Government of the People's Republic of Bangladesh

Bangladesh Public Service Commission Applicant's Copy

Application Form for Non-Cadre Examination [BPSC Form - 5 A]
Application for Ministry of Local Government, Rural Development and Co-operatives

User ID: NLQAIXDNZG Ref: 11-56/2019 | Last Date: 27 May 2019

Post Name Assistant Engineer (Civil)/Upazilla Assistant Engineer

Exam Centre DHAKA
Applicant's Name SREE ROCKY KUMAR DAS
Father's Name RATAN KUMAR DAS
Mother's Name TRIPTI RANI DAS
Date of Birth 1991-11-12 [YYYY-MM-DD] 27 Years 4 Months 20 Days
Gender Male

Freedom Fighter Status Non Freedom Fighter Ethnic Minority No

Marital Status Single Physically Handicapped No
Nationality/NID Bangladeshi/19912713031000169 Home District Dinajpur

Present Address: Permanent Address:

Care of: Rocky Das Care of: Ratan Kumar Das
Village/Town: KNI Hall (Ext), Room No:304, DUET Village/Town: Majhina
Post Office: DUET Post Office: Baideshir hat
Post Code: 1707 Post Code: 5240
Upazilla/Thana: Gazipur Sadar Upazilla/Thana: Chirirbandar
District: Gazipur District: Dinajpur

Academic Qualifications:

Examination Board/Institute Group/Subject/Degree Result Year Roll Duration

S.S.C Rajshahi Science 4.50 2006 146125 N/A

Diploma Technical Civil Technology 3.17 2010 750086 N/A
Dhaka University of Engineering &
B.Sc (Engineering/Architecture) Civil 3.29 2016 N/A 04
Technology

Enclosure: [Attested Certificates/Equivalent Certificates to be Submitted Later According to Tick Mark]

01. Recent Passpost Size Photograph | 02. Admit Card | 03. S. S. C. or Equivalent Certificate | 04. H. S. C. or Equivalent Certificate | 05. Graduation or Equivalent
Certificate | 12. National ID |
I declare that the information provided in this form are correct, true and complete to the best of my knowledge and belief. If any information is found
false, incorrect, incomplete or if any ineligibility is detected before or after the examination, any action can be taken against me by the Commission
including cancellation of my candidature.

-------------- Applicant's Signature --------------

Congratulations!! Application Submitted Successfully

NLQAIXDNZG is your User ID, Please keep this number to pay the application fee within 2019-05-22 11:42:37[YYYY-MM-DD
hrs:min:sec] from any Teletalk prepaid mobile phone by SMS.
1st - SMS Format: BPSC <space> <User ID> and send SMS to 16222
[Example : BPSC NLQAIXDNZG]. 1st-SMS Reply: Returns a PIN (8 Digits) like 23423495
2nd - SMS Format: BPSC <space> <YES> <space> <PIN> and send SMS to 16222
[Example : BPSC YES 23423495]. 2nd-SMS Reply: Returns a USER ID & PASSWORD
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