EX-99.6 10 u56241exv99w6.htm EX-99.6 EX-99.6
Exhibit 99(6)
CANARGO ENERGY CORPORATION
NOMINEE HOLDER CERTIFICATION
     The undersigned, a bank, broker, dealer or other nominee holder of rights (“Rights”) to purchase shares of common stock (“Common Stock”) of CanArgo Energy Corporation (the “Company”), pursuant to the Rights Offering described and provided for in the Company’s accompanying prospectus (the “Prospectus”), hereby certifies to the Company and to Computershare, as U.S. Subscription Agent for the Rights Offering, that the undersigned has subscribed for, on behalf of beneficial owners of Rights (which may include the undersigned), the number of shares of Common Stock specified below, upon the terms and conditions described in the Prospectus (without identifying any such beneficial owner):
             
    Number of Shares of       Number of Shares of
Beneficial   Common Stock Owned       Common Stock Elected
Holder of   on the Record Date,   Total Rights   to Purchase Upon
Rights   if any   Exercised   Exercise of Rights
 
           
1.
 
 
 
 
 
 
 
           
2.
 
 
 
 
 
 
 
           
3.
 
 
 
 
 
 
 
           
4.
 
 
 
 
 
 
 
           
5.
 
 
 
 
 
 
 
           
6.
 
 
 
 
 
 
 
           
7.
 
 
 
 
 
 
 
           
8.
 
 
 
 
 
 
 
           
9.
 
 
 
 
 
 
 
           
10.
 
 
 
 
 
 
Provide the following information if applicable:
 
Depository Trust Company (“DTC”)
Participant Number
 
DTC Participant Name
 
DTC Subscription Confirmation Number(s)
 
 
 
Name and Address of Nominee Holder
             
 
  By:        
 
  Name:  
 
   
 
  Title:        
Dated: _______________________, 2008