Exhibit 99.5
STOCK ORDER FORM | For Internal Use Only
| |||||
| BATCH # ORDER # CATEGORY #
REC’D O C
| |||||
| ||||||
ORDER DEADLINE & DELIVERY: A Stock Order Form, properly completed and with full payment, must be received (not postmarked) before 2:00 p.m., Eastern time, on December , 2022. Subscription rights will become void after the deadline. Stock Order Forms can be delivered by using the enclosed Stock Order Reply Envelope, by paying for overnight delivery to the Stock Information Center address on this form or by hand-delivery to First Seacoast Bank’s main office located at 633 Central Avenue, Dover, New Hampshire. Hand-delivered stock order forms will only be accepted at this location. You may not deliver this form to our other First Seacoast Bank offices. Do not mail Stock Order Forms to First Seacoast Bank. Faxes or copies of this form are not required to be accepted.
| ||||||
SEND OVERNIGHT PACKAGES TO: Stock Information Center c/o Keefe, Bruyette & Woods 18 Columbia Turnpike, Suite 100 Florham Park, NJ 07932 Call us toll-free, at 1-(877) - |
PLEASE PRINT CLEARLY AND COMPLETE ALL APPLICABLE SHADED AREAS. READ THE ENCLOSED STOCK ORDER FORM INSTRUCTIONS (BLUE SHEET) AS YOU COMPLETE THIS FORM. | ||||||||||||||||||||
(1) NUMBER OF SHARES | SUBSCRIPTION PRICE PER SHARE | (2) TOTAL PAYMENT DUE | (4) METHOD OF PAYMENT – DEPOSIT ACCOUNT WITHDRAWAL The undersigned authorizes withdrawal from the First Seacoast Bank deposit account(s) listed below. There will be no early withdrawal penalty applicable for funds authorized on this form. Funds designated for withdrawal must be in the listed account(s) at the time this form is received. IRA and other retirement accounts held at First Seacoast Bank and accounts with check-writing privileges may NOT be listed for direct withdrawal below.
| |||||||||||||||||
x $10.00 = | $ .00 | |||||||||||||||||||
Minimum Number of Shares: 25 ($250). Maximum Number of Shares: 40,000 ($400,000). See Stock Order Form Instructions for more information regarding maximum number of shares. | ||||||||||||||||||||
For Internal Use Only |
First Seacoast Bank Deposit Account Number |
Withdrawal Amount(s) | ||||||||||||||||||
(3) METHOD OF PAYMENT – CHECK OR MONEY ORDER | ||||||||||||||||||||
$ ..00 | ||||||||||||||||||||
Enclosed is a personal check, bank check or money order, from the purchaser, payable to First Seacoast Bancorp, Inc. in the amount of: | $ .00 | $ ..00 | ||||||||||||||||||
Cash, wire transfers and third party checks will not be accepted for this purchase. Checks and money orders will be cashed upon receipt. First Seacoast Bank line of credit checks may not be remitted as payment. | Total Withdrawal Amount | $ ..00 | ||||||||||||||||||
ATTACH A SEPARATE PAGE IF ADDITIONAL SPACE IS NEEDED. |
(5) PURCHASER INFORMATION | ACCOUNT INFORMATION – SUBSCRIPTION OFFERING | |||||||
Subscription Offering. Check the one box that applies, as of the earliest eligibility date, to the purchaser(s) listed in Section 9:
a. Depositors of First Seacoast Bank with aggregate balances of at least $50 at the close of business on June 30, 2021.
b. Depositors of First Seacoast Bank with aggregate balances of at least $50 at the close of business on September 30, 2022.
c. Depositors of First Seacoast Bank at the close of business on , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
CommunityOffering. If (a), (b) or (c) above do not apply to the purchaser(s) listed in Section 9, check the first box that applies to this order:
d. You are a resident of Rockingham or Strafford County in New Hampshire.
