Beacon - RB

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

APPLICATION FORM
APPLICATION FOR SHARES BY INVESTORS OTHER THAN NON-RESIDENT BANGLADESHIS
Warning: Please read the instructions at the back of this form. Incorrectly filled applications or applications failing to comply with any of the instructions
therein may be rejected.
The Managing Director Bankers Sl No.

BEACON PHARMACEUTICALS LTD.
153-154 Tejgaon I/A
Dhaka-1208.
Dear Sir,
I/we apply for and request you to allot me/us =500=. numbers of Shares and I/we agree to accept the same or any smaller number that may
be allotted to me/us upon terms of the Company's Prospectus approved by the Securities and Exchange Commission 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 Member(s) of the Company and deposit
the said ordinary shares in my Beneficiary Owner ("BO") account; I/we further authorize you to send a crossed (Account Payee only) cheque in respect of
any 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 ...........=500=.................of Tk. 10.00 each at par.

2. Total subscription money of the amount of Tk. (in figures) .........5,000/-............,Taka (in words)................FIVE THOUSAND ................only deposited
vide cash/Cheque/Draft/Pay Order No. .............................Dated .................................on........................................ Bank..................................Branch
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 Applica:nt
a) Sole/First Applicant
Name:
Fathers/Husbands Name:
Mothers Name:
Postal Address:
Phone Number* (If any):
Occupation: Nationality:
For Refund Warrant: For Refund Warrant (Application will not be treated as valid if any one uses a non-scheduled bank to avoid this complication,
investors are requested not to use the name of any non-schedule bank) please write the correct and full name of bank and branch.
For Refund Purpose: I/We want refund through Bank Account* Courier/Hand delivery (Please put tick mark in which refund will be made)
Applicants Bank A/c no.
Name of the Bank: Branch :
b) Second Applicant
Name:
Fathers/Husbands Name:
Mothers Name:
Postal Address:
Phone Number* (If any):
Occupation: Nationality:
6. I/we hereby declare that I/we have read the Prospectus of Beacon Pharmaceuticals Ltd. and have willingly subscribed for =500=.... No.
of Ordinary Shares of Tk. 10.00 each at par.
7. Specimen Signature(s) :
i) Name (in Block Letters) Signature:
(ii) Name (in Block Signature:
Letters)
* 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 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.
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BANKERS ACKNOWLEDGEMENT
Certified that this Ban has received Tk. (in figures)..............5000/-... (in word ............FIVE THOUSAND.......................) only from
Mr./Mrs./Ms................................................................................................
................................. being the Application money for .........=500=............. Ordinary Shares of Beacon
Pharmaceuticals Ltd.
Bankers SL. No. Seal & 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 Beneficiary Owner (BO)
Account number in the Application form. If you do not mention your valid BO account number 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 on 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 these criteria 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 favouring A/C "BEACON PHARMACEUTICALS LTD." 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 and where any amount is
refundable in whole or in part the same will be refunded by Account Payee Cheque by post/courier service to the person named first on this Application Form in the manner
prescribed in the Prospectus.
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 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 the event an applicant makes
more than two Applications, all applications will be treated as invalid and will not be considered for allotment purpose. In addition, part or whole of
