KvUMix :

ivRavbx Dbqb KZc

www.rajukdhaka.gov.bd

wSjwgj AvevwmK GjvKvq cU eivi

Ave`bc
(2.5 KvVv, 03 KvVv I 05 KvVv AvqZbi cU)

wet `t - Ave`bci mv_ cmcvm ewYZ KvMRcvw` `vwLj KwiZ nBe|

wgK bs Ave`bKvixi cvmcvU

mvBRi mZvwqZ 01
Kwc mvwZK Qwe

1| Ave`bKvixi bvg

(BsiRxZ)

: ...............................................................

(evsjvq) : ...............................................................
2| (K) wcZvi bvg

(BsiRxZ)

: ...............................................................

(evsjvq) : ...............................................................
(L) gvZvi bvg
3|

^vgx/xi bvg

: ...............................................................
(BsiRxZ)

: ...............................................................

(evsjvq) : ...............................................................
4| Rb ZvwiL
: ...............................................................
(eqm cgvbc mshy KwiZ nBe)
: ...............................................................
5| fvUvi AvBwW b^i (hw` _vK)
(AvBwW KvWi Dfq cvi mZvwqZ dUvKwc
mshy KwiZ nBe)
6| Ave`bKvixi (wbR bvg) evsK wnmve b^i: .............................., evsK...............................,
kvLv .........................................., Swift Code NO. (hw` _vK)..........................................,
Routing NO. (hw` _vK).............................., (RvgvbZi A_ diZ c`vbi chvR nBe)
7| eZgvb wVKvbv

(BsiRxZ)

: ...............................................................
...............................................................
...............................................................

8| vqx wVKvbv

: ...............................................................
...............................................................
...............................................................

cwiKwZ, cwiek eve, emevmhvM ivRavbx MoZ mvnvh Kib

9|

ckv/KvUMix
(mswk Ni ^vi w`b| GKvwaK Ni ^vi c`vb Kiv nBj Ave`bc evwZj ewjqv MY
nBe|)

(K)

gx/cwZgx/ Dc-gx/
mgghv`v mb/ msm` m`m

(S)

e`wkK gy`v
ARbKvix

(L)

wePvicwZ

(T)

emiKvix wkK

(M)

gywhvv

(U)

emiKvix PvKzwiRxex

1.

wcU wgwWqv

(V)

wkx/mvwnwZK I xov
ewZ

2.

BjwbK wgwWqv

(W)

AvBbRxex

(O)

miKvix PvKzwiRxex

(X)

Kwlwe`

(P)

^vqZkvwmZ msvq PvKzwiRxex (Y)

cKkjx

(Q)

mkevwnbx

wPwKrmK

(N) mvsevw`K:

(Z)

(R) eemvqx I wkcwZ:

1.

(Uvt 10,00,000/- gv Gi
(_)
Da AvqKi c`vbKvix)

cK wZM

2.

(Uvt 10,00,000/- gv Gi
(`)
wbg AvqKi c`vbKvix)

Abvb

10| ckvi weeiY

: ...............................................................

(K) Awdm/msv/eemv cwZvbi bvg

: ...............................................................

(L) PvKzixRxwe nBj (1) c`i bvg

: ...............................................................

(2) eZbi j (2009 Abyhvqx) : ...............................................................

(3) eZgvb cv g~j eZb : ...............................................................
(M) eemvqx nBj eemvi aiY

: ...............................................................

Aea wbgvY KvR _K weiZ _vKzb|

11| wU.AvB.Gb b^i (hw` _vK)

: ...............................................................

wbR^ evrmwiK Avvqi cwigvY

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(Ave`bKvixK mswk AvqKi Awdm nBZ BmyKZ eZgvb Ki ermii AvqKi mb`c Ges
AvB.wU 10(we) Gi mvwUdvBW Kwc (chvR ) AekB `vwLj KwiZ nBe)
12| bvMwiKZ

: ..............................................................

13| Ave`bc I cmcvm qi g~j iwk` b^i : ....................................................................

Pqvigvb, ivRDK eivei RgvKZ RvgvbZi c-AWvi/mW WvdU b^i ..................................
(K) evsjv`kx gy`vq RvgvbZi UvKv Pqvigvb, ivRDK Gi AbyK~j evsK WvdU/c-AWvi
AvKvi Rgv Kivi evsK iwk` b^i ...................................................................................
(L) RvgvbZi gvwKb Wjvi Pqvigvb, ivRDK Gi AbyK~j evsK WvdU/c-AWvi AvKvi Rgv
Kivi evsK iwk` b^i ....................................................................................................
ZvwiL : ............................................................. (g~j iwk` mshy KwiZ nBe)
14| wSjwgj AvevwmK cK Kzg `Lj/AwaMnY wZM nBj wbgewYZ Z_ DjL KwiZ nBe:
(K) Kzg `LjKZ Rwgi cwigvb

: ..............................................................................

(Rjv ckvmK, XvKv - Gi Awdm nBZ GIqvW wji g~j mvwUdvBW Kwc mshy KwiZ nBe)
(L) gRvi bvg

: ..............................................................................

(M) R.Gj. b^i

: ..............................................................................

(N) Askx`viMYi msLv

: ..............................................................................

(O) wm.Gm. `vM b^i

: ..............................................................................

(P) Ave`bKvixi Ask

: ..............................................................................

(Q) Rwgi cKwZ

: ..............................................................................

(R) Kzg `LjKZ RwgZ evox _vwKj Nii cKwZ I Nii msLv : ........................................
15| Ave`bKZ cUi cwigvY (chvR Ni ^vi w`b)|
2.5 (AvovB)KvVv
03 (wZb) KvVv
05 (cuvP) KvVv
Avwg AxKvi KwiZwQ h, Dciv Z_mg~n wbfyj I mZ|

Ave`bi ZvwiL :

Ave`bKvixi ^vi

cwiKwZ bMix cwiekMZ DbwZi c~ekZ