e. You are a public stockholder of First Seacoast Bancorp at the close of business on , 2022.
f. You are placing an order in the Community Offering, but (d) and (e) above do not apply. | If you checked box (a), (b) or (c) under ‘‘Subscription Offering,’’ please provide the following information as of the eligibility date under which purchaser(s) listed in Section 9 below qualify in the Subscription Offering: | |||||||
Account Title (Name(s) on Account) | First Seacoast Bank Account Number | |||||||
| ||||||||
| ||||||||
NOTE: NOT LISTING ALL ELIGIBLE ACCOUNTS, OR PROVIDING INCORRECT OR INCOMPLETE INFORMATION, COULD RESULT IN THE LOSS OF ALL OR PART OF ANY SHARE ALLOCATION. ATTACH A SEPARATE PAGE IF ADDITIONAL SPACE IS NEEDED.
| ||||||||
(6) MANAGEMENT Check if you are a First Seacoast Bank, First Seacoast Bancorp, Inc., First Seacoast Bancorp or First Seacoast Bancorp, MHC: | ||||||||
Director Officer Employee Immediate family member, as defined in the Stock Order Form Instructions
|
(7) MAXIMUM PURCHASER IDENTIFICATION | ||||||||||||
Check here if you, individually or together with others (see Section 8), are subscribing in the Subscription Offering for the maximum purchase allowed and are interested in purchasing more shares if the maximum purchase limitation(s) is/are increased. If you do not check the box, you will not be contacted and resolicited in the event the maximum purchase limitations are increased. | ||||||||||||
(8) ASSOCIATES/ACTING IN CONCERT | ||||||||||||
Check here if you, or any associate or persons acting in concert with you, have submitted other orders for shares in the Subscription Offering. If you check the box, list below all other orders submitted by you or your associates or by persons acting in concert with you. (This Section 8, including definitions used herein, is continued on reverse side of this form) | ||||||||||||
��Name(s) listed in Section 9 on other Stock Order Forms | Number of shares | Name(s) listed in Section 9 on other Stock Order Forms | Number of shares | |||||||||
(9) STOCK REGISTRATION The name(s) and address that you provide below will be reflected on your stock ownership statement, and will be used for other communications related to this order. Please PRINT clearly and use full first and last name(s), not initials. If purchasing in the Subscription Offering, you may not add the name(s) of persons/ entities who do not have subscription rights or who qualify only in a lower purchase priority than yours. See Stock Order Form Instructions for further guidance.
|
First Name, Middle Initial, Last Name | Reporting SSN/ Tax ID No. | |||||||||||
First Name, Middle Initial, Last Name | SSN/Tax ID No. | |||||||||||
Street | Daytime Phone # | |||||||||||
City | State | Zip | County (Important) | Evening Phone # | ||||||||
Individual | Tenants in Common | Uniform Transfers to Minors Act (for reporting SSN, use minor’s) | FOR TRUSTEE/BROKER USE ONLY: | |||||||||||||
Joint Tenants | Corporation | Partnership | Trust – Under Agreement Dated | Other | IRA (SSN of Beneficial Owner) - - |
(10) ACKNOWLEDGMENT AND SIGNATURE(S) | ||||||||||||
I understand that, to be effective, this form, properly completed, together with full payment, must be received before 2:00 p.m., Eastern time, on December , 2022, otherwise this form and all subscription rights will be void. (continued on reverse side of this form) | ||||||||||||
— ORDER NOT VALID UNLESS SIGNED — | ||||||||||||
ONE SIGNATURE REQUIRED, UNLESS SECTION 4 OF THIS FORM INCLUDES ACCOUNTS REQUIRING MORE THAN ONE SIGNATURE TO AUTHORIZE WITHDRAWAL. IF SIGNING AS A CUSTODIAN, TRUSTEE, CORPORATE OFFICER, ETC., PLEASE INCLUDE YOUR FULL TITLE. | ||||||||||||
|
| |||||||||||
Signature (title, if applicable) | Date | Signature (title, if applicable) | Date | |||||||||
(over)
STOCK ORDER FORM – SIDE 2
(8) ASSOCIATES/ACTING IN CONCERT (continued from front of Stock Order Form)
Associate – The term “associate” of a person means:
(1) | any corporation or organization (other than First Seacoast Bank, First Seacoast Bancorp, Inc., First Seacoast Bancorp or First Seacoast Bancorp, MHC or a majority-owned subsidiary of any of those entities) of which the person is a senior officer, partner or, directly or indirectly, 10% beneficial stockholder; |
