EX-99.6 12 ex99-6.txt Exhibit 99.6 ------------ FIDELITY FEDERAL BANCORP NOMINEE HOLDER CERTIFICATION The undersigned, a bank, broker, trustee, depositary or other nominee holder of subscription rights ("Rights") to purchase shares of common stock ("Common Stock") of Fidelity Federal Bancorp (the "Company") pursuant to the Rights Offering described and provided for in the Company's prospectus dated ________________, 2002 (the "Prospectus"), hereby certifies to the Company that: (1) the undersigned has exercised the number of Rights specified below pursuant to the Basic Subscription Privilege (as described in the Prospectus) and pursuant to the Over-Subscription Privilege (as described in the Prospectus), on behalf of beneficial owners of Rights listing separately below each such exercised Basic Subscription Privilege and the corresponding Over-Subscription Privilege (without identifying any such beneficial owner); and (2) each such beneficial owner's Basic Subscription Privilege has been exercised in full if it is exercising its Over-Subscription Privilege. -------------------------------------------------------------------------------- Number of Shares Owned Rights Exercised Pursuant Number of Shares Subscribed on The Record Date to Basic Subscription to Pursuant to Privilege Over-Subscription Privilege -------------------------------------------------------------------------------- 1. -------------------------------------------------------------------------------- 2. -------------------------------------------------------------------------------- 3. -------------------------------------------------------------------------------- 4. -------------------------------------------------------------------------------- 5. -------------------------------------------------------------------------------- --------------------------------------------------- [Name of Bank, Broker, Trustee, Depositary or Other Nominee] By: ________________________ Name: ________________________ Title: ________________________