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

ISSUER AND THE ISSUE MANAGER.

PREMIER CEMENT MILLS LIMITED
APPLICATION FORM
APPLICATION FOR SHARES BY INVESTORS OTHER THAN NON-RESIDENT BANGLADESHI(S)
War!"# Please read the instruction at the back of this form. Incorrectly filled application may be rejected.
The Managing Director
PREMIER CEMENT MILLS LIMITED
TK Bhaban (th !loor"
#$ Ka%ran Ba&ar
Dhaka ' #(#)
Ba$%r&' S(. N).
I*%e apply for and re+uest you to allot me*us the ,*+,,*,,.number of -hares and I*%e agree to accept the same or any smaller number that may be allotted to me*us upon the terms of the
.ompany/s appro0ed Prospectus and subject to the Memorandum and 1rticles of 1ssociation of the .ompany. !urther2 I*%e authori&e you to place my*our name(s" on the 3egister of Members of
the .ompany and deposit the said shares to my B4 (Beneficiary 4%ner" 1ccount and*or a .rossed (1ccount Payee only" .he+ue in respect of any application money refundable by post*courier at
my*our risk to the first applicant/s address stated belo%5'
1. No. Ordinary shares =200=. of Tk. ++-- each including a premium of Tk. 12/- per share.
2. Amoun of Tk. !in figure"# $$00/-.% Tk !in &ords"#.. FOUR THOUSAND FOUR HUNDREDonly
deposied 'ide (ash/ (he)ue/ draf/ pay Order No*ae..
On.+ank.....+ranch...
,. *eposiory !+/O" Accoun Num-er
!.f you do no menion your 'alid +O !+eneficiary O&ners" accoun% your applicaion &ill -e reaed as in 'alid"
$. ./&e agree o fully a-ide -y he insrucion gi'en herein.
/. 0ariculars of Applican!s"#
a" 1ole/2irs Applican#
Name#
2aher3s / 4us-and name#
5oher3s name#
0osal Address#
Occupaion# Naionaliy# +AN67A*814.
F)r r%./0 1arra2 (A33(!4a2!) 1!(( )2 5% 2r%a2%0 a' 6a(!0 !. a7)% /'%' a )-'48%0/(%0 5a$. T) a6)!0 28!' 4)93(!4a2!), !6%'2)r' ar% r%:/%'2%0 )2 2) /'% 28% a9% ). a7 )-
'48%0/(%0 5a$) P(%a'% 1r!2% 28% 4)rr%42 a0 ./(( a9% ). 5a$ a0 5ra48.
F)r r%./0 3/r3)'%# I-1% 1a2 r%./0 28r)/"8 ; Ba$ A44)/2< ; Ha0 0%(!6%r7-C)/r!%r (3(%a'% 3/2 2!4$ 9ar$' ! 18!48 r%./0 1!(( 5% 9a0%). T8% a33(!4a2 '8a(( 3r)6!0% 1!28 28% 'a9%
5a$ a44)/2 /95%r ! 28% a33(!4a2!) .)r9 a' !2 !' ! 28% BO A44)/2 ). 28% a33(!4a2. O28%r1!'% 28% a33(!4a2!) 1!(( 5% 4)'!0%r%0 !6a(!0 a0 28% '/5'4r!32!) 9)%7 9a7 5% .)r.%!2%0.
Applican3s +ank A/( No#
Name of he +ank# +ranch #
The applicant shall provide with the same Bank Account number in the application form as it is in the BO account of the applicant. Otherwise the
application will be considered invalid and the subscription money may be forfeited
-" 1econd Applican
Name#
2aher3s / 4us-and name#
5oher3s name#
0osal Address#
Occupaion# Naionaliy#
6. I*%e hereby declare that I*%e ha0e read the Prospectus of Ra"3/r Da!r7 = F))0 Pr)0/42' L!9!2%0 and ha0e %illingly subscribed for,,..=200=,, no. of shares of Tk >?-- each including a
premium of Tk. 7 *' per share on this form.
@. S3%4!9% S!"a2/r%(')#
1
s
applicans Name !in -lock leers"# 1ignaure#
2
nd
applicans Name!in -lock leers"# 1ignaure#
9.n case of deposi ino he applican3s -ank accoun% he applican &ill -ear he applica-le charge% if any% of he applicans -anker% and he issuer shall simulaneously issue a leer of inimaion o he
applican conaining% among ohers% he dae and amoun remied &ih deails of he -ank hrough and o &hich -ank such remiance has -een effeced.
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
BANAER&S ACANOWLEDGEMENT
.ertified that this Bank has recei0ed Tk. ,BC,,/-,.(in %ord" ,THREE THOUSAND SIX HUNDRED .. ...only form Mr.*Mrs.*Ms. ,,,,,,,,,,,,,,,,.,,,,,,,.,,,,,
being the application money for ,,,=200=,..nos. of 4rdinary -hares of Ra"3/r Da!r7 = F))0 Pr)0/42' L!9!2%0.
Ba$%r&' S(. N). S%a( a0 Da2% A/28)r!D%0 S!"a2/r%
(8ame 9 Designation"