(2) | any trust or other estate in which the person has a substantial beneficial interest or serves as a trustee or in a similar fiduciary capacity; provided, however, it does not include any employee stock benefit plan in which the person has a substantial beneficial interest or serves as trustee or in a similar fiduciary capacity; and |
(3) | any blood or marriage relative of the person, who either has the same home as the person or who is a director or officer of First Seacoast Bancorp or First Seacoast Bank. |
Acting in concert – The term “acting in concert” means:
(1) | knowing participation in a joint activity or interdependent conscious parallel action towards a common goal whether or not pursuant to an express agreement; or |
(2) | a combination or pooling of voting or other interests in the securities of an issuer for a common purpose pursuant to any contract, understanding, relationship, agreement or other arrangement, whether written or otherwise. |
A person or company that acts in concert with another person or company (“other party”) will also be deemed to be acting in concert with any person or company who is also acting in concert with that other party, except that any tax-qualified employee stock benefit plan will not be deemed to be acting in concert with its trustee or a person who serves in a similar capacity solely for the purpose of determining whether stock held by the trustee and common stock held by the employee stock benefit plan will be aggregated.
We have the sole discretion to determine whether prospective purchasers are “associates” or “acting in concert.” We may presume that certain persons are acting in concert based upon, among other things, joint account relationships or the fact that persons shares a common address (whether or not related by blood or marriage) or may have filed joint Schedules 13D or 13G with the Securities and Exchange Commission with respect to First Seacoast Bancorp or other companies. Our directors are not treated as associates of each other solely because of their membership on the board of directors.
Please see the Prospectus section entitled “The Conversion and Stock Offering – Additional Limitations on Common Stock Purchases” for more information on purchase limitations.
(10) ACKNOWLEDGMENT AND SIGNATURE(S) (continued from front of Stock Order Form)
I agree that, after receipt by First Seacoast Bancorp, Inc., this Stock Order Form may not be modified or canceled without First Seacoast Bancorp, Inc.’s consent, and that if withdrawal from a deposit account has been authorized, the authorized amount will not otherwise be available for withdrawal. Under penalty of perjury, I certify that (1) the Social Security or Tax ID information and all other information provided hereon are true, correct and complete, (2) I am purchasing shares solely for my own account and that there is no agreement or understanding regarding the sale or transfer of such shares, or my right to subscribe for shares, and (3) I am not subject to backup withholding tax [cross out (3) if you have been notified by the IRS that you are subject to backup withholding]. I acknowledge that my order does not conflict with the overall purchase limitation of $400,000 in all categories of the offering combined, for any person or entity, together with associates or persons acting in concert with such person or entity, as set forth in the plan of conversion and reorganization, and the Prospectus dated November , 2022.
Subscription rights pertain to those eligible to subscribe in the Subscription Offering. Subscription rights are only exercisable by completing and submitting a Stock Order Form, with full payment for the shares subscribed for. Federal regulations prohibit any person from transferring or entering into any agreement directly or indirectly to transfer the legal or beneficial ownership of subscription rights, or the underlying securities, to the account of another.
I ACKNOWLEDGE THAT THE SHARES OF COMMON STOCK ARE NOT DEPOSITS OR SAVINGS ACCOUNTS AND ARE NOT INSURED OR GUARANTEED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION OR ANY OTHER GOVERNMENTAL AGENCY.
