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New Candidates: Please print this page and submit it to the BCPS office on or before 18 November for January examination and 4 June for July examination each yearwith
the following documents:
Print copy of online registration
Copy of Bank deposit slip
Copy of the permanent registration certificate of BMDC
Copy of the certificate of MBBS/BDS
Training Certificates
Posting Order/ Attachment Order and Joining Letter and
Other necessary documents.
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Bangladesh College of Physicians and Surgeons (BCPS)
67, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka-1212, Bangladesh
Application for appearing MCPS Examination
For Official Use Only
Eligible
Not eligible
Training Certificate Accepted
Debarred Candidate
Other Comments ...............
BMDC Registration No: A54095
ID:8039
Name of the Speciality Sp. Code
Obstetrics & Gynaecology 30
1.Personal Identity
a. Applicant's Name (
As in MBBS/BDS DR. FARHANA YASMIN
Certificate):
b. Father's Name MD. ABDUR RAZZAK
c. Mother's Name NURJAHAN BEGUM
d. Date of Birth Tuesday, October 14, 1986
e. Nationality Bangladeshi
f. Mailing Address 10, Paribag, Eastern Cottage, Dhaka.
g. Permanent Address: Vill: Chapoldanga, P.O.-Boalmari, P.S.-Boalmari, Dist.-Faridpur.
c. Year of passing MBBS/BDS 2009
d. Name of the College where Graduated: MAG Osmani Medical College, Sylhet
3. Enrolment Identity:
a. Have you appeard in MCPS examination? No If yes, how any times? 0
iii. Roll (Last 4 digits) 0 Subject
c(a) Training Record
Duration
Speciality Name Name of Institute
From To
c(b). Training Record:
e.Present
a.Last Training b. Last Trainer's c. Chairman/Head of d.Type of f.Head of the
Employment
Institute Name the Dept. Candidate Institute
Institute
Sir Salimullah
Prof. Dr. Nazma Prof. Dr. Kanak
Medical College, 0 Govt BSMMU
Hoque Kanti Barua
Dhaka
4. Present Employment Record:
b. Code No (if Govt.
a. Employment Type c. Present Designation d. Institute Name e. Working Address
Employee)
Signature of the Head of the Institute/Chairman of the Dept.
(Applicable for applicants appearing with course or through proper Applicant’s Signature
channel) Date : ………………………………
Date : ………………………
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