“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 MANAGER.”

Deshbandhu Polymer Limited

APPLICATION FORM
APPLICATION FOR SHARES BY INVESTORS OTHER THAN NON-RESIDENT BANGLADESHI (S)
Warning: Please read the instruction at the back of this form. Incorrectly filled application may be rejected.
The Managing Director
Deshbandhu Polymer Limited Banker’s Sl. No.
Mostafa Centre H#59, R#27, Banani, Dhaka - 1213

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 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. Ordinary shares ………. of Tk. 10 each.

2. Amount of Tk. (in figure): …………………., Taka (in words): ……………………………………………………
only deposited vide Cash/ Cheque/ draft/ pay Order
No…………………………………Dated……………………………..
on………………………………………………. Bank………………………………..Branch.
3. Depository (B/O) Account Number
(If you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as in valid)

4. I/we agree to fully abide by the instruction given herein.

5. Particulars of Applicant(s):
a) Sole/First Applicant
Name:
Father’s / Husband name:
Mother’s name:
Postal Address:
Occupation: Nationality: Telephone No.(if any):
For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank. To avoid this complication, investors are requested not to
use the name of any non-scheduled bank) Please write the correct and full name of bank and branch.
For refund purpose: I/we wants refund through □ Bank Account* □ Hand delivery/Courier (please put tick marks in which refund will be made). The applicant
shall provide with the same Bank Account number in the application form as it is in the BO account of the applicant. Otherwise the application will be
considered invalid and the subscription money may be forfeited.

Applicant’s Bank A/C No:

Name of the Bank: Branch:
b) Second Applicant
Name:
Father’s / Husband name:
Mother’s name:
Postal Address:
Occupation: Nationality: Telephone No.(If any):
6. I/we hereby declare that I/we have read the Prospectus of Deshbandhu Polymer Limited and have willingly subscribed for ……… no. of shares
of Tk 10.00 each.

7. Specimen Signature(s):
(i) Name ( in block letters): Signature:
(ii) Name ( in block letters): Signature:
*In case of deposit into the applicant’s bank account, the applicant will bear the applicable 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 ACKNOWLEDGEMENT
Certified that this Bank has received Tk. ………….……….….. (in word) ……………..…………………………………..
only form Mr./Mrs./Ms………………………..……………………………………being the application money for
…………..nos. of Ordinary Shares of Deshbandhu Polymer Limited.
Banker’s Sl. No. Seal and Date Authorized Signature
(Name & Designation)
 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 typed or written in full (in Block letters) in English or in Bengali and must not be abbreviated.
3. Application must be made on the Company’s printed form/photocopy or typed copy/hand written form thereof.
4. Application must not be for less than 500 Ordinary Shares and must be for a multiple of 500 Ordinary Shares. Any Application not meeting this criterion
will not be considered for allotment purpose.
5. Remittance for the full amount of the Shares must accompany each Application and must be forwarded to any of the Bankers to the Issue. Remittance
should be in the form of Cash/ Cheque/ Bank Draft/ Pay Order payable to one of the Bankers to the Issue A/C “Deshbandhu Polymer Limited” and crossed
“A/C Payee only” and must be drawn on a Bank in the same town as the Bank to which the Application form has been sent.
6. In the case of Joint Application Form, the Allotment Letter will be dispatched to the person whose name appears first on this Application Form.
7. Joint Application form for more than two persons will not be accepted. In case of joint Application, each party must sign the Application Form.
8. Application must be in full name of individuals or companies or societies or trusts and not in the name of firms, minors or persons of unsound mind.
Application from financial and market intermediary companies and Private Company must be accompanied by Memorandum and Articles of Association
and Certificate of Incorporation.
9. An applicant can not 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, all applications will be treated as invalid and will not be considered for allotment purpose. In addition, whole or part
of application money may be forfeited by the Commission.
10. No receipt will be issued for the payment made with Application, but the bankers will issue a provisional acknowledgment to the Issue for
Application lodged with them.
11. In the case of non-allotment of securities, if the applicant’s bank accounts as mentioned in their IPO Application Forms are maintained with the Bankers
to the Issue, refund amount of those applicants will be directly credited in to the respective bank account as mentioned in their IPO Application Forms.
Otherwise, refund will be made only through “Account Payee” cheque(s) showing bank account number and name of bank and branch as mentioned in the
Application payable at Dhaka or Chittagong, as the case may be.
12. Allotment will be made solely in accordance with the instructions of the Securities and Exchange Commission (SEC).
13. 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.
14. Applications, which do not meet the above requirements, or applications, which are incomplete, shall not be considered for allotment purpose.
15. The Banker’s to the Issue Banks shall be obliged to receive the A/C Payee Cheque(s) on the closing day of the subscription of the IPO.
16. No sale of securities shall be made, nor shall any money be taken from any person, in connection with such sale until 25(twenty five) days after the
prospectus has been published.

