Dhaka Boat Club Limited

Borokakor, Birulia, Dhaka-1216, Bangladesh. Sl. No. ....................

Cell: +88 01324-295055, +88 01324-295066, Ph: +88 09612-779977, +88 09612-447744, Ex: 121
Email: [email protected], Web: www.dhakaboatclub.com
APPLICATION FORM FOR MEMBERSHIP OF THE CLUB
Please Use Capital Letters only & ( ) wherever required CONFIDENTIAL

Category of Membership applying for :

Two Copies
Regular Member
P.P Size
Doner Life Permanent
Photographs of
Use Member Applicant.
Special Associate

Section A : Your Personal Information

As per NID/ Passport
1. Applicant's Full Name :.............................................................................................................................................
As per NID/ Passport
2. Mother's Name :.......................................................................................................................................................
DD MM YYYY
3. Date of Birth :........./......../................ 4. Nationality : ..................................... 5. Blood Group :...............................

6. Passport / N.I.D No :...................................................... 7. TIN :..............................................................................

8. Marital Status : Married Spouse Name :...................................................................................................

DD MM YYYY
* Spouse Date of Birth :............./............/.................... Single Seperated Widow Widower

* Spouse NID/Passport No (if married):...............................................................................

9. Is your spouse a career person ? :...............................................................................
One Copy If so, please furnish details.
P.P Size .............................................................................
Photograph of
10. Children's Name DD MM YYYY
1......................................................................, ......./......./..........
Applicant's Spouse
& Date of Birth :
DD MM YYYY
2....................................................................., ......./......./..........

DD MM YYYY
3....................................................................., ......./......./..........

DD MM YYYY
4....................................................................., ....../......./...........

(1) (2) (3) (4)

One Copy One Copy One Copy One Copy
P.P Size P.P Size P.P Size P.P Size
Photograph of Photograph of Photograph of Photograph of
Applicant's Applicant's Applicant's Applicant's
Children Children Children Children
Section B: Information about Your Educational & Professional Qualification

1. Highest Academic Achievement : HSC/A - Level Graduation Post Graduation

Field of Education :..........................................Educational Institution :......................................................

2. Current Position :........................................................................................................................................

YYY
Company Name :..............................................................................Year of Commencement....................

Address :......................................................................................................................................................

:....................................................................................................................................................

Website :.....................................................................................................................................................

3. Annual Income (As furnished to Tax : ........................................................................................................

Authorities during last financial year)

Section C: Information about Your Residence

1. Present Address : ..................................................................................................................................

: ..................................................................................................................................

: ..................................................................................................................................

2. Permanent Address : ..................................................................................................................................

: ..................................................................................................................................

: ..................................................................................................................................

Section D: Information to Contact You

1. Work Phone : ............................ 2. Home Phone : ............................. 3. Cell : .........................................

4. Email (Work) : ................................................. 5. Email (Personal) :..........................................................

I prefer to receive Letters, Circulars & Bills from the Club at my :

(a) Mailing Address

Present Address Permanent Address Work Address

(b) E-mail Address

Email (Work) Email (Personal) Both
 Section E: Miscellaneous

1. Why are you interested to become a : ....................................................................................................

member of Dhaka Boat Club?
....................................................................................................

2. Membership of any other Club etc : ....................................................................................................

(if any)
....................................................................................................
3. Your area of interest in Club activities : Indoor Sports Outdoor Sports

Social Activities Cultural Activities

4. Name and signature of proposer & seconder :
(a) : ..................................................................... (b) : .......................................................................
Name of Proposer Name of Seconder
Club Membership No. :....................................... Club Membership No. :..........................................
Signature : .......................................................... Signature : ............................................................

Name of at least two friends or acquaintances other than proposer & seconder amongst existing
Permanent, Life and Donor Members of Dhaka Boat Club limited who may be referred to regarding your
eligibility.
Name : ...................................................................... Name : .............................................................
Club Membership No. :.............................................. Club Membership No. :......................................

5. Nominee (Optional):
(In case of your demise, you may nominate one eligible person from amongst your
Spouse / Children / Grand Children for consideration of awarding your membership.)
Name : .................................................................... Relationship :....................................................

Passport/ NID No. :.................................................

6. Any other information you wish to :.......................................................................................................
furnish in support of your application
* Religion :......................................................................................

* Date of Marriage :........................................................................

I hereby declare that the information provided above is true to the best of my knowledge. I understand
that any false and untrue declaration will make my application liable to cancellation and may result in
expulsion from the Club even after my election as member.

I hereby acknowledge that I have read and accepted the Memorandum and Articles of Association of
Dhaka Boat Club Limited.

I hereby forfeit my right to challenge through legal or other means any part of the Memorandum and
Articles of Association.
Date
Signature of Applicant
DD M/ M Y/ Y Y Y
........................................ ........................................
 CONDITIONS
1. Application form will be scrutinized and the candidate may be interviewed by the Executive Committee prior
to consideration of your Membership.

2. Application form to be filled in & signed by the candidate, duly proposed and seconded by two
Donor/Life/Permanent Members of the Club and submitted to the Secretary along with prescribed
membership fees and Development Surcharges in favor of Dhaka Boat Club Limited.

3. Membership Fees & Development Surcharges :

(a) Donor Member Tk. 30,000,00 (Taka Thirty Lacs)
(b) Life Member Tk. 25,000,00 (Taka Twenty Five Lacs)
(c) Permanent Member Tk. 20,000,00 (Taka Twenty Lacs)
(b) Associate Member Tk. 25,000 (Taka Twenty Five Thousand)

4. Attach to the following photocopy documents with the form.

(a) Applicant's NID, TIN & official visiting card.
(b) Spouse's NID/ Passport.
(c) 2 (two) copies photograph of applicant, 1 (one) copy photograph of Applicant's spouse and children (s) each.

DONOR & LIFE Members will not be required to pay monthly subscription of the club.

PLEASE DO NOT WRITE BELOW THIS LINE

For Office Use Only

Application Received on :
DD M/ M Y/ Y Y Y
........................................ ........................................
Secretary

Recommendation of the Membership Committee :

Recommended Not Recommended

DD M/ M Y/ Y Y Y
........................................ ........................................
Chairman

Date and Approval of the Executive Committee :

Approved Not Approved

DD M/ M Y/ Y Y Y
........................................ ........................................
President

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