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Application Form

Application List

SL Name Category Load Phase Select
{{item.SL}} {{item.Name}} {{item.Category}} {{item.Load}} {{item.Phase}}

Personal Info

* marked fields are required
Applicant Organization Please select Application Type
Connection Name required Connection Name must be minimum 3 words Connection Name must be maximum 100 words Applicant's Name required Name must be minimum 3 words Name must be maximum 100 words Name (in Bengali) required Name must be minimum 3 words Father's Name required Name must be minimum 3 words Name must be maximum 100 words Mother's Name required Name must be minimum 3 words Name must be maximum 100 words
Organization Name required Organization Name must be minimum 3 words Organization Name must be maximum 100 words Applicant's Name required Name must be minimum 3 words Name must be maximum 100 words Name (in Bengali) required Name must be minimum 3 words Designation required Designation must be minimum 3 words Designation must be maximum 100 words
Spouse Name required Name must be minimum 3 words Name must be maximum 100 words National ID required invalide National ID number Passport required invalide Passport number Mobile number is required invalide mobile number Male Female Please select Gender Date of Birth required
Mobile number is required invalide mobile number National ID required invalide National ID number Passport required invalide Passport number Male Female Please select Gender Date of Birth required

*** Maximum file size 150kb.

Signature

*** Maximum file size 150kb.

Photo
Chaptcha

Mailing Address

House/Plot/Dag No required {{item.Name}} No District matching were found. {{item.Name}} No Thana matching were found.
LANE/Road No required Post Code required Post Code should be 4 digit invalid E-mail

Connection Address

House/Plot/Dag No required Maximum 20 character Post Code required Post Code should be 4 digit
{{item.Name}} No District matching were found. {{item.Name}} No Thana matching were found.
{{item.Name}} No Zone matching were found. {{item.Name}} No Division matching were found. {{item.Name}} No Area matching were found. Mobile number is required invalide mobile number
{{item.Name}} No District matching were found. {{item.Name}} No Thana matching were found.

Description of Connection

Load Survey

Description of Load Load per Item(Watt) No. of Items Total Load (Watt)
None {{lItem.Name}} {{load.LoadValue}}
Total (Watt): {{TableTotalLoad}}

Description of Connection

Temporary Permanent Select Connection Type {{item.Name}} ({{item.Tariff}}) No Catagory matching were found.
Single Three Select Phase No. of Meter required Please servay Load 1st

Documents

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