application money may be forfeited by the Securities and Exchange Commission.
10.No receipt will be issued for the payment made with Application, but the bankers will issue a provisional acknowledgement to the Issue for Application lodged with them.
11. In the case of non-allotment of securities, if the applicants' 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 Payee" cheque(s) with bank account number and name of bank branch as mentioned in the
application payable at Dhaka or Chittagong , as the case may be.
12. Allotment shall 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 the 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 law.
14. Applications, which do not meet the above requirements, or Applications, which are incomplete, shall not be considered for allotment purposes.
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.
16. No sale of securities shall be made, nor shall any money be taken from any person, in connection with such sale until twenty five days after the
prospectus has been published.
Bankers to the Issue
Investment Corporation of Rajshahi Branch, Rajshahi Mirpur Branch, Dhaka Bogra Branch, Bogra
Bangladesh Dinajpur Branch, Dinajpur Karwan Bazar Branch, Dhaka Jessore Branch, Moulvi Bazar
Head Office, Dhaka Kustia Branch, Kustia Narayanganj Branch, Narayanganj Sirajgonj Branch, Sirajgonj Sadar
Local Office, Nayapaltan, Dhaka Comilla Branch, Comilla Shahjalal Uposhohar Branch,Sylhet
Chittagong Branch, Chittagong Kafrul Branch, Dhaka Bank Asia Limited
Rajshahi Branch, Rajshahi National Bank Limited Naval Base Branch, Chittagong Principal Office Branch, Dhaka
Sylhet Branch, Sylhet Anderkillah Branch, Chittagong Jubilee Road Branch, Chittagong MCB Dilkusha Branch, Dhaka
Bogra Branch, Bogra Agrabad Branch, Chittagong Feni Branch, Feni Corporate Branch, Dhaka
Khulna Branch, Khulna Bangshal Road Branch, Dhaka Khulna Branch, Khulna Scotia Branch, Dhaka
Barisal Branch, Barisal Babubazar Branch. Dhaka Sylhet Corporate Br., Sylhet Gulshan Branch, Dhaka
Dilkusha Branch, Dhaka Khatunganj Br., Chittagong MCB Banani Branch, Dhaka
The City Bank Limited Elephant Road Branch, Dhaka CDA Avenue Br., Chittagong Uttara Branch, Dhaka
B.B. Avenue Branch, Dhaka Foreign Exchange Br, Dhaka Mitford Branch, Dhaka
Dhaka Chamber Branch, Dhaka Gulshan Branch, Dhaka Southeast Bank Ltd. North South Road Branch, Dhaka
Dhanmondi Branch, Dhaka Imamganj Branch, Dhaka Principal Branch, Dhaka Dhanmondi Branch, Dhaka
Foreign Exchange Br, Dhaka Dhanmondi Branch, Dhaka Corporate Branch, Dhaka Bashundhara Branch, Dhaka
Imamagonj Branch, Dhaka Kawran Bazar Branch, Dhaka Imamganj Branch, Dhaka Sylhet Main Branch, Sylhet
Johnson Road Branch, Dhaka Motijheel Branch, Dhaka Dhanmondi Branch, Dhaka Sylhet Uposhahar Branch, Sylhet
Kawranbazar Branch, Dhaka Mohakahli Branch, Dhaka Mouchak Branch, Dhaka Agrabad Branch, Chittagong
New Market Branch, Dhaka Malibagh Branch, Dhaka Bandar Bazar Branch, Sylhet Khatunganj Br, Chittagong
VIP Road Branch, Dhaka Mirpur Branch, Dhaka Agrabad Branch, Chittagong MCB Sk. Mujib Road Branch, Ctg
Islampur Branch, Dhaka Z H Sikder M.C. Branch, Dhaka Khatunganj Br, Chittagong CDA Avenue Br, Chittagong
Barisal Branch, Barisha Islampur Branch, Dhaka Chowmuhani Branch (Rural),Noakhali Station Road Branch, Chittagong
Tongi Branch, Gazipur Uttara Branch, Dhaka Banani Branch, Dhaka Rajshahi Branch, Rajshahi
Tanbazar Branch, Narayangonj North Brook Hall Br, Dhaka Motijheel Branch, Dhaka Khulna Branch, Khulna
Comilla Branch, Comilla Lake Circus Branch, Kalabagan,Dhaka Karwan Bazar Branch, Dhaka Mohakahli Branch, Dhaka
Agrabad Branch, Chittagong Mohammadpur Branch, Dhaka Laldighirpar Branch, Sylhet Mirpur Branch, Dhaka
Jubilee Road Branch, Chittagong Pragati Sarani, Br. Dhaka Shahjalal Uposhahar Br., Sylhet Bogra Branch, Bogra
Khatungonj Branch, Chittagong Banani Branch, Dhaka Chhagalnaiya Branch, Feni Jessore Branch, Jessore
Bandar Bazar Branch, Sylhet Faridpur Branch, Faridpur Anderkilla Branch, Chittagong
