Golden Harvest Agro Industries LTD.: Application Form

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Golden Harvest Agro Industries LTD.: Application Form

ipo

Uploaded by

Md Shahjalal Sagor

We take content rights seriously. If you suspect this is your content, claim it here.

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Download as DOCX, PDF, TXT or read online on Scribd

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" T x r m F r T 1 1 1 k c 1 41 9j ,cf , 0 0 . .

\ 5 f f rc q _____________________ "Interested persons are entitled to a prospectus, be obtained from the issuer and the issue manager" if they so desire. Copies of prospectus may

APPLICATION FORM

GOLDEN HARVEST AGRO INDUSTRIES LTD.

APPLICATION FOR SHARES BY OTHER THAN NON-RESIDENT BANGLADESHIS Warning: Please read the instructions on the back of this form. Incorrectly filled Applications or Applications failing to comply with any of the instructions therein may be rejected
The Managing Director
Golden Harvest Agro Industries Ltd. Bankers SI. No. SPL Western Tower, Level 5, #501 & #502, 186 Gulshan, Tejgaon Link Road, Tejgaon, Dhaka- 1208, Bangladesh. Dear Sir, 300 I/we apply for and request you to allot me/us numbers of Shares and I/we agree to accept the same or any smaller number that may be allotted to me/us upon terms of the Company's Prospectus approved by the Securities and Exchange Commission subject to the Memorandum and Articles of Association of the Company. Further, I/we authorize you to place my/our name(s) on the Register of Member(s) of the Company and deposit the said ordinary shares in my Beneficiary Owner ("BO") account; I/we further authorize you to send a crossed (Account Payee only) cheque in respect of any Application money refundable to me/us by post/courier at my/our risk to the first applicant's address stated below.

1. No. of Shares 2.

300

of Tk. 10/- each including a premium of Tk. 15/- per share.

3. Beneficiary Owner (BO) A/C No.

(If you do not mention your valid BO A/C No. your application will be treated as invalid)
4. I/we agree to fully abide by the instructions given herein.

5. Particulars of Applicant: a) Sole/First Applicant Name:

Father's/Husband's Name: Mother's Name: Postal Address: Occupation: Nationality : BANGLADESHI

Telephone No. (If any):

For Refund Warrant: For Refund Warrant (Application will not be treated as valid if any one uses a non-scheduled bank to avoid this complication, investors are requested not to use the name of any non-schedule bank) please write the correct and full name of bank and branch. For refund purpose: I/we want refund through

Bank Account

Hand Delivery/Courier (please put tick mark in which refund will be made).

The applicant shall provide the same bank account number in the application form as it is in the BO account of the applicant.

Applicants Bank A/c no.

Name of the Bank: Branch

b) Second Applicant Name:

Father's/Husband's Name: Mother's Name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No. (If any): 6. I/we hereby declare that I/we have read the Prospectus of 'Golden Harvest Agro Industries Ltd.', and have willingly subscribed for 300 No. of Ordinary Shares of Tk. Tk. 10/- each including a premium of Tk. 15/- per share on this form. 7. Specimen Signature(s) : (i) Name (in Block Letters) Signeture (ii) Name (in Block Letters)

Signeture

*In case of deposit into the applicants' bank account, the applicant will bear the applicable service charge, if any, of the applicants' banker and the issuer shall simultaneously issue a letter of intimation to the applicant containing, among others, the date and amount remitted with details of the bank through and to which bank such remittance has been effected.

BANKER'S ACKNOWLEDGMENT.
Certified that this Bank has received Tk. (in figures ) 7,500/= (in word SEVEN THOUSAND FIVE HUNDRED ) only from Mr./Mrs./Ms..................................................... ....................................................................................................... being the Application money for 300 Ordinary Shares of Golden Harvest Agro Industries Ltd.