If anyone asserts that the shares of common stock are federally insured or guaranteed, or are as safe as an insured deposit, I should call the Board of Governors of the Federal Reserve System at (202) 452-3000.
I further certify that, before subscribing for shares of the common stock of First Seacoast Bancorp, I received the Prospectus dated November , 2022, and I have read the terms and conditions described in the Prospectus, including disclosure concerning the nature of the security being offered and the risks involved in the investment, described by First Seacoast Bancorp, Inc. in the “Risk Factors” section, beginning on page . Risks include, but are not limited to the following:
Risks Related to Our Lending Activities
1. | We have a substantial amount of commercial real estate and commercial and industrial loans, and intend to continue to increase originations of these types of loans. These loans involve credit risks that could adversely affect our financial condition and results of operations. |
2. | If our allowance for loan losses is not sufficient to cover actual loan losses, our earnings could decrease. |
3. | We are subject to environmental liability risk associated with lending activities or properties we own. |
Risks Related to Market Interest Rates
4. | The reversal of the historically low interest rate environment may adversely affect our net interest income and profitability. |
5. | Changes in interest rates could reduce our profits and asset values. |
Risks Related to Economic Conditions
6. | Inflation can have an adverse impact on our business and on our customers. |
7. | A worsening of economic conditions in our market area could reduce demand for our products and services and/or result in increases in our level of non-performing loans, which could adversely affect our operations, financial condition and earnings. |
8. | We have a high concentration of loans secured by real estate in our market area. Adverse economic conditions, both generally and in our market area, could adversely affect our financial condition and results of operations. |
9. | A worsening of economic conditions could reduce demand for our products and services and/or increase our level of non-performing loans, which could adversely affect our financial condition and results of operations. |
Risks Related to the COVID-19 Pandemic
10. | The economic impact of the COVID-19 pandemic could adversely affect our financial condition and results of operations. |
Risks Related to Competitive Matters
11. | Our asset size and strong competition within our market area may limit our growth and profitability. |
Risks Related to Operational Matters
12. | We face significant operational risks because of our reliance on technology. Our information technology systems may be subject to failure, interruption or security breaches, and we recently experienced a security event. |
13. | We are a community bank and our ability to maintain our reputation is critical to the success of our business. The failure to do so may materially adversely affect our performance. |
14. | We depend on our management team to implement our business strategy and execute successful operations and we could be harmed by the loss of their services. |
Risks Related to Accounting Matters
15. | Changes in management’s estimates and assumptions may have a material impact on our consolidated financial statements and our financial condition or operating results. |
16. | Changes in accounting standards could affect reported earnings. |
Risks Related to Laws and Regulations
17. | Changes in laws and regulations and the cost of regulatory compliance with new laws and regulations may adversely affect our operations and/or increase our costs of operations. |
18. | Non-compliance with the USA PATRIOT Act, Bank Secrecy Act, or other laws and regulations could result in fines or sanctions. |
19. | Monetary policies and regulations of the Federal Reserve Board could adversely affect our business, financial condition and results of operations. |
20. | We are an emerging growth company, and any decision on our part to comply only with certain reduced reporting and disclosure requirements applicable to emerging growth companies could make our common stock less attractive to investors. |
21. | We are also a smaller reporting company, and even if we no longer qualify as an emerging growth company, any decision on our part to comply only with certain reduced reporting and disclosure requirements applicable to smaller reporting companies could make our common stock less attractive to investors. |
Risks Related to the Stock Offering
22. | We do not have strong earnings and will have a relatively high capital level after the completion of the conversion and stock offering. We expect our return on equity will be low following the stock offering, which could negatively affect the trading price of our shares of common stock. |
23. | The future price of our shares of common stock may be less than the $10.00 purchase price per share in the stock offering. |
24. | Our failure to effectively deploy the net proceeds may have an adverse effect on our financial performance. |
25. | Our stock-based benefit plans will increase our expenses and reduce our income. |
26. | The implementation of stock-based benefit plans may dilute your ownership interest. Historically, stockholders have approved these stock-based benefit plans. |
27. | We have not determined when we will adopt one or more new stock-based benefit plans. Stock-based benefit plans adopted more than 12 months following the completion of the conversion and stock offering may exceed regulatory restrictions on the size of stock-based benefit plans adopted within 12 months, which would further increase our costs. |
28. | Various factors may make takeover attempts more difficult to achieve. |
29. | Our articles of incorporation provide that, subject to limited exception, state and federal courts in the State of Maryland are the sole and exclusive forum for certain stockholder litigation matters, which could limit our stockholders’ ability to obtain a favorable judicial forum for disputes with us or our directors, officers, and other employees. |
30. | There may be a limited trading market in our shares of common stock, which would hinder your ability to sell our common stock and may lower the market price of our common stock. |
31. | You may not revoke your decision to purchase First Seacoast Bancorp, Inc. common stock in the subscription offering or any community offering after you send us your order. |
¬ See Front of Stock Order Form
FIRST SEACOAST BANCORP, INC.
