Exhibit 99.5
The undersigned, a bank, custodian bank or other nominee holder (the Nominee Holder) of rights (the Subscription Rights) to purchase shares of common stock, par value $0.0001 per share (the Shares) of THE ONE GROUP HOSPITALITY, INC. (the Company), pursuant to the rights offering described in the Companys prospectus, dated January 19, 2016 (the Prospectus Supplement), hereby certifies to the Company and Continental Stock Transfer & Trust Company, as subscription agent for the rights offering, that the undersigned has exercised, on behalf of the beneficial owners thereof (which may include the undersigned), the Subscription Rights to subscribe for the number of Shares specified below under the basic subscription right, and on behalf of beneficial owners of Subscription Rights who have exercised their basic subscription rights in full, requests to subscribe for the number of additional Shares specified below pursuant to the oversubscription right, the terms of which are described further in the Prospectus Supplement, listing separately each exercised basic subscription right and any corresponding oversubscription right as to each beneficial owner (without identifying any such beneficial owner) for whom the Nominee Holder is acting hereby:
NUMBER OF SHARES OWNED ON RECORD DATE |
NUMBER OF SHARES SUBSCRIBED FOR PURSUANT TO BASIC SUBSCRIPTION RIGHT |
NUMBER OF SHARES SUBSCRIBED FOR PURSUANT TO OVERSUBSCRIPTION RIGHT |
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Name of Broker, Custodian Bank or Other Nominee |
By: | Authorized Signature |
Name: | (please type or print) |
Provide the following information if applicable:
Depository Trust Company (DTC) Participant Number |
Participant |
By: | |
Name: | |
Title: | |
DTC Subscription Confirmation Numbers