M.B.B.S.

University of Dhaka
The application will be rejected, if it is not duly filled in and signed by the candidate and certified
by the principal and Teacher/Teachers concerned.
Third Professional M.B.B.S. Examination of May 2024

Dhaka University Student's

Class Roll No 59
Application Registration No. 12033
Session 2019-2020
Session : 2019-2020

To.
The Controller of Examinations
University of Dhaka, Dhaka-1000.

Sir,
I request permission to present myself at the ensuing Third Professional M.B.B.S.
Examination of the University of Dhaka.
I agree that in any matter arising out of my candidature at this Examination, I will
accept the decision of the Syndicate of any officer authorised by them to deal with the
matter as final.

I am
Sir
Yours obediently
Dated, the 18-04-2024

Signature of the examinee in full

Local Address: CBMC,B Boy's Hostel
Mobile no: 01865924315

CERTIFICATES

The candidate was first admitted to the First year class of the Course in the year 2019 in
Community Based Medical College Bangladesh
The candidate has passed the Second Professional M.B.B.S. Examanation held in the
month of May, 2023 bearing Examination Roll No 1925
I certify that the above-named candidate has fulfilled the requirements of the Third
Professional M.B.B.S. Examination of May 2024 Examination of the University of Dhaka and that
he/she has got the required numbers of percentage of attendace and that I Know nothing against
his/her moral character. The statements made above are true to the best of my knowledge and
belief.
I further certify that since his/her failure at the last examination in the subject/subjects, the
candidate received my satisfaction, further instruction in the subject/subjects in which he/she
failed. A brief summary of his/her results at the last examination is noted below:-
Appeared at the last Third Professional 1. 1.Pathology
M.B.B.S.
Examination bearing Roll No 2427
held in the month of November , 2023
and failed in:
.........................................................
Dated, the 18-04-2024
Signature of the Principal with date
Office Seal of the Principal
 (2)

PARTICULARS TO BE FILLED IN BY THE EXAMINEE

1. Full name of the Examinee in Bengali : শেখ নাঈম

2. Full Name of the Examinee in English : Sheikh Nayem

3. Father's Name : Sheikh Shaheb Ali

4. Mother's Name : Mst. Nazma Akter

Permanent Address : House: K-81/01, Niyamot Post Office: Gazipur

5.
Sarak Sadar

Upa Zilla: Gazipur

Police Station: Joydebpur District: Gazipur
Sadar

6. Date of Birth : 2000-12-28

7. Age : 23

8. Nationality: Bangladeshi Religion: Islam Caste/Sect:

10. Scholarship of Stipend, If any, enjoyed: TK Session: 2019-2020

11. Monthly income of the parents/guardian: TK 30000

The medium of language in which the candidate will answer the questions:
12.
English

Whether debarred from appearing at the University Examination, if so

State the punishment given: _ _ _ _ _ _ _ _ . Examination held in the month of _
13.
_ _ _ _ _ _ _ _ _ _ , _ _ _ _ _ _ _ bearing Roll No _ _ _ _ _ _ _ _ and punishment given
___________

14. Name of the Subject / Subjects appearing at:

1 Pathology

Dated, the 18-04-2024

Signature of the Candidate in full

N B: 1. All the entries must be filled in by the Examinee himself/herself and checked up by the Office of the Principal which
will be treated as final.
2. Any erase or cut on any entry will not be allowed.