CONFIDENTIAL PARTICULARS AND RECORD OF SERVICE OFFICERS PART I – PERSONAL INFORMATION

PHOTO
3.5 cm x 3.5 cm 1. 2. (a) (b) (a) (b) (c) (d) 3. Personal Number: National ID Number: Rank (Temporary) MAJ MAJ Auth (Gazette Notification/MS Br/CORO Order etc) Rank (Substantive/Substantive Temporary) Auth (Gazette Notification/MS Br/CORO Order etc) S M ANISUZZAMAN BA-5445

NAME (IN BLOCK CAPITAL):

bvg (evsjvqu):
4. 5. Arms/Service: (a) (c) 6. (a) (b) (c) 7. 8. 9. 10. (a) (b) Date of Birth: INFANTRY, BIR 20 AUG 1976 (b) Place (Village/City): JESSORE

Birth Certificate Number: Height: Build: Complexion: Eyes (Colour): 5’ 9” MEDIUM FAIR BLACK CUT MARK AT THE RIGHT CHICK (in inch) (in pound) ( in cm) ( in kg) Weight: 155 LBS

Visible Identification Mark(s): Blood Group: Medical History Details: (a) (b) (c) (d) Present Medical Category: AB+

AYE NA NA Date of Hospital Admission From To Class Medical Category From To

Present Nature of Disability (if any): Present Attributably (if any): Name of Disease(s) Nature of Injury (Severe/Minor)

Previous Medical History (Add Additional Pages for More Information):

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11. 12. 13.

a. b.

Religion: Caste :

ISLAM SUNNI BANGLADESHI Previous Nationality (if any): NA

Nationality: Address(s): a.

Permanent Address:

b.

Present Address:

c.

Alternate Present Address (If Any):

14.

Contact Details: a. b. c. Personal e-mail Address: T&T Phone Number: Mobile Number: Passport Number: Date of Issue: Date of Expiry: Type of Passport: Reasons for Obtaining: Name of Country From Duration To Reasons for Visiting c. Place of Issue: e. Issuing Auth:

15.

a. b. d. f. g.

16.

Countries Visited (Add Additional Pages for More Information): Serial

17.

Language Skill (Except Bengali & English) - Please specify Speaking, Writing & Reading): Serial Language Efficiency

18.

a. b.

Father’s Name in Full: Nationality: Previous Nationality (if Any): 2 CONFIDENTIAL Date of Bangladeshi Citizenship and Authority (if Applicable):

c.

CONFIDENTIAL Present Address with Contact Numbers :

d. e.

Present Age:

or Date of Decease:

Father’s Occupation/Profession (Examples: Farmer, Business, Politician etc. with details)

Note:

(1) Please briefly specify the nature of Occupation/Profession with details of Job
Description, Designation and Details of Organization including Name and Address. (2) In case of Deceased specify the Previous Occupation/Profession with Details. f. 19. a. b. c. Annual Average Income: Mother’s Name in Full: Nationality: Previous Nationality (if Any): Date of Bangladeshi Citizenship and Authority (if Applicable): Present Address with Contact Numbers :

d. e.

Present Age:

or Date of Decease:

Mother’s Occupation/Profession (Examples: Farmer, Business, Politician etc. with details)

Note: (1) Please briefly specify the nature of Occupation/Profession with details of Job Description, Designation and Details of Organization including Name and Address. (2) In case of Deceased specify the Previous Occupation/Profession with Details. f. Annual Average Income:

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20.

CONFIDENTIAL Own Brothers and Sisters (Add Additional Pages for More Information): Name in Full Age Nationality Occupation and Present Address Dependency (On You)

21. 22.

Position of Own within Brothers and Sisters: (a) (b) (c) Marital Status (Please Tick): Date of Marriage: Authority (CORO Order): NAME (IN BLOCK CAPITAL): Married / Unmarried

23.

Details of Spouse: a.

e¡j (h¡wm¡u):
b. d. e. f. g. h. j. Date of Birth : Birth Registration Number: Nationality: National ID Card Number: Educational Qualification: Occupation of Spouse: Details of Occupation: Previous Nationality (if any) Authority of Bangladeshi Citizenship (If Applicable): (c) Place of Birth:

24.

Particulars of Children (As per CORO Order): Name of Children Sex Date of Birth Occupation Present Address

25.

Particulars of Chronic/Severe/xxxxxxxxxx Disease of Self/Spouse/Children (Add Additional Pages Name Name of Disease Nature of Disease Date of Illness Present Condition

for More Information):

26.

Details of Father In-Laws: a. Name of Father-in-Law in full: 4 CONFIDENTIAL

b. c.

Nationality:

CONFIDENTIAL Previous Nationality (if Any):

Date of Bangladeshi Citizenship and Authority (if Applicable): Present Address with Contact Numbers :

d. e.

Present Age: with details)

or Date of Decease:

Father in Law’s Occupation/Profession (Examples: Farmer, Business, and Politician etc.

Note: (1) Please briefly specify the nature of Occupation/Profession with details of Job Description, Designation and Details of Organization including Name and Address. (2) In case of Deceased specify the Previous Occupation/Profession with Details. f. 27. Annual Average Income:

Details of Mother In-Laws: a. b. c. Name of Mother-in-Law in full: Nationality: Previous Nationality (if Any): Date of Bangladeshi Citizenship and Authority (if Applicable): Present Address with Contact Numbers :

d. e.

