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Proxy Card
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COLUMBIA FINANCIAL OF KENTUCKY, INC.
Conversion Center - Florence Branch Office
7550 Dixie Highway
Florence, Kentucky 41042
(606) 525-6403
STOCK ORDER FORM
________________________________________________________________________________
DEADLINE The Subscription Offering ends at 12:00 noon, Eastern Time, on March
xx, 1998. Your original Stock Order and Certification Form, properly executed
and with the correct payment, must be received (not postmarked) at the address
on the top of this form, or at any Columbia Federal Savings Bank Branch Office,
by this deadline, or it will be considered void. FAXES OR COPIES OF THIS FORM
WILL NOT BE ACCEPTED.
________________________________________________________________________________
The minimum number of shares that may be subscribed
(1) Number of Shares Price Per Share (2) Total Amount Due for is 25. The maximum individual subscription is
------------------- ----------------------- 15,000 shares. No person, together with associates
| | x $10.00 = | | of and persons acting in concert with such person
------------------- ----------------------- may purchase more than 30,000 shares of the
Common stock sold in the Conversion. There are
additional purchase limitations for associates
and groups acting in concert as defined in the
Prospectus.
_______________________________________________________________________________
METHOD OF PAYMENT
(3) / /Enclosed is a check, bank draft or money order payable to Columbia
Financial of Kentucky, Inc., for $_________________ .
(4)/ / I authorize Columbia Federal Savings Bank to make withdrawals from my
Columbia Federal Savings Bank certificate or savings account(s) shown
below, and understand that the amounts will not otherwise be available
for withdrawal:
ACCOUNT NUMBER(S) AMOUNT(S)
________________________________________________________________________________
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________________________________________________________|_______________________
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________________________________________________________|_______________________
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________________________________________________________|_______________________
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________________________________________________________|_______________________
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TOTAL WITHDRAWAL |_______________________
________________________________________________________________________________
(5)/ / Check here if you are a director, officer or employee of Columbia Federal
Savings Bank or a member of such person's immediate family.
(name household)
________________________________________________________________________________
(6)/ / ASSOCIATE - ACTING IN CONCERT
Check here, and complete the reverse side of this form, if you or any
associate or persons acting in concert with you have submitted other orders for
shares in the Subscription Offering.
________________________________________________________________________________
(7) PURCHASER INFORMATION (CHECK ONE)
a./ / Eligible Account Holder Check here if you were a depositor with $50.00 or
more on deposit with Columbia Federal Savings Bank as of 09/30/96. Enter
information below for all deposit accounts that you had at Columbia
Federal Savings Bank on 09/30/96.
b./ / Supplemental Eligible Account Holder - Check here if you were a depositor
with $50.00 or more on deposit with Columbia Federal Savings Bank as of
12/31/97 but are not an Eligible Account Holder. Enter information below
for all deposit accounts that you had at Columbia Federal Savings Bank on
12/31/97.
c./ / Other Member - Check here if you were a depositor of Columbia Federal
Savings Bank as of 01/31/98, but are not an Eligible Account Holder or a
Supplemental Eligible Account Holder or were a borrower of Columbia
Federal Savings Bank as of 1/31/98 whose loan was in existence on
12/16/95, but are not an Eligible Account Holder or a Supplemental
Eligible Account Holder. Enter information below for all deposit accounts
and/or loan accounts that you had at Columbia Federal Savings Bank on
1/31/98.
ACCOUNT TITLE (NAMES ON ACCOUNTS) AMOUNT NUMBER
________________________________________________________________________________
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___________________________________________|____________________________________
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___________________________________________|____________________________________
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___________________________________________|____________________________________
PLEASE NOTE FAILURE TO LIST ALL OF YOUR ACCOUNTS MAY RESULT IN THE LOSS OF PART
OR ALL OF YOUR SUBSCRIPTION RIGHTS. (additional space on back of form)
________________________________________________________________________________
(8) STOCK REGISTRATION - PLEASE PRINT LEGIBLY AND FILL OUT COMPLETELY
(Note: The Stock Certificate and all correspondence related to this stock
order will be mailed to the address provided below)
/ / Individual / / Uniform Transfer to Minors / / Partnership
/ / Joint Tenants / / Uniform Gift to Minors / / Individual Retirement Account
/ / Tenants in Common / / Corporation / / Fiduciary/Trust (Under Agreement Dated _________)
___________________________________________________________________________________________________________________________________
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Name |Social Security or Tax I.D.
___________________________________________________________________________________________|_______________________________________
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Name |Social Security or Tax I.D.
___________________________________________________________________________________________|_______________________________________
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Street |Daytime
Address |Telephone
___________________________________________________________________________________________|_______________________________________
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Zip |Evening
City State Code County |Telephone
___________________________________________________________________________________________|_______________________________________
________________________________________________________________________________
/ / NASD AFFILIATION (This section only applies to those individuals who meet
the delineated criteria)
Check here if you are a member of the National Association of Securities
Dealers, Inc. ("NASD"), a person associated with an NASD member, a member of
the immediate person to whose support such person contributes, directly or
indirectly, or the holder of an account in which an NASD member or person
associated with an NASD member has a beneficial interest. To comply with
conditions under which an exemption from the NASD's Interpretation With Respect
to Free-Riding and Withholding is available, you agree, if you have checked the
NASD affiliation box: (1) not to sell, transfer or hypothecate the stock for a
period of three months following the issuance and (2) to report this
subscription in writing to the applicable NASD member within one day of the
payment therefor.
________________________________________________________________________________
ACKNOWLEDGMENT By signing below, I acknowledge receipt of the Prospectus dated
February xx, 1998 and understand I may not change or revoke my order once it is
received by Columbia Financial of Kentucky, Inc. I also certify that this stock
order is for my account and there is no agreement or understanding regarding any
further sale or transfer of these shares. Applicable regulations prohibit any
persons 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 person. Columbia Financial of
Kentucky Inc. will pursue any and all legal and equitable remedies in the event
it becomes aware of the transfer of subscription rights and will not honor
orders known by it to involve such transfer. Under penalties of perjury, I
further certify that: (1) the social security number or taxpayer identification
number given above is correct; and (2) I am not subject to backup withholding.
You must cross out this item, (2) above, if you have been notified by the
Internal Revenue Service that you are subject to backup withholding because of
under-reporting interest or dividends on your tax return. By signing below, I
also acknowledge that I have not waived any rights under the Securities Act of
1933 and the Securities Exchange Act of 1934.
SIGNATURE THIS FORM MUST BE SIGNED AND DATED TWICE: HERE AND ON THE
CERTIFICATION FORM. THIS ORDER IS NOT VALID IF THE STOCK ORDER FORM AND
CERTIFICATION FORM ARE NOT BOTH SIGNED. YOUR ORDER WILL BE FILLED IN
ACCORDANCE WITH THE PROVISIONS OF THE PROSPECTUS. An additional signature
is required only if payment is by withdrawal from an account that requires
more than one signature to withdraw funds.
________________________________________________________________________________
Signature Date
________________________________________________________________________________
Signature Date
________________________________________________________________________________
________________________________________________________________________________
FOR OFFICE Date Rec'd____/____/____ Check # ____________________
USE Amount $________________ Category ___________________
Batch # _________ - _____________Order # Deposit $___________________
________________________________________________________________________________
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COLUMBIA FINANCIAL OF KENTUCKY, INC.
________________________________________________________________________________
ITEM (6) CONTINUED; ASSOCIATE - ACTING IN CONCERT
ASSOCIATE LISTED ON NUMBER OF
OTHER STOCK ORDERS SHARES ORDERED
_______________________________________________________________________________________________
__________________________________________________|____________________________________________
__________________________________________________|____________________________________________
__________________________________________________|____________________________________________
ITEM (7) CONTINUED; PURCHASER INFORMATION
_______________________________________________________________________________________________
ACCOUNT TITLE (NAMES ON ACCOUNT) ACCOUNT NUMBER
_______________________________________________________________________________________________
______________________________________________|________________________________________________
______________________________________________|________________________________________________
______________________________________________|________________________________________________
______________________________________________|________________________________________________
________________________________________________________________________________
CERTIFICATION FORM
(This Certification Must Be Signed
In Addition to the Stock Order Form On Reverse Hereof)
I ACKNOWLEDGE THAT THE COMMON STOCK, NO PAR VALUE PER SHARE, OF COLUMBIA
FINANCIAL OF KENTUCKY, INC., ARE NOT A DEPOSIT OR AN ACCOUNT AND ARE NOT
FEDERALLY INSURED, OR GUARANTEED BY COLUMBIA FEDERAL SAVINGS BANK OR BY
THE FEDERAL GOVERNMENT.
If anyone asserts that the common stock are federally insured or
guaranteed, or are as safe as an insured deposit, I should call the Office of
Thrift Supervision Central Regional Director, Ronald N. Karr, at
(312) 917-5000.
I further certify that, before purchasing the common stock of Columbia
Financial of Kentucky, Inc., I received a copy of the Prospectus dated February
XX, 1998 which discloses the nature of the common shares being offered thereby
and describes the following risks involved in an investment in the common shares
under the heading "Risk Factors" beginning on page X of the Prospectus:
1. Low Return on Assets and Low Return on Equity
2. Reduction on Return on Equity Due to Proceeds of Offering
3. Competition in Market Area
4. Interest Rate Risk
5. Dilutive Effect and Expense of the ESOP, the Stock Option Plan and the
RRP
6. Limited Market for the Common Shares
7. Legislation and Regulation Which May Adversely Affect Columbia Federal's
Earnings and Operations
8. Anti-Takeover Provisions Which May Discourage Sales of Common Shares for
Premium Prices and Controlling Influence of Management
9. Risk of Delayed in Completion of the Offering
10. Dilutive Effect of Increase in Valuation Range
11. Possible Tax Liability Related to Subscription Rights
____________________________________ _____________________________________
Signature Date Signature Date
____________________________________ _____________________________________
(NOTE: IF STOCK IS TO BE HELD JOINTLY, BOTH PARTIES MUST SIGN)
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