Government of the People's Republic of Bangladesh

Bangladesh Public Service Commission Applicant's Copy

Application Form for Non-Cadre Examination [BPSC Form - 5 A]
Application for Ministry of Food

User ID: NKEEXJYDWT Ref: 177-207/2021 | Last Date: 25 January 2022

Regional Maintenance Engineer (RME)/Assistant

Post Name
Engineer
Exam Centre DHAKA
Applicant's Name SOURAV HAZRA
Father's Name BINOY HAZRA
Mother's Name TAPOTI HAZRA
Date of Birth 18 December 1995 [24 Years 3 Months 8 Days]
Gender Male

Freedom Fighter Status Non Freedom Fighter Ethnic Minority No

Marital Status Single Physically Handicapped No
Nationality/NID Bangladeshi/7752412234 Home District Khulna

Present Address: Permanent Address:

Care of: Binoy Hazra Care of: Binoy Hazra

Village/Town: Debduar Village/Town: Debduar
Post Office: Debduar Post Office: Debduar
Post Code: 9280 Post Code: 9280
Upazilla/Thana: Paikgachha Upazilla/Thana: Paikgachha
District: Khulna District: Khulna

Academic Qualifications:

Examination Board/Institute Group/Subject/Degree Result Year Roll Duration

S.S.C Jessore Science 5.0 2012 123751 N/A

H.S.C Jessore Science 5.0 2014 103894 N/A
Khulna University of
B.Sc
Engineering and Civil 3.37 2019 N/A 04
(Engineering/Architecture)
Technology

Enclosure: [Attested Certificates/Equivalent Certificates to be Submitted Later According to Tick Mark]

01. Recent Passpost Size Photograph | 02. Admit Card | 03. S. S. C. or Equivalent Certificate | 04. H. S. C. or Equivalent
Certificate | 05. Graduation or Equivalent Certificate | 12. National ID |

I declare that the information provided in this form are correct, true and complete to the best of my knowledge
and belief. If any information is found false, incorrect, incomplete or if any ineligibility is detected before or after
the examination, any action can be taken against me by the Commission including cancellation of my candidature.

-------------- Applicant's Signature --------------

Congratulations!! Application Submitted Successfully

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