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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 MANAGER.”
Active Fine Chemicals 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 Banker’s Sl. No.
Active Fine Chemicals Ltd
Tanaka Tower (2nd Floor),
42/1/Gha, Segun Bagicha,
Dhaka-1000, Bangladesh
Dear Sir,
I/we apply for and request you to allot me/us the 500 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 500 of Tk.10 each.
2.Amount of Tk. (in figure): 5000/-, Taka (in words): Five Thousand Only.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: BANGLADESHI 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:
b) Second Applicant
Name:
Father’s / Husband 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 Active Fine Chemicals Limited and have willingly subscribed for
500 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 5000/-(in word) Five Thousand only form M r./Mrs./Ms…………………………………………………………
……………………………....Being the application money for…500…..nos. of Ordinary Shares of Active Fine Chemicals Ltd.

Seal and Date Banker’s Sl. No. Authorized Signature
(Name &

14. 10. As per provision of Depository Act. Otherwise.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. Joint Application form for more than two persons will not be accepted. 13. The said forfeited Application money or share (unit) will be deposited in account specified by the Securities and Exchange Commission (SEC). all applications will be treated as invalid and will not be considered for allotment purpose. 1999 and regulations made there under shares will only be issued in dematerialized condition. 7. 2. In the case of non-allotment of securities. No sale of securities shall be made. If you do not mention your valid BO (Beneficiary Owner) Account. This may be in addition to any other penalties as may be provided for by the law. refund amount of those applicants will be directly credited in to the respective bank account as mentioned in their IPO Application Forms. whole or part of application money may be forfeited by the Commission. . No receipt will be issued for the payment made with Application. in connection with such sale until 25(twenty five) days after the prospectus has been published. your application will be treated as invalid. Any Application not meeting this criterion will not be considered for allotment purpose. Application must be made on the Company’s printed form/photocopy or typed copy/hand written form thereof. as the case may be. 11. In addition. Please mention your BO (Beneficiary Owner) Account number in the application form. 12. Application must be in full name of individuals or companies or societies or trusts and not in the name of firms. one in his/her own name and another jointly with another person. nor shall any money be taken from any person. In case of joint Application. Applications. the Allotment Letter will be dispatched to the person whose name appears first on this Application Form. but the bankers will issue a provisional acknowledgment to the Issue for Application lodged with them. An applicant can not submit more than two applications. or applications. 6. 4. Designation) INSTRUCTIONS 1. 8. Application must not be for less than 500 Ordinary Shares and must be for a multiple of 500 Ordinary Shares. which are incomplete. In the case of Joint Application Form. 9. All information must be typed or written in full (in Block letters) in English or in Bengali and must not be abbreviated. if the applicant’s bank accounts as mentioned in their IPO Application Forms are maintained with the Bankers to the Issue. 16. minors or persons of unsound mind. Remittance should be in the form of Cash/ Cheque/ Bank Draft/ Pay Order payable to one of the Bankers to the Issue A/C “Active Fine Chemicals 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. 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. which do not meet the above requirements. 5. 15. 3. Remittance for the full amount of the Shares must accompany each Application and must be forwarded to any of the Bankers to the Issue. 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. Application from financial and market intermediary companies and Private Company must be accompanied by Memorandum and Articles of Association and Certificate of Incorporation. shall not be considered for allotment purpose. each party must sign the Application Form. Allotment will be made solely in accordance with the instructions of the Securities and Exchange Commission (SEC). In case an applicant makes more than two applications.

Dhaka Dhaka 5. 5.B Road Corporate Branch. 8. Rajshahi 4. 1. Ring Road Brach .Bangla Bank Ltd. Khatungonj Branch . Rajshahi Br. Mohakhali Branch. Shantinagar Branch. Dhaka 10.Satmashjid Road Branch. Gulshan Branch. Dhaka. Principal Branch. Dhaka 7. Branch. Dhaka 13. Agargaon Br. 7. Gulshan Avenue Branch. Bangshal Branch . Kakrail Br. Bogra 10.Agrabad Br. Chittagong Dhaka 9. Gulshan Branch. Chittagong 7. Dhanmondi Branch. 5. Mirpur Circle -10 Branch. Rajshashi Branch.Feni Br. Khulna Branch. Dhaka. Narayanganj Br. 4. Sheikh Mujib Road Corporate Branch. 20. Naya Paltan Branch. Khatungonj Branch . Chittagong. Kamal Attatuk Avenue Branch. 5. Motijheel Br. Dilkusha Branch . Agrabad Branch . Chittagong 11. Dhaka. Khulna 13. Dhaka. Dilkusha. Rajshahi . Jessore. Investment Corporation of 3. Dhaka 3. Branch. 8. Agrabad Branch . Dhaka 9. Chittagong 13. 6.Janata Bank Ltd. 10. Dhaka 1. 3. 7. Agrabad Branch. Shyamoli Br. 12. Dhaka 6. Shyamoli Branch . Shantinagar Branch. Dhaka 5. Khulna Branch . Narayanganj Branch. Narayanganj Branch. Dhaka 11. 4. Dhanmondi Branch. Chowmuhani Branch. Chittagong 11. Uttara Branch.. Chittagong Br. Bogra Branch.Dhaka. Shantinagar Branch. Agrabad Branch. Dilkusha Branch . Barisal 8. Dhaka. 10.Chittagong. Dhaka 15. Rajarbag Corporate Branch. Banani Branch. 2.Dhaka 12. Banoshree Branch. 8. Dhaka 8. Khulna 4.Khulna Br. Rajshahi Branch. Chittagong . Kawran Bazar Branch.Dhaka 1. 15. Rajshahi 13. Chittagong 21. Dhaka 1. FIRST SECURITY ISLAMI BANK LTD. Dhaka 2. Motijheel Corporate Branch. Gulshan Branch. Narayangonj Branch. Faridpur 5. Chittagong Chittagong 13. Comilla 2. Jublee Road Branch. Mirpur Br. Khatunganj Br. Dhaka. Laldihirpar. Motijheel F. Dilkusha Branch. Rajsgahi Corporate Branch. Barisal Branch. Kawran Bazar Branch. Sylhet 5. Uttara Branch. Dhaka 10. Dhaka 7. Chittagong. Dhaka 10. Dhaka. Dhaka 21. 2. 12. Faridpur Branch. Dhaka 3. Barisal Branch .Potia Branch. 1. Jessore Branch .Moulvibazar Br. Malibagh Branch. Bogra Br. Dhaka. Bangshal Branch . Dhaka. Narayanganj 7. Uttara Branch. Mohakhali Branch . 14. 17. 4. Khatunganj Branch . Chittagong 9. Foreign Exchange Branch. Uttara Model Town Corporate Branch. Dhaka 16. Dhaka 7. Dhaka 23. 4. Anderkillah Branch. Comilla Corporate Branch.Barisal Branch. Chittagong 5. Kawran Bazar Branch. Khulna Branch. Dhaka 1. 24. Dhaka Dutch. Dhaka 15. Khulna Branch .Halishahar Br. Dhaka 15. Bogra 6. Dhaka National Bank Limited 9. Ex. Dhaka 3. Dhaka 5. Dhaka 10. Branch. Federation Branch. Dhaka 3. Gulshan Branch.. Chittagong 3. Moulvibazar 4. Dhaka 8. Dhaka 4. Dhanmondi Branch. Bogra Br. Dhaka. Dhaka 2. Topkhana Road Branch. B. Cox’s Bazar Br. Rajshahi. 19. Rampura. Bogara Branch. Sylhet Branch. Dhaka 16. 10. Dhaka. Dhaka 6.Dhaka. Agrabad branch. Dhaka 8. Chhatak Branch. Dhaka 11.Dhaka 14. Barisal 7 Islampur Branch. 16. Bogra. Chittagong 9. Dhaka 12. Principal Branch. Sylhet 3. Imamganj Branch. Dhaka 20. 11. Sylhet Br. 12. Gulshan Branch . Jubilee Road Branch. Bogra Branch. Dhanmondi Br. Chittagong IFIC Bank Limited 25. Chittagong One Bank Ltd 16.Dhaka Sylhet 9. Khatungonj Branch. ..Dhaka. Banani Branch . Dhaka 4. 14.Chittagong. Dhanmondi Branch . Principal Branch. 3. Banani Branch. Jatrabari Branch. Jublee Road Branch. Chittagong. Gulshan Br. Mohakhali Branch. 18. Motijheel Branch. Jessore Branch . Bogra Branch . Kawran Bazar Branch. Rajshahi Branch. Dhaka 17. Jubilee Road Br. 8. Dhaka 9. 12. 14. Cox’s Bazar 8. Chittagong. Dhaka 22. Chittagong 11. Dhaka 17. Narayanganj. Sylhet 14. Elephant Road Branch. Dhaka 3. Rajshashi 11. Dhaka Dhaka 6. Dhaka Dhaka 3. Dhaka 2. 10. Khulna 11. Local Office. Pragoti sarani Branch. Elephant Road Branch.. Khatungonj Branch. Dhanmondi Branch . Motijheel Branch . comilla Eastern Bank Ltd. Barisal Br. 1. Nababpur Branch. New Eskaton Br. 19. Dhaka 18. New Elephant Road Br. Motijheel Branch. Dhaka 6. Dhaka 7. Chittagong. Comilla Branch . Dhaka 2. Dhaka 12. United Commercial Bank Ltd. Sylhet Branch. Kawran Bazar. 9. Khulna Branch. Sylhet 5. Khulna 13. Feni 12. Moulavi Bazar Banch. Jubilee Road Br. Motijheel Branch.Bandar Bazar Br. Dhaka 1. Bogra 15. Chittagong. 5. Dhaka 2. Chittagong. Dhanmondi Branch . Barisal 16. Mirpur Branch . Sylhet Branch:. Khulna. 9. 2. Bogra Branch. Jessore. Dhaka 14. Gulshan Branch. Chittagong 6. Dhaka NCC Bank Ltd.Sylhet Chittagong 15. Khulna Br. Khulna 1. Dhaka 11. Chittagong 9.Dhaka. Khatunganj Branch. 8. Chittagong 8. Bangladesh (ICB) Southeast Bank Ltd. Dhaka 18. Mohakhali Branch. Banani Branch. 6. Dhaka University Campus Branch. Khulna 7. Gulshan Branch. 14. Moghbazar Branch . Rajshahi Branch. Sylhet Branch. Uttara Br. Sylhet. Dhaka 4. 16. Dhaka 2. Sylhet. Dhaka. Local Office. Rajshahi 1. Motijheel Branch. Dhaka 7. Agrabad Branch. Bogra Sunamganj 17. Dhaka 2. Stock Exchange Branch. Kawran Bazar Br. Dhaka 4. Feni Narayangonj 13. Khulna Corporate Branch. Dhaka. Head Office. Corporate Br. Dhanmondi Branch. Dhaka 6. Andar Killah Branch. Shyamoli Branch. Jubilee Road Br. Bogra 14. Shahjalal Upashahar. Khulna. Chittagong . Agrabad Branch .Dhaka 13.Nanupur Bazar Branch. Dhaka Dhaka 15. 10. 6. Bogra 6. Agrabad Branch. Bashundhara Branch. Mohakhali Corporate Branch. Uttara Branch . Principal Br. Khatunganj Branch. Dhaka 1.

DHAKA-1212 Occupation: SERVICE Nationality: BANGLADESHI Telephone No. To avoid this complication. 3. The Managing Director Banker’s Sl. Active Fine Chemicals Ltd Tanaka Tower (2nd Floor). your application will be treated as in valid) 4.only deposited vide Cash/ Cheque/ draft/ pay Order No…………………………………Dated……………………………. Further. (in figure): 5000/-. Segun Bagicha. Taka (in words): Five Thousand Only.. AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.Amount of Tk. Otherwise the application will be considered invalid and the subscription money may be forfeited. BLOCK # J. Applicant’s Bank A/C No: 00434014896 Name of the Bank: BANK ASIA b) Second Applicant . 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.10 each. I/we apply for and request you to allot me/us the 500 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. BARIDHARA.I/we agree to fully abide by the instruction given herein. Depository (B/O) Account Number 1 2 0 3 1 8 0 0 3 6 5 3 5 5 4 5 (If you do not mention your valid BO (Beneficiary Owners) account. Subscription Open on: 14th September’ 2010 Subscription Close on: 20th September’ 2010 “INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS. Dhaka-1000. 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..(if any): 01913518298 For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank.Branch. 5.on………….No. investors are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch. ROAD # 2A.Particulars of Applicant(s): a) Sole/First Applicant Name: MD ROBEL SHACK Father’s / Husband name: MD HABIBUR RAHMAN Mother’s name: MST RAWSHANARA Postal Address: PLOT #1B. IF THEY SO DESIRE.” Active Fine Chemicals 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. Ordinary shares 500 of Tk. Bangladesh Dear Sir. No. 42/1/Gha. Bank………………………………. 2. Incorrectly filled application may be rejected.

. investors are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch. 42/1/Gha..only deposited vide Cash/ Cheque/ draft/ pay Order No…………………………………Dated…………………………….(If any): 6. Segun Bagicha.on………….10 each. 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.Specimen Signature(s): (i) Name ( in block letters): MD ROBEL SHACK Signature: (ii) Name ( in block letters): Signature: *In case of deposit into the applicant’s bank account.(if any): 01913518298 For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank. (in figure): 5000/-. BARIDHARA.Name: Father’s / Husband name: Mother’s name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No. your application will be treated as in valid) 4.nos. To avoid this complication.00 each. No. Incorrectly filled application may be rejected. Authorized Signature (Name & Designation) “INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS. I/we hereby declare that I/we have read the Prospectus of Active Fine Chemicals Limited and have willingly subscribed for 500 no. Depository (B/O) Account Number 1 2 0 3 1 8 0 0 3 6 5 2 2 4 9 6 (If you do not mention your valid BO (Beneficiary Owners) account.” Active Fine Chemicals 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. Applicant’s Bank A/C No: 00434014888 . ROAD # 2A. 5. I/we apply for and request you to allot me/us the 500 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.. the date and amount remitted with details of the bank through and to which bank such remittance has been effected.. the applicant will bear the applicable charge. ………………………………………………………………………………………………………………………………………………………………………… BANKER’S ACKNOWLEDGEMENT Certified that this Bank has received Tk 5000/-(in word) Five Thousand only form M r.Being the application money for…500…. Active Fine Chemicals Ltd Tanaka Tower (2nd Floor).Amount of Tk. Bank………………………………. Bangladesh Dear Sir.Particulars of Applicant(s): a) Sole/First Applicant Name: MD ABUL KASHEM Father’s / Husband name: MD WAZAD MONDOL Mother’s name: MRS SHOKINA BEGUM Postal Address: PLOT #1B.No. of Ordinary Shares of Active Fine Chemicals Ltd.. 3. among others. If any. 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.. of shares of Tk 10.I/we agree to fully abide by the instruction given herein. AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER. DHAKA-1212 Occupation: SERVICE Nationality: BANGLADESHI Telephone No. No. Seal and Date Banker’s Sl. 7. Taka (in words): Five Thousand Only. The Managing Director Banker’s Sl. Dhaka-1000. BLOCK # J. Ordinary shares 500 of Tk. Further. and the issuer shall simultaneously issue a letter of intimation to the applicant containing. Otherwise the application will be considered invalid and the subscription money may be forfeited.Branch. of the applicants banker. IF THEY SO DESIRE. 2./ MD ROBEL SHACK …………………………….

