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Application Form-A

LAFARGE SURMA CEMENT LIMITED Suvastu Imam Square, 3rd Floor 65, Gulshan Avenue, Gulshan-1 Dhaka-1212, Bangladesh Rights Issue of 58,068,675 Ordinary Shares of Tk. 100.00 per share at par value offer to the Shareholders appeared in the share register at the close of business on October 3, 2011 Last-Date of Acceptance and Application: November 13, 2011

FORM OF ACCEPTANCE AND APPLICATION FOR SHARES
Managing Director Lafarge Surma Cement Limited Suvastu Imam Square, 3rd Floor 65, Gulshan Avenue, Gulshan-1 Dhaka-1212, Bangladesh Dated: ____/_____/2011

Dear Sir, I/We apply for allotment of ordinary shares indicated below in response to your letter of Rights Offer and Subject to the Memorandum and Articles of Association of the Company. I/We hereby agree to accept the shares as may be allotted to me/us on the terms laid down in the letter of offer and enclose the necessary remittance at Tk. 100.00 per share in cash or by Draft/Pay order/Cheque no. ……………………………… dated……………………………………… drawn on. …………………………………………………… Bank ……………………………………………… Branch. Holders' Folio/BO Account No. No. of shares held at the close of business on October 3, 2011 No. of shares offered No. of shares accepted Total amount paid

Taka (In word) …………………………………………………………………………………………………………………… Yours faithfully, 1. Name (in block)…………………………….………………………………… Signature. …………………….…………… Address:…………………………………………………….………………………………………….…………………………… Tel/Mobile No. ……………………………………….…………………………….……………………………….……………… 2. Name (in block)…………………………….………………………………… Signature. …………………….…………… Address:…………………………………………………….………………………………………….…………………………… Tel/Mobile No. ……………………………………….…………………………….……………………………….……………… Holders' B/O Account Number As per provision of the Depository Act, 1999 and regulations made there under, rights share shall only be issued in dematerialized condition. An applicant must apply for allotment of Rights Share mentioning his/her Beneficiary Owner (BO) Account number in the application form. Note: Signature must be the same as was furnished to the Company earlier. In case of incomplete application, the offer will be deemed to have been declined. A/C payee Cheque/Draft/Pay-order to be issued in favour of LAFARGE SURMA CEMENT LIMITED.

ACKNOWLEDGEMENT RECEIPT OF SHARE MONEY Received Tk ………….……………… (Taka (In word) ……………………….….………………………………………) only from Mr./Ms. ……………………………………………………………………………………………………… BO Account No. ……………………………………………… for…………… no.(s) of Rights Share of Lafarge Surma Cement Limited in Cash/Pay order/Draft/Cheque No. ………………………………………… date………………………………………… of ………………………………………… Bank ………………………………………… Branch.

Application Sl. No. (Bank's Seal)

Signature of Receiving Officer Date:

Chittagong Jubilee Road Branch. 19. Dhaka Asad Gate Branch. 3. Rangpur Sirajgonj Branch. 14. East Zindabazar. 20. Dhaka Bogra Branch. 7. Dhaka Banganandhu Road Branch. 35. Jamal Khan. 15. Khulna Nasirabad Branch. Dhaka New Market Branch. Savar. Dhaka Islampur Branch. Sylhet Banani Branch. KDA Avenue. Sector 3. 2. Chittagong Cox's Bazar Branch. Sylhet Moulvibazar Branch. Biswa Road. Uttara. 2. Sylhet Bandar Bazar Branch. Dhaka Nawabgonj Branch. 29. Chittagong Andarkilla Branch. Rajshahi Mirpur Dar-Us-Salam Road Branch. 2011 Closes : November 13. 15. Chittagong Pahartoli Branch. Motiiheel. Mirpur. 20. 12. Dhaka Nawabpur Branch. 16. 16. Chittagong Rajshahi Branch. Dhaka Bashundhara Branch. 8. 5. Principal Branch. 5. Ring Road. Narayanganj Uttara Garib-E-Newaz Branch. Dhaka Pragati Sarani Branch. 33. Barishal EASTERN BANK LIMITED 1. 17. Choumuhoni Siraj-Ud-Doula Road Branch. 6. Barogola. Chittagong Mirpur Branch. Chittagong Khatunganj Branch. 8. Sirajgonj Khulna Branch. 8. Dhaka VIP Road Branch. Rajshahi Uttara Branch. 9. 11. Chittagong Mirpur (OPCC) Branch. 15. 5. Agrabad Branch. 13. 12. Sylhet Barisal Branch. 7. Shyamoli. Chittagong Bashundhara Branch. Halisohor Housing Estate. 23. Dhaka Imamgonj Branch. 31. North Manda. 4. 27. 7. Gazipur Agrabad Branch. 34. 20. 22. Chittagong Mirpur Branch. Dhaka O. Dhaka Dhanmondi Branch. Barisal CDA Avenue Branch. Khulna Jessore Branch. Dhaka Zindabazar Branch. 6. Dhaka Khulna Branch. 28. Nawabpur Road. 12. R. West Rampura. 3. Dhaka Johnson Road Branch. Dhaka BRAC BANK LIMITED 1. Dhaka Jessore Branch. Sylhet Subscription Opens : October 19. Bogra Rangpur Branch. 18. Bogra Savar Branch. 11. 19. Chittagong Rajshahi Branch. 32. 18. 17. 3. 21. 4. Sadar Road. Sheikh Muiib Road. Narayangonj Zinzira Branch.Ghoramara. 16. Dhaka Karwan Bazar Branch. 23. Sylhet Amborkhana Branch. 6. Sector 11. Motijheel (OPCC) Branch. Dhaka Hallsohor Branch. 24. 9. Dhaka Shyamoli Branch. Dhaka Shamoly Branch. 4. Hatkhola Road. Asad Gate. New Eskaton Road. Sylhet Bogra Branch. Dhaka Kazirdeuri Branch. 11. 8. Rajshahi Bogra Branch. 3. Jessore Upashahar Branch. Dhaka Choumuhoni Branch.BANKERS TO THE ISSUE STANDARD CHARTERED BANK 1. 14. Dhaka Moulvibazar Branch. Narsingdi Zinda Bazar Branch. 2011 . Dhaka Agrabad Branch. Chittagong Khatungonj Branch. 19. Chittagong Comilla Branch. 5. Jessore Manda Branch. Mirpur. 6. B B Avenue Branch. Dhaka Shaymoli Branch. Dhaka Tongi Branch. Narayangonj Rampura Branch. 26. 10. Sylhet Rajshahi Branch. 2. Khulna Momin Road Branch. Chittagong Chawkbazar Branch. 21. 9. 14. Dhaka Narayanganj Branch. Chittagong Bogra Branch. Dhaka THE CITY BANK LIMITED 1. Dhaka Nawabpur Branch. 18. Comilla Narsingdi Branch. 22. 30. Sylhet Chouhatta Branch. 13. 25. Chittagong Khulna Branch. East Nasirabad. Dilkusha. Khulshi. 36. Dhaka Narayanganj Branch. Dhaka Principal Office Branch. Khulna Jessore Branch. Bogra Eskaton Branch. 10. 13. 7. Jessore Barishal Branch. Chittagong Graphics Building Branch. 17. Dhaka Donia Branch. Chittagong Khulna Branch. B B Road. Dhaka Motijheel Branch. 2. 4. Dhaka Agrabad Branch. Nizam Road Branch. Basundhara R/A. Bogra Sylhet Branch. 10. 21.

