TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (California BanCorp)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp MidWestOne Financial Group, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to the Securities Exchange Act of 1934, as amended (the “Exchange Act”) Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ ¨ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp German American Bancorp, Inc., referred to in the within-mentioned Indenture: U.S. Bank National Association, a national banking association, as Trustee By: Name: Name Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;:
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp First Northwest Bancorp referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (First Northwest Bancorp)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Bridgewater Bancshares, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Shore Bancshares, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: ____________________________ Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ ¨ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (Shore Bancshares Inc)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp County Bancorp, Inc. referred to in the within-mentioned Indenture: U.S. BANK NATIONAL ASSOCIATION as Trustee By: Name: Name Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (County Bancorp, Inc.)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Financial Institutions, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Authorized Signatory Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired 1)acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Peapack-Gladstone Financial Corporation referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Southside Bancshares, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ ¨ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (Southside Bancshares Inc)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Midland States Bancorp, Inc., referred to in the within-mentioned Indenture: a national banking association, as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ ¨ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp Southside Bancshares, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ ¨ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (Southside Bancshares Inc)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of California BanCorp County Bancorp, Inc. referred to in the within-mentioned Indenture: as Trustee By: Name: Title: Dated: To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbroker’sstockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;
Appears in 1 contract
Sources: Indenture (County Bancorp, Inc.)