PCBApps

Application Panel for the Pharmacy Certificate Registration Course(NB: Fill-out the form in English) .

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Select Date of Birth (According to SSC or Equivalent Certificate) *

Day*

Month*

Year*

Age (Min-18, Max-55): *

PRESENT ADDRESS

Division *

District *

Thana / Upazila*

Union/ Ward*

Road No/ Name/ Village Name (Must be fill-out in English)

House (Optional) (Must be fill-out in English)

Location (Optional) (Must be fill-out in English)

Post Office Name (Must be fill-out in English)

Post Code

PERMANENT ADDRESS

Is the permanent address same as present address? *

Yes No

N.B.: You can only apply in the districts selected under your permanent and present addresses. (বিঃদ্রঃ আপনি শুধুমাত্র আপনার স্থায়ী ঠিকানা এবং বর্তমান ঠিকানার আওতাভুক্ত নির্বাচিত জেলাসমূহে আবেদন করতে পারবেন।)

Training center*

Session*

PERSONAL INFORMATION

Full Name( According to SSC or Equivalent Certificate)*

Father's Name ( According to SSC or Equivalent Certificate)*

Mother's Name ( According to SSC or Equivalent Certificate)*

Applicant's Mobile *

Applicant's Email *

Passing Year *

National ID: *

Gender *

Pharmacy Name * (Must be fill-out in English)

Pharmacy Address* (Must be fill-out in English)

Nationality *

Religion *

Upload profile picture (Use the picture that you want to see in your certificate and must be size 300px * 300px)

Image resize link

DOCUMENTS

Max allowed file size 100kb and file must be pdf. Resize your file Click here

Document Type *

Document File*

Roll No: *

Reg. No: *

Document Type *

Document File*

Document Type *

Document File*

Document Type *

Document File*

tc_ Portal username *

Password *

Center Name:	Total Seat:
Booked:	Availble: