miKvwi Kg©Pvixi PvKzwi msµvšÍ Z_¨vw`

(Kg©Pvix KZ…©K c~iYxq)

cÖv_wgK Z_¨vw` (Primary
Information)
 Kg©Pvixi bvg (evsjv) [Names of Employee
Musammat Bushra Begum
(Bangla)]
 c`we (Rank) Health Assistant
 RvZxq cwiPqcÎ b¤^i (National ID Number) 19861219494413429
 Rb¥ ZvwiL (Date of Birth) 10/07/1986
1.0 cÖv_wgK Z_¨vw` (Primary Information)
1.1 e¨w³MZ Z_¨vw` (Personal Information)

 wj½ (Gender) □ cyiæl (Male) □ gwnjv (Femail) □ Ab¨vb¨

(Others)
 wcZvi bvg (Bs‡iwR) [Father’s Name (English)] Md. Salim Mia
 gvZvi bvg (Bs‡iwR) [Mother’s Name (English)] Norun Nahar Begum
□ Bmjvg □ wn›`y □ †eŠ× □ wLª÷vb □
 ag© (Religion) Ab¨vb¨
(Islam) (Hindu) (Buddist) (Christian) (Others)
□ weevwnZ □ AweevwnZ □ weaev □ wecZœxK
 ‰eevwnK Ae¯’v (Marital Status) □ Ab¨vb¨
(Married) (Unmarried) (Widow) (Widower) (Others)
 ‡gvevBj ‡dvb b¤^i (Mobile Phone Number)* 01683194509
 B-‡gBj wVKvbv (hw` _v‡K) [e-Mail Address (If
any)]
 B- wUAvBGb b¤^i (hw` _v‡K) [e-TIN Number
-------------------
(If any)]
1.2 cvwievwiK Z_¨vw` (Family Information)
1.2.1 ¯^vgx/ ¯¿xi m¤úwK©Z Z_¨vw` (Particulers of Spouse)
RvZxq cwiPqcÎ b¤^i Rb¥ ZvwiL bvg (evsjv)
(National ID Number) (Date of Birth) [Name (Bangla)]
‡gv. Avkivd
1. 19831219419258118 02/01/1983
Avjx
2. ------------------- ------------------- -------------------
1.2.2 mšÍvb m¤úwK©Z Z_¨vw` (Particulers of Children)
Rb¥ wbeÜb/ RvZxq cwiPqcÎ m¤úK
cwiwPwZi aiY Rb¥ ZvwiL bvg (evsjv) bvg (Bs‡iwR)
(Type of Identification) b¤^i (Birth Registration/ NID (Date of Birth) © [Name (Bangla)] [Name (English)]
Number) (Relation)

□ Birth Registration mvBd Avkivd

1. 20131219419 16/09/2013 ‡Q‡j Saif Ashraf Saad
□ NID mv`
□ Birth Registration
2. 28/10/2017 †g‡q bymiv Avkivd Nusra Ashraf
□ NID
□ Birth Registration
3. --- --- --- ---
□ NID