EX-99.5 14 d324057dex995.htm EXHIBIT 99.5 Exhibit 99.5

Exhibit 99.5



The undersigned acknowledge(s) receipt of your letter and the enclosed materials relating to the grant of non-transferable rights to purchase Shares (consisting of one share of common stock, par value $2.00 per share, and a warrant to purchase one (1) share of common stock for each five (5) Shares purchased in this offering), of New Peoples Bankshares, Inc. (the “Company”).

I (we) hereby instruct you as follows:


Box 1. ¨ Please DO NOT EXERCISE RIGHTS for Shares.

Box 2. ¨ Please EXERCISE RIGHTS for Shares as set forth below:


A. Number of Shares Being Purchased:





B. Total Exercise Price Payment Required:  



Payments should be made in U.S. Dollars and: (1) by personal check drawn on a U.S. Bank; (2) a bank check drawn on New Peoples Bank, Inc.; or (3) by wire transfer. Checks should be made payable to Registrar and Transfer Company – New Peoples Escrow. Wire instructions are attached.

Basic Subscription Right


I exercise                                                  rights   X   1.665    

(no. of Shares)

      (no. of your rights)

Therefore, I apply for                                         X   $        .00 =    


      (no. of Shares)

    (subscription price)                 (amount enclosed or wired)

Over-Subscription Privilege

If you fully exercise your Basic Subscription Right, and wish to subscribe for additional Shares up to the total number of unsubscribed Shares, you may exercise your Over-Subscription Privilege. The Over-Subscription Privilege is subject to the rights of other eligible shareholders. If sufficient Shares are available, the Company will seek to honor the over-subscription requests in full. If, however, over-subscription requests exceed the number of unsubscribed Shares, the Company will allocate the unsubscribed Shares among subscribers exercising their Over-Subscription Privilege by multiplying the number of Shares requested by each subscriber through the exercise of their Over-Subscription Privilege by a fraction that equals (x) the number of Shares available to be purchased through Over-Subscription Privileges divided by (y) the total number of Shares requested by all subscribers through the exercise of their Over-Subscription Privileges.

Accordingly, my maximum Over-Subscription Privilege is:







(total offered Shares)      (total no. of Shares subscribed for above)      (maximum unsubscribed Shares)

Therefore, I apply for:



    X                $1.50  


(no. of your over-subscription Shares subscribed for)           (subscription price)   (additional amount enclosed or wired)
Total Payment Required =       $                      

Box 3. ¨ Payment in the following amount is enclosed or wired.




(The total of the above Box 3 must equal the Total Payment Required.)

I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, or under whose directions, I am (we are) signing this form:



irrevocably elect to purchase the number of Shares indicated above upon the terms and conditions specified in the prospectus; and



agree that if I (we) fail to pay for the Shares I (we) have elected to purchase, the exercise will be invalid.


Name of beneficial owner(s):  






Signature of Beneficial Owner(s):  





If you arc signing in your capacity as a trustee, executor, administrator, guardian, attorney-in-fact, agent, officer of a corporation or another acting in a fiduciary or representative capacity, please provide the following information:








Address (including Zip Code):    





Telephone Number:  


Wiring Instructions:


For Benefit of:    Registrar and Transfer Company
   As Subscription Agent for Various Holders
Account Number:    276-053-5977
Bank:    TD Bank
   6000 Atrium Way
   Mt. Laurel, NJ 08054
ABA Number:    031-201-360