Attached files
| file | filename |
|---|---|
| EX-99.8 - FORM OF SUBSCRIPTION RIGHTS STATEMENT - ON TRACK INNOVATIONS LTD | ea139571ex99-8_ontrackinno.htm |
| EX-99.7 - FORM OF NOTICE OF GUARANTEED DELIVERY - ON TRACK INNOVATIONS LTD | ea139571ex99-7_ontrackinno.htm |
| EX-99.6 - FORM OF NOMINEE HOLDER CERTIFICATION - ON TRACK INNOVATIONS LTD | ea139571ex99-6_ontrackinno.htm |
| EX-99.4 - FORM OF BROKER LETTER TO CLIENTS WHO ARE BENEFICIAL HOLDERS - ON TRACK INNOVATIONS LTD | ea139571ex99-4_ontrackinno.htm |
| EX-99.3 - FORM OF LETTER TO BROKERS, DEALERS, BANKS AND OTHER NOMINEES - ON TRACK INNOVATIONS LTD | ea139571ex99-3_ontrackinno.htm |
| EX-99.2 - FORM OF LETTER TO SHAREHOLDERS WHO ARE RECORD HOLDERS - ON TRACK INNOVATIONS LTD | ea139571ex99-2_ontrackinno.htm |
| EX-99.1 - FORM OF INSTRUCTIONS AS TO USE OF SUBSCRIPTION RIGHTS STATEMENTS - ON TRACK INNOVATIONS LTD | ea139571ex99-1_ontrackinno.htm |
| S-1/A - AMENDMENT NO. 1 TO FORM S-1 - ON TRACK INNOVATIONS LTD | ea139571-s1a1_ontrackinno.htm |
Exhibit 99.5
FORM OF
BENEFICIAL OWNER ELECTION FORM
ON TRACK INNOVATIONS, LTD.
The undersigned acknowledge(s) receipt of your letter and the enclosed materials referred to therein relating to the rights offering (the “Rights Offering”) by On Track Innovations, Ltd., an Israeli company (the “Company”), of non-transferable subscription rights (the “Subscription Rights”) to purchase ordinary shares (“Shares”) of the Company, NIS 0.10 par value (“Ordinary Shares”).
This will instruct you whether to exercise Subscription Rights to purchase Shares distributed with respect to the Ordinary Shares held by you for the account of the undersigned, pursuant to the terms and subject to the conditions set forth in the Prospectus. (Check the applicable boxes and provide all required information.)
☐ Please DO NOT EXERCISE SUBSCRIPTION RIGHTS for Shares.
☐ Please EXERCISE SUBSCRIPTION RIGHTS for Shares as set forth below:
| Per Share | ||||||
| No. of Shares | Subscription Price | Payment | ||||
| Basic Subscription Right | x | $ | 0.174 | $ | ||
| Over-Subscription Privilege | x | $ | 0.174 | $ | ||
| Total Payment Required | $ | |||||
If you spoke with a broker who solicited such exercise, please indicate the name of the person you spoke with: __________________
☐ Payment in the following amount is enclosed $ ________________ (must match Total Payment Required above)
☐ Please deduct payment from the following account maintained by you as follows:
Type of Account: _________________________________________________________________
Account Number: _________________________________________________________________
Amount to be deducted: ____________________________________________________________
I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, on under whose directions, I am (we are) signing this form:
| ● | Irrecovably elect to purchase the number of Shares indicated above upon the terms and conditions specified in the Prospectus; and |
| ● | Agree that if I (we) fail to pay for the Shares I (we) have elected to purchase, the exercise will be invalid. |
| Signature: | ||
| Name: | ||
| Title: | ||
| Address: | ||
| Telephone: | ||
| Date: | ____________________________, 2021 |