Member Registration

Application for Membership Form

(Form Fee: TK. 1000/=)

Govt. Reg No: CH-10511/13
Sanmar Spring Valley, (2463/A/52), 1st floor)
Zakir Hossain Road, Khulshi, Chittagong.
Tell: 031-657221, 2550131

To
The Founder President/ Founder Vice President
Chittagong Khulshi Club Ltd.
Chattogram.

Submission For Chittagong Khulshi Club Ltd. Membership Form

Full Name

Father's/ Husband's Name

Mother's Name

Nominee

Date of Birth

Place of Birth

Nationality

Profession

Mobile Number

Fax

Blood Group

Telephone

Your Email

National ID No/ Passport No / Driving License No

Educational Qualification

Permanent Address

Village

Post Office

Police Station / Union Parisad

District

Present/ Mailing Residential Address

Office Address

Details of Other Club Membership (IF Any):

Declaration I hereby declare that I have neither committed any illegal/ Criminal act Judiciary Law of Bangladesh, nor been punished by Bangladesh Court for any offence. I further declare that the above statement/ particulars are correct therefore, request you to become a donor, life, service, permanent, temporary, corporate, honorary, diplomat and Foreign National Member as per constitution of the Chittagong Khulshi Club Ltd.

Date

Signature of Applicant

Identified By President/ Vice President

Member No

The constitution of club do hereby declare you as the Donor, Life, Service, Permanent, Temporary, Corporate, Honorary, Diplomat and Foreign National Member of the Chittagong Khulshi Club Ltd. and your Membership No. is:

Thanking You

___________________________________
Founder President
Chittagong Khulshi Club Ltd.

___________________________________
Founder Vice President
Chittagong Khulshi Club Ltd.

_____________________________________________________________________

Updated Income Tax Paid with TIN/ GIR No

Emergency Contact Person Name

Emergency Contact Person Cell No

Details of Passport

Passport No and Type

Place of Issue

Validity

Date of Issue

Issuing Authority

Family Details

Name of Spouse

Occupation of Spouse

Details of Childrens: (Must be Added with Birth Certificate copy)

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Name

Sex

Date of Birth

Occupation With Address

Proposed by (Any Member of Chittagong Khulshi Club Ltd.) :

Full Name

Membership No

Signature

Application for Membership Form

(Form Fee: TK. 1000/=)

Govt. Reg No: CH-10511/13Sanmar Spring Valley, (2463/A/52), 1st floor)Zakir Hossain Road, Khulshi, Chittagong.Tell: 031-657221, 2550131

Submission For Chittagong Khulshi Club Ltd. Membership Form

_____________________________________________________________________

Details of Passport

Family Details

Details of Childrens: (Must be Added with Birth Certificate copy)

Proposed by (Any Member of Chittagong Khulshi Club Ltd.) :

Follow Us

Govt. Reg No: CH-10511/13
Sanmar Spring Valley, (2463/A/52), 1st floor)
Zakir Hossain Road, Khulshi, Chittagong.
Tell: 031-657221, 2550131