Associate Memebership Form
Associate Memebership Form
Date Received
Application No
Membership No.
THE SECRETARY
The Institute of Cost and Management Accountants of Bangladesh, Dhaka.
Dear Sir,
I beg to apply for admission as an Associate member of the Institute of Cost and Management
Accountants of Bangladesh.
PART- A
1. Name in full (block capitals) ........................................................................................................................
2. Surname, if any (block capitals) ..................................................................................................................
3. Father's name ...............................................................................................................................................
*4. Address: (any change in address to be promptly notified to the Institute):
a) Permanent ...........................................................................................................................................
.................................................Phone :................................E-mail .....................................................
b) Present ................................................................................................................................................
.......................................................Phone :...............................E-mail ....................................................
c) Professional .........................................................................................................................................
......................................................Phone :............................... E-mail :..................................................
**5. Date of birth ..........................................................Present age ................................................................
6. Nationality ....................................................................................................................................................
***7. Academic Qualifications:
Sl. No.
Examination Institute/School/College Board/University Division/Class Year of
Passing
8. Professional Qualification:
Sl.No.
Name of the
Institute
Roll No.
PART-B
9. Present service status:
a) Name of the employer ............................................................................................................................
.................................................................................................................................................................
b) Address ..................................................................................................................................................
.................................................................................................................................................................
c) Designation (of the application) ............................................................................................................
d) Nature of the organisation (Govt./Autonomous/Corporation/Authority/Multinational/NGO/Any other
(Please specify) ..........................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
e) Nature of their business: ........................................................................................................................
................................................................................................................................................................
f) No. of employee in the organisation: .....................................................................................................
g) No. of employees under applicant's supervision ...................................................................................
h) Relative position to that of applicant's chief ..........................................................................................
i) Date of appointment ...............................................................................................................................
j) Date of promotion to the existing post ...................................................................................................
Name of Applicant:...................................................................................................................
10. Service experience :
Sl.
No.
Name of organisation
Applicant's
position
Total No. of
employees
No of
employees
responsible to
applicant
Period
Year &
Month
11. Name and address of three persons to whom reference may be made, at least two of whom should be
members of the Institute.
Sl.
Name and Address of referee
Membership No
Grade in the Institute or Designation
No.
12.
Sl.
No.
Date of Membership
PART-D
16. DECLARATION:
I...................................................................the undersigned do thereby declare that:1) The above statements are correct.
2) In the event of my admission as Member of the Institute, I will be governed by the Cost and
Management Accountants Ordinance 1977 (L III of 1977) and the Regulations made thereunder for
the time being in force.
3) I will advance the objectives of the Institute to the best of ability and will attend the meeting thereof
as often as I conveniently can during tenure of my Membership.
I further declare that:1) I am not and was never an insolvent.
2) I have not been convicted by any court of law of any offence moral turpitude or of an offence
committed by me in my professional capacity.
Yours faithfully
Date:..............................................