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"INTERESTED PERSONS ARE ENTITLED TO A PROSPECTUS, IF THEY SO DESIRE, AND THAT COPIES OF PROSPECTUS MAY BE OBTAINED FROM THE

ISSUER AND ISSUE MANAGERS"

PREMIER CEMENT MILLS LIMITED


Application Form
APPLICATION FOR SHARES BY INVESTORS OTHER THAN NON-RESIDENT BANGLADESHI(S) Warning: Please read the instructions at the back of this form. Incorrectly filled Applications may be rejected.

The Managing Director PREMIER CEMENT MILLS LIMITED TK Bhaban (4th Floor) 13 Kawran Bazar Dhaka - 1215

Banker's SI No :

Dear Sir, I/We apply for and request you to allot me/us the 200 number of Shares and I/we agree to accept the same or any smaller number that may be allotted to me/us upon the terms of the Companys approved Prospectus and subject to the Memorandum and Articles of Association of the Company. Further, I/we authorize you to place my/our name(s) on the Register of Members of the Company and deposit the said shares to my/our BO (Beneficiary Owner) Account and/or a Crossed (Account Payee only) Cheque in respect of any application money refundable by post/courier at my/our risk to the first applicants address stated below: 1. No. of Ordinary Shares 200 of Tk.22/- each including a premium of Tk.12/- per share. 2. Amount of Tk. 4400.00/= Taka (in words FOUR THOUSAND FOUR HUNDRED) only deposited vide Cash/Cheque/Draft/Pay Order No ______________ dated _______________ on ______________________________ Bank ______________________ Branch.

3. Beneficiary Owner (B/O) Account Number


4. I/We agree to fully abide by the instructions given herein. 5. Particulars of applicants: a) Sole/First Applicant

1 2 0 1 7 1 0 0 3 8 1 4 9 5 5 8

Name: Mr./Mrs./Ms. Fathers/Husbands name : Mothers name : Occupation : BUSINESS

MD.MONJUR RAHMAN MD.ABDUR RAHMAN MOJERON BEGUM Nationality : BANGLADESHI Phone : 01919029773

Postal address : PRANTIK TELECOM,158/A ARAMBAGH,MOTIJHEEL,DHAKA


For refund warrant (Application will not be treated as valid if any one uses a non-scheduled bank. To avoid this complication, investors are requested not to use the name of any non-scheduled bank) Please write the correct and full name of bank and branch In case of deposit into the applicant's bank account, the applicant will bear the applicable service charge, if any, of the applicant's banker, and the issuer shall simultaneously issue a letter of intimation to the applicant containing, among others, the date and amount remitted with details of the bank through and to which bank such remittance has been effected.

Applicants Bank A/C No : Name of the Bank :


b) Second Applicant

73194 Branch : LOCAL

Islami Bank Bangladesh Ltd.

The applicant shall provide the same bank account number in the application form as it is in the BO account of the applicant.

Name: Mr./Mrs./Ms. Fathers/Husbands name : Mothers name : Postal address : --- N/A --Occupation : --- N/A ---

--- N/A ----- N/A ----- N/A --Nationality : --- N/A --Phone : --- N/A ---

6. I / We hereby declare that I/We have read the Prospectus of PREMIER CEMENT MILLS LIMITED and have willingly subscribed for 200/- no. of shares of Tk. 22/- each including a premium of Tk. 12/- per share. 7. Specimen Signature(s):

Name (in Block Letters ) Sole / First Applicant Second Applicant MD.MONJUR RAHMAN --- N/A ---

Signature

............................................................................................................................................................. BANKER'S ACKNOWLEDGEMENT


Certified that this Bank has received Tk. 4400/- (in words FOUR THOUSAND FOUR HUNDRED only) from Mr./Mrs./Ms. MD.MONJUR RAHMAN being the application money for 200 nos. of ordinary shares of PREMIER CEMENT MILLS LIMITED.

Banker's SL. No.

Seal & Date

Authorized Signature (Name & Designation)

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