RE019(00)

Application for Supplementary ID Card

Name of the student :________________________________________________

Student ID No. :________________________________________________

Department/Program :________________________________________________

Contact Number :________________________________________________

Declaration by the student;

I have forgotten to bring/show ULAB student ID card for access and related activities. I may please
be allowed a supplementary ID card and the fine of Tk.100.00 (Taka One Hundred) only be charged
against my student ID at ULAB.

___________________________
Signature of the student

Date:____________________

For Office use only

The student whose name and ID number appears above consented to adjust the fine/payment of
Tk.100.00 (Taka One Hundred) only for supplementary ID card be charged against his/her account
with ULAB.

S/he was been issued with ID card #_____________________.

Signature of the front desk officer

Date:________________________

RE019(00) Page 1 of 1