Attached files
| file | filename |
|---|---|
| EX-99.2 - EX-99.2 - Presbia PLC | d301790dex992.htm |
| EX-99.6 - EX-99.6 - Presbia PLC | d301790dex996.htm |
| EX-99.4 - EX-99.4 - Presbia PLC | d301790dex994.htm |
| EX-99.3 - EX-99.3 - Presbia PLC | d301790dex993.htm |
| EX-99.1 - EX-99.1 - Presbia PLC | d301790dex991.htm |
| EX-23.2 - EX-23.2 - Presbia PLC | d301790dex232.htm |
| EX-23.1 - EX-23.1 - Presbia PLC | d301790dex231.htm |
| EX-21.1 - EX-21.1 - Presbia PLC | d301790dex211.htm |
| EX-8.1 - EX-8.1 - Presbia PLC | d301790dex81.htm |
| EX-5.1 - EX-5.1 - Presbia PLC | d301790dex51.htm |
| EX-4.1 - EX-4.1 - Presbia PLC | d301790dex41.htm |
| S-1/A - S-1/A - Presbia PLC | d301790ds1a.htm |
Exhibit 99.5
FORM OF
NOMINEE HOLDER CERTIFICATION
PRESBIA PLC
The undersigned, a bank, broker, dealer, trustee, depositary, or other nominee of non-transferable subscription rights (the “Subscription Rights”) to purchase ordinary shares of Presbia PLC (the “Company”), pursuant to the Subscription Rights offering described and provided for in the Company’s Prospectus dated [•] [•], 2017, hereby certifies to the Company and to Computershare, 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 ordinary shares pursuant to the Over-Subscription Privilege (as defined in the Prospectus), the number of ordinary shares 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 ordinary shares pursuant to the Over-Subscription Privilege, each such beneficial owner’s Basic Subscription Right has been exercised in full:
| Number of Ordinary Shares Owned on the Record Date | Individual Soliciting Broker (if any) |
Number of Ordinary Shares Subscribed for Pursuant to the Basic Subscription Right |
Number of Ordinary Shares Subscribed for Pursuant to the Over-Subscription Privilege |
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| Name of Nominee Holder | ||
| By: | ||
| Name: | ||
| Title: | ||
| Phone Number: | ||
| Fax Number: | ||
| Dated: | ||
Provide the following information, if applicable:
| DTC Participate Number
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| DTC Participant | ||
| By: | ||
| Name: | ||
| Title: | ||
| DTC Bank Subscription Confirmation Number(s) | ||
| Date: | ||