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FCPS-II Reg Form Final

This document is a registration form for FCPS part-II trainees at the College of Physicians and Surgeons in Bangladesh. It requires personal information, training history, and an undertaking by the trainee regarding the accuracy of the information provided and compliance with BCPS regulations. Additionally, it lists required documents for submission and emphasizes the importance of keeping contact information updated with BCPS.

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Moinul Haque
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98 views2 pages

FCPS-II Reg Form Final

This document is a registration form for FCPS part-II trainees at the College of Physicians and Surgeons in Bangladesh. It requires personal information, training history, and an undertaking by the trainee regarding the accuracy of the information provided and compliance with BCPS regulations. Additionally, it lists required documents for submission and emphasizes the importance of keeping contact information updated with BCPS.

Uploaded by

Moinul Haque
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Registration Form A BANGLADESH

for FCPS part-II trainee COLLEGE OF


Passport size
PHYSICIANS AND Colour Photo
SURGEONS (BCPS)

GENERAL INFORMATION
Name:
Father’s/Husband’s Name
Mother’s Name
Date of Birth
National ID No.

Mailing Address Mobile: Tel: (Res):


E-mail:

Permanent Address:

Enrollment/ Online Reg. No.


Money Receipt No. Date:

Year of Qualification:
MBBS / BDS DATA
Institute:

Subject :

FCPS PART-I DATA Roll No:


Year of Passing : January July

TRAINING DATA BEFORE FCPS PART-I


Name of the Institute Name of the Name of the Supervisor, Designation Duration of
Department & Post Graduate Qualification training
UNDERTAKING

The information given by me in this form is entirely correct. I understand that for wrong information
punitive action may be taken by BCPS which may amount to cancellation of Registration and debarring
from appearing in examination of the BCPS for such periods as specified by the BCPS.
I undertake to keep the BCPS informed about my training every six months and submit progress report
from my trainer/ supervisor after every six months period of training and within the time stipulated by the
BCPS. I undertake to inform the BCPS in case of transfer/change of supervisor. I understand that training
undertaken by me without registration and prior information and training for which progress report has not
been submitted within the stipulated time will not be accepted by the BCPS for the purpose of appearing
in BCPS examinations. I further understand that day to day activities during my training period should be
entered into the Log book collected from BCPS.
I understand that I have to complete my dissertation at least 6 months before I intend to appear in the FCPS
part-II examination. I undertake to complete the compulsory training for dissertation writing as soon as
possible.

(Full name of the trainee) Date: / / (Signature of the trainee)

I am willing to supervise the above named FCPS II trainee in the Speciality of ...........................................
commencing training from / /

Signature of the Head of Signature of the Supervisor


the Institute (With Seal) (With Seal)

DOCUMENTS TO BE ENCLOSED:

1. Three coloured passport size photographs


2. Photo Copies of (a) MBBS / BDS Certificate (b) MBBS / BDS Registration Certificate of BMDC (c)
FCPS part I result/exemption (d) Training Certificate (e) Appointment & joining letter from the
Training Institute.
3. Money receipt of Registration fee.
IMPORTANT NOTE: Communication will be undertaken via e-mail and cell phone. Trainees must keep
updated information with BCPS about their cell number and e-mail address.
FOR OFFICE USE ONLY
Reg. No.
Date of Application:
Subject:

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