Zinda Bazar Branch, Sylhet Jatrabari Branch, Dhaka ONE Bank Limited Santinagar Branch, Dhaka
Bogra Branch, Bogra Gazipur Branch, Gazipur Principal Branch, Dhaka
Rajshahi Branch, Rajshahi Savar Bazar Branch, Dhaka Motijheel Branch, Dhaka Shahjalal Islami Bank Limited
Khulna Branch, Khulna Narayanganj Br, Narayanganj Karwan Bazar Branch, Dhaka Dhaka Main Br., Dilkusha, Dhaka
Feni Branch, Feni Gulshan Branch, Dhaka Mitford Br., Mitford Road, Dhaka
Jamuna Bank Limited Sylhet Branch, Sylhet Mirpur Branch, Dhaka Dhanmondi Br., Dhaka
Mohakhali Branch, Dhaka Khatungong Br, Chittagong Uttara Branch, Dhaka Gulshan Br., Gulshan, Dhaka
Sonargaon Road Branch, Dhaka Jubilee Road Br, Chittagong Dhanmondi Branch, Dhaka Foreign Ex. Br., Motijheel, Dhaka
Moulvibazar Branch, Dhaka Sheikh Mujib Rd Br,Chittagong Banani Branch, Dhaka Kawran Bazar Br., Dhaka
Dilkusha Branch, Dhaka Pahartali Branch, Chittagong Kakrail Branch, Dhaka Uttara Br., Uttara, Dhaka
Motijheel Branch, Dhaka Chawk Bazar, Chittagong Progoti Sharani Branch, Dhaka Bangshal Br., Bangshal, Dhaka
Shantinagar Branch, Dhaka Narsingdi Branch, Narsindi Elephant Road Br., Dhaka Satmasjid Road Br., Dhanmondi,Dhaka
Gulshan Branch, Dhaka Tangail Branch, Tangail Jatrabari Branch, Dhaka Banani Br., Banani, Dhaka
Dhanmondi Branch, Dhaka Khulna Branch, Khulna Nowabgonj Branch, Dhaka Motijheel Br., Motijheel, Dhaka
Naya Bazar Islami Banking Branch, Rangpur Branch, Rangpur Bangshal Branch, Dhaka Mirpur Br., Mirpur-10, Dhaka
Dhaka Bogra Branch, Bogra Ganakbari (EPZ) Branch, Dhaka Bijoynagar Br., Kakrail, Dhaka
Foreign Exchange Branch, Dhaka Rajshahi Branch, Rajshahi Imamganj Branch, Dhaka Savar Br., Savar, Dhaka
Dholaikhal Branch, Dhaka Barisal Branch, Barisal Narayanganj Branch, Narayanganj Joydebpur Chowrasta Branch,Gazipur
Banani Branch, Dhaka Comilla Branch, Comilla Joypara Branch , Dhaka Narayanganj Branch, Narayanganj
Malibagh Branch, Dhaka Pagla Bazar Br. Narayanganj Khatunganj Br, Chittagong Beani Bazar Branch, Sylhet
Mirpur Branch, Dhaka Chowmohoni Br. Noakhali Agrabad Branch, Chittagong Sylhet Branch, Sylhet
Uttara Branch, Dhaka Sunamgong Br.Sunamgong. CDA Avenue Branch, Chittagong Agrabad Branch, Chittagong
Chistia Market Branch, Dhaka New Eskaton Br. Dhaka Nanupur Bazar Branch, Chittagong Khatunganj Br, Chittagong
Ashulia Branch, Dhaka Jubilee Road Br, Chittagong Jubilee Road Br, Chittagong
Narayangonj Br, Narayangonj Trust Bank Limited Cox's Bazar Br, Cox's Bazar Khulna Branch, Khulna
Agrabad Branch, Chittagong Principle Branch, Dhaka Chandragonj Branch, Lakshmipur Muradpur Br, Chittagong
Khatungonj Branch, Chittagong SKB Branch,Motijheel, Dhaka Chowmuhani Branch, Noakhali
Jubilee Road Islami Banking Branch, Agrabad Branch, Chittagong Feni Branch, Feni
Chittagong Dhanmondi Branch, Dhaka Dagon Bhuiyan Branch, Feni
Bahaddarhat Branch, Chittagong Gulshan Corporate Br. Dhaka Rajpur Branch, Lakshmipur
Kadamtali Branch, Chittagong Dilkusha Corporate Br. Dhaka Sylhet Branch, Sylhet
Anderlilla Branch, Chittagong Millennium Corporate Branch,Dhaka Islampur Branch, Sylhet
Sylhet Branch, Sylhet. Uttara Corporate Branch, Dhaka Sherpur Branch, Moulvi Bazar
Bogra Branch, Bogra
www.rashedchittagong.blogspot.com
Subscription Open on : 20th June 2010

Subscription Close on : 24th June 2010
For MS Word format IPO application form or any types of suggestion please mail me on rashedscollection@gmail/yahoo.com
Website & e-mail address of BEACON PHARMACEUTICALS LIMITED: www.beacon-pharma.com & beacon@beacon-pharma.com

Beacon - RB

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Beacon - RB

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Interested persons are entitled to a prospectus, if they so desire.

BEACON PHARMACEUTICALS LTD.

The Managing Director Bankers Sl No.

1. No. of Ordinary Shares ...........=500=.................of Tk. 10.00 each at par.

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

(ii) Name (in Block Signature:

Bankers SL. No. Seal & Date

Bankers to the Issue

Subscription Open on : 20th June 2010

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