Form-B

THE INSTITUTE OF COST AND MANAGEMENT ACCOUNTANTS OF BANGLADESH

ICMA Bhaban, Nilkhet, Dhaka-1205.

DATE RECEIVED
APPLICATION FOR ADMISSION AS FELLOW MEMBER OF THE INSTITUTE
APPLICATION ON
MEMBERSHIP NO.
PART-A
1. NAME IN FULL (Block Letters): MD MIZANUR RAHMAN 2. SURENAME, If Any (Block Letter)

3. FATHER’S NAME: MD ALEK HOSSAIN

4. ADDRESS a. Permanent b. Present

VILLAGE – JOYKRISHNAPUR HOUSE – 7(A-4), ROAD – 1, BLOCK – C
P.O – GAZIRDRAGAH, P.S – JHIKORGACHA SECTION – 2, MIRPUR, DHAKA – 1216
DIST – JESSORE

c. Professional
GMS Global Management Services Pvt. Ltd. 5. Day Month Year
Update Tower (Level – 10), 1 Shahjalal Avenue a. Date birth 29 02 1972
Sector – 6, Uttara. Dhaka - 1230 b. Present Age 17 02 46
6. NATIONALITY : BANGLADESHI

7. ACADEMIC QUALIFICATION (Start with First one. Copies of Certificates to be enclosed)

Serial Examination Board/University Division/ Year of
No. Class Passing
1 SSC (SCIENCE) ROTARY SCHOOL, KHULNA 1st Division 1988
2 HSC (SCIENCE) BL COLLEGE, KHULNA 1st Division 1990
3 B.A. (PASS) NATIONAL UNIVERSITY 2nd Class 1995
4 M.A. (ENGLISH) NATIONAL UNIVERSITY 3rd Class 1997

8. PROFESIONAL QUALIFICATION (Copies of Certificates to be enclosed)

Serial Institution Examination Roll No. Month & Year of
No. Passing
1 ICMAB CMA Final 1482 Aug 2003

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9. SERVICE EXPERIENCE ( Start from present, Copies of certificates of previous employment [if any] to be enclosed
9.1.a. Name of Organization b. Designation c. Pay Scale or Gross Pay d. Total Employee e. Employees supervised
GMS GLOBAL MANAGEMENT HEAD OF BDT 6,000,000 PER 46 3
SERVICES PVT. LTD. ADMINISTRATION AND YEAR
SUPPORT
f. Type of Organization(Please Tick) g. Period of Service
i) Public Sector iv) NGO i) From Day 15 Month 04 Year 2015
ii) Private Sector v) Professional Practice ii) To 16 05 2018
iii) Multinational Sector  vi) Others iii) Total 1 1 3
h. Details of area of experience: In charge of all Admin, Finance, Accounts, HR and IT relating activities in The company.
9.2.a. Name of Organization b. Designation c. Pay Scale or Gross Pay d. Total Employee e. Employees supervised
Hermes – Otto International (Hong Senior Finance and Operations BDT 2,800,000 per year 110 3
Kong) Limited Manager
f. Type of Organization(Please Tick) g. Period of Service
i) Public Sector iv) NGO i) From Day 01 Month 02 Year 2010
ii) Private Sector v) Professional Practice ii) To 13 04 2015
iii) Multinational Sector  vi) Others iii) Total 12 02 5
h. Details of area of experience: Acted as a head of Finance, HR and Administration departments.
9.3.a. Name of Organization b. Designation: c. Pay Scale or Gross Pay d. Total Employee e. Employees supervised
REDCATS ASIA LTD Finance Manager BDT 1,300,000 per year 75 3
f. Type of Organization(Please Tick) g. Period of Service
i) Public Sector iv) NGO i) From Day 01 Month 12 Year 2007
ii) Private Sector v) Professional Practice ii) To 31 01 2010
iii) Multinational Sector  vi) Others iii) Total 30 1 2
h. Details of area of experience: Handled finance and accounts related issues of the company
9.4.a. Name of Organization b. Designation c. Pay Scale or Gross Pay d. Total Employee e. Employees supervised
ABA Group DGM – Finance & Accounts BDT 840,000 per year 2000 12
f. Type of Organization(Please Tick) g. Period of Service
i) Public Sector iv) NGO i) From Day 01 Month 02 Year 2006
ii) Private Sector  v) Professional Practice ii) To 30 11 2007
iii) Multinational Sector vi) Others iii) Total 29 9 1
h. Details of area of experience: Worked as head of Finance and Accounts in this Group of Companies. Extensively worked on L/C operations, treasury
management, bank operations management etc.
9.5.a. Name of Organization b. Designation c. Pay Scale or Gross Pay d. Total Employee e. Employees supervised
H.R. Textile Mills Limited Assistant Manager – Cost & 455,000 per year 1500 0
Budget
f. Type of Organization(Please Tick) g. Period of Service
i) Public Sector iv) NGO i) From Day 01 Month 06 Year 2004
ii) Private Sector  v) Professional Practice ii) To 31 01 2006
iii) Multinational Sector vi) Others iii) Total 30 7 1
h. Details of area of experience: Worked on finding minute value of product, working out overhead cost etc.

