Join Us

Applicant Name (According to NID)

Father's Name

Mother's Name

Permanent Address

Present Address

Date of Birth

Gender
--Please Select Your Gender--MaleFemale

Blood Group

Nationality

Occupation
--Please Select Your Occupation--DoctorMedical or Dental College StudentOther

TIN No

NID No

Mobile Number

Email ID

Facebook ID (Optional)

Drawee Cheque Number

Drawee Bank Name

Branch Name

Drawee Bank Account Number

Deposited Amount
Select your amountBDT 1,00,000 TkBDT 2,00,000 TkBDT 3,00,000 TkBDT 4,00,000 Tk

Bkash No. (From which the Registration fee was paid)

BMDC Registration Number
--Please Select--Own Permanent BMDC Reg. NoTemporary BMDC Reg. No. (For Intern Doctors)Certified as a Medical/Dental College StudentReferred Doctor's BMDC Reg. No

Scan Copy of Bank Receipt

Scan Copy of NID

Scan Copy of TIN Certificate

Scan Copy of Passport Size Photo

Scan Copy of Applicant's Signature

Scan Copy of Own or Referred Doctor's Permanent BMDC Certificate / Temporary BMDC Certificate or Certificate as a Medical/Dental College Student

Confirmation
I hereby confirm that the above-mentioned information is true and correct to the best of my knowledge & belief. I will be bound by the rules & regulations of UADW Public Limited. If any information is given above found out wrong then UADW Public Limited has the right to cancel my application. I also declare that UADW Public Limited will not be responsible for any act done by me that is against the Court of the law of Bangladesh.