BANKERS TO THE ISSUE

Name of the Branches
Investment Corporation
Of Bangladesh (ICB)
Head Office, Br, Dhaka
Chittagong Br, Ctg
Rajshahi Br, Rajshahi
Khulna Br, Khulna
Barisal Br, Barishal
Sylhet Br, Sylhet
Bogra Br, Bogra
Local Office, Dhaka
Southeast Bank Ltd
Principal Br, Dhaka
Corporate Br, Dhaka
Imamgonj Br, Dhaka
Dhanmondi Br, Dhaka
Uttara Branch, Dhaka
N. Elephant Rd Br, Dhaka
Kakrail Branch, Dhaka
Banani Branch, Dhaka
Bangshal Branch, Dhaka
New Eskaton Br, Dhaka
Agargaon Br, Dhaka
Pragati Sarani Br, Dhaka
Shamoli Branch, Dhaka
Sat Mosjid Br, Dhaka
Madhabdi Br, N.shingdi
Ashulia Branch, Dhaka
Narayanganj Br, N.ganj
Joypara Br, Dhaka
Savar Branch, Dhaka
Mouchak Branch, Dhaka
Konabari Br, Gazipur
Tongi Branch, Gazipur
Bashundhara Br, Dhaka
Mohammadpur Br, Dhaka
Madambibir Hat Br, Ctg
Comilla Branch, Comilla
Bandar Bazar Br, Sylhet
Moulavibazar Br, M. Bazar
Hatimgonj Br, Sylhet
Chouhatta Br, Sylhet
Laldighirpar Br, Sylhet
Shajalal Uposhar Br, Sylhet
Kulaura Br, Moulvibazar
Pathantula Br, Sylhet
Agrabad Br, Ctg
Khatunganj Br, Ctg
Jublee Road Br, Ctg
Halishahar Br, Ctg
Chowmuhani Br, N.khali
CDA Avenue Br, Ctg
Cox’s Bazar Br, C. Bazar
Chhagalnaiya Br, Feni
Feni Branch, Feni
Pahartali Br, Ctg
Bashurhat Br, Noakhali
Momin Road Br, Ctg
Name of the Branches Name of the Branches
Rangpur Br, Rangpur Baraiyarhat Br, Ctg
Bogra Branch, Bogra Baralekha Br. Sylhet
Khulna Branch, Khulna Bogura Br, Bogura
Barisal Branch, Barisal Cakaria Br., Cox’s Bazar
Rajshahi Br, Rajshahi CEPZ Br., Chittagong
Naogaon Br, Naogoan Chowhatta Br., Sunamgonj
Chowmuhuni Br, Noakhali
Mercantile Bank Ltd. Comilla Br., Comilla
Dhanmondi Br, Dhaka Cox’s Bazar Br, Cox’s Bazar
Kawranbazar Br, Dhaka Dhanmondi Br, Dhaka
Agrabad Br, Ctg Dilkusha Br, Dhaka
Joypara Br, Dhaka Elephant Rd Br, Dhaka
Banani Br, Dhaka Foreign Ex. Br, Motijheel
Rajshahi Br, Rajshahi Feni Br, Feni
Naogaon Br, Naogoan Gulshan Br, Dhaka
Sylhet Br, Sylhet Gazipur Br, Gazipur
Board Bazar Br, Gazipur Hajigonj Br, Chandpur
Nayabazar Br, Dhaka Halishahar Br, Ctg
Khatunganj Br, Ctg Islampur Br, Dhaka
Mohakhali Br, Dhaka Jessore Br, Jessore
Mirpur Branch, Dhaka Joydebpur Br, Gazipur
Ashulia Branch, Dhaka Jatrabari Br, Dhaka
Uttara Branch, Dhaka Jubilee Rd Br, Ctg
Jubilee Rd Br, Ctg Kawran Bazar Br, Dhaka
Elephant Rd Br, Dhaka Khulna Br, Khulna
Motijheel Br, Dhaka Kushtia Br, Kushtia
Madam Bibir Hat Br, Ctg Kadamtali Br, Ctg
Khulna Branch, Khulna Khatungonj Br, Ctg
