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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.
1 2 0 1 7 1 0 0 3 8 1 4 9 5 5 8
MD.MONJUR RAHMAN MD.ABDUR RAHMAN MOJERON BEGUM Nationality : BANGLADESHI Phone : 01919029773
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