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Subscriber please clearly fill in the spaces below - BCEL-KT PO BCEL Form/PO Eng.pdf · in the ca ** Pleas subscrip >>> Fo Subscrip Evidence ... V XXXXXXXXX CEL) as the follo ency:

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Page 1: Subscriber please clearly fill in the spaces below - BCEL-KT PO BCEL Form/PO Eng.pdf · in the ca ** Pleas subscrip >>> Fo Subscrip Evidence ... V XXXXXXXXX CEL) as the follo ency:

Subscrip

Name an

( ) ID C

National

Address

Telephon

WhatsAp

Hereby

No. of

Made pa

Acc. Nam

BCEL

If the shaallotted strading aof the se

If I/we hdeposit i

Depo

(Note: B

I/We herin the ca

** Pleassubscrip

>>> Fo

SubscripEvidenceshares oPaymentIf the shaallotted sno._____

 

 

ption Date: _____

nd Surname (Eng

ard ( ) Alien Ca

lity____________

BCEL-KT Secur

ne No. 021 26548

pp: XXXXXXXX

subscribe for an

Share subscrib

ayable to Bank: B

me:LCS(BCEL FO

L Address: No. 1

ares are allotted tshares and arrangaccount name___curities trading a

have not been allointo my/our accou

sit to my/our acco

Bank charges or an

reby undertake toase that my/our su

se be aware thation.**

or officer uses on

-------------------

Subscription

ption Date: _____e of subscription

of BCEL from PutDate: _______/_ares are allotted tshares and arrang______________

Subscriptio

Public o (

__/ _______/ 201

lish) __________

ard ( ) Passpor

______________

rities Co. LTD, B

80 -487 M

XXXXX W

nd request allotm

bed Offerin

Banque Pour Le C

OR SHARE SUBS

, PangkhamStre

to me/us , I/we hege further to BCE_______________account)

otted the Share orunt as the followi

ount at Bank ___

ny other expense

o subscribe the abubscription is to b

at there is risk

nly >>>

---------------------

n Receipt for Pu

__/_______/2017fund payment fro

ublic Offering wit_______/2017 hasto me/us, I/we herge further to___________.

on Form for N

offering (PO) of(Minimum subsc

17

______________

rt ( ) Company

Su____ Date of Birt

Ban Phonethan Ne

Mobile Phone XXX

We Chat: XXXXX

ment of new ordi

ng Price (Kip)

5,300

Commerce Exterie

SCRIPTION)Acc.

eet, VTE, LAO P

ereby agree to theEL-KT Securities ______________

r have been allotteing information.

_______________

e will be deducted

bove ordinary shabe refused becaus

involved in stoc

Checker

---------------------

ublic Offering

7Subscription Noom (name of substh_____________s been submitted reby agree to the ______________

New Ordinary S

f 2,857,100 newcription requirem

_______________

y Registration Cer

ubscriber pleash_________/___

eua, Kamphengm

XXXXXXXXXX

XXXXXXXX inary sharesof B

Amoun

eur Lao Public Co

No: 010190001

PDR. SWIFT Co

e underwriter to isCompany Limite

_______________

ed lower than the

______________

d from the refund

res as allocated toe of incompletion

k investment and

r: ____________ ________ / __

---------------------

(PO) of New O

._____________scriber)_____________________shand duly receiveunderwriter to is

_______________

Shares of Banq

ordinary sharesment is one (01)

___Securities Ac

rtificate No. __

se clearly fill in______/_______

meuang Road, Say

X E-Mail:

BCEL as follows:

nt (Kip)

ompany Bank (B

1353261001 Curr

ode : COEBLAL

ssue a share certied to deposit the s______no.______

e subscribed amou

__ Branch ______

amount to the su

o me/us and shalln of document as

d make sure yo

_____________________ / _______

---------------------

Ordinary Shar

______________________________shares at the offered. ssue a shareholdin______________

A

que Pour Le C

with par value olot, with each lo

Subscription No.

c. No. _________

______________

n the spaces be Occupation __

ysettha District, V

XXXXXXXXX

:

BCEL) as the follo

rency: LAK Am

LA

ficate in the namsaid Shares with L______________

unt, I/we agree to

______________

ubscriber).

l not cancel this o required by the C

Sig

u have thorough

_ __

---------------------

res of BCEL (S

___________________________

ring price of 5,300

ng certificate in th________Securiti

Authorized Office

Commerce Exte

of 5,000 Kip at tot equal to one h

. BCEL-KT………

______________

_______________

low ______________

Vientiane Cap, La

XXXX

Amo

owing accounts:

mount:_________

e of “Settlement aLao Securities De____(Name of the

o have the paymen

__________ Acc.

offering subscriptCompany or any

nature ______

(_______

hly studied all in

Input: ___ ___

---------------------

Subscriber plea

_______________0 kip, Amount: __

he name of “Lao ies Company Lim

er:___________

(___________

erieur Lao Pub

the offering prichundred (100) un

……………..

______________

_______________

______________

ao PDR, LSX bui

mount in words

___________ ___

and Depository Depository Center e subscriber must

nt or excess paym

No___________

tion including accother reasons.

_______________

______________

information befor

______________________ / ______

---------------------

ase also fill out

_____ for the subs_______________

Securities Deposmited, my/our sec

______________

_______________

blic Company

ce of 5,300 Kipnits of share)

___________

___________

_______________

ilding, 7th floor.

____________ L

Department” for tfor my/our secur

t be the same as th

ment returned to m

_______________

ceptance of fund

______________

_______________

re deciding on t

____________ __ / ________

---------------------

t this portion)

scription of new o______________

sitory Center” forurities trading ac

________

________)

(BCEL)

per share

______

LAK

the rities he name

me/us by

_______

return

___

___)

the share

----

ordinary ____Kip,

r the count