MEMBERSHIP APPLICATION FORM

(Please use block letter & tick where applicable)

1. Name of the Industry:

(In English): Global Concrete Products

(In Bangla): গ্লোবাল কংক্রিট প্রডাক্টস

2. Address:
(a) Corporate Office: Flat-B5, H-37, Gausul Azam Avenue, Sec-14, Uttara, Dhaka-1230.

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Telephone: 01404009919 Mobile No: 01404009922

Fax: ……………………………………………………..........……......................

E-mail: globalblocks2021@gmail.com

Website: ………………………………………………………….........................

3. Type of the organization: 􀀀 Private Ltd., Proprietorship.

(All corporate bodies, registered as limited company)

4. Establishment date of the company: 02/12/2020

5. Factory location:
Gosinga to Kapasia Road, Gosinga, Sreepur, Gazipur

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6. List of shareholder Directors (if applicable):

1.....................................................................................................................

2.....................................................................................................................

3.....................................................................................................................

4.....................................................................................................................

Address: House No# 248 (Ground Floor), Road No# 02, Baridhara DOHS, Dhaka
8. Name and address with specimen signature of the nominee who will
represent:
(must be shareholder or owner)
(a)Name

(In English): Mohammad Shakawat Hossain

(In Bangla): মোহাম্মদ সাখাওয়াত হোসেন

(b) Designation: Proprietor

(c) Specimen Signature: ................................................................................

Declaration: (If the application is approved by BCBMS)

1. I do hereby agree to be bound by the Laws, Bye-laws, Regulations and the Codes of

Business Conduct as prescribed in the Articles of Association of BCBMS or made hereafter by

the management of BCBMS.

2. I will abide by the settlement through BCBMS of any dispute relating to Registered under the

Societies Registration Act xxt of 1994

3. I will furnish any public information relating to my company and information regarding my

Factory REHAB Data Base from time to time.

4. I will pay the Annual Subscription of Tk. ..................../- (……………………..) for the current

year in favor Bangladesh Concrete Block & Pavers Manufacturer Society.

5. I will pay any other fee related to the membership of BCBMS and other services, as decided

by BCBMS from time to time.

Address: House No# 248 (Ground Floor), Road No# 02, Baridhara DOHS, Dhaka
Certification (if the application is approved by BCBMS):

I certify that all information stated above are true and complete to the best of my knowledge. I

Further certify that, if any information given here regarding my company and project profile is

proved to be false or incomplete, BCBMA holds the right to cease the Membership of my

company.

(Signature of the Executive Authority of the Company

Date: ..../...../..........

(with Official seal)

(Attach separate sheets if needed)

Note: Please submit the required papers as per attached list.

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For Official Use Only

01. Date of Interview :

02. Approval Date :

03. Payment Order No :

(Admission Fee Tk. ………......…. /-)

04. Date of Issuance of Certificate :

Signature Date: ...................

Address: House No# 248 (Ground Floor), Road No# 02, Baridhara DOHS, Dhaka