Moshiur Telecom

5x5 †m.wg. Qwe (m¤cÖwZ †Zvjv, `yB Kwc)

PvKwii Av‡e`b dig

1.

c‡`i bvgt

2.

weÁwßi b¤^it

তারিখঃ

3.

প্রার্থীর bvg

বাংলায়ঃ

ইংরেজিতে (বড় অক্ষরে) t

4.

জাতীয় পরিচয় নম্বরঃ

(‡h †Kvb GKwU)

জন্ম নিবন্ধ নম্বরঃ

5.

Rb¥ ZvwiLt

6. Rb¥¯’vb (‡Rjv)t

7.

weÁw߇Z Dল্লিwLZ Zvwi‡L cÖv_©xi eqmt

বছর

মাস

দিন

8.

gvZvi bvgt

9.

wcZvi bvgt

10.

wVKvbv

eZ©gvb

¯’vqx

evmv I moK (bvg/b¤^i)t

MÖvg/cvov/gnল্লাt

BDwbqb/IqvW©t

WvKNit

†cv÷‡KvW b¤^it

Dc‡Rjvt

†Rjvt

11.

†hvMv‡hvMt

মোবাইল নম্বরঃ

ই-মেইলঃ

12.

RvZxqZvt

13.

†RÛvit

14.

ag©t ইসলাম

14.

†ckvt

16.

wk¶vMZ †hvM¨Zvt

cix¶vi bvg

welq

wk¶v cÖwZôvb

cv‡mi mb

†evW©/wek¦we`¨vjq

†MÖW/‡kªwY/ wefvM

17.

AwZwi³ †hvM¨Zv (hw` _v‡K)t wimvP©, Kw¤cDUvi A¨vwপ্ল‡Kkb,

18.

AwfÁZvi weeiY (cÖ‡hvR¨ †¶‡Î)t

19.

†KvUv (wUK w`b)

gyw³‡hv×v/knx` gyw³‡hv×v‡`i cyÎ-Kb¨v/cyÎ-Kb¨vi cyÎ-Kb¨v

GwZg/ kvixwiK cÖwZeÜx

¶z`ª b„-‡Mvôx

Avbmvi I MÖvg cÖwZi¶v m`m¨

Ab¨vb¨t

20.

Pvjvb/e¨vsK WªvdU/‡c-AW©vi b¤^it

ZvwiLt

e¨vsK I kvLvi bvgt

21.

wefvMxq cÖv_©x wKbv (wUK w`b)t

n¨vu

bv

√   cÖ‡hvR¨ bq

Avwg G g‡g© A½xKvi KiwQ †h, Ic‡i ewY©Z Z_¨vewj m¤c~Y© mZ¨| †gŠwLK cix¶vi mgq Dwj­wLZ Z_¨ cÖgv‡Yi Rb¨ mKj g~j mvwU©wd‡KU I †iKW©cÎ Dc¯’vcb Kie| †Kvb Z_¨ AmZ¨ cÖgvwYZ n‡j AvBbvbyM kvwস্ত †fvM Ki‡Z eva¨ _vKe|

ZvwiLt

প্রার্থীর স্বাক্ষর

cÖ‡ek cÎ

Qwe (AvVv w`‡q jvMv‡Z n‡e)

  `yb©xwZ `gb Kwgkb

    cÖavb Kvh©vjq

                                                         XvKv

         Awdm KZ©…K c~iYxq                                                                          Av‡e`bKvix KZ©…K ¯^n‡স্ত c~iYxq

         †ivj b¤^it ...............................................                          c‡`i bvgt ...................................................

         cix¶v †K‡›`ªi bvgt ...................................                           c‡`i bvgt ..................................................

                                                                                                 wcZvi bvgt ..................................................

         cix¶vi ZvwiLt ...........................................                        eZ©gvb wVKvbvt ..............................................

         cix¶vi mgqt ............................................                                           ..............................................

                                                                                                                  ..............................................

mwPe

 `yb©xwZ `gb Kwgkb

      cÖavb Kvh©vjq, XvKv