Rangpur Br, Rangpur Laxmipur Br, Laxmipur
Satmasjid Br, Dhaka Laldighirpar Br, Sylhet
OR Nazim Rd Br,, Ctg Majhirghat Br, Ctg
Bogra Branch, Bogra Motijheel Br, Dhaka
Konabari Br, Gazipur Malibagh Br, Dhaka
Gulshan Br, Dhaka Mogbazar Br, Dhaka
Feni Br, Feni Mirpur Br, Dhaka
Moulvibazar Br, M.Bazar Mitford Rd, Dhaka
Bijoynagar Br, Dhaka Madaripur Br, M.pur
Moghbazar Br, Dhaka Madabdi Br, Madabdi
Barisal Br, Barisal Naogaon, Naogoan
Comilla Br, Comilla Narayangonj Br, N.gonj
Greeen Rd Br, Dhaka Nawabpur Rd Br, Dhaka
Sheikh Mujib Rd Br, Ctg Patgram Br, Lalmonithat
Eng. Inst. Br, Dhaka Pragati Sharani Br, Dhaka
Mazar Road Br, Dhaka Rajshahi Br, Rajshahi
Dinajpur Br, Dinajpu Rangpur Br, Rangpur
Jessore Br, Jessore Savar Br, Dhaka
Pragati Sarani Br, Dhaka Shaymoli Br, Dhaka
Chittagong EPZ Br, Ctg Tangail Br, Tangail
Narayangonj Br, N.gonj Uttara Br, Dhaka
Patia Br. Chittagong
Bank Asia Limited
NCC Bank Limited Agrabad Br, Ctg
Agrabad Br, Ctg Anderkilla Br, Ctg
Anderkilla Br, Ctg Bashundhara Br, Dhaka
Banani Br, Banani Bogra Branch, Bogra
Babubazar Br, Dhaka Bahadderhat Br, Ctg
Bijoy Nagor Br, Dhaka Corporate Br, Noor Tower
Bangshal Br, Dhaka C.R. Dutta Road, Dhaka
Name of the Branches
CDA Avenue Br, Ctg
Dhanmondi Br, Dhaka
Jessore Branch, Jessore
Khatunganj Br, Ctg
Khulna Branch, Khulna
Moghbazar Br, Dhaka
Mohakhali Br, Dhaka
Mirpur Branch, Mirpur
MCB Sk. Mujib Rd Br, Ctg
MCB Dilkusha Br, Dhaka
MCB Banani Br, Dhaka
Mitford Branch, Dhaka
North South Rd Br, Dhaka
Principal Office Br, Dhaka
Rajshahi Br, Rajshahi
Sylhet Main Br, Sylhet
Sylhet Uposhahar Branch
Scotia Branch, Dhaka
Shantinagar Br, Dhaka
Station Road Br, Ctg
Gulshan Branch, Dhaka
Uttara Branch, Dhaka
One Bank Limited
Principal Br, Dhaka.
Motijheel Branch, Dhaka.
Kawran Bazar Br, Dhaka
Gulshan Branch, Dhaka
Mirpur Branch, Dhaka
Uttara Branch, Dhaka
Dhanmondi Br, Dhaka
Banani Branch, Dhaka.
Kakrail Branch, Dhaka
Pragati Sharani Br Badda
Elephant Road Br, Dhaka
Jatrabari Br, Jatrabari
Nawabganj Br, Dhaka
Bangshal Branch, Dhaka
Ganakbari (EPZ) Br, Dhaka.
Imamganj Branch, Dhaka.
Narayanganj Br, N.ganj
Joypara Branch, Dhaka
Agrabad Br, Ctg
Khatunganj Br, Ctg
CDA Avenue Br, Ctg
Nanupur Bazar Br, Ctg
Cox’s Bazar Br, Cox’s Bazar.
Jubille Road Br, Ctg
Chowmuhuni Br, Noakhali
Chandraganj Br, L.pur
Feni Branch, Feni
Raipur Branch, L.pur
Dagon Bhuiyan Br, Feni
Sylhet Branch, Sylhet
Sherpur Branch, Sherpur
Islampur Branch, sylhet
Jessore Branch, Jessore
Bogra Branch, Bogra
