14 Tzar Osvoboditel sq., Sofia
tel.:+359 02/8166491,+ 359 02/8166236,
fax: 02/9888104;02/9888191 e-mail:;
To Eurobank EFG Bulgaria AD
FC……………………
Through investment intermediary ………………………
Global number………………
APPLICATION – DECLARATION№………………/……….
For subscription of shares against rights from the capital increase of Balkancar ZARYA AD /ticker:4BU, ISIN: BG11BAPAAT13/
Applicant
Name: ......
BULSTAT/UIC/: ......
Company File №……………………………………………………………………………………………………………….
Seat and Headquarters Address:......
Client №/Code in Central Depository AD......
Represented by:
Name: ...... , UCN/Citizen of ......
ID №/passport № ………………………, issued on...... by…………………......
Address:......
and
Name: ...... , UCN/Citizen of ......
ID №/passport № ………………………, issued on...... by…………………......
Address:......
Proxy:...... , UCN/Citizen of ......
ID №/passport №………………………, issued on...... by…………………......
Power of Attorney №......
By the present application – declaration I wish to subscribe...... (number) /…….….……………...…...... /(in words)shares from share issue with ticker:4BU,ISIN:BG11BAPAAT13against the possessed by the company, which I/we represent...... /number/...... /(in words)rights with ticker: 4BU1,ISIN: BG4000012105.
Value of the subscribed shares: BGN ...... /……….……………….…..…...... /(in words)
Hereby I/we specify the following bank account for refund of the paid amounts in case of unsuccessful capital increase procedure:
IBAN:………………………………………………………………………..., BIC……………………………………………...
Date, hour and place of reception of the application:......
/one right give the right for subscription of one new share with issue value BGN 1/
With the present application I/we declare that:
I am/we are acquainted with the procedure and the terms of the capital increase, as well as with the fact, that subscription of shares before the initial (22.10.2010г.) and after the final term (29.11.2010г.) of the capital increase procedureis not allowed;
I am/we are acquainted with current investors’ compensation system, incl. its scope and guaranteed amount of the clients assets.
I am/ we are acquainted with the fact that it is in my/ourfavor and it is in favor of the company, which I/we represent to get familiar with the Prospectus for Initial Public Offering of Shares from the Capital Increase of Balkancar ZARYA AD, which can be found on a hard copy in the office of Balkancar ZARYA AD, as well as in the office of Eurobank EFG Bulgaria AD – 14 Tzar Osvoboditel sq., Sofia.
I am/we are acquainted with the fact thatsubscription of shares, respectively deals with shares from the capital increase of Balkancar ZARYA AD and payments related to it are not allowed before FSC to confirm the prospectus for public offering of securities, as well as not before the first business day after the expiration of 7 days after the notification for the public offering of securities, published in State Gazette, №.71/10.09.2010 and in Dnevnik,№.197/14.10.2010, respectively before BSE to list the shares from the capital increase of Balkancar ZARYA AD for trading.
I have/ we havereceived from investment intermediary ……………………, respectively from Eurobank EFG Bulgaria AD the information, that the respective investment intermediary/Eurobank EFG Bulgaria AD is obliged to present to the company, which I/we represent in relation to art. 9, 10, 12, 18 and 32of Regulation № 38 of the Financial Supervision Commission Regarding the Requirements for the Activities of Investment Intermediaries (in case of retail client), respectively the scope of information, that the relevant investment intermediary/Eurobank EFG Bulgaria AD is obliged to present to the company, which I/we represent, in its capacity of professional client/eligible counterparty.
I am/we are acquainted with the necessity the company, which I/we represent, to pay the due amount to the fund-raising bank account of Balkancar ZARYA AD: IBAN:BG70BPBI79315047917001, BIC: BPBIBGSFwith Eurobank EFG Bulgaria AD until 16:30on the final date of the capital increase procedure (at latest)- 29.11.2010;
I am/we are acquainted with the fact that Eurobank EFG Bulgaria AD shall not has any responsibility in case of presentation by me/us of untrue, insufficient or misleading information, as well as if the company, that I/we represent, does not pay the due amount for payment of issue price of the subscribed shares until the final date of the capital increase procedure –29.11.2010
I am/we are acquainted with the fact that the submitted application shall be valid only up to the number of subscribed shares, for which the issue price was fully paid.
I/we do not possess insider information for the rights and for the shares from the capital increase of Balkancar ZARYA AD, neither for Balkancar ZARYA AD.
The subscription of shares from the capital increase of Balkancar ZARYA AD against the possessed by the company, which I/we represent, rights is not concealed purchase or sale of financial instruments.
For the Applicant – Declarer: For the Applicant – Declarer:
/...... / /...... /
stamp andsignature stamp andsignature
Herewith I declare that the application has been submitted after the identity of thelegal representative/s of the applicant /his proxy had been checked.
Person under art.39, RRAII, who received the application: Internal Control Officer in investment intermediary ……………...………….:
/...... / /...... /
stamp andsignature stamp andsignature
Internal Control Officer inEurobank EFG Bulgaria AD:
/...... /
stamp andsignature