Attached files
| file | filename |
|---|---|
| EX-99.9 - EXHIBIT 99.9 - ClearSign Technologies Corp | v454544_ex99-9.htm |
| EX-99.8 - EXHIBIT 99.8 - ClearSign Technologies Corp | v454544_ex99-8.htm |
| EX-99.6 - EXHIBIT 99.6 - ClearSign Technologies Corp | v454544_ex99-6.htm |
| EX-99.5 - EXHIBIT 99.5 - ClearSign Technologies Corp | v454544_ex99-5.htm |
| EX-99.4 - EXHIBIT 99.4 - ClearSign Technologies Corp | v454544_ex99-4.htm |
| EX-99.3 - EXHIBIT 99.3 - ClearSign Technologies Corp | v454544_ex99-3.htm |
| EX-99.2 - EXHIBIT 99.2 - ClearSign Technologies Corp | v454544_ex99-2.htm |
| EX-99.1 - EXHIBIT 99.1 - ClearSign Technologies Corp | v454544_ex99-1.htm |
| EX-10.1 - EXHIBIT 10.1 - ClearSign Technologies Corp | v454544_ex10-1.htm |
| EX-5.1 - EXHIBIT 5.1 - ClearSign Technologies Corp | v454544_ex5-1.htm |
| EX-4.1 - EXHIBIT 4.1 - ClearSign Technologies Corp | v454544_ex4-1.htm |
| 8-K - 8-K - ClearSign Technologies Corp | v454544_8k.htm |
Exhibit 99.7
FORM OF
NOMINEE HOLDER CERTIFICATION
CLEARSIGN COMBUSTION CORPORATION
The undersigned, a bank, broker, dealer, trustee, depositary, or other nominee of non-transferable subscription rights (the “Subscription Rights”) to purchase units (“Units”) of ClearSign Combustion Corporation (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 (a “Warrant”) pursuant to the Subscription Rights offering described and provided for in the Company’s Prospectus Supplement dated December 7, 2016, hereby certifies to the Company and to VStock Transfer, LLC, as Subscription Agent for such Rights Offering, that the undersigned has exercised, on behalf of the beneficial owners thereof (which may include the undersigned), the number of Subscription Rights specified below, listing separately below each such exercise (without identifying any such beneficial owner):
| Number of Shares Owned on the Record Date |
Individual Soliciting Broker (if any) |
Number of Units Allowed |
Number of Units Subscribed For | |||
| 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: | ||
2