Bond License Application Form

[Page 1] Information of Owner and Partners 1 | Directors/ Partners Information (For Limited/ Partnership Company) Name | Mr. Kotaro Takeuchi Nominee Director of NICCA CHEMICAL CO., LTD. Degisnation | Managing Director Percentage of Share | 99.999% Valur of Share | 904,640,000/- TIN | N/A Net Wealth/ Asset | N/A Mobile Number | +88 0173 5901417 Email Address | kotakeuchi@niccachemical.com NID | N/A Passport Number | TT1404083 Father's Name | Kenichi Takeuchi Mother's Name | Reiko Takeuchi Permanent Address | 54-28, Ishizuka, Harue-cho, Sakai-shi, Fukui, Japan Present Address | District | Upazila Address Description Photo | Signature 2 | Directors/ Partners Information (For Limited/ Partnership Company) Name | Mr. Yasumasa Emori Nominee Director of HONG KONG NICCA CHEMICAL CO., LTD. Degisnation | Chairman Percentage of Share | 0.001% Valur of Share | 10,000/- TIN | N/A Net Wealth/ Asset | N/A Mobile Number | +81-90-3297-3185 Email Address | yemori@niccachemical.com NID | N/A Passport Number | TS1580066 Father's Name | Mikio Emori Mother's Name | Sueko Emori Permanent Address | 1-609, keya, Fukui-city, Japan Present Address | District | Upazila Address Description Photo | Signature 3 | Directors/ Partners Information (For Limited/ Partnership Company) Name | Mr. Atsutaka Kobayashi Nominee Director of NICCA CHEMICAL CO., LTD. Degisnation | Director Percentage of Share Valur of Share | 10000/- TIN | N/A Net Wealth/ Asset | N/A Mobile Number | +81-90-2129-2678 Email Address | akobayashi@niccachemical.com NID | N/A Passport Number | TZ1040129 Father's Name | Yasukuni Kobayashi Mother's Name | Sueko Emori Permanent Address | 1-609, keya, Fukui-city, Japan Present Address | District | Upazila Address Description Photo | Signature [Page 2] 4. Information About Authorized Signatory Authorized Signatory-1 | Authorized Signatory-2 Name | Mr. Kotaro Takeuchi | Name | Mr. Yasumasa Emori Designation | Managing Director | Designation | Chairman Country | Japan | Country | Japan NID/ Passport | TT1404083 | NID/ Passport | TS1580066 Present Address | 54-28, Ishizuka, Harue-cho, Sakai-shi, Fukui, Japan. | Present Address | 1-609, keya, Fukui-city, Japan. Permanent Address | 54-28, Ishizuka, Harue-cho, Sakai-shi, Fukui, Japan. | Permanent Address | 1-609, keya, Fukui-city, Japan. Mobile Number | +880-173-590-1417 | Mobile Number | +81-90-3297-3185 Email Address | kotakeuchi@niccachemical.com | Email Address | yemori@niccachemical.com Information of Association Business 5. Associate Business Details Name of the person who is doing Associate Business | Mr. Kotaro Takeuchi Ownership Category | Private Limited TIN of that person | N/A NID/ Passport | TT1404083 BIN of the Associate Business | 005911976-0304 Name of the Associate Business | NICCA BANGLADESH CO., LTD. TIN of the Associate Business | 898325152243 Address of the Associate Business | Lot No. C6, Bangladesh Special Economic Zone (BSEZ), Sonpara, Panchrukhi Via Rupganj, Araihazar, Narayanganj, Bangladesh Nature of the Associate Business | Manufacturing/ Industry Percentage of Share | 99.99% Value of Share | 904,640,000/- Net Wealth/Asset | N/A Information of the Organization 6 | Name of the Organization | NICCA BANGLADESH CO., LTD. 7 | Address of the Head Office | District | Narayanganj | Address Description | Lot No. C6, Bangladesh Special Economic Zone (BSEZ), Sonpara, Panchrukhi Via Rupganj, Araihazar, Narayanganj, Bangladesh Thana | Rupganj | Mobile Number | +880-173-590-1417 Phone Number | Email ID | nicca.chemical.bd@gmail.com 8 | Type of Bond Operational Area | Type of Bond 1. Domestic Type Area (DTA); 2. EPZ; 3. Economic Zone; ✓ 4. High Tech Park; | 1. Direct Expor Bond; 2. Deemed Bond; ✓ 3. Direct & Deemed Bond; 4. Home Consumption Bond; 5. Diplomatic/Duty Paid Warehouse Bond; 6. Duty Free Shop; 7. Supervised Bond; 8. Ship Store; [Page 3] 9 | Equity Information 10 | TIN Number | Number | 898325152243 | Issue Date | 11/10/23 11 | BIDA/ BSCIC Registration Certificate | Number | N/A | Issue Date 12 | ERC | Number | Issue Date 13 | IRC | Number | Issue Date 14 | BIN | Number | 05911976-9102 | Effective Date | 01/2024 15 | Trade License | Number | TL-20231204094407991453 | Issue Date | 16/01/2025 16 | Fire License | Number | 58.03.0000.007.34.001.24(Shobha-03)-3576 | Issue Date | 31/03/2024 Expirty Date | N/A 17 | Environmental Clearance (If Applicable) | Number | 22.02.6700.140.071.281.25.755 | Issue Date Expirty Date | 20/11/2025 22/04/2026 18 | Enrollment (If Any) A. Enrolled With [Please Tick] | BGMEA | BKMEA | BGAPMEA BTMA | BTA | BPGMEA BCMEA | BLMEA | LFMEAB BTTLMEA | CGAG Other (Specify): | Japan-Bangladesh Chamber of Commerce and Industry (JBCCI) B. Membership Number | N-28 | Issue Date Expiry Date | 04/03/2026 30/06/2026 19 | Lien Bank Sl No. | Code | Name | Branch 01 | HSBCBDDH | HSBC (HongKong and Shanghai Banking Corporation) | Management Office Information of Manufacturing Unit (Not Applicable) 20 | Address of the Manufacturing Unit | District | Narayanganj | Address Description Thana | Rupganj | Mobile Number Phone Number | Email ID 21 | Manufacturing Unit Premises [Please Tick] (Not Applicable) Owned | Khotian | Mouza CS Dag Number | RS Dag Number Hired | Deed Number | Deed Date | Deed Expiry Date CS Dag Number | RS Dag Number 22 | Description of Boundaries North | East South | West 23 | Whether there was other bonded factory before at the same Premises? [Please Tick] ✓ | No | Name | BIN Bond License Number No 24 | Area of the Factory (Not Applicable) Sl. No. | Length (ft) | Width (ft) | Area (SQ ft) | Description of the Factory 25 | Volume of Raw Materials Warehouse (Not Applicable) S.l. No. | Length (ft) | Width (ft) | Height (ft) | Volume (CU ft) [Page 4] 26 | Finished Goods Warehouse S.l. No. | Length (ft) | Width (ft) | Height (ft) | Volume (CU ft) | Description of the Finished Goods Warehouse 1 2 3 4 5 6 7 8 9 Total Information of Manufactured Goods and Raw Materials 27 | Main Products | N/A 28 | Descripotion of the Raw Materials (As per the Registration certificate of BIDA/ BSCIC) (Not Applicable) S.l No. | Name of Raw Materials (Commercial Dexcription) | HS Code | BCT Wise Description 29 | Description of the Finished Goods (Copy Attached) (Not Applicable) Sl. No. | Name of Finished Goods (Commercial Description) | HS Code | BTC Wise Description | Annual Production Capacity | Unit Information of Installed Machineres (Not Applicable) 30 | Description of the Machineres Machine Category Machine Particulars Brand Name Model Number HS code of Machine Country of Origin Manufacturing Year | Date of Installation Quantity | Life Cycle Machine Hyperlink to web address of Machine Catalogue Value BDT | Physical Condition Main/ Auxiliary Machine | Annual Production Capacity Unit Invoice Information [Please Tick] Local Purchase | BIN No. | Name Address | Vat Challan No. Bill of Entry No. | Vat challan Date Bill of Entry Date | Life Span of Machine Bill No. | Invoice No. Bill Date | Invoice Date LC No | Invoice Amount LC Date | Number of Machines LC Amount International Purchase | Bil of Entry No. | Bill of Entry Date BL No. | BL Date Invoice No. | Invoice Date Invoice Amount | LC No. LC Date | LC Amount Number of Machines [Page 5] 31 | Indemnity Bond/ Undertaking for imported Machineries (If any) (Not Applicable) Installed Machines Name | Model Number B/E No. | B/E Date. Indemnity Bond/Undertaking No. | Indemnity Bond/Undertaking Date Cash Memo/ Vat challan/Voucher No. | Cash Memo/Vat challan/Voucher Date Due Date of Release | Actual Date of Release Number of Machines 32 | If Machineries are purchased from other Bonded Factory (Afer Release or Indemnity Bond/ Undertaking by Importer) (Not Applicable) Bonder Name | Bond Licene Number Machine Name | Number of Machines B/E No. | B/E Date. Clearance Certificate Number (from BIDA/BSCIC/Other) | Clearance Certificate Date Permission from BOND Authority | Permission from BOND Authority Date Cash Memo/ Vat challan/Voucher No. | Cash Memo/Vat challan/Voucher Date Transfer Lien Bank NOC Number | Transfer Lien Bank NOC Number Date Bank Name | District | Branch 33 | Raw Materials Wise Main and Auxiliary Machineries and Production Capacities (Not Applicable) Sl No. | Name of Raw Materials (Commercial Description) | HS Code | Main Machine Particulars | Quantity of Main Machine of this type | Auxiliary Machine Particulars | Annual Main Machine Production Capaqcity | Unit 34 | Clearing and Forwarding Agent (C & F agent) Sl. No. | C & F Agent Name | Issue Date | AIN | Address 1 | Homebound 2 [Page 6] 35 | Information of Entitlement Raw Materials Commercial Type (Auto Fill) Raw Materials Name (Auto Fill) | Main Machine Name (Auto Fill) 36 | Required Documents 37 | Declaration (By Chairman/ Partner/ MD/ Proprieto/ Sole Partner I hereby certify that solemnly declare that all the above information is correct and nother has been concealed. I am aware that giving false information or concealing any information is a legal offence. Name (In block letters) | MR. KOTARO TAKEUCHI Designation | Managing Director Signature and Seal Date 38 | Office Zone Selection Customs Bond Commissionerate, Dhaka (South)