RANGPUR GOLF AND COUNTRY CLUB PHOTOGRAPH
RANGPUR CANTT P.P. SIZE
MEMBERSHIP APPLICATION FORM 4 COPIES
1. CATEGORY OF APPLICANT (Tick the correct box):
Serving Retired Serving Non Corporate Diplomat Foreigner
Defence Defence Government Military Business
Officer Officer Officer Organisation
2. TYPE OF MEMBERSHIP APPLIED FOR (Tick the correct box):
Full Temporary Honorary Corporate
Membership Membership Membership Membership
3. APPLICANT’S PERSONAL INFORMATION (Fill up the applicable blank):
a. Personal Number Rank
(In case of defence/retired defence officers)
b. Name:
(1) (In English):
(2) (In Bangla):
c. Father’s/Husband’s Name:
d. Nationality:
e. Occupation:
f. Blood Group:
g. Official Address (With telephone no):
h. Present Address (With telephone no):
j. Permanent Address (With telephone no):
k. National ID Card Number:
l. Mobile phone no:
m. E-mail Address:
4. DETAILS OF INCOME & INCOME TAX ; (fill up the blank and attach the required documents
with the application form):
a. Monthly Income:
b. Certified true copy of current year’s Income Tax Return:
5. DESCRIPTION OF PASSPORT.
a. Passport Number
b. Type
c. Place of Issue
d. Date of Expiry
e. Type of Visa with date of Expiry (For foreigners only) ____________________________
6. DESCRIPTION OF FAMILY.
a. Name of Spouse:
b. Occupation of Spouse (With details including address):
c. Children/dependants below 21 years (Extra page may be attached):
Ser Name Date of Birth Son/Daughter Honorary Rmk
Membership
Requested
Yes No
1.
2.
7. MEMBERSHIP DETAILS OF GOLF CLUB (if any) :
8. OFFICIAL HANDICAP (if any):
1
9. I hereby certify that the information given in this form by me are correct to the best of my knowledge.
I also certify that if I am accord the rules for the members of Rangpur Golf Club. I shall be obliged to
regularly take part in all the activities of the Club.
Date :
Signature of applicant
RECOMMENDATION
.
Commanding Officer/Officer Commanding
Date: (for serving officers only)
10. PROPOSED BY (for civilian only):
a. Name:
b. Membership Number: Name of Club:
c. Signature :
FOR OFFICIAL USE ONLY
11. PAYMENT OF BILL:
Registration Fee Monthly Bill Cheque/ Bank Draft / Pay Order
Date : Lieutenant Colonel
Treasurer
Rangpur Golf Club
RECOMMENDATION
Brigadier General
Vice President
Date: Rangpur Golf Club
APPROVED / NOT APPROVED
Major General
Date: Club President
Rangpur Golf Club
1. Membership number:
2. Membership Granted (With effect from):
3. Number of Children/Dependants Allowed:
As applied for or otherwise (define in details): ______
Date : Lieutenant Colonel
Member Secretary
Rangpur Golf Club
2
Notes:
1. Membership Fees:
a. Defence Services Officers (Serving & Retired) – Tk 5000.00, Monthly Fee Tk
250.00.
b. Serving Govt officers (Non Military): Tk 25,000.00, Monthly Fee Tk 400.00.
c. Non Military: Tk 1,00,000.00, Monthly Fees: Tk 850.00.
d. Foreigners: Tk 5,00,000.00, Monthly Fees: Tk 1000.00.
e. Corporate Membership: Tk 10,00,000.00.
f. Life Time Membership: Tk 10,00,000.00.
2. Money me be Deposited to Rangpur Golf and Country Club Acct No- 0007-0210018866, Trust
Bank, Cantt Br, Rangpur
3. Except serving Defence Services Officers membership of all others are subjected to
security clearance please.
4. Contacts for any other details are:
a. Member Secretary: BA-5209 Lt Col Kudrat-E-Khuda, psc Telephone Numbers; +880-
521-67300 extension 2046 (office) /Mobile: +8801769662046
b. Golf Clerk: 0521-67300 extension 3142 / Mobile: +8801769663142
5. For Military: Please attach following documents with the application:
a. Photocopy of Passport.
b. Tax Payer’s Certificate of current year.
c. Photocopy of National ID Card.
d. Passport Size Picture 02 copis.
6. For Non Military: Please attach following documents with the application:
a. Photocopy of Passport (if available).
b. Tax Payer’s Certificate of current year.
c. Photocopy of National ID Card.
d. Employer’s certificate.
e. Passport Size Picture 04 copis.
7. For foreigners: Please attach following documents with the application:
a. Photocopy of Passport.
b. Photocopy of Bangladeshi Visa.
c. Employer’s certificate (if self employed or owner ‘Work Permit by Bangladesh Govt.)
d. Passport Size Picture 04 copis.
