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CPD Requirement List

* = Required fields,
- Bangla Characters are not accpeted

Name:* (Block Letters)

Email Address:*

Mobile Number:*



Degree: (Select "Others" for Data Analysis, Abstract, Publications)

Package: If Need To Change Package Click Here

Payment Clearance with Price in BDT: (ex: Select partial if payment in 2 installments)

Payment Method:*

Present Address:* (where any courier can reach)

Entry of Phase B: (If applicable)

Date of Passing FCPS Part-1:

Subject of your Post-graduation:*

Study Period: Extend of your study period (Example: January 2018 to December 2018)

Name of the Study Title (Block letter):*

Date of Title Passing/ Date if Protocol Acceptance (if applicable):*

Name, Degree and Designation of your Guide:*

Name, Degree and Designation of your Co-guide: (if Not Available please write - NA)

Place of Study:* (Example: Department of Hematology), you can add more than one department here

Sample Size (Applicable for Dissertation/Thesis):* (if not known please write - 0)

Reference Style:*

Social Network ID (Viber/Whats App):* It will be used in Correction Phase

Any Necessary Comments: