Application for Share Holder Form

(Form Fee: TK. 5000/=)

Govt. Reg No: CH-10511/13
Sanmar Spring Valley, (2463/A/52), 1st floor)
Zakir Hossain Road, Khulshi, Chittagong.
Tell: 031-657221, 2550131

Information:
Total Share sale will be among the CKCL members

Number of Shares: 5,000++ (Minimum)
Ordinary Shares of TK.100/= each
Document of Share: Certificate

To
The Chairman/ Managing Director
The Bess Barn Limited (Public)
Chattogram.

Submission For The Bess Barn Limited (Public) Share Form

Full Name

Father's/ Husband's Name

Mother's Name

Nominee

Date of Birth

Place of Birth

Nationality

Profession

Mobile Number

Fax

Blood Group

Telephone

Your Email

National ID No/ Passport No / Driving License No

Educational Qualification

Permanent Address

Village

Post Office

Police Station / Union Parisad

District

Present/ Mailing Residential Address

Office Address

Declaration:

I hereby declare that I have neither committed any illegal/ criminal act Judiciary Law of Bangladesh, nor been awarded any punishment by Bangladesh Court for any offence. I further declare that the above statement/ particulars are correct therefore, request you to become a Share Holder as per the constitution of The Bess Barn Limited (Public).

Date

Signature of Applicant

Identified By Chairman/ Managing Director

Share Holder No

The constitution of The Bess Barn Limited (Public) do hereby declare you as the Share Holder of The Bess Barn Limited (Public) and your Share Holder No. is:

Thanking You

___________________________________
Chairman
The Bess Barn Limited (Public)

___________________________________
Managing Director
The Bess Barn Limited (Public)

_____________________________________________________________________

Updated Income Tax Paid with TIN/ GIR No

Emergency Contact Person Name

Emergency Contact Person Cell No

Details of Passport

Passport No and Type

Place of Issue

Validity

Date of Issue

Issuing Authority

Family Details

Name of Spouse

Occupation of Spouse

Details of Childrens: (Must be Added with Birth Certificate copy)

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Category of Share Holder Applied for (Please Select One Box)

Director (50,000+)

Share Holder (5,000+)

Proposed by (Any Share Holder of The Bess Barn Limited (Public)):

Full Name

Membership No

Signature

Application for Share Holder Form