Present Age: with details)

or Date of Decease:

Mother in Law’s Occupation/Profession (Examples: Housewife, Business, and Politician etc.

Note: (1) Please briefly specify the nature of Occupation/Profession with details of Job Description, Designation and Details of Organization including Name and Address. (2) In case of Deceased specify the Previous Occupation/Profession with Details. f. Annual Average Income:

28. Ser

Details of Next Of Kin (NOK) Name in Full (With Relationship, Occupation and Address): Allounce /Project /Fund/Assets 5 CONFIDENTIAL Name Relation Rate % Adds and Phone Auth

CONFIDENTIAL a. b. c. d. e. For Pension For Family Security Scheme For DOSP Fund For Personal Assets In case Listed NOK is not traceable Name) 29. Near Relations in Defence Services (To Include Brothers, Sisters, First Cousins and Uncles of Both Husband and Wife): (Add Additional Pages for More Information): Rank Name Relationship Arms/Svc Present Address (Give another

30.

Name and Address of all Brother and Sister-in-Laws: Name in Full Address Occupation

31.

Details of Bank Accounts: (Add Additional Pages for More Information): a. b. c. Name of Bank: Account Number: Type of Account:

PART II – EDUCATION 32. Educational Qualification(s): Duration From To School/ College/ University Examination Passed (Give Subjects) Division / GPA Obtained Year of Passing the Exam Remarks
(Include Standing in the Board if any)

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PART III – PRE COMMISSION 33. Pre Commission (Government/Non-Government) Service: Duration From To Name of Unit Establishment Designation & Appointment Remarks

34.

Pre Commission Training: Duration From To Name and Location of Training Establishment Any Appointment Held Any Distinction Obtained Remarks

PART IV – COMMISSION 35. a. b. c. d. f. g. Course at Academy: Date of Joining at Academy: Date of Commission: Type of Commission: letter/Gazette/Notification/CORO Order Number etc): Ante Date Seniority: letter/Gazette/Notification/CORO Order Number etc): Date Granted Permanent Regular Commission in case of Originally Granted a Non-Regular Commission: letter/Gazette/Notification/CORO Order Number etc): h. j. k. Date of Joining Bangladesh Army: letter/Gazette/Notification/CORO Order Number etc): Arms/Services into which Originally Commissioned: (Name of Arms/Services and Unit/ Regiment) Name of Previous Arms/Service in case of change of Arms/Service: Authority (Ministry of Defence Authority (Ministry of Defence Authority (Ministry of Defence Authority (Ministry of Defence

PART V – POST COMMISSION 36. Post Commission Training (Home and Abroad). Duration Qualification/

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From

To

CONFIDENTIAL Name and Location of Training Establishment

Name of Course Attended

Grading Obtained on Completion

37 38.

Additional Qualification (If Any). Qualification in Officers Standard/ Advanced Map Reading and Promotion Examinations: Name of Examination Officers Standard/Advanced Map Reading Promotion Examination – Lieutenant to Captain Promotion Examination –Captain to Major Year of Passing Authority

PART VI – RANKS HELD 39. Promotions and Held Appointments (Add Additional Pages for More Information): Date Type of Promotion Temporar y Substantive/ Substantive Temporary Rank Any Retrospective effect Notified in What Orders (Quote Number and Date of Notification if known)

PART VII – BRIEF RECORD OF SERVICE IN CHRONOLOGICAL ORDER 40. Duration From To Regimental and Command Appointments On the Staff Appointments Instructional Appointments

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PART VIII – PARTICULARS OF ACTIVIE SERVICE (WAR) 41. Duration From To Name of Operation /War Appointment held in Operation/War Any Gallantry Award Received Authority (Gazette Notification/CORO Order) Remarks

42.

Non-Operational Awards: Date and Year Granted Brief details of Service for which awarded with auth (Gazette Notification/CORO Order etc) Remarks

Description of Honors and Awards

PART IX – EVENTS AFFECTING CAREER 43. Details of Breaking Military Law: (e.g. Court Martial, Summary Award, Court of inquiry affecting the officer even if he was acquitted/ exonerated and also adverse report) Dates Details of Events Finding/Final Decision (State by Whom)

44.

Details of Breaking Civil Law (If Applicable): Section Details of Crimes Place and Date of Judgment Punishments

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CONFIDENTIAL PART X - ADDITIONAL INFORMATION FOR CORO 45. Fill up by Concerned Officer:

Five Fingers print of concerned officer by permanent ink:

Right Hand

(1) (First Finger)

(2) (Fore Finger)

(3) (Middle Finger)

(4) (Ring Finger) Left Hand

(5) (Small Finger)

(1) (First Finger)

(2) (Fore Finger)

(3) (Middle Finger)

(4) (Ring Finger)

(5) (Small Finger)

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CONFIDENTIAL 46. Identification Marks: Down lock-jaw: Number: Number: Number: Position: Position: Position:

Number of teeth: Upper lock-jaw: (a) (b) (c) Teeth filling: Root Cannel: Crown Prosthesis:

PART XI - CERTIFICATE (Fill up the bellow gaps by concerned officer in own-self) 47. I (rank and full name) do here by

solemnly state that the statement and particulars given by me in part I to IX above, are true, complete and I have not with held any relevant facts. I understand that in the events of any of the contents of the proceeding parts being found incorrect or incomplete I shall be liable to punishment, including dismissal from the service.

Signature of Officer ................................. Dated........................ Appt: ....................... Rank: ....................... Unit: .......................

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