DFIM Circular No. 01: Regarding Statement of Diagnostic Review Report (DRR)

Department of Financial Institutions and Markets Financial Institutions and Markets Department Bangladesh Bank Head Office Dhaka. 30 Poush 1422 DFIM Circular No.-01 Date: ------------------ 13 January 2016 Managing Director / Chief Executive Officer All Financial Institutions Operating in Bangladesh Dear Sir, Subject: Submission of Statement of Diagnostic Review Report In order to accurately determine the true status of various financial indicators of financial institutions, the Diagnostic Review Report (DRR) is prepared based on information collected according to the prescribed format. You are advised to submit this report to this department within 01 (one) month after the audit of the financial statements of the concerned institution, as prepared in accordance with the Financial Information and prescribed format prepared under the Financial Institutions Act, 1993, Sections 23 and 24(5). Enclosure: As stated. Yours faithfully, (Md. Rafiqul Islam) Deputy General Manager Phone: 9530249

Diagnostic Review Report Name of the Financial Institution: ........... Date: .......

Name of the Financial Institution: .................. Date: .............. Diagnostic Review Report Page 2 of 6 Name of the Financial Institution: .................. Date: .............. Diagnostic Review Report Page 3 of 6

1. Name and Address of the Institution: Name of the Institution: Address: Name of the Branch/Office: Address: Branch Code: Head Office/Regional Office Code: Date of Establishment: Date of Commencement of Business: Date of Commencement of Operations:

Name of the Financial Institution: .................. Date: .............. Diagnostic Review Report Page 4 of 6

2. Balance Sheet: S.No. As of 31-12-20... As of 31-12-20... As of 31-12-20... * 1 2 3 4 5 1 Total Assets 2 Total Liabilities 3 Total Equity 4 Total Liabilities (Note 1) 5 Total Liabilities (Note 2) 6 Total Liabilities / (Total Assets) 7 Total Liabilities Ratio 8 Total Liabilities to Total Assets

• The above figures are for the concerned branch.

3. Assets: S.No. As of 31-12-20... As of 31-12-20... As of 31-12-20... 1 2 3 4 5 1 Cash, Balances with Banks and Treasury Bills 2 Balances with Banks and Treasury Bills 3 Balances with Banks: 4 NCDs 5 CDs 6 Bonds 7 Shares 8 Loans and Advances to Banks 9 Loans and Advances to Customers 10 Loans and Advances / (Total Assets) 11 Total Loans and Advances 12 Fixed Assets 13 Intangible Assets (Net of Amortization) 14 Intangible Assets (Net of Amortization) 15 Investments in Subsidiaries 16 Treasury Bills 17 'Investment' Assets

Name of the Financial Institution: .................. Date: .............. Diagnostic Review Report Page 5 of 6

4. Income Statement: S.No. As of 31-12-20... As of 31-12-20... As of 31-12-20... 1 2 3 4 5 1 Interest Income 2 Interest Expense 2.1 Interest on Deposits 2.2 Interest on Borrowings and Advances 3 Total Interest Income 4 Interest, Fees and Commissions 5 Interest on Borrowings 6 Interest on Borrowings 7 Net Interest Income and Fees 8 Net Interest Income 9 Net Interest Income (NII) 10 Net Interest Income (NII) 11 Non-Interest Income 12 Non-Interest Income

Name of the Financial Institution: .................. Date: .............. Diagnostic Review Report Page 6 of 6

5. Expenses: S.No. As of 31-12-20... As of 31-12-20... As of 31-12-20... 1 2 3 4 5 1 Interest and Interest-bearing Expenses 2 Interest and Non-interest Expenses 3 Provision for Bad and Doubtful Debts 4 NPL (Non-Performing Loans) 5 NPL (Non-Performing Loans)

6. Capital Adequacy: S.No. As of 31-12-20... As of 31-12-20... As of 31-12-20... 1 2 3 4 5 1 Total Capital 2 Capital to Risk-Weighted Assets 3 Capital Adequacy Ratio to Risk-Weighted Assets 4 Total Capital to Risk-Weighted Assets 5 Capital Adequacy Ratio to Total Assets 6 Total Capital to Total Assets 7 Net Profit to Total Assets

7. Additional Information:  Name of the Auditor:  Auditor's Firm Name:  Date of Audit Report:  Auditor's Opinion:  Auditor's Firm Name: