Attached files

file filename
EX-99.7 - EXHIBIT 99.7 - Xtant Medical Holdings, Inc.v450880_ex99-7.htm
EX-99.5 - EXHIBIT 99.5 - Xtant Medical Holdings, Inc.v450880_ex99-5.htm
EX-99.4 - EXHIBIT 99.4 - Xtant Medical Holdings, Inc.v450880_ex99-4.htm
EX-99.3 - EXHIBIT 99.3 - Xtant Medical Holdings, Inc.v450880_ex99-3.htm
EX-99.2 - EXHIBIT 99.2 - Xtant Medical Holdings, Inc.v450880_ex99-2.htm
EX-99.1 - EXHIBIT 99.1 - Xtant Medical Holdings, Inc.v450880_ex99-1.htm
EX-23.1 - EXHIBIT 23.1 - Xtant Medical Holdings, Inc.v450880_ex23-1.htm
EX-5.1 - EXHIBIT 5.1 - Xtant Medical Holdings, Inc.v450880_ex5-1.htm
EX-4.10 - EXHIBIT 4.10 - Xtant Medical Holdings, Inc.v450880_ex4-10.htm
EX-4.9 - EXHIBIT 4.9 - Xtant Medical Holdings, Inc.v450880_ex4-9.htm
EX-4.8 - EXHIBIT 4.8 - Xtant Medical Holdings, Inc.v450880_ex4-8.htm
EX-4.7 - EXHIBIT 4.7 - Xtant Medical Holdings, Inc.v450880_ex4-7.htm
S-1/A - S-1/A - Xtant Medical Holdings, Inc.v450880_s1a.htm

 

Exhibit 99.6

 

FORM OF
NOMINEE HOLDER CERTIFICATION
XTANT MEDICAL HOLDINGS, INC.

 

The undersigned, a bank, broker, dealer, trustee, depositary, or other nominee of non-transferable subscription rights (the “Subscription Rights”) to purchase units (“Units”) of Xtant Medical Holdings, Inc. (the “Company”), said Units each comprised of one share of common stock (“Common Stock”) and one warrant to purchase an additional share of Common Stock, pursuant to the Subscription Rights offering described and provided for in the Company’s prospectus dated October , 2016, (the "Prospectus"), hereby certifies to the Company and to Corporate Stock Transfer, 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 Subscription Rights specified below pursuant to the Basic Subscription Right (as defined in the Prospectus) and, on behalf of beneficial owners of Subscription Rights who have subscribed for the purchase of additional Units pursuant to the Over-Subscription Privilege (as defined in the Prospectus), the number of Units specified below, 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 Units pursuant to the Over-Subscription Privilege, each such beneficial owner’s Basic Subscription Right has been exercised in full:

 

Number of Shares Owned on the Record Date   Individual
Soliciting
Broker (if any)
  Number of Units
Subscribed for
Pursuant to the
Basic Subscription Right
  Number of Units
Subscribed for
Pursuant to the
Over-Subscription Privilege
1.             
2.            
3.            
4.            
5.            
6.            
7.            
8.            

 

   
Name of Nominee Holder  

 

By:    

 

Name:    

 

Title:    

 

Phone Number:    

 

Fax Number:    

 

Dated:    

 

   

 

 

Provide the following information, if applicable:

 

   
DTC Participate Number  

 

   
DTC Participant  

 

By:    

 

Name:    

 

Title:    

 

   
DTC Bank Subscription Confirmation Number(s)  

 

Dated: