DCB FINANCIAL CORP - FORM S-1/A - EX-99.6 - FORM OF NOMINEE HOLDER CERTIFICATION - August 24, 2012

Attached files

file filename
S-1/A - PRE-EFFECTIVE AMENDMENT NO. 2 TO FORM S-1 - DCB FINANCIAL CORPd381336ds1a.htm
EX-4.2 - FORM OF RIGHTS CERTIFICATE - DCB FINANCIAL CORPd381336dex42.htm
EX-4.1 - SPECIMEN COMMON STOCK CERTIFICATE OF DCB FINANCIAL CORP - DCB FINANCIAL CORPd381336dex41.htm
EX-99.3 - FORM OF LETTER TO NOMINEE HOLDERS WHOSE CLIENTS ARE BENEFICIAL HOLDERS - DCB FINANCIAL CORPd381336dex993.htm
EX-99.8 - FORM OF LETTER TO PARTICIPANTS - DCB FINANCIAL CORPd381336dex998.htm
EX-99.4 - FORM OF LETTER TO CLIENTS OF NOMINEE HOLDERS - DCB FINANCIAL CORPd381336dex994.htm
EX-99.7 - FORM OF NOTICE OF IMPORTANT TAX INFORMATION - DCB FINANCIAL CORPd381336dex997.htm
EX-99.2 - FORM OF LETTER TO SHAREHOLDERS WHO ARE RECORD HOLDERS - DCB FINANCIAL CORPd381336dex992.htm
EX-99.5 - FORM OF BENEFICIAL OWNER ELECTION FORM - DCB FINANCIAL CORPd381336dex995.htm
EX-5.1 - OPINION OF VORYS, SATER, SEYMOUR AND PEASE LLP - DCB FINANCIAL CORPd381336dex51.htm
EX-99.1 - FORM OF INSTRUCTIONS AS TO USE OF SUBSCRIPTION RIGHTS CERTIFICATE - DCB FINANCIAL CORPd381336dex991.htm

Exhibit 99.6

DCB FINANCIAL CORP

UP TO 1,307,799 COMMON SHARES ISSUABLE UPON

EXERCISE OF SUBSCRIPTION RIGHTS

NOMINEE HOLDER CERTIFICATION

The undersigned, a bank, broker, trustee, depository or other nominee holder of rights (the “Subscription Rights”) to purchase common shares, no par value (“Common Shares”), of DCB Financial Corp (the “Company”), pursuant to the rights offering described in the Company’s prospectus dated             , 2012, (the “Prospectus”), hereby certifies to the Company and Broadridge Corporate Issuer Solutions, Inc., as subscription agent for the rights offering, that (1) the undersigned has exercised on behalf of the beneficial owners thereof (which may include the undersigned), the basic subscription right as to the number of Common Shares specified below on behalf of beneficial owners of Subscription Rights, (2) the undersigned has exercised on behalf of the beneficial owners thereof (which may include the undersigned), the over-subscription privilege as to the number of Common Shares specified below, applicable only to those beneficial owners who have fully exercised their basic subscription right, listing separately below for each beneficial owner the basic subscription right and any associated over- subscription privilege (without identifying any such beneficial owner) and (3) with respect to any exercise of the over-subscription privilege described in (2) above, each such beneficial owner’s basic subscription right has been exercised in full:

 

    

NUMBER OF

SHARES OWNED

ON RECORD DATE

   

NUMBER OF SHARES

SUBSCRIBED FOR

PURSUANT TO BASIC

SUBSCRIPTION

RIGHT

   

NUMBER OF SHARES

SUBSCRIBED FOR

PURSUANT TO OVER-

SUBSCRIPTION

PRIVILEGE

1.   

 

   

 

   

 

2.   

 

   

 

   

 

3.   

 

   

 

   

 

4.   

 

   

 

   

 

5.   

 

   

 

   

 

 

 

[Certification continues on the following page]

 

-1-

 

Name of Bank, Broker, Trustee, Depository or Other Nominee
By:  

 

  Authorized Signature
Name:  

 

  (please print or type)
Title:  

 

  (please print or type)
Provide the following information if applicable:

 

Depository Trust Company (“DTC”) participant number
Participant:                                                                  
By:  

 

  Signature                  
Name:  

 

  (please print or type)
Title:  

 

  (please print or type)

DTC Subscription Confirmation Numbers

 

-2-

Stock widget

Investing forum

DCB FINANCIAL CORP Reports

Also read