FINANCE FACILITY (IES) APPLICATION FORM

The Manager Dated ____________ Dubai Islamic Bank Pakistan LTD. (DIBPL)

I/We hereby apply for Shari’a compliant finance facility (ies) from your Bank. My/our particulars are as follows:

Registered Name of Company / Name:

a) Type of Entity: Sole-proprietor / partnership / private limited company / public limited company / individual / others (Please specify)

b) Date of Establishment / Incorporation:

c) NTN No. (Where applicable):

d) Business Registration No. (If applicable):

e) Credit Rating with Credit Rating Agency: Name (where applicable)

f) Member of any relevant SME association:

g) Nature of Business:

h) Registered Address:

i) Correspondence Address: (if different from above)

j) Contact Person: - Position - Contact telephone Numbers: Office: Mobile : - Office Fax Number:

k) Name (s) of Group / Associated Company (ies) / Other Business Interests

1.___________________________ 2.__________________________ 3.____________________________ 4.__________________________

1. INFORMATION OF APPLICANT

2. BUSINESS INFORMATION

Sales Turnover (Rs ‘M) Net Profit Before Tax (Rs ‘M)Imports (Rs ‘M) ExportsPeriod

Estimated this year( ) Last year( )Last two years[Other than above

The Manager Dated ____________ Dubai Islamic Bank Pakistan LTD. (DIBPL)

3. EXISTING BANKING RELATIONSHIP

4. DETAILS OF FINANCE FACILITIES REQUESTED

Amount(Rs ‘M)

a) Finance facility (ies) being availed from Dubai Islamic Bank Branches:

b) Credit/Finance facility (ies) being availed from other banks:

c) Finance/ Credit Facility (ies), if any, being availed by Group of / Associated Companies from Dubai Islamic Bank/ other Bank (s)

Branch Name Pricing Tenor Purpose SecurityFinance Facility

Type

Credit/Finance Facility Type

Credit/Finance Facility Type

Other Bank (s) Name

CompanyName

Branch / Other Bank(s) Name

FINANCE Facility Type

Outstanding/(Limit) Amount

(Rs ‘M)

Security Offered

Pricing

Pricing

Tenor

Tenor

Tenor

Purpose

Purpose

Purpose

Security

Security

Outstanding/(Limit) Amount

(Rs ‘M)

Outstanding/(Limit) Amount

(Rs ‘M)

5. DOCUMENTS TO BE ATTACHED

6. DECLARATION

7. BANK USE ONLY

Documents listed in Annexure “A” as applicable to applicant

Please read carefully. I / We confirm that all particulars / information / documents provided above are true, complete and accurate and I / we have not withheld any information. I / We confirm that I / We have no insolvency proceedings initiated against me / us nor have I / We ever been adjudicated insolvent or convicted for financial impropri-ety/money laundering. I / We authorize DIBPL or its agent (s) to seek references and inquiries relative to information in this application, which DIBPL consider necessary. I / We authorize DIBPL to exchange, share, part with any or all information relating to my / our facility (ies) account (s) to other banks / financial institutions / credit bureau / regulatory authorities as may be required and shall not hold DIBPL liable for use of this information. I / We agree and acknowledge that the Bank reserves the right to reject this application without assigning / giving any reason. I / We authorize the Bank to make any enquiries the Bank consider necessary to verify the information for facility assessment purpose. I / We also understand that any wrong information provided by me / us or withheld would render my / our application liable to rejection.

I / We further confirm that no other application for finance facility (ies) has been made to any other branch of DIBPL. I / We also confirm that DIBPL has declined no application for finance facility (ies) in the past (if declined, please state reasons).

I / We acknowledge and agree that all information including personal data provided by me / us may be used and disclosed by the Bank for such purpose and to such persons in accordance with the Bank’s policies on use and disclosure of personal data.

Reference No:

Date Received:

Marketing Officer:

ANNEXURE “A”

Authorized Signature (with co. stamp) Authorized Signature (with co. stamp)

Authorized Signature (with co. stamp) Authorized Signature (with co. stamp)

DOCUMENTS TO BE ATTACHED (Contd.)

For Individual:

- Copy of CNIC (Checked to original by the Bank’s official);- Duly completed BBFS (for individuals)

For Sole Proprietorship:

- Copy of CNIC (checked to the original by the bank’s official)- A copy of Business Registration Certificate, if any;- Duly completed BBFS – whichever is applicable (Corporate, ME, SE)

For Partnership:

- Copy of CNIC of all partners (checked to the original by the Bank’s official);- Attested copy of “Partnership Deed”; (If any / available)- Attested copy of Registration Certificate with the Registrar of Firms,(If any / available)- Duly completed BBFS – whichever is applicable (Corporate, ME, SE)

For Limited Company:

- Certified copies of: i) Memorandum & Articles of Association; ii) Certificate of Incorporation; iii) Certificate of Commencement of Business; iv) Attested photocopies of CNIC of all directors; v) Latest list of Directors on Form 29 and ‘A’ issued by the Registrar of Joint Stock Company / Security & Exchange Commission of Pakistan (SECP);- Duly completed BBFS – whichever is applicable (Corporate, ME, SE)

For Clubs / Societies / Associations / Trusts:

- Attested copies of Certificate of Registration (except for Trusts which is not required);- Attested copies of by-laws / Rules & regulations;- Certified copy of ‘Instrument of Trust/trust Deed’ (in case of Trust)- Copies of CNICs of the members of the Governing Body / Executive Committee/Trustees (checked to the original by the Bank’s official) - Duly completed BBFS – whichever is applicable (Corporate, ME, SE)

General:

- A copy of latest “Facility Letter” and loan/finance repayment evidence, if any (Other banks)- Financial Statements for the last three years signed as per Prudential Regulations (not applicable to individuals) [Also required for associated concerns, if any, of limited companies]