``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE

ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: STUDENT Nationality: BANGLADESHI. Phone (if any): 01673499040
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited , and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: STUDENT Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: STUDENT

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: STUDENT Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: STUDENT Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited, and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: BUSINESS Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited, and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: BUSINESS Nationality: BANGLADESHI. Phone (if any): 01823144884
For refund purpose: I/we refund through Bank account * Hand delivery/ courier (Please put marks in which refund will be made).

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:

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: SERVICE

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 3. Depository (B/O) Account Number 1 2 0 (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: HOUSE WIFE Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 3. Depository (B/O) Account Number : 1 2 0 (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: HOUSE WIFE Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: SERVICE

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 1 2 0 3. Depository (B/O) Account Number : (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: Nationality: BANGLADESHI. Phone (if any): 01674793066
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch: JESSORE

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.

``INTERESTED PERSONS ARE ENTITED TO A PROSPECTUS, IF THEY SO DESIRE AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE ISSUER AND THE ISSUE MANAGER.

APPLICATION FORM

Padma Islami Life Insurance Limited

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 the rejected. Bankers SL. NO. The managing Director Padma Islami Life Insurance Limited Surma Tower (11th floor), 59/2, Purana Palton Dhaka-1000, Bangladesh. Dear sir, I/we apply for and request to allot me/us 500 number of Share and I/we agree to accept the same or any smaller number that be allotted to me/us upon the terms of the Companys 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 a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stared below.

1. No of Ordinary shares 500 of Tk. 10/- each at per share. 2. Amount of Tk. 5000/- , Taka (in words) FIVE THOUSAND only deposited vide Cash/Cheque/Draftpay Order No._______________________ Dated 26/01/2012 ON_________________ Bank:_DUTCH-BANGLA BANK LTD._ Branch___mohakhali_____. 3. Depository (B/O) Account Number : 1 2 0 (if you do not mention your valid BO (Beneficiary Owners) account, your application will be treated as invalid) 4. I/we agree to fully abide by the instruction given herein. 5. Particulars of applicant(s). a). Sole/First applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation: BUSINESS Nationality: BANGLADESHI. Phone (if any): 01823144884
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 refund through

Bank account *

Hand delivery/ courier (Please put marks in which refund will be made).

Applicants Bank A/C No. Name of the Bank:

Branch:

The applicant shall provide with the same 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 for forfeited.

b) Second Applicant: Name: Fathers/Husbands Name: Mothers Name: Postal Address: Occupation:

Nationality: BANGLADESHI.

Phone (if any): 01823144884

6. I/we hereby that I/we have read the prospectus of ` Padma Islami Life Insurance Limited., and have willingly subscribed for 500 No of share of Tk. 10/- each at par.

7. Specimen Signature(s):

i) Name (in Block Letters) ii) Name (in Block Letters)

*in case of deposit into the applications bank account, the applicant will bear the applicable charge, if any, of the applicants banker, and the issuer shall simultaneously issue 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.

_______________________________________________________________________________________________

BANKETRS ACKNOWLEDGEMENT
Certified that this bank has received Tk. 5,000/- (in word) FIVE THOUSAND only from Mr./Mrs./Ms MD being the Application Money for 500 nos. Ordinary Shares of Padma Islami Life Insurance Limited. Authorized Signature (Name & Designation)

Bankers SL NO.

Seal & Date.