Systematic Investment Plan (SIP)Asset Manager: Impress Capital Limited (ICL)

APPLICATION FORM TO PURCHASE UNITS-INDIVIDUAL (Please read the “Terms and Conditions” carefully)

Managing Director Impress Capital Limited Evergreen Plaza (1st Floor) 260/B, Tejgaon I/ADhaka -1208, Bangladesh

(Please fill up the form in block letters)

For Office Use Only

Registration No.: ..................................... Sale No.: ...............................

Selling Agent's Name: ...............................................................................

Selling Agent's Signature & ID: ........................................................

Authorized Person's Signature: ........................................................

I/We would like to avail Systematic Investment Plan of

SIP Installment Frequency: Monthly Quaterly

yearsICL Balanced Fund BCB ICL Growth Fund Esquire ICL Apparel Fund Tenure:

Half-yearly Yearly Payment Option: Auto-DebitCheque

amount of BDT ............................................................. (in words .............................................................................................................................................................) with this application.

SIP Installment Amount in BDT.............................................. (in words ........................................................................................................ ) 2nd Installment Date: ...................................

I/We enclose p ost-dated cheque(s)/cheque for 1st/other installment(s) bearing No. ............................................................................................................. for SIP investment

DD/MM/YYYY

Principal Applicant Mr. Mrs. Ms.

Name of Employer:

National ID/Passport No.:

Email: Mode of Communication: EmailMobile Phone

Branch:

BO A/C No.:

Dividend Option:

Name:

Father:

Spouse:

Occupation:

Present Address:

Permanent Address:

Nationality:

Contact No.:

Bank:

Account No.:

Cash CIP

Mr. Mrs. Ms.

Name of Employer:

National ID/Passport No.:

Occupation:

Present Address:

Permanent Address:

Nationality:

Contact No.: Email: Mode of Communication: EmailMobile Phone

ETIN:

Joint Applicant (If Any)

Name:

Father:

Spouse:

Mother:

Date of Birth: dd mm yyyy

Mother:

Date of Birth: dd mm yyyy

Mr. Mrs. Ms.Nominee 1

Name:

Address:

Contact No.: National ID / Passport No. /Birth Certificate No.:

Relationship with A/C Holder: Email: Percentage of Holding Unit:

Principal

Applicant

Impress Capital Limited : Evergreen Plaza (1st Floor), 260/B, Tejgaon Industrial Area, Dhaka-1208, Bangladesh Email: info@impresscapital.com

Website: www.impresscapital.com || Tel: +880 2 9830776, +880 2 9830765 || Hotline: +880 170 9685673 ||

Mr. Mrs. Ms.

Mr. Mrs. Ms.

Documents Enclosed

Joint

Applicant

1st Nominee (Attested By

Principal Applicant)

2nd Nominee

(Attested By

Principal Applicant)

Guardian

(Attested By

Principal Applicant)

Guardian

Signature

2nd Nominee Principal Applicant Joint Applicant (if any) 1st Nominee

I have explained the "Terms and Conditions of investment" and "Fundamentals of Mutual Fund" to this investor.

Signature of Unit Holder(s)

National ID / Passport No.:Contact No.:

Relationship with A/C Holder: Email: Percentage of Holding Unit:

Nominee 2 (if any)

Name:

Address:

National ID / Passport No. :Contact No.:

Relationship with the Nominee: Email:

Guardian (if Nominee is minor)

Name:

Address:

Cheque for 1st/other SIP installment(s) Photocopy of a Blank Undated Cheque leaf

Photographs

Date: DD/MM/YYYY

Copy of NID/Passport/Birth Certificate (Applicant, Nominee & Guardian)

E-TIN Certificate (Applicant)Passport Size Photograph (Applicant: 2 copies, Nominee: 1 copy & Guardian: 1 copy)

Terms and Conditions

I/we confirm that on receiving the Acknowledgement Slip against my/our investment in Mutual Fund managed by ICL, I/ We will abide by the "Terms and Conditions", which

may be altered, replaced and modified from time to time by Impress Capital Limited as per regulatory requirements.