Proxy Form AGM

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					                        Head Office: T. K. Bhaban (7th Floor), 13, Kawran Bazar, Dhaka-1215
                                         Web site: www.asiainsurancebd.com


                                            PROXY FORM
I/We…………………………………………………………………….of….………………………………………………………………………
…………………………………………………………………… being a member of Asia Insurance Limited do here by
appoint Mr./Mrs.…………………………………………………….…of…………………………………………......... as my/our
proxy to attend and vote on my/our behalf at the 12th Annual General Meeting of the Company to be held
on June 28, 2012 at 11:30 A.M. at Bashundhara Convention Center - 2, Block – C, Umme Kulsum Road,
Bashundhara R/A, Baridhara, Dhaka-1229 and any adjournment thereof.

Signed this: ……………..…………………….day of………………………..………………….2012.


………………………….........…                                                        ..………...................
Signature of Shareholder(s)                                                  Signature of Proxy

No. of shares held: ………………………………

 Folio No.
or
                                                                                         Revenue
BO ID No.                                                                                 Stamp
                                                                                        Taka 10.00

Note:
i. The Proxy Form signed across 10.00 (Ten) Taka revenue stamp and must be deposited at least 48 hours before the
meeting at the Company’s Registered Office.
ii. Signature of the Shareholders should agree with the specimen signature registered with Company and/or Depository
Register.

……………………………………………………………………………………………………………………………………………………………………………




                        Head Office: T. K. Bhaban (7th Floor), 13, Kawran Bazar, Dhaka-1215
                                         Web site: www.asiainsurancebd.com


                                       ATTENDANCE SLIP
I/We hereby record my/our attendance at the 12th AGM being held today, the June 28, 2012 at 11:30 A.M. at
Bashundhara Convention Center-2, Block – C, Umme Kulsum Road, Bashundhara R/A, Baridhara, Dhaka-1229

 Name of the Shareholder(s)
 (in Block Letter)
 No. of Shares
 Folio No.
 BO ID No.
 Name of the Proxy (if any)
 No. of Shares held


…………………………………………….…                                                                    ………..………………….
Signature of Shareholder(s)/Proxy                                                      Signature verified by

Note: Shareholder attending meeting in person or by Proxy are requested to complete the Attendance slip and hand
over it at the entrance of the auditorium.

				
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