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 $1,000 principal amount notes ("Notes") of Fidelity Federal Bancorp (the "Company") pursuant to the Rights Offering described and provided for in the Company's prospectus dated __________, _____ (the "Prospectus"), hereby certifies to the Company that: (1) the undersigned has exercised the number of Rights specified below pursuant to the Basic Subscription Right (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 Subscription Right 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 Number of Notes Number of Notes Owned on the Record Subscribed Subscribed to Date Pursuant to Basic Pursuant to Subscription Right Over-Subscription Privilege ---------------------------------------------------------------- 1. ---------------------------------------------------------------- 2. ---------------------------------------------------------------- 3. ---------------------------------------------------------------- 4. ---------------------------------------------------------------- 5. ---------------------------------------------------------------- ------------------------------------------------------------ [Name of Bank, Broker, Trustee, Depositary or Other Nominee] By: ________________________ Name: ________________________ Title: ________________________