ঢাকা উ�র wmwU K‡c©v‡ikb

ঢাকা Qwe

wd : UvKv µwgK bs-

ে�ড লাইেস� এর আেবদন ফরম
g
M/S Energypac
1. e¨emv cªwZôv‡bi bvg t ..........................................................................................
2. Enamul Haque Chowdhury
Av‡e`bKvixi bvg t ..........................................................................................
✔
Late. Mujammel Haque Chowdhury
3. Av‡e`bKvixi wcZv/¯^vgxi bvg t ..........................................................................................
Husnes Safa Chowdhury
4. Av‡e`bKvixi gvZvi bvg t ..........................................................................................
Holding-338 Dhaka Senanibs
5. Av‡e`bKvixi ¯’vqx wVKvbv t MÖvg/ †nvwìs bs t .............................. †cv t ............................
Cantonment Dhaka
_vbv t .......................................... †Rjv t............................
House-338, Road-24, New DOHS, Dhaka Senanibas.
6. Av‡e`bKvixi emev‡mi wVKvbv t ........................................................................................
Energy point 430/2, Tejgaon I/A, Dhaka – 1208.
7. Av‡e`bKvixi cÖ¯ÍvweZ e¨vemv‡qi mwVK wVKvbv t ......................................................................................
Attached
8. RvZxq cwiPq c‡Îi d‡UvKwc t .........................................................................................
Bangladeshi
9. Av‡e`bKvixi RvZxqZv t .........................................................................................
Supplier.
10. wK ai‡bi e¨emv t .........................................................................................

11. e¨emv‡qi Avi¤¢ Kivi ZvwiL t .........................................................................................

1000,000.00
12. e¨emv‡qi g~jab t .........................................................................................
135152653697
13. AvqKi cÖ`vb Kwi‡j TIN b¤^i t ..........................................................................................
✔
14. e¨emv/†`vKvb N‡ii ¯’vb wbR¯^/ fvov ( wbR evoxi Rb¨ U¨v‡·i iwm` mshy³ Kwi‡Z nB‡e).................................
Have
15. mvBb †evW© Av‡Q wK bv? t .........................................................................................
No
16. cÖ¯ÍvweZ †`vKvb/ e¨emv‡qi ¯’vb, †cŠi f~wg/ miKvix f~wgi Dci wK bv? ..........................................................
✔
17. ‡`vKvb Ni / Awdm bxPZjv / 2q Zjv / 3q Zjv / 4_© Zjv|
01708454352
18. Av‡e`bKvixi †gvevBj †dvb bs...........................................................................................................

Avwg †NvlYv Kwi‡ZwQ †h, D‡jøwLZ weeiYx Avgvi Rvbvg‡Z mwVK| D³ weei‡Yi g‡a¨ hw` †Kvb AmZ¨ wKsev Am¤ú~Y© weeiY
†MvPixf~Z nq, Z‡e wmwU K‡c©v‡ik‡bi wewa †gvZv‡eK jvB‡mÝ evwZj Kwi‡j Avgvi †Kvb AvcwË _vwK‡e bv|

mshyw³ t Av‡e`bKvixi ¯^vÿi I bvg

Enamul Haque Chowdhury
(K) gvwj‡Ki mZ¨vwqZ Qwe 03 (wZb) Kwc|
ZvwiL t .........................
(L) AbvcwË mb` (bZzb cÖwZôv‡bi †¶‡Î)
(M) g~jab cÖgv‡Yi cÖ‡qvRbxq KvMRcÎvw` ( wjwg‡UW †Kv¤úvwbi †¶‡Î †g‡gv‡iÛvg Ae AvwU©‡Kjm&)
(N) gvwjKvbv cÖgv‡Yi Rb¨ `wjj/cP©v (fvovwUqv n‡j fvovi Pzw ³cÎ)|
(O) nvjbvMv` †nvwìs U¨v· cwi‡kv‡ai iwk` (cÖ‡hvR¨ †¶‡Î)
(P) dvqvi mvwf©m I wmwfj wW‡dÝ KZ©„K jvB‡mÝ Gi d‡UvKwc (wkí KviLvbvi †¶‡Î)
(Q) RvZxq cwiPq c‡Îi d‡UvKwc|
we:`ª :- mshy³ mKj KvMR cÎ mZ¨vwqZ nB‡Z nB‡e| (cª_g †kªYxi †M‡R‡UW Kg©KZ©v / IqvW© KvDwÝji KZ©„K)
......................................................................................................................................................................................................................
(Awdm KZ…K c~iYxq)
1. jvB‡mÝ cwi`k©‡Ki gZvgZ :