STOCK INFORMATION CENTER: 1-(877) -
STOCK ORDER FORM INSTRUCTIONS – SIDE 1
Sections (1) and (2) – Number of Shares and Total Payment Due. Indicate the Number of Shares that you wish to subscribe for and the Total Payment Due. Calculate the Total Payment Due by multiplying the Number of Shares by the $10.00 price per share. The minimum purchase is 25 shares ($250). No individual, or individuals acting through a single qualifying account held jointly, may purchase more than 40,000 shares ($400,000). Additionally, no person or entity, together with associates or persons acting in concert with such person or entity, may purchase more than 40,000 shares ($400,000) of common stock in all categories of the offering combined.
Please see the Prospectus section entitled “The Conversion and Stock Offering – Additional Limitations on Common Stock Purchases” for more specific information. By signing this form, you are certifying that your order does not conflict with these purchase limitations.
Section (3) – Method of Payment – Check or Money Order. Payment may be made by including with this form a personal check, bank check or money order, from the purchaser, made payable to First Seacoast Bancorp, Inc. These will be deposited upon receipt. The funds remitted by personal check must be available within the account(s) when your Stock Order Form is received. Indicate the amount remitted. Interest will be calculated at % per annum from the date payment is processed until the offering is completed or terminated, at which time the subscriber will be issued a check for interest earned. Please do not remit cash, a First Seacoast Bank line of credit check, wire transfers or third party checks for this purchase.
Section (4) – Method of Payment – Deposit Account Withdrawal. Payment may be made by authorizing a direct withdrawal from your First Seacoast Bank deposit account(s). Indicate the account number(s) and the amount(s) you wish withdrawn. Attach a separate page, if necessary. Funds designated for withdrawal must be available within the account(s) at the time this Stock Order Form is received. Upon receipt of this order, we will place a hold on the amount(s) designated by you – the funds will be unavailable to you for withdrawal thereafter. The funds will continue to earn interest within the account at the contractual rate until the offering is completed. The interest will remain in the accounts when the designated withdrawal is made, at the completion or termination of the offering. There will be no early withdrawal penalty for withdrawal from a First Seacoast Bank certificate of deposit (CD) account. Note that you may NOT designate accounts with check-writing privileges. Please submit a check instead. If you request direct withdrawal from such accounts, we reserve the right to interpret that as your authorization to treat those funds as if we had received a check for the designated amount, and we will immediately withdraw the amount from your checking account(s). Additionally, you may not designate direct withdrawal from a First Seacoast Bank IRA or other retirement accounts. For guidance on using retirement funds, whether held at First Seacoast Bank or elsewhere, please contact the Stock Information Center as soon as possible – preferably at least two weeks before the December , 2022 offering deadline. See the Prospectus section entitled “The Conversion and Stock Offering – Procedure for Purchasing Shares in the Subscription and Community Offerings – Using Individual Retirement Account Funds.” Your ability to use retirement account funds to purchase shares cannot be guaranteed and depends on various factors, including timing constraints and the institution where those funds are currently held.
