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Bangladesh College of Physicians and Surgeons (BCPS)
Bangladesh College of Physicians and Surgeons (BCPS)
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the following documents:
Print copy of online registration
Copy of Bank deposit slip
Copy of the permanent registration certificate of BMDC
Copy of the certificate of MBBS/BDS
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Bangladesh College of Physicians and Surgeons (BCPS)
67, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka-1212, Bangladesh
Application for appearing MCPS Examination
For Official Use Only
Eligible
Not eligible
Training Certificate Accepted
Debarred Candidate
Other Comments ...............
BMDC Registration No: A66761
ID:8051
Name of the Speciality Sp. Code
Medicine 24
1.Personal Identity
a. Applicant's Name (
As in MBBS/BDS SUCHISMITA DEBNATH
Certificate):
b. Father's Name SUBHASH CHANDRA DEBNATH
c. Mother's Name BABY DEBNATH
d. Date of Birth Sunday, July 30, 1989
e. Nationality Bangladeshi
f. Mailing Address NEW LADIES HOSTEL, DHAKA MEDICAL COLLEGE, DHAKA.
g. Permanent Address: VILL- JAWAR, P.O- JAWAR, P.S- TARAIL, DIST- KISHOREGONJ.
c. Year of passing MBBS/BDS 2013
d. Name of the College where Graduated: Dhaka Medical College, Dhaka
3. Enrolment Identity:
a. Have you appeard in MCPS examination? No If yes, how any times? 0
iii. Roll (Last 4 digits) 0 Subject
c(a) Training Record
Duration
Speciality Name Name of Institute
From To
c(b). Training Record:
4. Present Employment Record:
b. Code No (if Govt.
a. Employment Type c. Present Designation d. Institute Name e. Working Address
Employee)
BIRDEM GENERAL
Private RMO SHAHBAGH, DHAKA
HOSPITAL
Autonomous
Signature of the Head of the Institute/Chairman of the Dept.
(Applicable for applicants appearing with course or through proper Applicant’s Signature
channel) Date : ………………………………
Date : ………………………
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