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Interested Persons are entitled to a prospectus, if they so desire, and that copies of prospectus may be obtained from the issuer and the issue manger.

APPLICATION FORM

CITY GENERAL INSURANCE COMPANY LTD.

APPLICATION FOR SHARES BY NON-RESIDENT BANGLADESHI(S)
(TO BE SENT DIRECTLY TO THE COMPANY’S CORPORATE OFFICE)
Warning: Please read the instructions at the back of this form. Incorrectly filled applications or failing to comply with any of the instructions in there, applications may be rejected.

The Managing Director
City General Insurance Company Ltd.
Baitul Hossain Building (3rd floor),
27, Dilkusha C/A, Dhaka-1000.

Dear Sir,
I/we apply for and request you to allot me/us the ............................number of Shares and I/we agree to accept the same or any smaller number that may be allotted to me/us upon the terms of the Company’s approved Prospectus and 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 Members of the Company and deposit the said shares to my BO (Beneficiary Owner) Account and/or a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicant’s address stated below:

  1. No. of Ordinary Shares .......................................... of Tk 100 each at par.
  2. Amount of Tk (in figure)...............................................,  (in words)    ..................................................................................only
    3. Convertible into US Dollar 1.00 = Tk .................., UK Pound Sterling 1.00 = Tk. ..................., and Euro 1.00 = Tk ................
  3. Payment by Cheque/draft no. .............................  dated............................. for US Dollar or UK Pound Sterling or Euro or TK
    4. .............................. drawn on ..............................Bank...............................Branch.

    4. Depository (B/O) Account Number
                                   

(If you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid)

5. I/we fully agree to abide by the instructions given herein.

6. Particulars of Applicant(s):

a)   Sole/First Applicant  

  Name  
  Father’s/Husband’s name  
  Mother’s name  
  Mailing Address  
  Occupation   Nationality  
  Telephone (if any)      
  Passport No.   Valid up to  
  Date of Birth  
  For refund warrant: Applicant’s Bank A/C No:
  Name of the Bank   Branch  
a)     Second Applicant
  Name  
  Father’s/Husband’s name  
  Mother’s name  
  Mailing Address  
  Occupation   Nationality  
  Passport No.   Valid up to  
  Date of Birth  
      Nominee:
  Name  
  Mailing Address  
      Specimen Signature(s):
 
Name in Block Letters
Signature
  Sole/First Applicant:    
  Second Applicant:    
  Nominee:    
INSTRUCTIONS
  1. As per provision of Depository Act, 1999 and regulations made there under shares will only be issued in dematerialized Condition. Please mention your BO (Beneficiary Owner) Account number in the Application form. If you do not mention your valid BO (Beneficiary Owner) Account, your application will be treated as invalid.
  2. All information must be written or typed in block letters in English and must not be abbreviated.
  3. Application must not be for less than 50 Ordinary shares and must be for a multiple of 50 ordinary shares. Any application not meeting this criterion will not be considered for allotment purpose.
  4. An application must be accompanied by a foreign demand draft drawn on a bank payable at Dhaka or cheque drawn out of foreign currency deposit account maintained in Bangladesh for the full value of shares favoring “City General Insurance Company Ltd.” and crossed “ACCOUNT PAYEE ONLY”.
  5. An application shall be sent by the applicant directly to the Company within 19-08-2007 so as to reach the Company within 01-09-2007 No Applications sent after 19-08-2007 or received by the Company after 01-09-2007 will not be considered for allotment purpose.
  6. Refund against over-subscription shall be made in the currency in which the value of shares was paid for by the applicant through Account Payee cheque payable at Dhaka with bank account number, Bank’s name and Branch as indicated in the securities application form.
  7. All the applicants shall first be treated as applied for one minimum lot. If, on this basis, there is over subscription, then lottery shall be held amongst the applicants allocating one identification number for each application, irrespective of the application money. On the other hand, if there is under subscription, then all the applicants shall first be distributed with a single lot and thereafter, for the balance amount, lottery, shall be held for the applicants who have applied for multiple lots on the basis of dividing the application money by amount of a market lot separately for both NRB and general public.
  8. Money receipt of clearance of draft or cheque, as the case may be, shall be sent by post to the applicant by the Company.
  9. Joint application by two persons will be acceptable. In such a case, allotment or refund shall be made by post to the first applicant.
  10. Application must be made by an individual, a corporation or company, a trust or a society and not by a firm, minor or persons of unsound mind.
  11. Making of any false statement in the application or supplying of incorrect information therein or suppressing any relevant information shall make the Application liable to rejection and subject to forfeiture of application money and/or forfeiture of share (unit) before or after issuance of the same by the issuer. The said forfeited application money or share (unit) will be deposited in account specified by the Securities and Exchange Commission (SEC). This may be in addition to any other penalties as may be provided for by the law.
  12. The intending NRB applicants shall deposit share money by US ($) / UK Pound Sterling (£) / Euro (€) draft drawn on any Bank and payable in Dhaka, Bangladesh or through a nominee by paying out of foreign currency deposit account maintained in Bangladesh in Taka, supported by foreign currency encashment certificate issued by the concerned bank, so that the issuer’s collecting bank can clear the proceeds and deposit the same into issuer bank’s account in time.
  13. The spot buying rate (TT Clean) in US dollars, UK Pound Sterling and Euro of Sonali Bank as prevalent on the day opening of subscription opening will be applicable for the Non Resident Bangladeshi (NRB) applicants.
  14. The applicant shall furnish photocopies of relevant pages of valid passports in support of his being a NRB, duel citizenship or of the foreign passport bearing an endorsement from the concerned Bangladeshi Embassy to the effect that no visa is required for him to travel to Bangladesh.
  15. In case of joint NRB application joint applicant shall submit supporting papers/ documents in supported of their being an NRB as mentioned in para – 14 above.
  16. An applicant cannot submit more than two applications, one in his/her own name and another jointly with another person. In case an applicant makes more than two applications, entire application money will be forfeited by the Commission.
  17. No sale of securities shall be made, nor shall any money be taken from any person, in connection with such sale until twenty five days after the prospectus have been published.THE NRB APPLICATION ALONG WITH THE DRAFT, AS ABOVE, IS TO BE SUBMITTED TO THE COMPANY’S HEAD OFFICE DIRECTLY WITHIN THE STIPULATED TIME MENTIONED IN PARA 5.
  
Application for NRB
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