Anmeldeformular / Registration Form Deutsch Lernen in Bangladesh/ Learning German in Bangladesh *Please fill in this form electronically Course Level: B1 [=] Participant/Registration Number: 0060983317 Course Type & Timing: B1 Intensive Evening: Sat, Sun, Mon, Tues: 6.00 PM [=] Gender: (@) Male () Female Given/First Name: ABU SUFIAN Family Name (According to passport): SHANTO Date of Birth: 23 APR 2001 _Place of Birth: DHAKA, Nationality: SANGLADESH! Mailing Address: DEMRA, DHAKA, Gocthensivt eaneiadesh Garman cuts cere 8801627834513 E-Mail: shantohridoy32@gmail.com vou foe oe thas 05, Educational Qualifications: HIGHER SECONDARY CERTIFICATE ses su +090 2 91211 Profession (if student, details of studies): STUDENT fax B00 231761 language2-dhala@eoethede Tel./Mobil Mother Tongue: BANGLA Languages Known: ENGLISH, DEUTSCH Purpose of Learning German: STUDY ABROAD How did you get to know about our courses? Language Course Brochure a Others (please specify): Do you have prior knowledge of the German language? (@) Yes © (~) No | declare herewith tha | wll abide by the rules and regulations of the language course program of the German Cultural Centre and that | will altend the classes regularly as per schedule ofthe course. | also understand clearly that in case of iregular or insufficient attendance, the teacher may disallow me to continue the class. In such a case | ill not be enitled to get any Attendance Certificate, na wil any fees paid by me be glven back {or discontinuation ofthe course Furthermore, | decare that | have taken the following condtons to notice: a) Withdrawal from a course is possible before 10 days ofthe course begins, ) In case of withdrawal from a course the course fee will be refunded deducting an administrative feo of Tk. 4000, -. And the current course fees are valid for the forthcoming semester only. «) For any correction in the attendance certificate, which will be issued after the course, | have to pay an amount of 1000, - Taka, provided that the correction is necessary because of any ‘wrong information that | have given in this admission form, www goethe.de/aaka General Terms & conditions: https://www.goethe.de/ins/bd/en/spr/kur/gia/kue.html | | have read all the terms & con jons, and agree to the same. 10 JAN 2021 GOETHE Place. Dz snature of Applicant a