Bangladesh Dear Sir. Taka (in words): Five Thousand Only. DHAKA-1212 Occupation: SERVICE Nationality: BANGLADESHI Telephone No. . Bank………………………………. 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. ROAD # 2A. the date and amount remitted with details of the bank through and to which bank such remittance has been effected.Specimen Signature(s): (i) Name ( in block letters): MD ABUL KASHEM Signature: (ii) Name ( in block letters): Signature: *In case of deposit into the applicant’s bank account. Incorrectly filled application may be rejected.nos. AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER. your application will be treated as in valid) 4.. BLOCK # J.. of shares of Tk 10. 42/1/Gha./ MD ABUL KASHEM …………………………….” Active Fine Chemicals 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. investors are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch. Dhaka-1000..Particulars of Applicant(s): a) Sole/First Applicant Name: MD JALAL UDDIN Father’s / Husband name: MD MUSLE UDDIN Mother’s name: MRS JANNATUN NESA Postal Address: PLOT #1B. the applicant will bear the applicable charge. Depository (B/O) Account Number 1 2 0 3 1 8 0 0 3 6 5 5 9 5 1 3 (If you do not mention your valid BO (Beneficiary Owners) account.(if any): 01913518298 For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank.I/we agree to fully abide by the instruction given herein.Amount of Tk. of the applicants banker. 2.10 each. No.Name of the Bank: BANK ASIA b) Second Applicant Name: Father’s / Husband name: Mother’s name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No. BARIDHARA. 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. of Ordinary Shares of Active Fine Chemicals Ltd. 5.(If any): 6. Authorized Signature (Name & Designation) “INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS. I/we hereby declare that I/we have read the Prospectus of Active Fine Chemicals Limited and have willingly subscribed for 500 no. (in figure): 5000/-. The Managing Director Banker’s Sl.on…………. Ordinary shares 500 of Tk.Being the application money for…500…. 3. Seal and Date Banker’s Sl. If any. To avoid this complication. I/we apply for and request you to allot me/us the 500 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.. Segun Bagicha.. and the issuer shall simultaneously issue a letter of intimation to the applicant containing. Active Fine Chemicals Ltd Tanaka Tower (2nd Floor).only deposited vide Cash/ Cheque/ draft/ pay Order No…………………………………Dated……………………………. Further..00 each.Branch. No. ………………………………………………………………………………………………………………………………………………………………………… BANKER’S ACKNOWLEDGEMENT Certified that this Bank has received Tk 5000/-(in word) Five Thousand only form M r. IF THEY SO DESIRE. 7. among others.

of the applicants banker. I/we hereby declare that I/we have read the Prospectus of Active Fine Chemicals Limited and have willingly subscribed for 500 no.Amount of Tk. 42/1/Gha. DHAKA-1212 Occupation: HOUSEWIFE Nationality: BANGLADESHI Telephone No. 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. ………………………………………………………………………………………………………………………………………………………………………… BANKER’S ACKNOWLEDGEMENT Certified that this Bank has received Tk 5000/-(in word) Five Thousand only form M r. The Managing Director Banker’s Sl.(if any): 01913518298 For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank. Incorrectly filled application may be rejected. Bangladesh Dear Sir.00 each. Seal and Date Banker’s Sl. 3.. To avoid this complication. If any. Applicant’s Bank A/C No: 00434019160 Name of the Bank: BANK ASIA b) Second Applicant Name: Father’s / Husband name: Mother’s name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No. AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER. I/we apply for and request you to allot me/us the 500 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. your application will be treated as in valid) 4.only deposited vide Cash/ Cheque/ draft/ pay Order No…………………………………Dated……………………………. No.(If any): 6. Bank………………………………. 7. Segun Bagicha.Particulars of Applicant(s): a) Sole/First Applicant Name: MST SULYEM AKTER BEAUTY Father’s / Husband name: MD ABUL KASHEM Mother’s name: MRS. No. ROAD # 2A. Taka (in words): Five Thousand Only. Further. of Ordinary Shares of Active Fine Chemicals Ltd. (in figure): 5000/-. Active Fine Chemicals Ltd Tanaka Tower (2nd Floor). SUMAYA BEGUM Postal Address: PLOT #1B.Specimen Signature(s): (i) Name ( in block letters): MD JALAL UDDIN Signature: (ii) Name ( in block letters): Signature: *In case of deposit into the applicant’s bank account. and the issuer shall simultaneously issue a letter of intimation to the applicant containing.10 each.. the applicant will bear the applicable charge.. the date and amount remitted with details of the bank through and to which bank such remittance has been effected. BLOCK # J. Depository (B/O) Account Number 1 2 0 3 1 8 0 0 3 6 5 2 2 4 6 1 (If you do not mention your valid BO (Beneficiary Owners) account.I/we agree to fully abide by the instruction given herein.No.nos. of shares of Tk 10..on………….Otherwise the application will be considered invalid and the subscription money may be forfeited. among others. BARIDHARA.Branch./ MD JALAL UDDIN ……………………………. 2. Ordinary shares 500 of Tk.” Active Fine Chemicals 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. 5. IF THEY SO DESIRE. investors . Authorized Signature (Name & Designation) “INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS..Being the application money for…500….. Dhaka-1000.

42/1/Gha. BARIDHARA.Being the application money for…500…. 3. DHAKA-1212 . The Managing Director Banker’s Sl..Branch.nos. Dhaka-1000. I/we apply for and request you to allot me/us the 500 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.Particulars of Applicant(s): a) Sole/First Applicant Name: MD HARUN UR RASHID Father’s / Husband name: MD ALI AKBOR Mother’s name: MRS ROWSHANARA BEGUM Postal Address: PLOT #1B. No. among others. AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.No. Ordinary shares 500 of Tk. ROAD # 2A. 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.” Active Fine Chemicals 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. Bank………………………………. BLOCK # J. your application will be treated as in valid) 4. Applicant’s Bank A/C No: 00434015680 Name of the Bank: BANK ASIA b) Second Applicant Name: Father’s / Husband name: Mother’s name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No. I/we hereby declare that I/we have read the Prospectus of Active Fine Chemicals Limited and have willingly subscribed for 500 no.(If any): 6.are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch.Specimen Signature(s): (i) Name ( in block letters): MST SULYEM AKTER BEAUTY Signature: (ii) Name ( in block letters): Signature: *In case of deposit into the applicant’s bank account. IF THEY SO DESIRE. Authorized Signature (Name & Designation) “INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS..00 each.. Further. of Ordinary Shares of Active Fine Chemicals Ltd. Otherwise the application will be considered invalid and the subscription money may be forfeited.Amount of Tk. Bangladesh Dear Sir.. Active Fine Chemicals Ltd Tanaka Tower (2nd Floor). Incorrectly filled application may be rejected. Taka (in words): Five Thousand Only. the applicant will bear the applicable charge. the date and amount remitted with details of the bank through and to which bank such remittance has been effected.only deposited vide Cash/ Cheque/ draft/ pay Order No…………………………………Dated…………………………….I/we agree to fully abide by the instruction given herein. If any. No. Seal and Date Banker’s Sl. (in figure): 5000/-. and the issuer shall simultaneously issue a letter of intimation to the applicant containing. 5.. 7. ………………………………………………………………………………………………………………………………………………………………………… BANKER’S ACKNOWLEDGEMENT Certified that this Bank has received Tk 5000/-(in word) Five Thousand only form MST SULYEM AKTER BEAUTY ……………………………. Segun Bagicha.. of the applicants banker. 2.10 each. 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. Depository (B/O) Account Number 1 2 0 3 1 8 0 0 3 6 5 5 9 4 9 1 (If you do not mention your valid BO (Beneficiary Owners) account.on…………. of shares of Tk 10.

the date and amount remitted with details of the bank through and to which bank such remittance has been effected.. 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. of the applicants banker. No. 7./ MD HARUN UR RASHID …………………………….nos.00 each.Occupation: SERVICE Nationality: BANGLADESHI Telephone No.. Authorized Signature (Name & Designation) . Seal and Date Banker’s Sl. among others.(If any): 6. the applicant will bear the applicable charge. Otherwise the application will be considered invalid and the subscription money may be forfeited. If any. investors are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch.Being the application money for…500….Specimen Signature(s): (i) Name ( in block letters): MD HARUN UR RASHID Signature: (ii) Name ( in block letters): Signature: *In case of deposit into the applicant’s bank account. I/we hereby declare that I/we have read the Prospectus of Active Fine Chemicals Limited and have willingly subscribed for 500 no. of shares of Tk 10. and the issuer shall simultaneously issue a letter of intimation to the applicant containing. To avoid this complication. of Ordinary Shares of Active Fine Chemicals Ltd.. ………………………………………………………………………………………………………………………………………………………………………… BANKER’S ACKNOWLEDGEMENT Certified that this Bank has received Tk 5000/-(in word) Five Thousand only form M r.. Applicant’s Bank A/C No: 00434014871 Name of the Bank: BANK ASIA b) Second Applicant Name: Father’s / Husband name: Mother’s name: Postal Address: Occupation: Nationality: BANGLADESHI Telephone No.(if any): 01913518298 For refund warrant (Application will not be treated as valid if anyone uses a non-scheduled bank.