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| Full Name | MD MOAZZEM HOSSAIN KHAN |
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| Type | Student |
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| SSC Batch | 1994 |
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| Father's Name | ANWAR HOSSAIN KHAN |
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| Mother's Name | Ashura Khanam |
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| Email Address | moazzem_spl@yahoo.com |
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| Present Address | MITU GAWSIA MINAR 436, FLAT#5/A, VASHANTEK POCKET GATE,DHAKA CANTONMENT |
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| Blood Group | O+ |
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| Occupational Address | SQURARE PHYMACEUTICALS PLC, GROUP COORDINATOR, INTERNATIONAL MARKETING DEPT. 48,MOHAKHALI C/A, DHAKA-1212 |
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| Permanent Address | 483,BMTF OFFCER'S COLONY GATE, SOUTH CHATAR, P.O-BOF, GAZIPUR SADAR, GAZIPUR |
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| Mobile Number | 01713041187 |
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| Payment Information | |
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| Date of Birth | 21/10/1978 |
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| Member Type | Lifetime Member |
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| National ID No. | 5544242067 |
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| Present Occupation | PHARMACIST |
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| Membership fee (Lifetime) | 5000 |
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| Payment Option | bKash |
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| Sender Mobile Number | 01713041187 |
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| Approved? (Admin-only) | |
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| Agreement |  I agree to the privacy policy.
I hereby declare that the information above provided by me are true and correct to the best of my knowledge. I hereby sign this form to register myself to be member at the Gazipur Cantonment Board High School Alumni Association. |
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