TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial Institutions, Inc. referred to in the within-mentioned Indenture: as Trustee By: 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 for the undersigned’s own account, without transfer;
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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsCivista Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (Civista Bancshares, Inc.)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of MidWestOne Financial InstitutionsGroup, Inc. referred to in the within-mentioned Indenture: as Trustee ByName: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsMidland States Bancorp, Inc. Inc., referred to in the within-mentioned Indenture: a national banking association, as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial Institutions, Inc. First Northwest Bancorp referred to in the within-mentioned Indenture: as Trustee By: Authorized Signatory _________________________________ 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (First Northwest Bancorp)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsGerman American Bancorp, Inc. Inc., referred to in the within-mentioned Indenture: U.S. Bank National Association, a national banking association, as Trustee ByName 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’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;:
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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsCounty Bancorp, Inc. referred to in the within-mentioned Indenture: as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (County Bancorp, Inc.)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial Institutions, Inc. First Northwest Bancorp referred to in the within-mentioned Indenture: as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (First Northwest Bancorp)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsSouthside Bancshares, Inc. referred to in the within-mentioned Indenture: as Trustee ByName: Authorized Signatory DatedTitle: 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;
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Samples: Indenture (Southside Bancshares Inc)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial Institutions, Inc. California BanCorp referred to in the within-mentioned Indenture: as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (California BanCorp)
TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Peapack-Gladstone Financial Institutions, Inc. Corporation referred to in the within-mentioned Indenture: as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Financial InstitutionsCounty Bancorp, Inc. referred to in the within-mentioned Indenture: U.S. BANK NATIONAL ASSOCIATION as Trustee By: Authorized Signatory 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 1) acquired for the undersigned’s own account, without transfer;
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Samples: Indenture (County Bancorp, Inc.)