DSE TREC # 059 CSE TREC # 130
GREEN DELTA SECURITIES LIMITED
A wholly-owned Subsidiary of Green Delta Insurance Company
Hadi Mansion, 2, Dilkusha C/A, Dhaka-1000
.
DEMATERIZLIAZATION REQUEST FORM (DRF)
(CDBL BYE LAW 9.1.1)
To be filled up in capital letter in triplicate i. copies for shareholder, depository participants and issuer. Names must be
correctly stated. Separate forms must be filled up for different issuers and free securities and licked in securities of
the same issuer. One form can accommodate up to 25 certificate numbers and within each certificate number up to 4
distinctive number rangers. All communication/advice shall be send to the mailing address of only the first name
account holder.
Date:
1. To be filled up by CDBL participants:
Name of the CDBL Participants: (up to 99 characters):
CDBL Participant ID:
Dematerialization Request No (DRN):
CDBL System Generated Number:
DRE No:
Request setup date:
2. Details of securities surrendered for Dematerialization
BO ID:
BO Name:
ISIN:
Name of the issuer company:
Quantity Type: Free Lock In
Expiry Date:
Employee Quota Promoter’s Quota Foreign Investor’s Quota
Private Placement Quota Sponsors Quota Others
DSE TREC # 059 CSE TREC # 130
Total Quantity:
Quantity in word:
Type of securities:
OrdinaryShare Preference Share Debentures Bond Uni ts Others
I/we request you to dematerialize the enclosed certificates registered in my/our name for the credit of
my/our depository account.
Serial Registered Folio Certificate Distinctive Number
No. Number Number From To
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
DSE TREC # 059 CSE TREC # 130
The original certificate(s) as listed above are hereby surrendered by me/us for dematerialization and
the same are free from any lien or change or encumbrance and represent the bonafied
securities of the issuer company to the best of my/our knowledge and belief.
Account Holder Name Signature
First A/C Holder
Second A/C Holder
Third A/C Holder
3. Authentication by CDBL Participant
We Have received the above mentioned securities for dematerialization. The Dematerialization Request form (DRF) is
verified with the certificate(s) surrendered for dematerialization and we certify that the DRF is in accordance with the
detailed mentioned in the enclosed certificate(s). It is also certified that the holder(s) of the securities have a Depository
Account with us in the same name.
Name Designation Signature Participant’s Seal