Name of the Branches Name of the Branches
Sirajgonj Br, sirajganj Sonagazi Br, Feni
Laksham Branch, comilla Goala Bazar Br, sylhet
Ramganj Branch, laxmipur Khatunganj Br, Ctg
Maijdee Court Br, Noakhali Mymenshing Br, M.hing
Banasree Br, Dhaka Shahzadpur Br, Sirajganj
Beani Bazar Br, Sylhet
DBBL Chhatak Br, sunamganj
Local Office, Dhaka Bandura Br, Dhaka
Motijheel For. Exch. Br Saidpur Br, Nilphamary
Nababpur Br, Dhaka Rangpur Br, Rangpur
Banani Branch, Dhaka Jessore Br, Jessore
Kawran Bazar Br, Dhaka Mirpur Br, Dhaka
Shantinagar Br, Dhaka Halishahar Br, Ctg
Dhanmondi Br, Dhaka Moulavi Bazar Branch
Baburhat Br, Narshingdi Basurhat Br, Noakhali
Narayanganj Br, N.ganj Sremangal Br, Sylhet
B.B Road Branch, N.gonj Kushtia Br, Kushtia
Agrabad Branch, Ctg Pabna Br, Pabna
Mohakhali Br, Dhaka. Narsingdi Br, Narsingdi
Gulshan Branch, Dhaka Satmosjid Rd Br, Dhaka
Mirpur Branch, Dhaka Dinajpur Br, Dinajpur
Uttara Branch, Dhaka Bhairab Br, Kishorgonj
Patherhat Br, Ctg Dagonbhuiyan Br, Feni
Hathazari Br, Ctg Gobindaganj Br, Gaibandha
Islampur Branch, Dhaka Bhulta Branch, N.gonj
Dania Branch, Dhaka BSCIC Branch, N.gonj
Khulna Branch, Khulna Rampura Branch, Dhaka
Sylhet Branch, Sylhet Tongi Branch, Gazipur
Dhaka EPZ Br, Dhaka
Board Bazar Br, Gazipur National Bank Ltd
Netaiganj Br, N.ganj Banani Br, Dhaka
Bogra Branch, Bogra Babubazar Br, Dhaka
Elephant Road Br, Dhaka Bangshal Road Br, Dhaka
Barisal Branch, Barisal Dhanmondi Br, Dhaka
Simrail Branch, N.ganj Dilkusha Br, Dhaka
CDA Avenue Br, Ctg Elephant Road Br, Dhaka
Joypara Branch, Dhaka Foreign Ex. Br, Dhaka
Biswanath Br, Sylhet Gulshan Br, Dhaka
Muradpur Branch, Ctg Imamganj Br, Dhaka
Golapgonj Br, Sylhet Islampur Br, Dhaka
Rajshahi Br, Rajshahi Jatrabari Br, Dhaka
Naya Bazar Br, Dhaka Kawran Bazar Br, Dhaka
Imamgonj Br, Dhaka Lake Circus Br, Dhaka
Savar Bazar Br, Dhaka Malibagh Br, Dhaka
Gazipur Chow Br, Gazipur Mirpur Br, Dhaka
Feni Branch, Feni Mohakhali Br, Dhaka
Comilla Br, Comilla Mohammadpur Br, Dhaka
Jubilee Road Br, Ctg Motijheel Branch, Dhaka
Kadamtali Branch, Ctg Narayanganj Br, N.gonj
Mirzapur Br, Tangail Netaigonj Br, N.gonj
Cox’s Bazar Br, C. Bazar New Eskaton Br, Dhaka
Lohagara Br, Ctg N. Brk Hall Rd Br, Dhaka
Basundhara Br, Dhaka Prgati Sarani Br, Dhaka
Ring Road Br, Dhaka Rokeya Sarani Br, Dhaka
Manikgonj Br, Manikgonj Savar Bazar Br, Dhaka
Fatikchori Br, Ctg Uttara Branch, Dhaka
Konabari Br, Gazipur Z.H Sikder Br, Dhaka
Choumuhani Br, Feni