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10. PROFESSIONAL EXPOSURE (Copies of Certificates/evidences to be enclosed)
a. Participation in CPE
Topics Date Time Days Hours
attended attended
As per record in ICMAB

b. Publication in reputed journal & newspapers

Name of journal/newspaper Publisher Date of Name of article Size of article
publication (approx words)

c. Professional Addressing
Organiser Topics Date Venue Duration
From To (hrs)

d. Attendance in seminar & conference

Organiser Topics Date Venue Duration
From To (hrs)

e. Research works
i) Research topic Source of data(tick) Day Month Year Media and name of publication
Primary Commencement date
Secondary Completion date
Both Publication date

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 ii) Research topic Source of data(tick) Day Month Year Media and name of publication
Primary Commencement date
Secondary Completion date
Both Publication date
iii) Research topic Source of data(tick) Day Month Year Media and name of publication
Primary Commencement date
Secondary Completion date
Both Publication date
iv) Research topic Source of data(tick) Day Month Year Media and name of publication
Primary Commencement date
Secondary Completion date
Both Publication date
v) Research topic Source of data(tick) Day Month Year Media and name of publication
Primary Commencement date
Secondary Completion date
Both Publication date
11. REFEREES (Two should be members of the ICMAB and one should be present employer)
i) a. Name: Mohammad Abul Hossain b. Address: Amin Mohammad Lands c. Grade /Designation of the Institute
Dev. Ltd., 752 Shatmasjid Road, Controller – Finance & Accounts
d. Membership No.: F – 0727 Dhanmondi C/A, Dhaka 1205

ii) a. Name : Syed Ahmed b. Address: National Housing Fin. And c. Grade /Designation of the Institute
Inv. Ltd. Concord Baksh Tower (7th
VP and CFO
d. Membership No.: F – 0729 Floor), Plot – 11-A, Road – 48, Block –
CWN (a), Gulshan – 2, Dhaka – 1212

iii) a. Name : Konstantin Kirchfeld b. Address: Update Tower (L-10), 1 c. Grade /Designation of the Institute
Shahjalal Avenue, Sector – 6, Uttara,
Managing Director
d. Membership No. N/A Dhaka - 1230

12. MEMBERSHIP WITH OTHER PROFESSIONAL INSTITUTIONS (Copies of certificates to be enclosed)

Date of month
Institution Membership Category
Day Month Year
i)
ii)
iii)

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13. ASSOCIATION WITH ICMA BANGLADESH
a. As Student
i) Registration ii) Date of Registration iii) Last examination passed iv) Roll No. 1482
No. 2003
9720172
v) Prizes won(if any) vi) Scholarships awards (if any)

b. As Member 14. ADDITIONAL INFORMATION(if any)

i) Previous Membership
No.
A-716
ii) Date of Membership

25 11 2004

PART – C

15. PAYMENT INFORMATION

i) Enclosed a Bank Draft/Crossed Cheque for Tk. Taka Only
ii) As Admission Fee Annual Membership Fee
Tk. Taka Only Tk. Taka Only

PART – D
15. DECLATION
I ........................Md Mizanur Rahman......................................................................the undersigned do hereby declare that:
the above statements are correct;

in the event of my admission as Fellow Member of the Institute. I will be governed by the Cost and Management
Accountants Ordinance 1977 (L Ill of 1977) and the regulations made thereunder for the time being in force.

I will advance the objectives of the Institute to the best of ability and will attend the meeting thereof as often as I
conveniently can during tenure of my Membership.

I further declare that:

I am not and was never an insolvent;

I have not been convicted by any court of law of any offence invoiting moral turpitude or of any offence committed by
me in my professional capacity.

Yours faithfully

Signature Date
Day Month Year

N.B. Following documents should be attached with this membership application:

i) Recent Photograph (colour) 2 nos.
ii) Salary certificate from the present employer.

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iii) Certificate from the employer stating the number of employees work under the number of employees
working in the organization.