE BOXES AND PROVIDE ALL REQUIRED INFORMATION.)
Box 1: ¨ Please DO NOT EXERCISE SUBSCRIPTION RIGHTS for Units.
Box 2: ¨ Please EXERCISE SUBSCRIPTION RIGHTS for Units as set forth below:
| Number of Units Being Purchased (the sum of A and C below): |
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| Total Exercise Price Payment Required (the sum of B and D below): |
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Basic Subscription Right
I wish to exercise my full Basic Subscription Right or a portion thereof as follows:
| X | $[—] | = | $ | |||||
| No. of Units subscribed for under your Basic Subscription Right (A) |
(Subscription price) | Payment due under Basic Subscription Right (B) |
Over-Subscription Privilege
I have exercised my Basic Subscription Right in full and in addition to my Basic Subscription Right I wish to subscribe for additional Units under my Over-Subscription Privilege as follows:
| X | $[—] | = | $ | |||||
| No. of Units subscribed for under your Over-Subscription Privilege* (C) |
(Subscription price) | Payment due under Over- Subscription Privilege (D) |
| * | The maximum number of Units that you may subscribe for under your Over-Subscription Privilege is equal to [—] Units less the number of Units you subscribed for under your full Basic Subscription Right, subject to availability, pro ration and the limitations described in the Prospectus. |
| Box 3: ¨ Payment in the following amount is enclosed or has been/will be wired in accordance with the instructions set forth in the Prospectus: | $ | |||
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(The total of the above Box 3 must equal the Total Exercise Price Payment Required.)
I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, or under whose directions, I am (we are) signing this form:
| • | irrevocably elect to purchase the number of Units indicated above upon the terms and conditions specified in the Prospectus; and |
| • | agree that if I (we) fail to pay for the Units I (we) have elected to purchase, you may exercise any remedies available to you under law. |
| Name(s) of Beneficial Owner(s) |
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| Signature(s) of Beneficial Owners |
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| Date |
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| State(s) of Residence of Beneficial Owners |
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If you are signing in your capacity as a trustee, executor, administrator, guardian, attorney-in-fact, agent, officer of a corporation or another acting in a fiduciary or representative capacity, your signature must be Medallion Signature Guaranteed. Additionally, please provide the following information:
| Name: |
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| Capacity (full title): |
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| Address (including Zip Code): |
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| Telephone Number: |
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