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Bangladesh University of Engineering and Technology Directorate of Students Welfare BUET ALUMNI DATABASE FORM

Name (Capital Letter) Fathers name Mothers name Date of birth Year of admission Registration/Student No. Highest degree attained Hall of residence Occupation/Position
(Last position held)

IMTIAZ AHMED JALAL UDDIN AHMED BILQIS BEGUM 01/01/1983 1999 9904178 BSc TITUMIR HALL ASSISTANT ENGINEER PWD Sex:

M F
Year of graduation:

Blood group: 2006

A+

(BSc/MSc/PhD//MPhil/Dip)

Department/Institute:

CIVIL ENGINEERING

Organization Contact address

58/44/1, NORTH MUGDAPARA, DHAKA-1214 Permanent address Telephone Mobile Email DITTO Work: O1911751513 imtiaz_ostad@yahoo.com Home:7277555 Fax:

Professional Information: speciality/expertise area (optional):

Imtiaz Signature Date:

Please send the completed form to: DSW Office, BUET, Dhaka-1000, Bangladesh Tel: 9665650 ext 7143/7140, E-mail: dsw@dsw.buet.ac.bd