Contact – MCJ Club

Application Form for Membership

1. Applicant Information

Name of Applicant (in full) (English) *

Name of Applicant (Bangla) *

Date of Birth *

Nationality *

Blood Group *

National ID (NID) *

Passport Number (If applicable)

TIN Number (If applicable)

2. Academic Background

University *

Department Name *

Session *

3. Professional Details

Profession *

Designation *

Organization (with Address and Contact Number) *

4. Contact Information & Addresses

Mobile Number *

Email Address *

Residence Contact Number (If any)

Residence Address *

Permanent Address *

5. Family Details

Father's Name *

Mother's Name *

Spouse Information (If applicable)

Spouse's Name

Spouse's Date of Birth

Date of Marriage

Spouse's NID

Spouse's Blood Group

Spouse's Contact Number

Occupation of Spouse with Designation and Organization

Children Information (If applicable)

#	Name	Blood Group	Date of Birth	Gender	Occupation
1
2
3

6. Nominee Details

Name of Nominee *

Relation with Member *

Nominee NID *

Nominee Contact Number *

Nominee Occupation

Nominee Address *

7. Supporting Documents (Enclosures)

Applicant Photo (2x2 / Passport size) *

Spouse Photo (If applicable)

Nominee Photo *

Money Receipt *

NID Copies (Applicant, Spouse & Nominee in 1 PDF/Image) *

TIN Certificate & University Certificate *

8. Declaration

I hereby declare that:

All information provided in this application is true, correct, and updated.
I haven't been withdrawn from any university on any serious offence.
I have never been involved in any criminal and/or anti-state activities.
Never applied for MCJ Club Limited before and never refused from any club.

If any of the above declaration is found false or incorrect at any time after getting membership, I shall accept any decision of the club including cancellation of my membership. I fully subscribe to the Memorandum and Articles of Association and the Bylaws of MCJ Club Limited and hereby undertake to abide by all Rules and Regulations of the Club.

I accept and agree to all terms of the declaration above.

Date of Application *

Applicant Digital Signature (Upload scanned signature file) *

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