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the following documents:
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Copy of Bank deposit slip
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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: A59434
ID:8032
Name of the Speciality Sp. Code
Obstetrics & Gynaecology 30
1.Personal Identity
a. Applicant's Name ( As
in MBBS/BDS SHOHANA ASKARY
Certificate):
b. Father's Name MD. HASAN ASKARY
c. Mother's Name TAHMINA HASAN
d. Date of Birth Sunday, October 2, 1988
e. Nationality Bangladeshi
f. Mailing Address 101, Nazim Uddin Road (4th floor), Chankharpool, Dhaka.
g. Permanent Address: Gorosthan Road, Biswas Para, Joypurhat
h. Contact Res: Cell:01714466534 Email:sristi.askary@gmail.com
2. Academic Identity:
c. Year of passing MBBS/BDS 2011
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:
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
Dhaka Medical
Other College Dr. Nahid Sultana N/A Govt Brig. General Nasir
College, Dhaka
4. Present Employment Record:
b. Code No (if Govt.
a. Employment Type c. Present Designation d. Institute Name e. Working Address
Employee)
Dhaka Medical College Dhaka Medical College
Government 130030 Indoor Medical Officer
Hospital Hospital, Dhaka.
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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