I/We hereby renounce my/our rights to the shares offered to me/us as noted below in favor of person(s) accepting the same and signing in Application by Renounce(s) and apply for allotment in his/her/their name(s). Gulshan Avenue.00 per share at par value offer to the Shareholders appeared in the share register at the close of business on October 3.068. ……………………. 2011 Last-Date of Acceptance and Application: November 13.………………………………. Gulshan Avenue.………………………………………….…………… Address:……………………………………………………. Bangladesh Rights Issue of 58. Bangladesh Dear Sir.675 Ordinary Shares of Tk. 2011 FORM OF RENUNCIATION Managing Director Lafarge Surma Cement Limited Suvastu Imam Square.……………… 2.…………………………… Tel/Mobile No. Name (in block)……………………………. Holders' BO Account No.……………… Renouncees' B/O Account Number As per provision of the Depository Act. of shares accepted Dated: ____/_____/2011 Taka (In word) …………………………………………………………………………………………………………………… Yours faithfully.…………………………… Tel/Mobile No. 3rd Floor 65.……………………………. rights share shall only be issued in dematerialized condition.………………………………… Signature. Gulshan-1 Dhaka-1212. 1999 and regulations made there under. ………………………………………. Note: Signature must be the same as was furnished to the Company earlier. Name (in block)…………………………….…………………………….Renunciation Form-B LAFARGE SURMA CEMENT LIMITED Suvastu Imam Square. 1. 3rd Floor 65. ……………………. of shares offered No. ………………………………………. No. of shares held at the close of business on October 3. In case of incomplete .………………………………………….………………………………… Signature. Gulshan-1 Dhaka-1212. application. 100.…………… Address:…………………………………………………….………………………………. the offer will be deemed to have been declined. An applicant must apply for allotment of Rights Share mentioning his/her Beneficiary Owner (BO) Account number in the application form. 2011 No.

… (Taka (In word).…… Tel/Mobile No... No.…………………………… S/0.... W/0……………………. An applicant must apply for allotment of Rights Share mentioning his/her Beneficiary Owner (BO) Account number in the application form. in my/our favor.…………………………………………… ………….. by making payment of Tk... Bangladesh Dear Sir. 1..... D/O.00 per share. ……………………………………………… for…………… no.. W/0 ………………….. …………………………………………. ………………………………………..………………………………………) only from Mr....... Note: Signature must be the same as was furnished to the Company earlier.. (Bank's Seal) Signature of Receiving Officer Date: . As the share holder(s) at pre-page has/have renounced his/her/their rights to the shares offered.……………………… Address…………....… Shares at Tk. ………………………………………… date………………………………………… of ………………………………………… Bank ………………………………………… Branch.... Dated: ____/_____/2011 Yours faithfully... 1999 and regulations made there under./Ms..... Gulshan Avenue...……………… (Taka (In word)………………………. ……………………………………………………………………………………………………… BO Account No. ……………………. 100..) being the value of ………..…..…………………………… 2.Renunciation Form-C APPLICATION BY RENOUNCEE(S) Managing Director Lafarge Surma Cement Limited Suvastu Imam Square. In case of incomplete application...……………………………… Name (in block) …………………. 3rd Floor 65....…………………………………………………… ………….. ACKNOWLEDGEMENT RECEIPT OF SHARE MONEY Received Tk …………. Signature…………………….... rights share shall only be issued in dematerialized condition... ……………………………………………… 2..... A/C payee Cheque/Draft/Pay-order to be issued in favour of LAFARGE SURMA CEMENT LIMITED.…………………………… Address ……………………... Signature…………………….(s) of Rights Share of Lafarge Surma Cement Limited in Cash/Pay order/Draft/Cheque No.... Application Sl.. the offer will be deemed to have been declined.………………………… S/0. D/0. …………………………………………… As per provision of the Depository Act.……………………………………………………… Tel/Mobile No... I/We do hereby apply for the number of share noted above as renounced...... Gulshan-1 Dhaka-1212.…… Renouncees' B/O Account Number Signature of the renouncer (s) 1.....……….………………………… Name (in block)…………………….