JBC Computer Society

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Jiban Bima Bhoban, 10th Floor, ICT Division, 24 Motijheel C/A, Dhaka-1000. Phone: 9512167
jbc.copmutersociety@gmail.com,Web-site: http://jbccomputersociety.blogspot.com/

For Office Use only

Membership Form Affix Your
SL. No. :
Photograph
Receipt No. : here

Date :

1. Applied Member 1y 2yrs. 3yrs. Life

for r.
2. Applicant’s Name Title:Mr./Mrs./Ms
./Dr.
3. Father’s/Husband’s
Name
4. Mother’s Name
5. Spouse’s Name
6. Designation
7. Organization
8. Place of Posting
9. Mailing Address

Phone Number Office: Residence:

Fax Number Mobile :
E-mail URL :
10. Permanent Address Dist. : Upazila :
P.O. : Vill. :
Road : Block :
House : Post Code:
11. Nationality : 12. Date of Birth:
13. Blood Group : 14. Gender :
15. Passport No. (Optional): 16. NID :
17. Academic Career :
Qualification/Degree Institution Board/Varsit Year of Passing Score/Class
y

18. Training (use extra page if necessary) :

Training Institute Name of Topic/Course Duration Training Year

Attention: For Membership Form, Please Contact to Mr. Md. Mosharraf Hossain, Secretary General,
Phone: 01673896327 or Mr. Md. Salim khan, R & D Secretary, JBC Computer Society, Phone: 01716518500.
 JBC Computer Society
‡Rwewm Kw¤úDUvi †mvmvBwU
Jiban Bima Bhoban, 10th Floor, ICT Division, 24 Motijheel C/A, Dhaka-1000. Phone: 9512167
jbc.copmutersociety@gmail.com,Web-site: http://jbccomputersociety.blogspot.com/

19. Professional Degree/Diploma (use extra page if necessary)

Institute Name of Topic/Course Duration Training Year

20. Mode of Payments

Cash/ Cheque or DD Amount (In word) :

Figure :

If Cheque or DD:
Cheque or DD No. : Date :
Drawn on : Branch :
Bank :

21.Declaration to be signed by Applicant

I apply for as a Member of JBC Computer Society. If my application is approved I
agree to conform to the Rules and Professionals Conduct Standards as they
currently exist or as they may in future be adopted, amended or enlarged, and I will
promote the objectives of the Society to the best of my ability. I understand that to
withdraw from membership I must inform the society by paying or giving back any
arrears, delivery of books, papers or other property of the Society. I further declare
that I have not applied earlier to the Society for admission as a member.

I do hereby declare that the above statements are true & correct.

Date…................. Applicant’s Signature

Place

Before signing this declaration you are strongly advised to read the Memorandum of Association and
Rules of the Society, which is available on our Web-site, http://jbccomputersociety.blogspot.com/.
..........................................................................................................................................................

Attention: For Membership Form, Please Contact to Mr. Md. Mosharraf Hossain, Secretary General,
Phone: 01673896327 or Mr. Md. Salim khan, R & D Secretary, JBC Computer Society, Phone: 01716518500.
 JBC Computer Society
‡Rwewm Kw¤úDUvi †mvmvBwU
Jiban Bima Bhoban, 10th Floor, ICT Division, 24 Motijheel C/A, Dhaka-1000. Phone: 9512167
jbc.copmutersociety@gmail.com,Web-site: http://jbccomputersociety.blogspot.com/

Comments of Membership

The Applicant is recommended for Member of..............................

Date: Secretary General

(Seal & Signature)

Membership is approved.

Date: President
(Seal & Signature)

Office Secretary
Date of Issue
Membership No.

Attention: For Membership Form, Please Contact to Mr. Md. Mosharraf Hossain, Secretary General,
Phone: 01673896327 or Mr. Md. Salim khan, R & D Secretary, JBC Computer Society, Phone: 01716518500.