IPO Full (all in one).docx

7/28/2019 IPO Full (all in one).docx

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Interested persons are entitled to a prospectus, if they so desire. Copies of prospectus may be obtained from the issuer and the issue manager

BENGAL WINDSOR THERMOPLASTICS LIMITEDAPPLICATION FORM

APPLICATION FOR SHARES BY OTHER THAN NON-RESIDENT BANGLADESHI(S)

(To be sent directly to the Companys Corporate Office)Warning: Please read the instructions on the back of this form. Incorrectly filled Applications may be rejected.

The Managing DirectorBengal Windsor Thermoplastics LimitedBengal House, 75 Gulshan Avenue, Gulshan 1, Dhaka 1212, Bangladesh

Dear Sir,I/we apply for and request you to allot me/us the 200 numbers of Shares and I/we agree to accept the same or any smaller number that maallotted to me/us upon terms of the Company's Prospectus approved by the Securities and Exchange Commission subject to the Memorandum and Articl

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 ordinary shares in my Beneficiary Owner ("BO") account; I/we further authorize you to send a crossed (Account Payee only) cheque in respect of Application money refundable to me/us by post/courier at my/our risk to the first applicant's address stated below:

1. No. of Ordinary Shares 200 of Tk 25/- each at par.2. Total subscription money of the amount of Tk. (in figures) 5000/- Taka (in words) Five Thousand only

Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... ............................................................................................................................................................................................................ ...................Bank................................................................................. Br

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(s):

a) Sole/First Applicant:

Name: MOST. SHAMSUN NAHAR

Father's/Husbands Name: LATE SHAMSUL HOQ

Mothers Name: SADIRON NESA

Postal Address: 47, SOUTH KAMLAPUR, DHAKA, 1217

Occupation: HOUSE WIFE Nationality: Bangladeshi Phone (if any): 01748566325

For Refund Warrant: Please write the correct and full name of bank and branch (Application will not be treated as valid if any one uses a non-schedul

bank. To avoid this complication, applicants are requested not to use the name of any non-scheduled bank).

For refund purpose: 1/we want refund through Bank Account Hand Delivery / Courier ( put tick mark in which refund will be madThe applicant shall provide the same Bank Account number in the application form as it is in the BO account of the applicant.

Applicant's Bank A/C No : 100024188

Name of the Bank : SONALI BANK LTD Branch : KAMLAPUR RAILWAY STATION

b) Second Applicant:

6. I/we hereby declare that I/we have read the Prospectus of

Bengal Windsor Thermoplastics Limited and have willi

subscribed for 200 No. of Ordinary Shares of Tk 25/- each at par.7. Specimen Signature(s):

(i) Name (in Block Letters) MOST. SHAMSUN NAHAR Signature :

(ii) Name (in Block Letters) Signature :

* 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 aof 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.

BANKERS ACKNOWLEDGEMENT

Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MOST. SHAMSUN NAHAR being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.

Authorized SignaBankers SL. No. Seal &Date (Name & Designa

1 2 0 3 5 7 0 0 4 6 4 0 8 5 5

Name :

Father's/Husbands Name :

Mothers Name :

Postal Address :

Occupation : Nationality: Phone (if any) :

Bankers SI. No.


2/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated..................................................................................................................................................................................................................................Bank................................................................................. Bran






Name: MOST. SHAMSUN NAHAR




Occupation: HOUSE WIFE Nationality: Bangladeshi Phone (if any): 01748566325




Applicant's Bank A/C No : 100024188

Name of the Bank : SONALI BANK LTD Branch : KAMLAPUR RAILWAY STATION





(i) Name (in Block Letters) MOST. SHAMSUN NAHAR Signature :

(ii) Name (in Block Letters) MST. MORIUM BEGUM Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a

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.


Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MOST. SHAMSUN NAHAR&MST. MORIUM BEGUM being the application money for 2nos. of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 4 0 9 1 3

Name: MST. MORIUM BEGUM

Father's/Husbands Name: MD. SHARIF MIAH

Mothers Name : LATE SAFIA BEGUM

Postal Address : _DO_

Occupation : HOUSE WIFE Nationality: Bangladeshi Phone (if any) :

Bankers SI. No.