Section (5) – Purchaser Information. Please check the one box that applies to the purchaser(s) listed in Section 9 of this form. Purchase priorities in the Subscription Offering are based on eligibility dates. Boxes (a), (b) and (c) refer to the Subscription Offering. If you checked box (a) or (b), list all First Seacoast Bank deposit account numbers that the purchaser(s) had ownership in as of the applicable eligibility date. If you checked box (c), list all First Seacoast Bank deposit and/or applicable loan account numbers that the purchaser(s) had ownership in at the close of business on , 2022. Include all forms of account ownership (e.g. individual, joint, IRA, etc.). If purchasing shares for a minor, list only the minor’s eligible accounts. If purchasing shares for a corporation or partnership, list only that entity’s eligible accounts. Attach a separate page, if necessary. Failure to complete this section, or providing incorrect or incomplete information, could result in a loss of part or all of your share allocation in the event of an oversubscription. Boxes (d), (e) and (f) refer to the Community Offering. Orders placed in the Subscription Offering will take priority over orders placed in the Community Offering. See the Prospectus section entitled “The Conversion and Stock Offering” for further details about the Subscription and Community Offerings.
Section (6) – Management. Check the box if you are a First Seacoast Bank, First Seacoast Bancorp, Inc., First Seacoast Bancorp or First Seacoast Bancorp, MHC director, officer or employee, or a member of their immediate family.
Section (7) – Maximum Purchaser Identification. Check the box, if applicable. Failure to check the box will result in you not receiving notification in the event the maximum purchase limit(s) is/are increased. If you checked the box but have not subscribed for the maximum amount in the Subscription Offering, you will not receive this notification.
Section (8) – Associates/Acting in Concert. Check the box, if applicable, and provide the requested information. Attach a separate page if necessary.
Section (9) – Stock Registration. Clearly PRINT the name(s) in which you want the shares registered and the mailing address for all correspondence related to your order, including a stock ownership statement. Each Stock Order Form will generate one stock ownership statement, subject to the stock allocation provisions described in the Prospectus. IMPORTANT: Subscription rights are non-transferable. If placing an order in the Subscription Offering, you may not add the names of persons/entities who do not have subscription rights or who qualify only in a lower purchase priority than yours. A Social Security or Tax ID Number must be provided. The first number listed will be identified with the stock for tax reporting purposes. Listing at least one phone number is important in the event we need to contact you about this form. NOTE FOR FINRA MEMBERS: If you are a member of the Financial Industry Regulatory Authority (“FINRA”), or a person affiliated or associated with a FINRA member, you may have additional reporting requirements. Please report this subscription in writing to the applicable department of the FINRA member firm within one day of payment thereof.
FIRST SEACOAST BANCORP, INC.
STOCK INFORMATION CENTER: 1-(877) -
STOCK ORDER FORM INSTRUCTIONS – SIDE 1—(Continued)
Form of Stock Ownership. For reasons of clarity and standardization, the stock transfer industry has developed uniform stockholder registrations for issuance of stock ownership statements. Beneficiaries may not be named on stock registrations. If you have any questions about wills, estates, beneficiaries, etc., please consult your legal advisor. When registering stock, do not use two initials – use the full first name, middle initial and last name. Omit words that do not affect ownership such as “Dr.” or “Mrs.” Check the one box that applies.
Buying Stock Individually – Used when shares are registered in the name of only one owner. To qualify in the Subscription Offering, the individual named in Section 9 of the Stock Order Form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
Buying Stock Jointly – To qualify in the Subscription Offering, the persons named in Section 9 of the Stock Order Form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
Joint Tenants – Joint Tenancy (with Right of Survivorship) may be specified to identify two or more owners where ownership is intended to pass automatically to the surviving tenant(s). All owners must agree to the sale of shares.
