Format

Declaration of acquisition cost for consideration regarding Advance

Income Tax purpose

Name of seller/transferor:
______________________________________________________________
BOID: ________________________________
TIN No: ______________________________

I/we hereby declare that I/we have acquired shares/mutual fund units of
_________________________
_____________________________________________________________________________________
Types of shares/units to be transferred: Quantity Acquisition Cost
Original (enclose document if needed) __________ Tk._____________
Right (enclose document if needed) __________ Tk._____________
Bonus (enclose document if needed) __________
Bought from Market (enclose document if needed) __________
Tk._____________
Other (gift etc.) (enclose document if needed) __________
Tk._____________
Total __________ Tk._____________
Weighted average acquisition cost for consideration (per share or unit): Tk.
__________________
Signature

(Name in block letters)

Dated:______________
Place: ______________
Designation and Seal (for other than individual)

Declaration
I/we _________________________________ son of/wife of________________________________
of (address)
___________________________________________________________________________ solemnly
declare that to the best of my/our knowledge and belief the information given above
is correct and complete.

Signature

(Name in block letters)

Dated:______________
Place: ______________
Designation and Seal (for other than individual)

For Official Use:

 Format
Effective Close Price _________________
Date: __________________ Time: ________________