3/24















Name: MD. SHAHJALAL SAGOR

Father's/Husbands Name: MD. ABDUL KAIYUM

Mothers Name: RINA BEGUM


Occupation: STUDENT Nationality: Bangladeshi Phone (if any) : 01717824691




Applicant's Bank A/C No : 118. 105. 62161

Name of the Bank : DUTCH BANGLA BANK LTD. Branch : ISLAMPUR





(i) Name (in Block Letters) MD. SHAHJALAL SAGOR Signature :




Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SHAHJALAL SAGOR being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 4 0 9 1 5

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


4/24















Name: MD. SHAHJALAL SAGOR

Father's/Husbands Name: MD. ABDUL KAIYUM

Mothers Name: RINA BEGUM






Applicant's Bank A/C No: 118. 105. 62161

Name of the Bank : DUTCH BANGLA BANK LTD. Branch : ISLAMPUR





(i) Name (in Block Letters) MD. SHAHJALAL SAGOR Signature :

(ii) Name (in Block Letters) MD. SHAHJAHAN SIRAJI Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SHAHJALAL SAGOR&MD. SHAHJAHAN SIRAJI being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 4 0 9 1 5

Name : MD. SHAHJAHAN SIRAJI

Father's/Husbands Name : ABDUR ROB HOWLADER

Mothers Name : ACHIA KHATUN


Occupation : SERVICE Nationality: Bangladeshi Phone (if any) :

Bankers SI. No.


5/24















Name: MD. NAZIR HOSSAIN

Father's/Husbands Name: LATE ANSAR ALI

Mothers Name: LATE SOBURON NESA


Occupation: SERVICE Nationality: Bangladeshi Phone (if any) : 01911384742




Applicant's Bank A/C No: 10002378-4

Name of the Bank : SONALI BANK LTD. Branch : KAMLAPUR ICD





(i) Name (in Block Letters) MD. NAZIR HOSSAIN Signature :


* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicantsbanker, and the issuer shall simultaneously issue aof 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.


Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. NAZIR HOSSAIN being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 5 3 7 3 0

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


6/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... ........................................................................................................................................................................................................... ...................Bank................................................................................. Br






Name: MD. NAZIR HOSSAIN

Father's/Husbands Name: LATE ANSAR ALI







Applicant's Bank A/C No: 10002378-4






(i) Name (in Block Letters) MD. NAZIR HOSSAIN Signature :

(ii) Name (in Block Letters) MST. NAZMA BEGUM Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, ofthe applicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. NAZIR HOSSAIN & MST. NAZMA BEGUM being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 5 3 7 3 1

Name: MST. NAZMA BEGUM

Father's/Husbands Name: MD. ANSAR ALI

Mothers Name: SOBURON NESA

Postal Address: _DO_


Bankers SI. No.


7/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated................................................................................................................................................................................................................ ...................Bank................................................................................. Bran






Name: MD. SAKIL HOSSAIN


Mothers Name: SAMSUN NAHAR







Name of the Bank : EASTERN BANK LTD. Branch : MOTIJHEEL





(i) Name (in Block Letters) MD. SAKIL HOSSAIN Signature :


* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue aof 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.


Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SAKIL HOSSAIN being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 5 3 7 3 2

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


8/24

Interestedpersons are entitled to a prospectus, if they so desire. Copies of prospectus may be obtained from the issuer and the issue manager



(Tobe sent directly to the Companys Corporate Office)Warning: Please read the instructions on the back of this form. Incorrectly filled Applications may be rejected.


Dear Sir,I/we apply for and request you to allot me/us the 200 numbers of Shares and I/we agree to accept the same or any smaller number that maallotted to me/us upon terms of the Company's Prospectus approved by the Securities and Exchange Commission subject to the Memorandum and Article



Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated...................................................................................................................................................................................................................................Bank................................................................................. B






Name: MD. SAKIL HOSSAIN









Name of the Bank : EASTERN BANK LTD. Branch : MOTIJHEEL





(i) Name (in Block Letters) MD. SAKIL HOSSAIN Signature :

(ii) Name (in Block Letters) MD. MANIK MIAH Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SAKIL HOSSAIN & MD. MANIK MIAH being the application money for 200 noordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 5 3 7 3 3

Name : MD. MANIK MIAH

Father's/Husbands Name : LATE TAHER MIAH

Mothers Name : MST. SALEHA BANU



Bankers SI. No.


