** http://bris.lgd.gov.bd/beta/pub/?

pg=application_form
(Rgwb dig - 1)
webvg~j weZiYi Rb
Rb wbeb Ave`bc 1
1. wbebvaxb ewi weeiY:
evsjvq
bvg:
BsiRx (eo nvZi Ai)
msLvq bvix
Rb ZvwiL (Lx:)
2 wj

Rbvbi wVKvbv (evsjvq) 3 :

Rbvbi wVKvbv (BsiRx) :

`k: evsjv`k
2. wcZv I gvZvi weeiY :
evsjvq RvZxqZv:
wcZvi bvg:
BsiRx (eo nvZi Ai)

evsjvq RvZxqZv:
gvZvi bvg:
BsiRx (eo nvZi Ai)

3.
vqx wVKvbv: vqx wVKvbv:
(evsjvq) (BsiRx)
eZgvb wVKvbv: eZgvb wVKvbv:
(evsjvq) (BsiRx)

4. Ave`bKvixi cZqb (wbebvaxb ewi eqm 18 ev Z`ya nBj wZwb wbR Kjvg ^vi/ wUcmwn w`Z cvwieb):
Avwg ^vb NvlYv KwiZwQ h, Dci ewYZ hveZxq Z_ mwVK, ewi Ab Kv_vI Rb wbewZ nq bvB| Ave`bi ZvwiL (msLvq)

bvg
^vi/ wUcmwn
mK wcZv gvZv (wUK wP w`b)| Abvb (mK wjLyb): ........................................... w`b gvm ermi
5. Z_ msMnKvix/ hvPvBKvixi cZqb:
Rbi 5 eQii ga Ave`bi aygv 1 bs Kjvg cZ qb cqvRb nBe| Rbi 5 eQi ci Ave`bi wkv cwZvbi eZgvb ev cvb Qv/ Qvx nBj 2 bs Kjvg aygv
mswk wkv cwZvb cavbi cZ qb cqvRb nBe| Abvb Ave`bKvix`i eqm c gvYi Rb 2 bs Kjvg GgweweGm Wvvi Ges Rbvb/ vqx wVKvbv cgvYi Rb 3 bs Kjvg BDwc
m`m/ KvDwjii cZ qb cqvRb nBe| Ze wbeK KZ K wbw`KZ Kvb GbwRI Kgx eqm I R vb/ vqx wVKvbv cgvYi Rb 3bs Kjvg cZqb KwiZ cvwieb| GQvov BwcAvB KvW/
GmGmwm ev mggvbi mvwU wdKU/ cvmcvU / nvmcvZvj Rb msv Qvoc/ Rb ZvwiL Ges Rb vb mcwKZ wbeK hBic cqvRb gb Kwieb mBic hKvb `wjji Abyw jwc (h Kvb c_g
ev wZxq kY xi miKvix KgKZv ev wkv cwZvbi Aa /ca vb wkK KZ K mZvwqZ) mshy _vwKj wbgi Kvb Kjvg cZqb cqvRb nBe bv|
Z_ msMnKvixi4 cZqb (bvg, c`ex, GgweweGm Wvvi ev mswk wkv cwZvbi cavb BDwc m`m/ KvDwji/ GbwRI Kgxi cZqb (^vi,
^vi I ZvwiL) wkKi cZqb (^vi, ZvwiL I bvgmn mxj) ZvwiL I bvgmn mxj)
(1) (2) (3)

6. wbeKi Kvhvjq KZK c~iYxq:

wbeKi Abygv`bt ^vi, ZvwiL I wbeb ewnZ wjwceKvixi ^vi, ZvwiL wbeb ewn bs: wbebi ZvwiL: ............/.........../...........
bvgmn mxj I bvgmn mxj ew cwiwPwZ bs(ecb)t

Rb mb` c`vbi mve ZvwiL

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Ave`bKvixi Ask5: (Z_ msMnKvix/ R wbeb Ave`b c MnYKvix wbPi AskwU c~iY Kwiqv Ave`bKvixK diZ w`eb)
wbebvaxb ewi bvg
Ave`bKvixi bvg Rb mb` c`vbi mve ZvwiL ........./ ........../ .............
Z_ msMnKvix/ Ave`b c
ZvwiLmn ^vi:
MnYKvixi bvg I c`ex:

1
GB digwU BDwbqb/ cimfv/ wmwU Kcvikb/ KvUbgU evW Rb wbebi Rb chvR hvnv Ave`bKvix ev wbeK Kwc Kwiqv eenvi KwiZ cvwieb|
2

3
BDwbqbi wVKvbvt (1) Mvg, (2) BDwbqb, (3) DcRjv, (4) Rjv| Abvb wVKvbvt (1) nvws/ evmv bs (2) moKi bvg ev bs (3) gRv/ gnjv (4) IqvW bs (5) cimfv/ wmwU
Kcvikb/ KvUbgU evW| Rb vbi nvmcvZvj ev Kvb cwZvb Rb nj mB wVKvbv|
4
KvDwji/BDwc m`m, ^ v Kgx, cwievi cwiKbv Kgx, GbwRI gvVKgx, nvmcvZvj ev wKwbK KZc, Rj mycvi, wkv cwZvbi Aa/ cavb wkK |
5
mb` MnYi mgq Ave`bKvix Zvi Aski Aci cvq ^ vi Kwiqv mswk KZci wbKU Rgv w`eb Ges Rb mb` msMn Kwieb