Exhibit 99.6
CITIZENS INDEPENDENT BANCORP, INC.
NOMINEE HOLDER CERTIFICATION
The undersigned, a broker, custodian bank, trustee, depository or other nominee holder of subscription rights (the “Subscription Rights”) to purchase common shares, without par value per share (“Common Shares”) of Citizens Independent Bancorp, Inc. (the “Company”) pursuant to the rights offering (the “Rights Offering”) described and provided for in the Company’s registration statement on Form S-1, and final prospectus dated _____________, 2013 (the “Prospectus”), hereby certifies to the Company and Registrar and Transfer Company, as subscription agent of the 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 privilege and on behalf of beneficial owners of Subscription Rights who have subscribed for the purchase of additional Common Shares pursuant to the over-subscription privilege, listing separately below each such exercised basic subscription privilege and the corresponding over-subscription privilege (without identifying any such beneficial owners), and (2) each such beneficial owner’s basic subscription privilege has been exercised in full if shares are subscribed for pursuant to the over-subscription privilege:
| Number of Common Shares Owned on the Record Date | Rights Exercised Pursuant to Basic Subscription Privilege | Number of Shares Subscribed for Pursuant to the Over-Subscription Privilege | ||
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Provide the following information, if applicable:
| Depository Trust Company (“DTC”) Participant Number | |
| Participant Name |
| DTC Basic Subscription Confirmation Number(s) |
| Name of Broker, Custodian Bank, Trustee, Depository or Other Nominee |
| By: | ||
| Name: | ||
| Title: |