test00 – Brown & Company PLC

Online Application Form

"*" indicates required fields

Initial Public Offering

Type of Investor*

Share Price (LKR)

Number of Shares*

RETAIL Individual Investors can apply from 100 to 8000 shares in multiples of 100 shares.
NON-RETAIL Individual Investors can apply for 8100 shares or more in multiples of 100 shares thereafter.

Total Amount to be Paid (LKR)

Applicant Information*

Title*

Initials*

Surname*

Names Denoted By Initials*

Address*

NIC/Passport Number*

Email*

Contact Number*

Nationality*

Sri Lankan

Other

Residency*

Resident

Non-resident

CDS Account Information*

Broker Code*

CDS Account Number*

2-Letters Suffix

Account Type

Broker Guide

Deposit as Shares in CDS Account*

If specific instructions are not selected the shares will be deposited to the Trading balance account

Deposit Of Share In CDS*

Trading Balance
DO NOT DEPOSIT the Shares to my “locked” balance of the CDS account mentioned above

Locked Balance
DEPOSIT the Shares to my “locked” balance of the CDS account mentioned above (I understand that the Shares in the ‘locked’ balance
WOULD NOT BE AVAILABLE FOR TRADING PURPOSE and would not be visible to the respective CDS participants)

Payment Details*

Ensure that there is no difference between the value of the shares applied for in the Online Application Form and the payment confirmation attached.

Please note: Applicants are required to indicate their NIC Number or CDS account number as payment reference in the bank deposit slip or under the transfer reference field for CEFT/ SLIPS/ RTGS

Payment Method*

Name of Bank*

Bank Branch*

Bank Deposit Slip/CEFT/SLIPS/RTGS Reference Detail*

Payment Date*

Proof of Payment Attachment (for Non-resident applicants this should also include IIA confirmation)*

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 5 MB, Max. files: 2.

Refund Payment Instructions*

(in the event of an oversubscription of the Issue)

Refund Payment Method*

Cheque sent by ordinary mail to the address relevant to the above CDS account

Direct transfer via SLIPS (please enter your bank details accurately below)

Name of Bank

Bank Branch

Account Number

Declaration required to facilitate compliance with the Foreign Exchange Act
and relevant regulations made thereunder

Foreign Exchange Act and relevant regulations*

For Sri Lankan citizens resident in Sri Lanka
I, the above Applicant, of the above mentioned Ordinary Voting Shares hereby declare that I am a citizen of and resident in Sri Lanka and I am not acting as a nominee of any person resident outside Sri Lanka

For Non-residents and foreign citizens
I, the above Applicant, of the above mentioned Ordinary Voting Shares hereby declare that I have made the applicable remittance out of funds maintained in an IIA as per the Foreign Exchange Act No.12 of 2017 and Foreign Exchange (Classes of Capital Transactions Undertaken in Sri Lanka by a Person Resident Outside Sri Lanka) Regulations No. 2 of 2021 dated February 3, 2021.Confirmation from the bank to such effect is attached to this Application.

Terms and Conditions*

I, the undersigned hereby apply for and request you to allot me the number of Ordinary Voting Shares stated in this application as per the Prospectus. The amount payable on Application is submitted herewith. I hereby agree to an allotment of Ordinary Voting Shares applied for or a lesser number as may be applicable, subject to the terms and conditions contained in the Prospectus and the Articles of Association of the Company. Please enter my name in the register of shareholders of hSenid Business Solutions Limited for such number of Shares that may be allotted on the basis of acceptance by the Company.

Duly signed by:

Full Name (according to the NIC/Passport)*

Signed Date*

Signing Method*

Digitally Signed

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