Tenants in Common – May be specified to identify two or more owners where, upon the death of one co-tenant, ownership of the stock will be held by the surviving co-tenant(s) and by the heirs of the deceased co-tenant. All owners must agree to the sale of shares.
Buying Stock for a Minor – Shares may be held in the name of a custodian for a minor under the Uniform Transfer to Minors Act. To qualify in the Subscription Offering, the minor (not the custodian) named in Section 9 of the Stock Order Form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022.
The standard abbreviation for custodian is “CUST.” The Uniform Transfer to Minors Act is “UTMA.” Include the state abbreviation. For example, stock held by John Smith as custodian for Susan Smith under the NH Uniform Transfer to Minors Act, should be registered as John Smith CUST Susan Smith UTMA-NH (list only the minor’s social security number).
Buying Stock for a Corporation/Partnership – On the first name line indicate the name of the corporation or partnership and indicate the entity’s Tax ID Number for reporting purposes. To qualify in the Subscription Offering, the corporation or partnership named in Section 9 of the Stock Order Form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
Buying Stock in a Trust/Fiduciary Capacity – Indicate the name of the fiduciary and the capacity under which the fiduciary is acting (for example, “Executor”), or name of the trust, the trustees and the date of the trust. Indicate the Tax ID Number to be used for reporting purposes. To qualify in the Subscription Offering, the entity named in Section 9 of the Stock Order Form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
Buying Stock in a Self-Directed IRA (for trustee/broker use only) – Registration should reflect the custodian or trustee firm’s registration requirements. For example, on the first name line, indicate the name of the brokerage firm, followed by CUST or TRUSTEE. On the second name line, indicate the name of the beneficial owner (for example, “FBO JOHN SMITH IRA”). You can indicate an account number or other underlying information and the custodian or trustee firm’s address and department to which all correspondence should be mailed related to this order, including a stock ownership statement. Indicate the TAX ID Number under which the IRA account should be reported for tax purposes. To qualify in the Subscription Offering, the beneficial owner named in Section 9 of this form must have had an eligible deposit account at First Seacoast Bank at the close of business on June 30, 2021, September 30, 2022 or , 2022 or a borrower of First Seacoast Bank as of July 16, 2019 whose borrowings remained outstanding at the close of business on , 2022.
Section (10) – Acknowledgment and Signature(s). Sign and date the Stock Order Form where indicated. Before you sign, please carefully review the information you provided and read the acknowledgment. Verify that you have printed clearly and completed all applicable shaded areas on the Stock Order Form. Only one signature is required, unless any account listed in Section 4 requires more than one signature to authorize a withdrawal.
Please review the Prospectus carefully before making an investment decision. Deliver your completed original Stock Order Form, with full payment or deposit account withdrawal authorization, so that it is received (not postmarked) before 2:00 p.m., Eastern time, on December , 2022. Stock Order Forms can be delivered by using the enclosed postage paid Stock Order Reply Envelope, by paying for overnight delivery to the Stock Information Center address listed on the front of the Stock Order Form, or by hand-delivery to First Seacoast Bank’s main office located at 633 Central Avenue, Dover, New Hampshire. Hand-delivered stock order forms will only be accepted at this location. You may not deliver this form to our other First Seacoast Bank offices. Please do not mail Stock Order Forms to First Seacoast Bank. We are not required to accept Stock Order Forms that are found to be deficient or incorrect, or that do not include proper payment or the required signature. Faxes or copies of this form are not required to be accepted.
OVERNIGHT DELIVERY can be made to the Stock Information Center address listed on the front of the Stock Order Form.
QUESTIONS? Call our Stock Information Center, toll-free, at 1-(877) - , between 10:00 a.m. and 4:00 p.m., Eastern time, Monday through Friday. The Stock Information Center is not open on bank holidays.