APPLICATION FORM FOR MEMBERSHIP

OF

BANGLADESH SHIPPING AGENTS’ ASSOCIATION

Khulna Branch

Jiban Bima Bhaban (2nd Floor) 46, K.D.A. Avenue

Khulna-9100, Bangladesh

1)

Name of the Firm

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

2)

Local Office Address

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

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

3)

Name of Directors

: 1) ................................................, Nationality :...................................

: 2) ................................................, Nationality :...................................

: 3) ................................................, Nationality :...................................

: 4) ................................................, Nationality :...................................

: 5) ................................................, Nationality :...................................

4)

Registration with Customs

: License No. ...................................., Dated :........................................

5)

Name of Office In-charge

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

: Designation : ..................................., Nationality : ...............................

6)

Contact Numbers 

: Telephone (Office) ............................................. (Res.) .......................

: Mobile : ..........................................., Fax : ........................................

: E-mail : ..............................................................................................

7)

Address of Head Office

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

8)

Contact of Head Office

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

Details

Ordinary Member

 Associate Member  

1) Admission Fee

= Tk.  3,000.00 

= Tk.  1,500.00 

2) Annual Subscription for the year 200......

= Tk.  3,000.00 

= Tk.  1,500.00 

3) BAC Registration Fee for the year 200......

= Tk.  1,060.00  

= Tk.  1,060.00  

4) Development Charges

= Tk.50,000.00

= Tk.50,000.00

Total 

=Tk.57,060.00

= Tk.54,060.00

5) Attested photocopy of Custom License  

6) Attested 2 copies PP/Stamp size photograph of applicant.

7) List of office staff.

....................................................

...................................................

Proposed by (any member with seal)  

Signature of the Applicant with Seal  

Date : .......................................

....................................................

Seconded by (any member with seal)