9/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... ...............................................................................................................................................................................................................................Bank................................................................................. Bran






Name: MD. SAJIB HOSSAIN

Father's/Husbands Name: LATE MD. SHAMSUL HOQ



Occupation: BUSINESS Nationality: Bangladeshi Phone (if any) : 01923291572




Applicant's Bank A/C No: 100019826






(i) Name (in Block Letters) MD. SAJIB HOSSAIN Signature :




Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SAJIB HOSSAIN being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 4 0 8 5 4

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


10/24















Name: MD. SAJIB HOSSAIN

Father's/Husbands Name: LATE MD. SHAMSUL HOQ



Occupation: BUSINESS Nationality: Bangladeshi Phone (if any) : 01923291572










(i) Name (in Block Letters) MD. SAJIB HOSSAIN Signature :

(ii) Name (in Block Letters) MD. JAHANGIR HOSSAIN Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. SAJIB HOSSAIN & MD. JAHANGIR HOSSAIN being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 5 3 7 3 6

Name: MD. JAHANGIR HOSSAIN

Father's/Husbands Name: LATE KALA MIA

Mothers Name : LATE JOYNOB BIBI



Bankers SI. No.


11/24



APPLICATION FOR SHARES BY AFFECTED SMALL INVESTOR(S)












Name: MD. ANWAR HOSSAIN

Father's/Husbands Name: LATE MD. TURAB ALI

Mothers Name: MRS. SALEMAN KHATUN

Postal Address: M/S. MODHUMOTI ENTERPRISE, 44, DILKHUSHA C/A(3RD FLOOR), DHAKA, 1000






Name of the Bank : DUTCH BANGLA BANK LTD. Branch : FOREIGN EXCHANGE





(i) Name (in Block Letters) MD. ANWAR HOSSAIN Signature :

(ii) Name (in Block Letters) MST. ABEDA SULTANA Signature :* 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



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms MD. ANWAR HOSSAIN & MST. ABEDA SULTANA being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 1 1 8 8 6 5

Name : MST. ABEDA SULTANA

Father's/Husbands Name : MD. ANWAR HOSSAIN

Mothers Name : SURAYA KHATUN



Bankers SI. No.


12/24















Name: RAHANA AKTER

Father's/Husbands Name: MD. KHALILUR RAHMAN

Mothers Name: RAZIA KHATUN

Postal Address: 67/4 NORTH GOLAPBAG DHAKA, 1203






Name of the Bank : JANATA BANK LTD. Branch : WAPDA





(i) Name (in Block Letters) RAHANA AKTER Signature :


* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuershall simultaneously issue aof 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.


Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms RAHANA AKTER being the application money for 200 nos. of ordinary sharBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 2 7 9 6 8

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


13/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... ........................................................................................................................................................................................................... ...................Bank................................................................................. Br






Name: RAHANA AKTER

Father's/Husbands Name: MD. KHALILUR RAHMAN

Mothers Name: RAZIA KHATUN

Postal Address: 67/4 NORTH GOLAPBAG DHAKA, 1203






Name of the Bank : JANATA BANK LTD. Branch : WAPDA





(i) Name (in Block Letters) RAHANA AKTER Signature :

(ii) Name (in Block Letters) SHILA AKTER Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms RAHANA AKTER & SHILA AKTER being the application money for 200 noordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 2 7 9 6 9

Name: SHILA AKTER

Father's/Husbands Name: ALI AKBER MIA

Mothers Name: ASMA BEGUM

Postal Address: _DO_


Bankers SI. No.


14/24















Name: NIRJONA IRIN

Father's/Husbands Name: MD. SAKIL HOSSAIN

Mothers Name: RABEYA


Occupation: HOUSE WIFE Nationality: Bangladeshi Phone (if any) : 01674942296





Name of the Bank : SONALI BANK LTD. Branch : K. RAIL WAYSTATION





(i) Name (in Block Letters) NIRJONA IRIN Signature :




Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms NIRJONA IRIN being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 2 7 9 7 2

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


15/24









Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... ...............................................................................................................................................................................................................................Bank................................................................................. Bran






Name: NIRJONA IRIN

Father's/Husbands Name: MD. SAKIL HOSSAIN

Mothers Name: RABEYA







Name of the Bank : SONALI BANK LTD. Branch : K. RAILWAY STATION





(i) Name (in Block Letters) NIRJONA IRIN Signature :

(ii) Name (in Block Letters) MST. BEAUTY BEGUM Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicantsbanker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms NIRJONA IRIN & MST. BEAUTY BEGUM being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 2 7 9 6 7

Name: MST. BEAUTY BEGUM

Father's/Husbands Name: ABDUL KAIUM

Mothers Name: JELATUN BEGUM



Bankers SI. No.


16/24















Name: NURNAHAR BEGUM

Father's/Husbands Name: MD. YOUSUF ALAM








Name of the Bank : ISLAMI BANK BD. LTD. Branch : F. EX. CORP.





(i) Name (in Block Letters) NURNAHAR BEGUM Signature :




Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms NURNAHAR BEGUM being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 3 6 5 3 2

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


17/24

Interestedpersons are entitled to a prospectus, if they so desire. Copies of prospectus may be obtained from the issuer and the issue manager



(Tobe sent directly to the Companys Corporate Office)Warning: Please read the instructions on the back of this form. Incorrectly filled Applications may be rejected.


Dear Sir,I/we apply for and request you to allot me/us the 200 numbers of Shares and I/we agree to accept the same or any smaller number that maallotted to me/us upon terms of the Company's Prospectus approved by the Securities and Exchange Commission subject to the Memorandum and Article



Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated...................................................................................................................................................................................................................................Bank................................................................................. B






Name: HASNA HENA

Father's/Husbands Name: ABDUL MALEK

Mothers Name: KHOSHNAHAR BEGUM












(i) Name (in Block Letters) HASNA HENA Signature :




Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms HASNA HENA being the application money for 200 nos. of ordinary shareBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 3 7 0 6 0

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


18/24















Name: HASNA HENA

Father's/Husbands Name: ABDUL MALEK

Mothers Name: KHOSHNAHAR BEGUM












(i) Name (in Block Letters) HASNA HENA Signature :

(ii) Name (in Block Letters) ABDUL MALEK Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms HASNA HENA & ABDUL MALEK being the application money for 200 noordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 3 7 0 7 1

Name: ABDUL MALEK

Father's/Husbands Name: LATE ABDUL SATTAR

Mothers Name: LATE AZMERI BEGUM


Occupation : BUSINESS Nationality: Bangladeshi Phone (if any) :

Bankers SI. No.


19/24















Name: NURJAHAN AKTER

Father's/Husbands Name: SULTAN AHAMED








Name of the Bank : SHAHJALAL ISLAMI BANK LTD. Branch : DHAKA MAIN





(i) Name (in Block Letters) NURJAHAN AKTER Signature :


* In case of deposit into the applicantsbank account, the applicant will bear the applicable service charge, if any, of the applicants banker, and the issuer shall simultaneously issue aof 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.


Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms NURJAHAN AKTER being the application money for 200 nos. of ordinary sharBengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 3 7 0 8 1

Name :


Mothers Name :

Postal Address :


Bankers SI. No.


20/24















Name: NURJAHAN AKTER

Father's/Husbands Name: SULTAN AHAMED








Name of the Bank : SHAHJALAL ISLAMI BANK LTD. Branch : DHAKA MAIN





(i) Name (in Block Letters) NURJAHAN AKTER Signature :

(ii) Name (in Block Letters) SULTAN AHAMED Signature :* In case of deposit into the applicants bank account, the applicant will bear the applicable service charge, if any, of the a pplicants banker, and the issuer shall simultaneously issue a



Certified that this Bank has received Tk. (in figure) 5000/- (in word: Five Thousand ) only Mr./Mrs./Ms NURJAHAN AKTER & SULTAN AHAMED being the application money for 200of ordinary shares of Bengal Windsor Thermoplastics Limited.


1 2 0 3 5 7 0 0 4 6 3 7 0 8 2

Name: SULTAN AHAMED

Father's/Husbands Name: LATE ABUL HASHEM

Mothers Name: KHURSIA BEGUM



Bankers SI. No.


21/24



APPLICATION FOR SHARES BY AFFECTED SMALL INVESTOR(S)






Deposited vide Cash/Cheque/Draft/Pay Order No ......................................................................dated.... .........................................................................................

IPO Full (all in one).docx

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