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New Candidates: Please print this page and submit it to the BCPS office on or before 18 November for January examination and 4 June for July examination each yearwith
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
Training Certificates
Posting Order/ Attachment Order and Joining Letter and
Other necessary documents.
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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: A66855
ID:8028
Name of the Speciality Sp. Code
Medicine 24
1.Personal Identity
a. Applicant's Name ( As
in MBBS/BDS ZAKIR HOSSION
Certificate):
b. Father's Name EAKUB ALI
c. Mother's Name JAHANARA BEGUM
d. Date of Birth Friday, December 22, 1989
e. Nationality Bangladeshi
f. Mailing Address 231/1, Vagolpur, Savar, Dhaka.
g. Permanent Address: 231/1, Vagolpur, Savar, Dhaka.
c. Year of passing MBBS/BDS 2013
d. Name of the College where Graduated: Shaheed Suhrawardy Medical College, Dhaka
3. Enrolment Identity:
a. Have you appeard in MCPS examination? No If yes, how any times? 0
c(a) Training Record
Duration
Speciality Name Name of Institute
From To
c(b). Training Record:
e.Present
a.Last Training b. Last Trainer's c. Chairman/Head of d.Type of f.Head of the
Employment
Institute Name the Dept. Candidate Institute
Institute
Shaheed
Prof. Ridwanur Dhaka Medical
Suhrawardy Medical N/A Govt Brig. General Nasir
Rahman College, Dhaka
College, Dhaka
4. Present Employment Record:
b. Code No (if Govt.
a. Employment Type c. Present Designation d. Institute Name e. Working Address
Employee)
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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