Institute of Chartered Secretaries of Bangladesh (ICSB)

A Statutory Body Under an Act of Parliament

APPLICATION FOR ADMISSION IN CHARTERED SECRETARY COURSE
Preliminary Examination
Please complete this form using BLOCK CAPITAL and properly sign & date where indicated

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The Secretary
Institute of Chartered Secretaries of Bangladesh (ICSB)
Padma Life Tower (8th Floor)
115, Kazi Nazrul Islam Avenue
Bangla Motor, Dhaka-1000

Dear Sir,
I would like to take admission and appear in Preliminary Examination of the Institute for registering as a student for
pursuing Chartered Secretary Course. I submit below the information required for appearing in Preliminary
Examination.
A. Personal Details (BLOCK CAPITAL)

Name (As per certificate) MD SHAKHAWAT HOSSAIN

Father’s Name (As per certificate) MD SANO MIAH
Mother’s Name (As per certificate) RINA AKTER
Date of Birth 25-Oct-88
Nationality & Home District BANGLADESHI / CUMILLA
N.I.D. Card No. & Blood Group NID No. 1918158762352 Blood Group: Enter no.
Present Occupation JOB HOLDER
Present Address HOUSE NO-RUPALI, FLAT NO-2-B-2, LAKE CITY CONCORD, KHILKHET,
DHAKA
Permanent Address VILL. NAGARPAR, PO: COMPANYGANJ, UPAZILA: MURADNAGAR,
DISTRICT. CUMILLA
Telephone Off: Enter No. Res: Enter No. Mob: 01985886988
E-mail Address Shakhawat.hossain85@gmail.com
01) Enovell Bangladesh Co. Ltd
Service Details
Executive, Administration & Logistics
Company Name & Address
With Designation
Period of Service: From 11/29/2011 To 12/30/2016
02) Microtrade Group
Senior Executive, Administration and Cost Analysis

Period of Service: From 1/1/2017 To Till Today

B. Academic /Professional Qualification(S)

 Name of
Examination Passed Year Group/Subject Div./Class/CGPA
School/College/University
S. S. C 2003 Companiganj Badiul Alam Commerce 2.50
high School
H.S.C 2006 Companiganj Badiul Alam Commerce 2.90
College
B.Com /BBS./BBA (Hon’s) 2010 Bachelor of Business Finance 3.07
Administration
M.Com/MBS/MBM Year Enter text. Enter text. Result.
MBA Year Enter text. Enter text. Result.
Prof. Qualification (if any) Year Enter text. Enter text. Result.
Others Year Enter text. Enter text. Result.
C. Attachments
Attachments: (Main copy of Certificates must be shown at Admission time)

i) All Academic Certificates Photocopy;

ii) National I. D. Card Photocopy;
iii) 3 P. P. Size Photographs;
iv) Employer Certificates if employed;
v) Character Certificate from the head of the Institution last attended.

D. Declaration
I declare that the particulars furnished above are true and correct to the best of my knowledge and belief. I also undertake
to abide by the rules & regulation of the Institute.

Faithfully Your’s

…………………… 5/29/2021
Signature Date

Institute of Chartered Secretaries of Bangladesh (ICSB)

A Statutory Body Under an Act of Parliament
 ADMIT CARD

Admission Test for Chartered Secretary Course

Name: MD SHAKHAWAT HOSSAIN

Father’s Name: MD SANO MIAH

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Mother’s Name: RINA AKTER

Exam Roll:

Exam Date & Time:

Address:

__________________
Secretary (Acting) Seal