Jonmo Nibondhon

** http://bris.lgd.gov.bd/beta/pub/?
pg=application_form
(Rgwb dig - 1)
webvg~j weZiYi Rb
Rb wbeb Ave`bc 1
1. wbebvaxb ewi weeiY:
bvg:
evsjvq
BsiRx (eo nvZi Ai)
Rb ZvwiL (Lx:)
msLvq
bvix
wj
Rbvbi wVKvbv (evsjvq) 3 :

Rbvbi wVKvbv (BsiRx) :
`k: evsjv`k
2. wcZv I gvZvi weeiY :

wcZvi bvg:
evsjvq
RvZxqZv:
BsiRx (eo nvZi Ai)
gvZvi bvg:
evsjvq
RvZxqZv:
BsiRx (eo nvZi Ai)

3.
vqx wVKvbv:
(evsjvq)
eZgvb wVKvbv:
(evsjvq)
vqx wVKvbv:
(BsiRx)
eZgvb wVKvbv:
(BsiRx)
4. Ave`bKvixi cZqb (wbebvaxb ewi eqm 18 ev Z`ya nBj wZwb wbR Kjvg ^vi/ wUcmwn w`Z cvwieb):
Avwg ^vb NvlYv KwiZwQ h, Dci ewYZ hveZxq Z_ mwVK, ewi Ab Kv_vI Rb wbewZ nq bvB|
Ave`bi ZvwiL (msLvq)
bvg
^vi/ wUcmwn
mK
wcZv
w`b
gvZv (wUK wP w`b)| Abvb (mK wjLyb): ...........................................
gvm
ermi
5. Z_ msMnKvix/ hvPvBKvixi cZqb:

Rbi 5 eQii ga Ave`bi aygv 1 bs Kjvg cZ qb cqvRb nBe| Rbi 5 eQi ci Ave`bi wkv cwZvbi eZgvb ev cvb Qv/ Qvx nBj 2 bs Kjvg aygv
mswk wkv cwZvb cavbi cZ qb cqvRb nBe| Abvb Ave`bKvixì eqm c gvYi Rb 2 bs Kjvg GgweweGm Wvvi Ges Rbvb/ vqx wVKvbv cgvYi Rb 3 bs Kjvg BDwc
m`m/ KvDwjii cZ qb cqvRb nBe| Ze wbeK KZ K wbw`KZ Kvb GbwRI Kgx eqm I R vb/ vqx wVKvbv cgvYi Rb 3bs Kjvg cZqb KwiZ cvwieb| GQvov BwcAvB KvW/
GmGmwm ev mggvbi mvwU wdKU/ cvmcvU / nvmcvZvj Rb msv Qvoc/ Rb ZvwiL Ges Rb vb mcwKZ wbeK hBic cqvRb gb Kwieb mBic hKvb `wjji Abyw jwc (h Kvb c_g
ev wZxq kY xi miKvix KgKZv ev wkv cwZvbi Aa /ca vb wkK KZ K mZvwqZ) mshy _vwKj wbgi Kvb Kjvg cZqb cqvRb nBe bv|
Z_ msMnKvixi4 cZqb (bvg, cèx,

^vi I ZvwiL)
GgweweGm Wvvi ev mswk wkv cwZvbi cavb

wkKi cZqb (^vi, ZvwiL I bvgmn mxj)
BDwc m`m/ KvDwji/ GbwRI Kgxi cZqb (^vi,

ZvwiL I bvgmn mxj)
(1)
(2)
(3)
6. wbeKi Kvhvjq KZK c~iYxq:

wbeKi Abygv`bt ^vi, ZvwiL I
bvgmn mxj
wbeb ewnZ wjwceKvixi ^vi, ZvwiL

I bvgmn mxj
wbeb ewn bs:
wbebi ZvwiL: ............/.........../...........
ew cwiwPwZ bs(ecb)t
Rb mb` c`vbi mve ZvwiL

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Ave`bKvixi Ask5: (Z_ msMnKvix/ R wbeb Ave`b c MnYKvix wbPi AskwU c~iY Kwiqv Ave`bKvixK diZ wèb)
wbebvaxb ewi bvg
Ave`bKvixi bvg
Z_ msMnKvix/ Ave`b c
MnYKvixi bvg I cèx:
1
Rb mb` c`vbi mve ZvwiL
........./ ........../ .............
ZvwiLmn ^vi:
GB digwU BDwbqb/ cimfv/ wmwU Kcvikb/ KvUbgU evW Rb wbebi Rb chvR hvnv Ave`bKvix ev wbeK Kwc Kwiqv eenvi KwiZ cvwieb|

3
BDwbqbi wVKvbvt (1) Mvg, (2) BDwbqb, (3) DcRjv, (4) Rjv| Abvb wVKvbvt (1) nvws/ evmv bs (2) moKi bvg ev bs (3) gRv/ gnjv (4) IqvW bs (5) cimfv/ wmwU
Kcvikb/ KvUbgU evW| Rb vbi nvmcvZvj ev Kvb cwZvb Rb nj mB wVKvbv|
4
KvDwji/BDwc m`m, ^ v Kgx, cwievi cwiKbv Kgx, GbwRI gvVKgx, nvmcvZvj ev wKwbK KZc, Rj mycvi, wkv cwZvbi Aa/ cavb wkK |
5
mb` MnYi mgq Ave`bKvix Zvi Aski Aci cvq ^ vi Kwiqv mswk KZci wbKU Rgv wèb Ges Rb mb` msMn Kwieb
2

Jonmo Nibondhon

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** http://bris.lgd.gov.bd/beta/pub/?

Rbvbi wVKvbv (evsjvq) 3 :

2. wcZv I gvZvi weeiY :

BsiRx (eo nvZi Ai)

BsiRx (eo nvZi Ai)

Ave`bi ZvwiL (msLvq)

gvZv (wUK wP w`b)| Abvb (mK wjLyb): ...........................................

5. Z_ msMnKvix/ hvPvBKvixi cZqb:

Z_ msMnKvixi4 cZqb (bvg, c`ex,

GgweweGm Wvvi ev mswk wkv cwZvbi cavb

BDwc m`m/ KvDwji/ GbwRI Kgxi cZqb (^vi,

6. wbeKi Kvhvjq KZK c~iYxq:

wbeb ewnZ wjwceKvixi ^vi, ZvwiL

wbeb ewn bs:

wbebi ZvwiL: ............/.........../...........

Rb mb` c`vbi mve ZvwiL

Rb mb` c`vbi mve ZvwiL

........./ ........../ .............

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