UNIROYAL SECURITIES LIMITED OPENNING FORM (01/13)


DSE Brokerage Account Opening Form

UNIROYAL SECURITIES LIMITED

45 DILKUSHA C/A (2nd FLOOR), Dhaka 1000, TEL:9563073, 9563074

SEC REGISTRATION # 3.1/DSE-89/2006/114

DSE MEMBER #89, CDBL DP # 21

Account Category * Cash Margin Account Type * Individual Company Joint Holder
First Applicant
Name in Full of Account Holder(Up to 99 Characters)*
(In case of a company/Firm/Statutory Body) Name of Contact Person*
In Case of Individual* Male Female
Father's/CEO Name* Mother's Name*
Husband's/Wife Name* Occupation*
Address*
City* Post Code* State/Division*
Country* Telephone
Mobile Phone* Fax E-mail*
Residency:* Resident Non Resident Nationality* Date of Birth (DDMMYYYY)*
In Case of Company: Registration No Date of Registration (DDMMYYYY)
Joint Application (Second Account Holder)
Name in Full of Account Holder(Up to 99 Characters)
Gender Male Female
Father's/Name Mother's Name
Husband's/Wife Name Occupation
Address
City Post Code State/Division
Country Telephone
Mobile Phone Fax E-mail
Residency: Resident Non Resident Nationality Date of Birth (DDMMYYYY)
ADDITIONAL INFORMATION
Are you Officer/Director of any stock Exchange/Listed Company? Yes No
If YES, name/s of the Stock Exchange/Listed Company
DECLARATION
The rules and regulations of Dhaka Stock Exchange Limited, Central Depositoty Bangladesh Limited and UNIROYAL SECURITIES LIMITED pertaining to an account which are in force now have been read by me/us and I/We have understood the same and I//we agree to abide by and to be bound by the rules as are in force from time to time for such accounts. I/We also declare that the particulars given by me/us are true the best of my/our knowledge as on the date of making such application. I/We further agree that any false/misleading information given by me/us or suppression of any material fact will render my/our account liable for termination and further action.
Applicants Name Signature
First Applicant*
Second Applicant
Authorized Person(if any)
FOR OFFICIAL USE ONLY
Name of Officer of Member Firm Accepting the Account
Signature of Officer With Date