CENTRE FOR LOCAL HEALTH OF MEDICAL TECHNOLOGY

Under By: LOCAL HEALTH & PEOPLES DEVELOPMENT SOCIETY

GOVT. REG.NO-S-3815
SOUTH JATRA BARI. DHAKA-1204

Name of the Technology: Local Diploma Medical (L.D.M.S.)

Permanent Address

Present Address




General Qualification (Fill up the table) :

Passed School/College Group Grade Average Point Year

In case emergency whom to contract:

Dear Sir,
I am candidate of Local Diploma Medical (L.D.M.S.) in your Institute . I wiah to complie for the Local Diploma Medical (L.D.M.S.) training programme. I promise that I will follow & adhere faithfully to Institute rules and regulation.