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BANGLADESH INSTITUTE OF BANK MANAGEMENT

PLOT NO.4, MAIN ROAD NO.1 (SOUTH), SECTION NO.2,


MIRPUR, DHAKA-1216.
PHONE: 9003031-5
9003051-2
Fax: 88-02-9006756
E-Mail: training@bibm.org.bd
Application Form
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Title of the Certification Program: ____________________________________________________

Name of the Participant (Block Letter): ________________________________________________

Date of Birth: __________________ Designation of the Participant: ________________________

Name of the Organization: ___________________________________________________________

Last Academic Degree:


University Examination Year Subject

Contact Address:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Contact Phone Number(s):

Personal: _________________________________ Emergency: _____________________________

E-mail Address:

Primary: _______________________________ Alternative: _____________________________

Nominated by: Bank Self

Registration for the Intake (Duration):

Signature & Date: ______________________

Please send the filled application form to: cecm@bibm.org.bd

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